Sexually Transmitted Infections

Collart, P; Poitevin, M; Milovanovic, A; Herlin, A; Durel, J

doi: 10.1136/sti.56.6.355pmid: 7448577

In a comparative kinetic study of the serum concentrations of two penicillin complexes--medium-long-acting (benethamine penicillin) and long-acting (benzathine bipenicillin)--after a single injection in young adults and elderly people, the following results were confirmed statistically: (a) age was a major factor in the variations in serum penicillin concentrations and in their persistence in the serum; (b) the penicillin was absorbed faster in young than in elderly subjects even when a long-acting complex was used; (c) serum concentrations below the level regarded as lethal for treponemes appeared much earlier and more frequently in young than in old people; and (d) the bioequivalence between penicillin preparations could not be estimated solely for the number of units of the agent used but from the bioavailability of the chosen formulation. Thus a uniform and standard penicillin dosage allowing no safety margin may help in the superficial healing of a syphilitic chancre or the resolution of a roseola but it will certainly be insufficient to kill Treponema pallidum. It seems essential therefore to provide an antibiotic cover at high dosage over a long period of time.

Polnikorn, N; Witoonpanich, R; Vorachit, M; Vejjajiva, S; Vejjajiva, A

doi: 10.1136/sti.56.6.363pmid: 7448578

The concentrations of penicillin in the cerebrospinal fluid (CSF) were compared simultaneously with those in the serum in 17 patients with syphilis. The antibiotic concentrations were measured by the agar well diffusion method. There were no detectable concentrations of penicillin in the CSF after administration of benzathine penicillin 2.4 megaunits, benzathine penicillin 7.2 megaunits, procaine penicillin in aluminium monostearate (PAM) 12 megaunits, or aqueous procaine penicillin G 2.4 megaunits. Only after high doses of aqueous penicillin G 24 megaunits daily or aqueous penicillin G 2 megaunits daily together with oral probenecid 2 g daily was penicillin detectable in the CSF. The concentrations after the latter regimen were the highest and much higher than the minimum inhibitory concentration for Treponema pallidum.

Giles, A J

doi: 10.1136/sti.56.6.368pmid: 7448579

A man with a history of treatment for early syphilis presented with tabes dorsalis. Despite receiving a course of penicillin accepted as adequate by the World Health Organisation the illness progressed to tabo-paresis after 20 years. Reinfection cannot be excluded.

Borobio, M V; Nogales, M C; Palomares, J C

doi: 10.1136/sti.56.6.377pmid: 7448581

The diagnosis of congenital syphilis is difficult since it depends mainly on the results of serological tests. The results of five serological tests (three specific and two non-specific) in nine neonates with congenital syphilis are compared with those obtained in three with passively acquired antibodies. It appeared that the serological diagnosis of congenital syphilis must be based on the finding of specific neonatal antibodies in cord serum, which give positive results to the fluorescent treponemal antibody absorption test for immunoglobulin M, together with high titres of total IgM and negative results to latex tests. The non-specific tests are useful for confirming the efficacy of treatment. The mean number of cases of congenital syphilis in Seville is 0.81/1000 live births.

Graves, S R; Edmonds, J W; Shepherd, R C

doi: 10.1136/sti.56.6.381pmid: 6893808

Sera from 608 wild rabbits were examined using serological tests for syphilis as an indicator of infection with Treponema paraluis-cuniculi. Only eight sera gave positive or weakly positive results in the rapid plasma reagin (RPR) test, and none of these eight sera gave positive results in the Treponema pallidum haemagglutination assay (TPHA). Thus, it appears that wild rabbit populations in Victoria, Australia, are not naturally infected with T paraluis-cuniculi. Normal Australian laboratory rabbits however were readily infected with T paraluis-cuniculi, either by intradermal or intratesticular inoculation or by the venereal route. In the latter case, treponeme-containing lesions developed after about five months' cohabitation with infected mates. The disease was successfully transmitted from male to female and from female to male rabbits by the venereal route. In most cases infected rabbits became RPR-positive (17/19 rabbits) and in all cases TPHA-positive (19/19), indicating that serological tests for syphilis can be used to screen rabbits for this disease.

Graves, S

doi: 10.1136/sti.56.6.387pmid: 7004567

Three female rabbits, venereally infected with Treponema paraluis-cuniculi between five and eight months previously, had treponeme-containing genital lesions and positive results to serological tests for syphilis. These rabbits and four normal female rabbits were challenged with Treponema pallidum intradermally on the shaved back with triplicate doses of 10(4), 10(3), 10(2), and 10 treponemes (all at different sites). Significantly fewer syphilitic lesions developed in the rabbits previously infected with T paraluis-cuniculi (4/36) compared with the control rabbits (37/48), and the mean size of the lesions (diameter of induration) was significantly less (4 mm compared with 10 mm). It appears that previous venereal infection of female rabbits with T paraluis-cuniculi induced a level of cross-immunity against infection with T pallidum. Protection was however not complete.

Taylor, E; Phillips, I

doi: 10.1136/sti.56.6.390pmid: 6778588

Urethral discharge from men was diluted to give heavy and light inocula and cultured on seven different solid culture media, including two transport/isolation media, or held in three types of semi-solid transport medium for varying periods and then cultured. The amount of growth was quantitated and the performance of the different systems compared. Fresh non-selective media were best, with up to two failures in 254 cultures on each medium. With selective media there were 9-23 failures with heavy inocula and 22-47 failures with dilute inocula. For Transgrow or the Jembec system incubation before holding at ambient temperature was better than holding followed by incubation. Transport media yielded good results if cultures were set up within six hours; only minor losses occurred after 24 hours.

Tan, N J; Rajan, V S; Pang, R; Sng, E H

doi: 10.1136/sti.56.6.394pmid: 6778589

Ninety-seven patients with infections due to penicillinase-producing Neisseria gonorrhoeae (PPNG) were treated with single doses of gentamicin 280 mg intramuscularly. The failure rate among those followed up was 3%. No significant side effects were recorded. Gentamicin is a valuable alternative in the treatment of infections due to PPNG strains.

Fluker, J L; Deherogoda, P; Platt, D J; Gerken, A

doi: 10.1136/sti.56.6.397pmid: 6449977

In a review of rectal gonorrhoea 73 episodes were studied in 65 homosexual men. The presenting signs and symptoms were carefully noted. Treatment with a single injection of spectinomycin hydrochloride 2 g resulted in a cure rate of 94.5%. The relatively high treatment failure rate associated with rectal gonorrhoea may possibly be due to microbial mechanisms.

Genvert, G I; Drusin, L M; Seybolt, J F; Braun, D W

doi: 10.1136/sti.56.6.400pmid: 7004568

To assess the Papanicolaou smear as a screening test for asymptomatic gonorrhoea 311 women who had had simultaneous Papanicolaou smears and cervical cultures performed were studied. Of the 151 women who were culture-positive only 27 (18%) had a positive result by Papanicolaou smear. The presence of either endocervical or metaplastic cells did not increase the frequency with which gonococci were recognised. The eight cytotechnologists spent at least 30 minutes for each case looking for diplococci; the variability between observers was high. The possibility of using an already widely accepted diagnostic technique, such as the cytological smear, as a means of screening for gonococci is very attractive. Unfortunately in this study the excessive time taken to examine the slides, the poor correlation of observers' findings, and a low sensitivity for finding diplococci made the Papanicolaou smear an impractical method for detecting gonorrhoea in asymptomatic women.