Sexually Transmitted Infections

Strugnell, R A; Handley, C J; Drummond, L; Faine, S; Lowther, D A; Graves, S R

doi: 10.1136/sti.60.2.75pmid: 6704698

We investigated by means of radiolabelled precursors the source and nature of the polyanionic macromolecules present in rabbit tissues during active syphilis infection. Previous studies indicated that Treponema pallidum itself does not synthesise glycosaminoglycans, at least in vitro. In replicate experiments on unilaterally infected rabbits, tissue from the orchitic testis incorporated two to three times more 35S-sulphate and 3H-glucosamine (on a wet weight basis) than tissue from the non-orchitic contralateral testis. Incorporation of 35S-sulphate was independent of the number of viable T pallidum organisms present in the infested tissue, which suggested that incorporation represented biosynthesis by the host and not the treponeme. Testes from syphilitic rabbits two days after treatment with high doses (100 mg/kg) of penicillin incorporated less 35S-sulphate than untreated infected testes, but more than normal uninfected rabbit testes. This suggests that active syphilitic infection was necessary for maximum biosynthesis of the macromolecule(s) by host tissue. Hydrodynamic profiles showed incorporation of radiolabelled precursors into two distinct fractions of different sizes, which may represent a proteoglycan and a sulphated glycoprotein. Alcian blue staining of syphilitic testes at or after peak orchitis showed focal deposition of newly synthesised polyanionic components during peak orchitis and a more generalised fibrosis in testes after peak orchitis.

Terry, S I; Hanchard, B; Brooks, S E; McDonald, H; Siva, S

doi: 10.1136/sti.60.2.83pmid: 6704699

Hepatic structure and function of 22 unselected patients with early syphilis was assessed. In 20 (91%) routine hepatic tests or bromsulphalein retention showed mild non-specific abnormalities. Minor changes in hepatic structure were present in 12 (55%), in three of whom intrahepatic spirochaetes were found. The only patient who had hepatomegaly also had splenomegaly. Observed changes in hepatic structure correlated with neither physical signs nor results of biochemical tests. Hepatic changes in early syphilis are common but frequently subclinical.

Young, H; Harris, A B; Tapsall, J W

doi: 10.1136/sti.60.2.87pmid: 6423211

We evaluated the superoxol (catalase) test as a means of differentiating gonococci from related species of organisms which were cultured from a variety of anatomical sites. An isolate was almost certainly not a gonococcus if it gave a negative superoxol test result, as all but one of 596 available gonococci gave positive test results. However, a proportion of the non-gonococcal neisseriae and isolates of Branhamella catarrhalis, also gave positive test results. The superoxol test is thus a useful addition to the techniques available for the characterisation of gonococci, but additional procedures are needed to confirm the identities of isolates giving positive results.

Spencer, R C; Smith, T; Talbot, M D

doi: 10.1136/sti.60.2.90pmid: 6322910

A total of 74 men and 26 women with uncomplicated gonorrhoea were treated with ceftizoxime sodium 0.5 g intramuscularly. The cure rate was 99% and included successful treatment of four infections due to beta-lactamase producing organisms. The minimum inhibitory concentrations (MICs) of ceftizoxime in vitro were very much lower than those of penicillin and cefuroxime, and side effects were minimal. We conclude that ceftizoxime is effective against Neisseria gonorrhoeae in vivo and in vitro.

Tjiam, K H; van Heijst, B Y; de Roo, J C; de Beer, A; van Joost, T; Michel, M F; Stolz, E

doi: 10.1136/sti.60.2.92pmid: 6367887

We compared the survival of a laboratory strain of Chlamydia trachomatis serovar L-2 in different media and at different temperatures (room temperature, 4 degrees C, and -70 degrees C). At these temperatures the best storage medium was 2SP (0.2 mol/l sucrose in 0.02 mol/l phosphate buffer supplemented with 10% fetal calf serum). We used material obtained from patients to study the sensitivity of the culture method as a function of sample storage time and temperature. Compared with results on direct inoculation, material stored in 2SP for 48 hours gave 11% fewer positive cultures at 4 degrees C and 14% fewer at room temperature. Of samples which gave negative results on direct inoculation, 4% were positive after storage at 4 degrees C for 48 hours and 2% after storage at -70 degrees C for a week. As expected, the number of inclusion forming units in the original material proved to be important for the percentage of positive cultures among the stored samples.

Csángó, P A; Salveson, A; Gundersen, T; Jagars, G; Bjerk, O

doi: 10.1136/sti.60.2.95pmid: 6367888

Each of 201 men with symptoms and signs of acute urethritis was randomly assigned to one of two treatment regimens: ampicillin (2g) plus probenecid (1g), or sulphamethoxazole-trimethoprim (SMX-TMP) (sulphamethoxazole 1600 mg plus trimethoprim 320 mg) four tablets twice daily for two days. Before treatment Neisseria gonorrhoeae was isolated from 162 patients, while coexistent Chlamydia trachomatis was recovered from 42 (26%) men. After treatment N gonorrhoeae persisted in 11 (14.3%) of the 77 patients treated with ampicillin and probenecid and in three (3.5%) of the 85 treated with SMX-TMP (p less than 0.05), while C trachomatis persisted in four (16%) of the 25 men treated with SMX-TMP and in all 17 patients treated with ampicillin and probenecid. SMX-TMP was thus more effective than ampicillin in treating acute gonorrhoea in men and in eradicating concurrent C trachomatis infection.

Alderete, J F; Pearlman, E

doi: 10.1136/sti.60.2.99pmid: 6608395

Exposure of monolayer cultures of human urogenital and vaginal (HeLa), human epithelial (HEp-2), normal baboon testicular (NBT), and monkey kidney (Vero) cells to live pathogenic Trichomonas vaginalis resulted in extensive disruption of monolayers. Trypan blue was taken up by all host cells released from cell monolayers, which indicated irreversible damage of these cell types by trichomonads. Time and dose related data on cytotoxicity kinetics were obtained using increasing ratios of parasites to cells. All cell types were most sensitive to trichomonads at a multiplicity of infection of one. Release of tritiated thymidine (3H-thymidine) of the deoxyribonucleic acid (DNA) of prelabelled host cells after incubation with T vaginalis corroborated that extensive cytotoxicity was caused by pathogenic trichomonads in man. Only living parasites were cytotoxic, and no trichomonal toxic products were implicated in disruption of the cell monolayer cultures. A pathogenic bovine trichomonad, Tritrichomonas foetus KV-1, produced half as much cell damage as did T vaginalis. Trichomonas tenax, a non-pathogenic member of the normal flora of the oral cavity in man, produced no measurable cytotoxicity to HeLa cells when compared with the pathogenic human trichomonads.

Cotton, D W; Kirkham, N; Hicks, D A

doi: 10.1136/sti.60.2.106pmid: 6704693

We report four cases of rectal spirochaetosis, one in an active male homosexual. One of the heterosexual patients was referred to the genitourinary clinic by a general surgeon after spirochaetes had been found on histopathological examination of a rectal biopsy specimen. We doubt that most of our cases represent sexual transmission of spirochaetosis, or that the condition causes disease in most people. Rectal spirochaetosis possibly occurs only when the normal flora of the gut are disturbed for other reasons. Most of our patients became asymptomatic after nonspecific treatment, although metronidazole appears to be specific.

Ross, M W

doi: 10.1136/sti.60.2.110pmid: 6546702

I investigated over 600 homosexual men in four countries (Sweden, Finland, Ireland, and Australia) regarding the number of times they had contracted a sexually transmitted disease (STD) and several psychological variables including masculinity and feminity, sex role conservatism, relationships with parents, number of sexual partners, attitudes towards homosexuality, and involvement in the homosexual subculture. Using multiple linear regression in each country, it was found that 19-42% of the variance of number of times infected could be accounted for by psychosocial factors, seven of which were common to all countries. The number of sexual partners was not a significant variable in any country. These data strongly suggest that numbers of infections in homosexual men are best predicted by psychological factors, and this has considerable implications for preventative and treatment programmes for homosexuals.

Asuzu, M C; Ogunbanjo, B O; Ajayi, I O; Oyediran, A B; Osoba, A O

doi: 10.1136/sti.60.2.114pmid: 6704694

Contact tracing carried out at this clinic was analysed as part of measures for control of sexually transmitted disease (STD). Results showed that 50% of 156 contacts could not be traced at all for various reasons, and that 47% of the contacts were brought in through persuasion by index patients who had been counselled at the clinic. Only four contacts were traced, and two of these attended the clinic. Index patient cooperation is thus identified as the most important factor in the success of contact tracing, because of the high level of illiteracy and poor communications facilities in Nigeria, compared with industrialised countries.