Sexually Transmitted Infections

Odugbemi, T O; Whittington, W L; DeWitt, W; Perkins, G; Johnson, S; Biddle, J; Piziak, M; Albritton, W L

doi: 10.1136/sti.59.5.285pmid: 6412959

One hundred strains of Neisseria gonorrhoeae (including 30 penicillinase producing (PPNG) strains) originating from Korea were characterised by plasmid analysis, auxotyping, and serogrouping. Eighty per cent of the isolates possessed the conjugative 24.5 megadalton (Mdal) plasmid. A novel 7.8 Mdal plasmid was present in four isolates (one PPNG and three non-PPNG strains). Seventy five per cent of all the strains tested were wild type and belonged to serogroup WII, while 20% were proline requiring and belonged to serogroup WII. Two of the remaining strains were tyrosine auxotrophs, while another strain was arginine requiring; these three strains carried the conjugative plasmid and belonged to serogroup WII.

Herzog, C; Ison, C A; Easmon, C S

doi: 10.1136/sti.59.5.289pmid: 6311320

The sensitivity of 42 strains of penicillinase producing Neisseria gonorrhoeae (PPNG) and 46 strains of non-PPNG was tested against benzyl penicillin, spectinomycin, erythromycin, cefuroxime, ceftriaxone, tetracycline, sulphamethoxazole, and trimethoprim. The minimum inhibitory concentrations (MICs) of all antimicrobials, except trimethoprim and ceftriaxone, differed significantly for PPNG and non-PPNG strains. Ceftriaxone was the most active compound tested, the MIC for all strains being less than or equal to 0.015 mg/1. PPNG were less sensitive than non-PPNG strains to spectinomycin. It remains to be seen whether the increase in prevalence of PPNG strains is followed by a gradual increase in low level resistance to spectinomycin as well as the occasional finding of high level resistance to this antibiotic.

Atia, W A; Emmerson, A M; Holmes, D

doi: 10.1136/sti.59.5.293pmid: 6311321

A single oral dose of 2 g of sultamicillin and 1 g of probenecid was effective in the treatment of men with uncomplicated gonococcal urethritis caused by both penicillin sensitive strains of Neisseria gonorrhoeae and penicillinase producing strains of N gonorrhoeae (PPNG). Of 94 infected men who attended for at least one follow up examination, 91 (97%) were cured. The remaining three (3%) patients were still infected at follow up. Two of these patients had been re-exposed to an infected partner and were considered to be possible reinfections, while the third was deemed a treatment failure. Six of the 94 patients were infected with PPNG strains and all were successfully treated. Plasmid analysis of the PPNG strains showed Asian and African types both with and without transfer plasmid.

Panikabutra, K; Ariyarit, C; Chitwarakorn, A; Saensanoh, C

doi: 10.1136/sti.59.5.298pmid: 6225482

Between 25 December 1981 and 11 March 1982, 400 men with uncomplicated gonococcal urethritis were randomly assigned to one of four treatment regimens: spectinomycin 2 g intramuscularly (group A); cefamandole 1 g intramuscularly after probenecid 1 g orally (group B); cefaclor 3 g orally with probenecid 1 g orally (group C); and cefaclor 3 g orally (group D). The cure rates were 91 of 92 (98.9%) in group A, 68 of 96 (70.8%) in group B, 88 of 92 (95.8%) in group C, and 86 of 96 (89.6%) in group D. Cefaclor at a dose of 3 g given orally with 1 g probenecid appears to be an effective alternative to spectinomycin 2 g in the treatment of gonorrhoea in areas where strains of penicillinase producing Neisseria gonorrhoeae (PPNG) are prevalent.

Sanderson, B E; White, E; Baldson, M J

doi: 10.1136/sti.59.5.302pmid: 6604557

Amounts of putrescine, cadaverine, and tyramine were measured in vaginal washings from five patients with non-specific vaginitis (NSV) associated with Gardnerella vaginalis, five patients with trichomoniasis, and five healthy controls. Putrescine and cadaverine were present in all but one sample from the infected patients; tyramine was found in four of five samples from the women with NSV and in two of five samples from those with trichomoniasis. The mean cadaverine to putrescine ratio was significantly higher in the patients with NSV than in those with trichomoniasis. Samples from the five controls contained only very small amounts of any of the three amines. The amine content of nine of 10 samples from the infected women was reduced to normal values after metronidazole treatment. The possible sources of the amines from Trichomonas vaginalis and Gardnerella vaginalis are discussed with reference to the clinical response to treatment.

Simmons, P D; Thin, R N

doi: 10.1136/sti.59.5.306pmid: 6604558

Chronic non-bacterial prostatitis is a difficult condition to diagnose accurately either by symptoms and signs or by investigations. Four groups of patients were assessed for the number of leucocytes and the presence of pathogens in expressed prostatic secretions before and after treatment with co-trimoxazole two tablets twice daily for three months. The pretreatment findings suggest that the upper limit of normal for the number of leucocytes in expressed prostatic secretions is about five per microscope field (X 40 magnification) and that for the cell count about 0.5 X 10(9)/l using the method described. Increased microscopical cell estimations and cell counts in the expressed prostatic secretions of patients with symptoms of prostatitis and those with recurrent non-specific urethritis seem to indicate the presence of prostatitis.

Woodman, C B; Buchan, A; Fuller, A; Hartley, C; Skinner, G R; Stocker, D; Sugrue, D; Clay, J C; Wilkins, G; Wiblin, C

doi: 10.1136/sti.59.5.311pmid: 6311322

A subunit antigenoid vaccine, Ac NFU1 (S-) MRC 5, was used in patients who had had a clinical episode of herpes genitalis. The rate of recurrence was compared with that in unvaccinated patients to determine the efficacy of vaccination in preventing recurrence and spread of the virus in the community. Seven of 22 (31%) vaccinated patients had eight recurrences after the initial clinical episode; in contrast there were 51 recurrences in 17 of 20 (85%) unvaccinated patients. Although further studies are needed, the results indicate that the vaccine may prevent recurrent episodes of herpes genitalis and thereby reduce the dissemination of this virus in the population.

Munday, P E; McDonald, W; Murray-Sykes, K M; Harris, J R

doi: 10.1136/sti.59.5.314pmid: 6688540

In an epidemiological study of patients diagnosed as having hepatitis B virus (HBV) infection during a 12 month period in a London health district, 98 (67%) of 144 index cases and 146 (67%) of 218 of their named contacts were interviewed. The problems and benefits of using conventional contact tracing techniques in the management of this infection are discussed. Named contacts in stable relationships were more easily traced than young homosexuals with frequent anonymous contacts, and drug addicts. Information on the disease and the risk of its transmission to others was, however, welcomed by some homosexuals who were concerned to establish ways of identifying chronic carriers, immune men, and those at risk. A self help group was started as a result of this study.

Grice, G C; Hafiz, S

doi: 10.1136/sti.59.5.317pmid: 6616167

Actinomyces spp were isolated by culture of endocervical specimens from two groups of women attending the department of genitourinary medicine of the Royal Hallamshire Hospital, Sheffield. The first group consisted of 78 users of intrauterine contraceptive devices (IUCD) of whom 20 (25.6%) were culture positive. The second group contained 63 women using various forms of contraception 12 (19%) of whom were culture positive. None of these 12 women had an IUCD or foreign body in situ. The results suggest that Actinomyces spp may be part of the commensal flora of the genital tract in some women.

Fast, M V; Nsanze, H; Plummer, F A; D'Costa, L J; MacLean, I W; Ronald, A R

doi: 10.1136/sti.59.5.320pmid: 6351957

Since sulphonamides are no longer predictably effective in the treatment of chancroid the combination of trimethoprim-sulphamethoxazole (TMP-SMX) was evaluated to identify other effective regimens. One hundred and nine patients with genital ulcers (75 men and 34 women) seen at the Special Treatment Clinic in Nairobi, Kenya, were randomly assigned to treatment with a seven day course of either sulphamethoxazole 1000 mg twice daily or trimethoprim (160 mg)-sulphamethoxazole (800 mg) (TMP-SMX) twice daily. Haemophilus ducreyi was isolated from the ulcer in 57 patients (33 men and 24 women). 16 patients were subsequently diagnosed serologically as having syphilis. No aetiological diagnosis was made in 40 patients. Treatment with sulphamethoxazole failed in five of 21 (24%) culture positive patients who were available for evaluation after seven days, whereas all 19 of such patients who were treated with TMP-SMX responded to treatment. Of the 21 isolates available for susceptibility testing, all were susceptible to trimethoprim alone (MIC less than 0.5 mg/l) and three were resistant to sulphonamides, all three containing a 4.9 megadalton (Mdal) plasmid. Two of the three patients from whom these isolates had been obtained were treated with sulphamethoxazole and both were clinical and bacteriological failures. Five of six patients with sulphonamide-susceptible H ducreyi responded to treatment with sulphamethoxazole. Failure of sulphonamides to eradicate H ducreyi in some patients with chancroid is associated with the presence of a sulphonamide resistant plasmid. In regions where this plasmid is present in H ducreyi TMP-SMX is the preferred treatment for chancroid.