Sexually Transmitted Infections

Willcox, R R

doi: 10.1136/sti.56.5.277pmid: 6893568

Papua New Guinea, which contains nearly three-quarters of the population of the 20 islands, or island groups, studied by the South Pacific Commission has a commensurate proportion of reported cases of syphilis and gonorrhoea. It is a country with an exceptional interest for the venereologist as it exhibits all the facets of venereal disease problems as experienced the world over. With the opening up of communications syphilis has gained a foothold in what were areas previously endemic with yaws; moreover, some yaws still remains (particularly in the offshore islands)--the two conditions tending to be mutually exclusive. In the area around the capital, Port Moresby, the prevalence of Donovanosis is unparalleled.

Harahap, M

doi: 10.1136/sti.56.5.282pmid: 6893569

Epidemiological factors and changing ecological conditions have greatly facilitated the spread of sexually transmitted diseases and led to their rising incidence in Indonesia. Gonorrhoea is at present very prevalent, and drug resistance among circulating strains of gonococci is a contributing factor. Despite medical advances in both diagnosis and treatment of sexually transmitted diseases, these are becoming commoner; unlike other communicable diseases they have so far defied efforts to control them.

Edwards, D I

doi: 10.1136/sti.56.5.285pmid: 7000306

The selectively toxic effect of nitroimidazole drugs towards anaerobic bacteria and protozoa depends on a number of factors. The killing action of such drugs as metronidazole requires the reduction of the nitro group, a process which influences the rate of entry of the drug into the susceptible cell and which is determined by mechanisms involving ferredoxin-linked (or the equivalent) reactions in the cell. The reduced agent subsequently causes strand breakage of DNA, the extent of which depends on the A + T content of the DNA. Other effects of such drugs may include the possible inhibition of DNA repair mechanisms which exacerbate DNA damage, Inhibition of activity of nitroimidazoles may be caused by aminothiol radical scavengers and radioprotectors normally present in the cell or by the presence of other organisms in the environment (that is, the vagina) capable of inactivating the drugs.

Tight, R R; White, A C

doi: 10.1136/sti.56.5.291pmid: 7000307

The quantitative microhaemagglutination assay for Treponema pallidum antibodies (MHA-TP) was studies in 52 untreated and treated rabbits with experimental syphilis. Rabbits with incubating experimental syphilis were cured or inadequately treated with penicillin G and some cured rabbits were later reinfected. MHA-TP conversion occurred within 45 days in untreated rabbits. Titres reached peak levels about four months after inoculation and remained relatively high for up to two years. The quantitative MHA-TP test differentiated between rabbits cured of experimental incubating syphilis and those untreated and inadequately treated. MHA-TP titres decreased after treatment given six or 12 months after inoculation but reversion did not occur. MHA-TP conversion or significant increases in titre occurred as soon as seven days after reinfection and preceded corresponding changes in a quantitative non-treponemal test. The MHA-TP is useful as a screening test for treponemal antibodies in rabbits. The quantitative MHA-TP in humans after treatment for syphilis and reinfection deserves further study.

de Jong, N J; Koehorst, J A; van der Sluis, J J; Boer, A M

doi: 10.1136/sti.56.5.297pmid: 7427700

Nineteen of 23 serum samples from patients with secondary syphilis, six of 24 from patients with primary syphilis, and four of seven from patients with early latent syphilis had complement-dependent autolymphocytotoxic reactivity at 15 degrees C. After treatment, the reactivity was decreased. It was not directed only against autologous lymphocytes but also against allogeneic lymphocytes. Sephadex G-200 gel filtration showed that the lymphocytotoxins were present in the IgM-containing exclusion peak. Furthermore, serum samples that had high antibody titres in the Reiter protein complement-fixation test or Wassermann-Kolmer reaction also had a high frequency of cold-reacting autolymphocytotoxins. This indicates that the autolymphocytotoxic reactivity is related to the humoral response in syphilis.

Sarojini, P A; Dharmaratnam, A D; Pavithran, K; Gangadharan, C

doi: 10.1136/sti.56.5.302pmid: 7427701

A female patient with secondary syphilis presented with concentric rings of papules simulating tinea imbricata. To avoid the occurrence of "ping-pong" syphilis, it is stressed that both sexual partners should be treated simultaneously.

Takeguchi, M M; Weetall, H H; Smith, D K; McDonald, H C; Livsey, K A; Detar, C C; Chapel, T A

doi: 10.1136/sti.56.5.304pmid: 6775769

In a study using a non-serological enzymatic approach for the detection of Neisseria gonorrhoeae in cervical and urethral swabs, the technique was shown to be technically feasible. The enzyme, 1, 2-propanediol oxidoreductase, was used as a presumptive diagnostic marker for N gonorrhoeae. Enzymatic activity was measured with a fluorometer. Two assay procedures were performed: (a) enzyme detection (two-tube and three-tube assays) requiring 60 minutes; and (b) enzyme inhibition (EI) (90-minute and modified 20-minute assays). Sensitivities of the two-tube, three-tube, and the 90-minute EI assays with male urethral specimens from a high-prevalence population were 80%, 84%, and 91% respectively. The specificities of these assays in a low-prevalence male population were not determined. Sensitivity of the 90-minute EI assay in a high-prevalence female group was 77% and specificity in a low-prevalence female group was 75%. The modified EI assay was tested only in a low-prevalence female group and had 87% specificity. Although the specificity of the assays needs improvement, several advantages--including early case detection, rapid availability of results, detection of current active infections, and the possibility of automation--are intrinsic in this enzymatic approach.

Rodin, P; Seth, A D; King, D M; Wilkinson, A E

doi: 10.1136/sti.56.5.308pmid: 6775770

The distribution of the sensitivity to penicillin of gonococci isolated from 631 men and 290 women was analysed in relation to the racial origin of the patients and the type of source contact alleged by the men. No difference in the sensitivity patterns was found between strains from white patients from the United Kingdom and those from immigrants from the Caribbean area. Asian men harboured significantly more insensitive strains than men of other racial groups. Men of Caribbean stock who had been born in this country had significantly more infections due to fully sensitive strains. The reasons for these variations are not known, but one contributory factor may be differences within the racial groups in the proportions of infections contracted from prostitutes.

Sng, E H; Yeo, K L; Rajan, V S; Lim, A L

doi: 10.1136/sti.56.5.311pmid: 6775771

In an evaluation of four methods for detecting penicillinase-producing Neisseria gonorrhoeae the chromogenic cephalosporin, rapid iodometric, and penicillin disc diffusion methods gave complete agreement for all the 202 strains of gonococci tested. No false-positive or false-negative results occurred. The filter paper iodometric method detected 99% of the penicillinase-producing strains without any false-positive result.

Cole, C H; Lacher, T G; Bailey, J C; Fairclough, D L

doi: 10.1136/sti.56.5.314pmid: 7427702

A clinical investigation was undertaken to determine if chemoprophylaxis in the form of a contraceptive pessary would reduce the rate of reinfection with gonorrhoea in 1245 female patients attending a venereal disease clinic. After the introduction of the pessary the reinfection rate over a 16-week period was 19% compared with 40% in the control clinic patients. It was also found that women could be motivated to use a pessary; 65% of women used pessaries before sexual intercourse at least some of the time. High reinfection rates in venereal disease clinic patients emphasise the need for improved methods of preventing reinfection. Vaginal chemoprophylaxis appears to be an alternative means of reducing gonorrhoea morbidity.