Sexually Transmitted Infections

Fitzgerald, T J; Repesh, L A; Blanco, D R; Miller, J N

doi: 10.1136/sti.60.6.357pmid: 6394096

As shown by scanning electron and phase contrast microscopy, Treponema pallidum attached in vitro to basement membranes purified from kidney cortex tissues or from retinal vessels. This organism also attached to the extracellular matrix remaining after cultured cells had been solubilised with Triton X. Fibronectin, laminin, collagen, IV, collagen I, and hyaluronic acid are structural components of basement membranes and extracellular matrices. Experiments were performed to investigate the in vitro attachment of T pallidum to each of these components. Viable or heat inactivated treponemes were added to glass coverslips precoated with different concentrations of each component. After various times of incubation, coverslips were washed and the attached organisms were counted. Large numbers of viable organisms attached to each of these five components. In contrast, heat inactivation sharply reduced numbers of attached organisms. The IgG fractions of immune and non-immune rabbit serum samples were affinity purified using protein A. T pallidum was preincubated with both fractions, then incubated with either intact cultured cells or with coverslips coated with the five tissue components. The IgG from immune serum blocked treponemal attachment to the cultured cells and to fibronectin, laminin, collagen IV, and collagen I, but not to hyaluronic acid. These results are discussed in terms of attachment mechanisms of T pallidum and potential applications to in vivo infection.

Sato, T; Kubo, E; Yokota, M; Kayashima, T; Tomizawa, T

doi: 10.1136/sti.60.6.364pmid: 6394097

The Treponema pallidum specific IgM haemagglutination (TP-IgM-HA) test uses erythrocytes sensitised with antiserum to human IgM to separate IgM from IgG in serum. Specific antitreponemal IgM captured in this way is detected by adding a second reagent comprising erythrocytes sensitised with T pallidum antigen. Eighty two serum samples from 82 patients with untreated syphilis, 521 samples from 73 patients with treated syphilis, and 1872 samples from people who did not have syphilis were examined by the 19S(IgM)-TPHA (T pallidum haemagglutination), IgM-FTA-ABS (fluorescent treponemal antibody absorbed), TP-IgM-ELISA (enzyme linked immunosorbent assay), and TP-IgM-HA tests for the presence of 19S(IgM) antibodies specific to treponemes. The sensitivity of the TP-IgM-HA test was 97.6% and the specificity was 99.7%. We also traced IgM specific to treponemes in untreated patients with primary syphilis by four different tests. The TP-IgM-HA test results clearly reflected the effect of the treatment.

Goh, B T; Smith, G W; Samarasinghe, L; Singh, V; Lim, K S

doi: 10.1136/sti.60.6.371pmid: 6518348

Paired specimens of cerebrospinal fluid and serum were taken from 21 patients to estimate penicillin concentrations two to three hours after the last dose of a course of 14-21 daily intramuscular injections of procaine penicillin 0.6 MU. Of 10 patients treated with procaine penicillin alone, eight had no detectable penicillin and two had sub-treponemicidal concentrations (less than 0.018 mg/l) in the cerebrospinal fluid. Of 11 patients treated with procaine penicillin as above and probenecid 2 g a day by mouth, three had no detectable penicillin, two had sub-treponemicidal concentrations, and six had treponemicidal concentrations of penicillin in the cerebrospinal fluid. All 21 patients had treponemicidal concentrations of penicillin in the serum. This dose of procaine penicillin alone or with probenecid is therefore not recommended for treating neurosyphilis.

Sng, E H; Lim, A L; Yeo, K L

doi: 10.1136/sti.60.6.374pmid: 6240311

The antimicrobial susceptibility of gonococci isolated in Singapore has been studied over several years. In 1983, the prevalence of penicillinase producing Neisseria gonorrhoeae (PPNG) was 33.5% and 64% of non-PPNG isolates had minimum inhibitory concentrations (MICs) of penicillin of greater than or equal to 0.5 mg/l. After a control programme, the isolation of the gonococcus from prostitutes was reduced and there was improvement in its susceptibility to antimicrobials. The incidence of PPNG strains was stabilised with a change in the treatment regimen. An influx of foreign prostitutes, however, had an unfavourable impact on these variables. Countries in South East Asia have a high prevalence of PPNG and non-PPNG strains that have reduced susceptibility to antimicrobials. In view of increased air travel the problem should be seen from a global perspective. Better treatment regimens and control strategies are urgently needed.

Edwards, L D; Gartner, T

doi: 10.1136/sti.60.6.380pmid: 6440658

Sixty three patients presumed to have genital gonorrhoea who gave histories of extragenital sexual practices were randomly treated with amoxycillin 3 g or bacampicillin 4.8 g (equivalent to 3.5 g ampicillin) with probenecid 1 g to compare the efficacy of the drugs in treating gonorrhoea at all sites. Three patients were initially culture negative, and seven failed to return for follow up. Twenty seven of 28 patients receiving bacampicillin and all 25 receiving amoxycillin gave negative genital cultures for Neisseria gonorrhoeae five to nine days after treatment. Twenty two of 60 patients had extragenital gonorrhoea. One failed to return, but all eight who had received amoxycillin and 12 of 13 who had received bacampicillin gave negative pharyngeal and anorectal cultures after treatment. N meningitidis was isolated from the pharynx in 17 of 60 patients on initial attendance. Three of 14 were still colonised with the meningococcus after treatment. Two of 32 patients receiving amoxycillin and 12 of 31 receiving bacampicillin reported experiencing gastrointestinal side effects.

Munday, P E; Carder, J M; Hanna, N F; Taylor-Robinson, D

doi: 10.1136/sti.60.6.384pmid: 6518349

Three swabs were taken from the cervix of each of 104 women for the detection of Chlamydia trachomatis. The processing of three swabs instead of one increased the isolation rate by only 2%, and later swabs did not result in the production of more chlamydial inclusions than first swabs. In most clinics, therefore, a single cervical swab is adequate to detect chlamydial infection.

Hunter, J M; Sommerville, R G

doi: 10.1136/sti.60.6.387pmid: 6518350

A total of 157 women attending departments of genitourinary medicine were treated for chlamydial infection of the cervix with erythromycin stearate 500 mg twice a day. Chlamydiae were eradicated from the cervix in 64/80 women treated for seven days and in 51/77 women treated for 14 days. In 12 of those treated for seven days and 15 of those treated for 14 days, reinfection was the probable cause of reisolation after treatment. The possibility of latent infection with Chlamydia trachomatis could not be excluded in five women, but was not more likely to occur with the shorter treatment course. Erythromycin stearate 500 mg twice daily for seven days appears to be an effective regimen for the treatment of uncomplicated chlamydial infection of the cervix.

Alacoque, B; Cloppet, H; Dumontel, C; Moulin, G

doi: 10.1136/sti.60.6.390pmid: 6394098

We studied the course of a case of lymphogranuloma venereum (LGV) over two years. The comparative histological, immunological, and ultrastructural studies showed the existence of characteristic granulations within the macrophages of the granuloma. We suggest that direct immunofluorescence is a specific method for diagnosing cutaneous LGV. Some ultrastructural aspects lead us to believe that different chlamydial bodies exist inside the granuloma.

Johnson, A P; Davies, H A

doi: 10.1136/sti.60.6.396pmid: 6151415

Eight strains of Gardnerella vaginalis were examined by electron microscopy for the presence of pili. Narrow pili ranging from 3.0 to 7.5 nm in diameter were seen on bacteria from five of the strains studied.

Slatford, K; Currie, C

doi: 10.1136/sti.60.6.398pmid: 6518351

The prevalence of self reported psychosexual problems in 265 men and 160 women who attended the genitourinary clinic at this hospital was assessed. Twenty-six (10.6%) men and 13 (9.0%) women had sexual problems either as an individual or within their regular relationship. The highest prevalence of problems was in married or cohabiting women and men, both homosexual and heterosexual, over 30.