Sexually Transmitted Infections

Schober, P C; Gabriel, G; White, P; Felton, W F; Thin, R N

doi: 10.1136/sti.59.4.217pmid: 6871650

In a study of the sexual contacts of patients with primary and secondary syphilis, 65 of 127 (51%) contacts at risk developed syphilis. There was no significant difference between figures for homosexuals (48/98, 49%) and for heterosexuals (17/29, 58%). Our findings are similar to those of the prepenicillin era, but the question, Why are so few contacts infected? remains unanswered.

Wong, G H; Steiner, B; Graves, S

doi: 10.1136/sti.59.4.220pmid: 6347332

The time course of antibody synthesis during syphilis was studied in experimentally infected rabbits. A rapid antibody response was seen; the rabbits became positive in both the rapid plasma reagin (RPR) test and Treponema pallidum haemagglutination assay (TPHA) by nine days after infection. Treponemal immobilising antibodies were also seen as early as nine days after infection. Antibody inhibition of treponemal attachment to baby rabbit genital organ (BRGO) cells in culture occurred with immune sera taken 30 days after infection but not earlier. When T pallidum was mixed with immune syphilitic rabbit sera taken at different stages of the infection and used to infect normal rabbits the rabbits became partially resistant to T pallidum only when the treponemes were mixed with sera taken at least 30 days after syphilitic infection. This appearance correlated well with the development of antibodies which blocked attachment of T pallidum to host cells. These antibodies may be involved in the resistance to reinfection which develops in syphilis as the disease progresses.

Romanowski, B; Starreveld, E; Jarema, A J

doi: 10.1136/sti.59.4.225pmid: 6871651

Although penicillin is the drug of choice in syphilis, treatment failures with benzathine and procaine penicillin have occurred in neurosyphilis. Patients allergic to penicillin have traditionally been treated with tetracycline but, since this drug diffuses poorly into the cerebrospinal fluid, its use in neurosyphilis is uncertain. In the case reported here, a penicillin allergic patient with general paresis of the insane was successfully treated with chloramphenicol. This drug has been used in the treatment of syphilis and achieves high concentrations in the cerebrospinal fluid. Thus chloramphenicol may be a more appropriate agent than tetracycline in treating patients with neurosyphilis who are allergic to penicillin.

Young, H; Bain, S S

doi: 10.1136/sti.59.4.228pmid: 6409342

The spectrum of neisserial colonisation of the pharynx was determined from 3557 throat exudates cultured on modified New York City (MNYC) medium. Oxidase positive Gram-negative diplococci (GNDC) were isolated from 1204 (33.8%) of the throat cultures. Neisseria gonorrhoeae, N meningitidis, and N lactamica accounted for 20.3%, 74.2%, and 3.7% of the oxidase positive GNDC respectively. The observed coexistence of gonococci and meningococci in the pharynx (0.39%) was significantly different (p less than 0.001) from the theoretical expected value (1.7%). The prevalence of pharyngeal infection in patients with gonorrhoea was 4.3% for all men, 11% for homosexual men, and 7.9% for women. Despite the risks of disseminated infection and spread to sexual partners, the detection of pharyngeal gonorrhoea is less important than that of endocervical infection in women, urethral infection in heterosexual men, and anorectal infection in homosexual men.

Ng, W S; Chau, P Y; Ling, J; Echeverria, P; Rockhill, R; Arnold, K

doi: 10.1136/sti.59.4.232pmid: 6409343

Sixty four penicillinase-producing Neisseria gonorrhoeae (PPNG) and 24 non-penicillinase-producing (non-PPNG) strains isolated from six different south east Asian localities were tested by the agar dilution method against 15 antibiotics. All isolates were susceptible to spectinomycin and sulphamethoxazole-trimethoprim (19:1 ratio). A large proportion of both PPNG and non-PPNG strains showed, however, a decreased susceptibility to tetracycline, kanamycin, and erythromycin: 49% with minimum inhibitory concentrations (MICs) of tetracycline greater than or equal to 2 micrograms/ml, 34% with MICs of kanamycin greater than or equal to 32 micrograms/ml, and 80% with MICs of erythromycin greater than or equal to 2 micrograms/ml. These MIC cut-off values were chosen since they are close to the highest concentrations of these antibiotics attainable in serum after drug administration. Resistance to these antibiotics was not related to penicillinase production and does not appear to be confined to gonococci isolated from one particular locality. Strains showing resistance concurrently to two or three of these drugs were often isolated from different south east Asian countries. All eight cephalosporins tested were effective against both PPNG and non-PPNG strains. On a weight to weight basis the new cephalosporins--namely, moxalactam, cefoperazone, cefotaxime, and ceftriaxone--were the most effective. In contrast to those of cefoxitin, cefuroxime, moxalactam, and cefoperazone the MICs of cefamandole, cefotaxime, and ceftriaxone were significantly affected when the inoculum size was increased from 10(3) to 10(6) colony forming units (cfu).

Walsh, R J; Scott, R; Bittiner, J B; Shahidullah, M; Slack, R C

doi: 10.1136/sti.59.4.242pmid: 6409345

Acrosoxacin was given as a single 300 mg oral dose to 105 patients with acute gonorrhoea. Of the 100 patients followed completely there was a 93% cure rate and 33% of men developed postgonococcal urethritis (PGU). This compared with a 97% cure and 30% PGU with 2 megaunits penicillin. The in vitro activity of acrosoxacin in Nottingham against strains of Neisseria gonorrhoeae showed that it was a highly active agent with 90% of strains inhibited by a concentration of 0.03 mg/l.

Oriel, J D; Ridgway, G L

doi: 10.1136/sti.59.4.245pmid: 6871652

The activity of tetracycline hydrochloride and minocycline hydrochloride was compared against 12 strains of Chlamydia trachomatis and Ureaplasma urealyticum; minocycline was more active in vitro against both organisms. A group of 145 men with non-gonococcal urethritis was treated for one week with either tetracycline hydrochloride 500 mg six hourly or minocycline 50 mg twice daily. The clinical results obtained were similar: 61 of 77 (79%) men treated with tetracycline and 53 of 68 (78%) men treated with minocycline were free from urethritis one to two weeks after completing treatment. Both antibiotics were clinically effective against C trachomatis, but activity against U urealyticum was less consistent. Side effects were noted in 14 (18%) men treated with tetracycline and eight (12%) men treated with minocycline; they were predominantly gastrointestinal.

Street, D A; Taylor-Robinson, D; Hetherington, C M

doi: 10.1136/sti.59.4.249pmid: 6409346

Marmosets, tamarins, owl monkeys, and squirrel monkeys were inoculated intravaginally with Trichomonas vaginalis. The latter animal species was most susceptible, trichomonads being recovered from four of six monkeys for periods ranging usually up to one month. Vaginal discharge was seen in most infected animals but polymorphonuclear leucocytes were rare. Infected animals developed serum IgG antibody responses and also local IgG and IgA responses, the latter occurring sometimes on reinoculation in the absence of organism recovery. Antibody responses were, however, of short duration and, overall, immunity was weak because two animals were reinfected on a second or subsequent challenge. Some of the observations are relevant to vaginal trichomoniasis in women.

Masfari, A N; Kinghorn, G R; Duerden, B I

doi: 10.1136/sti.59.4.255pmid: 6871653

Urethral and sub-preputial swabs from 150 men were examined. There was a strong association between the isolation of anaerobic bacteria, particularly Bacteroides spp, and a clinical diagnosis of balanoposthitis, non-specific urethritis (NSU), or both. Aerobic bacteria formed the predominant flora in 28 healthy controls whereas anaerobes were predominant in specimens from 79 patients with balanoposthitis, from 24 with NSU, and from 19 with both. Bacteroides spp were the commonest isolates in all patient groups; B asaccharolyticus, B melaninogenicus ss intermedius, B ureolyticus, and B bivius were the most common species. The results obtained with the two swabs were identical except that Gardnerella vaginalis was isolated from the urethral swab only in five patients.

McMillan, A; Gilmour, H M; Slatford, K; McNeillage, G J

doi: 10.1136/sti.59.4.260pmid: 6347333

One hundred and seventy six men with histories of anal intercourse were studied to determine if there was a correlation between the clinical features, cytological findings in the mucosal secretions, and the histological appearance of the rectal mucosa. The presence or absence of gastrointestinal symptoms did not differentiate between patients with and without proctitis. Sigmoidoscopy was normal in each of the 117 men with normal rectal histology. Macroscopic abnormalities were evident in the mucosa of nine of 11 men with infective proctitis, and sigmoidoscopy was normal in 40 of the 48 men with chronic proctitis. Cytological examination was often useful in detecting infective proctitis but not chronic proctitis.