Sexually Transmitted Infections

Zeigler, J A; Jones, A M; Jones, R H; Kubica, K M

doi: 10.1136/sti.52.1.1pmid: 769911

Pathogenic T. pallidum cells possess and extracellular layer when observed in vivo and in vitro after exposure to ruthenium-red. The extracellular layer is partially removed from a pre-fixed cell by repeated washing in vitro. Non-pathogenic treponemes examined in this study do not possess an extracellular layer. It is hoped that the data presented herein will cause our colleagues to take another look at the methods and techniques used for preparing pathogenic T. pallidum cells for practical end-point objectives.

Jones, A M; Zeigler, J A; Jones, R H

doi: 10.1136/sti.52.1.9pmid: 769915

This study shows that 1 per cent. glutaraldehyde fixation of unwashed Treponema pallidum, Nichols pathogen, preserves the integrity of the outer envelope as well as the ruthenium-red (RR) staining extracellular slime layer. Since other researchers wash their treponemal suspensions before preparing their vaccines, it is likely that the vaccine preparations used in this study contain antigens not tested elsewhere. In an attempt to eliminate the requirement of large numbers of injections to achieve any protection, the rabbits in this study were injected with glutaraldehyde-fixed T. pallidum (GFTP) only once, with or without one of a spectrum of adjuvants, and 5 months later were challenged intradermally or intratesticularly with freshly harvested pathogenic treponemes. Data of time of lesion appearance and severity of lesions reveal a differential protective effect of the various vaccine preparations when compared to the response of non-vaccinated controls. Vaccines which included phytohaemagglutinin (PHA) or alumina C gel (ALC) as adjuvants provided some degree of protection, whereas vaccines which contained the adjuvants incomplete Freund's, zymosan, complete Freund's, polyadenylic-polyuridylic acid, or no adjuvant at all produced enhanced infections. The differential protection data indicate that various portions of the immune mechanism are either suppressed or are not stimulated by T. pallidum antigens alone, but can be made to respond with a minimum of vaccine injections.

Jones, R H; Finn, M A; Thomas, J J; Folger, C

doi: 10.1136/sti.52.1.18pmid: 769912

The growth and nine subcultivations of the experimental Nichols strain of pathogenic Treponema pallidum were successfully accomplished in cultured baby hamster kidney tissue cells (BHK-21) using serum-free media. The number (motile and non-motile cells occurring extracellulary) of cell generations generally increased with each subcultivation, the largest increases (greater than 3-0) occurring in subcultures 4, 5, 7, 8, and 9. Also, the number of motile cells decreased with each subcultivation. Virulent organisms were demonstrated in subcultures 1, 4, 5, 7, and 8, and their numbers estimated with the use of standards established by the animal inoculation titration of counted numbers of organisms freshly harvested from experimental infections; the estimated number of virulent organisms was higher than or equal to the counted cultivated treponemes injected, which may be attributable to uncounted virulent spirochaetes occurring intracellularly.

Koostra, W L; Judd, R C; Baker, R E

doi: 10.1136/sti.52.1.24pmid: 816413

Ribosomes isolated from N. gonorrhoeae and N. meningitidis were used as skin test antigens in guinea-pigs which had been previously sensitized with killed Neisseria cells in incomplete Freund adjuvant. Intradermal injection of ribosomes from skin test dose N. gonorrhoeae into the skin of animals sensitized to the homologous organism was characterized by a specificity based upon ribosomal skin test dose 50's (STD50) sensitivity which was at least five-fold greater than that of the animals sensitized to the heterologous organism. The sensitized guinea-pigs had lost their skin-test reactivity within 3 months of the cessation of immunization but regained it immediately on reimmunization. The results of this model system indicate that gonococcal ribosomes may be used as antigens in skin testing or other testing modes in gonorrhoea.

Judd, R C; Koostra, W L

doi: 10.1136/sti.52.1.28pmid: 816414

Gonococcal crude ribosome preparation was found to be specific and sensitive when used to elicit delayed hypersensitivity reactions in sensitized guinea-pigs. Gonococcal crude ribosomes possess the ability to react with humoral antibody in sensitized animals; thus, ribosomes may be of value as an antigen in a sero-diagnostic test for gonorrhoea. Ribosomal protein or RNA, or gonococcal cell components including protoplasm, cell walls, and pilin, were less reactive than intact ribosomes. The ribosome preparation was used in an in vitro correlate of delayed hypersensitivity, suggesting that the human immune response in gonorrhoea might be studied using the crude ribosome in in vitro experiments with human peripheral lymphocytes.

Klanica, J; Stejskalová, M

doi: 10.1136/sti.52.1.33pmid: 816415

In the course of 4 years we have examined a total of 1,100 women with chronic gynaecological complaints. The direct fluorescent antibody test was used successfully for the detection of gonorrhoea. In Group 1 (200 patients) we found 39-1 per cent. with gonorrhoea. In group 2 (220 patients) the percentage fell to 27-7 per cent, in Group 3 (220 patients) to 23-2 per cent., in Group 4 (220 patients) to 12-3 per cent., and in Group 5 (220 patients) to 11-8 per cent. By employing a consistent programme of diagnosis and therapy we succeeded in reducing the incidence of gonorrhoea in the Prague 3 District from 39-1 per cent. in 1970 to 11-8 per cent. in 1973-74. In all we discovered 251 female patients suffering from gonorrhoea, who would otherwise have escaped observation and registration. When patients are not registered as sources of gonococcal infection, special cultures are not performed as a routine, and these women would therefore infect the same number of men at least. The immunofluorescent method proved to be of great value. The direct FAT is a superior test; even in cases in which, because of damage by such factors as antibiotics, Neisseria gonorrhoeae does not grow on artificial media, gonorrhoea can be detected by this method.

Chipperfield, E J; Catterall, R D

doi: 10.1136/sti.52.1.36pmid: 56974

A retrospective study of 209 consecutive cases of gonorrhoea showed that more than 98 per cent. of cases were detected by two sets of examinations at weekly intervals. This was compared with earlier results obtained at this clinic when only 86 per cent. of cases were detected by two examinations. It is believed that modifications in culture techniques were responsible for the improvement and that two tests are now sufficient to screen for gonococcal infection in the majority of patients when an efficient microbiological service is available. Because of the high incidence of infection in contacts of men with gonorrhoea, a third test is recommended for the small number of such patients who have negative results of their first two tests. This also serves to monitor the efficiency of the culture techniques. The majority of women with gonorrhoea attended because they were believed to be contacts of men with the disease but many attended of their own accord because they had symptoms. Mild symptoms were described by as many as 53-5 per cent. of all infected women. Nine cases of gonorrhoea were detected during the follow-up period. Three of the four cases which were thought to be due to treatment failure were detected at the first test, in contrast to the cases which were thought to be due to re-infection, the majority of which were diagnosed at subsequent tests. Constant surveillance of the accuracy of the diagnostic methods used in the detection of gonorrhoea in women is of great importance if errors are to be reduced to a minimum.

Evans, B A

doi: 10.1136/sti.52.1.40pmid: 1260406

A retrospective survey of 210 female patients with gonorrhoea who attended the West London Hospital during 4 months of 1973 showed that nine out of ten were diagnosed by tests taken at the first examination. Ten patients were diagnosed at third or subsequent examinations, but nine of them had defaulted for more than one month before the diagnosis was made, and the tenth gave a clear history of later infection. Three-quarters of the patients came because of known contact with infected males, and less than a quarter of patients who came for this reason were not infected. After one negative post-treatment test, all recurrences were associated with prematurely resumed sexual intercourse or contact with fresh infection. It is concluded that routine repetitive testing is unproductive, and that the tracing of contacts is of paramount importance.

Masterton, G; Schofield, C B

doi: 10.1136/sti.52.1.43pmid: 1260407

349 male patients with uncomplicated gonococcal urethritis were treated with a single dose of 300 mg. or 400 mg. minocycline hydrochloride. The lower dose gave a lower failure rate, 3-2 compared with 5-1 per cent., but this difference was not statistically significant. The overall known failure rate of 4-2 per cent. compares most favourably with our previous findings in this area using other drugs of the tetracycline group. The incidence of post-gonococcal urethritis (5-1 per cent.) was also the lowest we have found. The few side-effects reported were comparatively trivial. Because of its high degree of therapeutic efficacy, the relatively lack of side-effects, and the reduced incidence of post-gonococcal urethritis, minocycline hydrochloride should be considered the drug of choice whenever single-dose oral treatment is given in uncomplicated gonorrhoea in men.

Oriel, J D; Reeve, P; Wright, J T; Owen, J

doi: 10.1136/sti.52.1.46pmid: 816416

Urethral specimens from 477 men were collected with endourethral swabs and examined for Chlamydia trachomatis by cell culture on McCoy cells pretreated with idoxuridine. Of these men, 141 had gonococcal urethritis, 262 non-gonococcal urethritis (NGU), and 74 showed no evidence of urethritis. Of 118 men with heterosexually acquired gonococcal urethritis, thirty (25 per cent.), and of 23 men with homosexually acquired gonococcal urethritis, five (22 per cent.), yielded C. trachomatis from the urethra. Urethral specimens from 240 heterosexual men with NGU were examined, and 118 (49 per cent.) yielded C. trachomatis. Of these 240 men, 140 gave a past history of gonococcal or nongonococcal urethritis and 67 (48 per cent.) of these were positive for C. trachomatis; no past history was given by 100 men, of whom 51 were positive for C. trachomatis. Of the 240 heterosexual men with NGU, 81 had had symptoms for 7 days or more before examination, of whom 48 (59 per cent.) yielded isolates of C. trachomatis, and 145 had had symptoms for less than 7 days, of whom 59 (41 per cent.) yielded isolates. Of fourteen asymptomatic men, three were positive for C. trachomatis. Of 22 homosexual men with NGU, seven (32 per cent.) yielded C. trachomatis. C. trachomatis was recovered from the urethra in three (5 per cent.) of sixty heterosexual men without urethritis, and none of fourteen homosexual men without urethritis yielded C. trachomatis.