Sexually Transmitted Infections

Bogaerts, J; Vandepitte, J; Van Dyck, E; Vanhoof, R; Dekegel, M; Piot, P

doi: 10.1136/sti.62.4.217pmid: 2942456

The in vitro sensitivity of 104 isolates of Neisseria gonorrhoeae to six antimicrobial agents was tested. More than 50% of the isolates produced penicillinase. Of those that did not produce penicillinase, 26% were resistant (minimum inhibitory concentration (MIC)) greater than or equal to 0.5 mg/l), and 68% showed a decreased sensitivity for penicillin G (0.06 less than or equal to MIC less than or equal to 0.25 mg/l). Twenty six per cent and 50% of the strains, respectively, showed a decreased sensitivity to thiamphenicol (MIC greater than or equal to 1 mg/l) and tetracycline (MIC greater than or equal to 2 mg/l). All isolates were sensitive to spectinomycin, kanamycin, and norfloxacin. Of 20 penicillinase producing N gonorrhoeae (PPNG) isolates examined, seven contained the 3.4 megadalton R-plasmid, another seven contained both the 3.4 megadalton and 22.5 megadalton plasmids, five the 4.3 megadalton and 22.5 megadalton plasmids, and one isolate harboured both the 3.4 and 4.3 R-plasmids, together with the 22.5 megadalton plasmid. A disturbing increase in resistance to penicillin has been observed since the publication of earlier surveys, and the clinical implications of these findings are discussed.

Wanas, T M; Williams, P E

doi: 10.1136/sti.62.4.221pmid: 3733084

The efficacy and tolerance of single oral doses of cefuroxime axetil (1.5 g) were compared with oral ampicillin (3 g) for treating acute gonococcal urethritis in 110 men and 30 women. Each dose was given with 1 g probenecid. Of the 62 assessable patients who received ampicillin, two failed to respond to treatment. Of 67 assessable patients who received cefuroxime axetil, one failed to respond. Pencillinase producing strains of Neisseria gonorrhoeae were isolated from five patients; one received ampicillin and failed to respond, whereas the other four received cefuroxime axetil and three were cured. A single oral dose of 1.5 g cefuroxime axetil with 1 g probenecid seemed to be an effective treatment for acute gonococcal urethritis, especially for penicillin resistant strains.

Lim, K B; Thirumoorthy, T; Lee, C T; Tham, S N; Sng, E H; Tan, T

doi: 10.1136/sti.62.4.224pmid: 3089907

A total of 136 patients with uncomplicated gonorrhoea were treated with intramuscular cefoxitin 2 g (25 patients) or 1 g (111 patients) and oral probenecid 1 g. Cefoxitin 1 g cured 95% (42 out of 45 men and all of 14 women) with infections caused by penicillinase producing Neisseria gonorrhoeae (PPNG) strains and 98% (all of 38 men and 13 out of 14 women) with non-PPNG infections, giving an overall cure rate of 96%. The rate of postgonococcal urethritis (PGU) in men treated with 1 g cefoxitin was 28%. No serious side effects of treatment were observed in patients treated with either dose. The failure rate of 7% in men infected with PPNG strains who were treated with the 1 g dose is, however, disturbing. We therefore recommend that intramuscular cefoxitin 2 g and oral probenecid 1 g may be used to treat uncomplicated gonorrhoea, especially in areas where PPNG strains are common.

Blackwell, A L; Eykyn, S J

doi: 10.1136/sti.62.4.228pmid: 3733085

Household epidemics of gonorrhoea are relatively rare in the United Kingdom. We report a cluster of cases of gonococcal infection in four children living in one household. The cases show the importance of full screening, including pharyngeal cultures, of all family members when paediatric gonorrhoea is diagnosed. Our cases also suggest that both boys and girls should be screened for gonorrhoea when gonococcal infection is found in an adult member of the household.

Judson, F N; Tavelli, B G

doi: 10.1136/sti.62.4.230pmid: 3089908

We compared the clinical and epidemiological characteristics of 89 women with pelvic inflammatory disease (PID) seen at a clinic for sexually transmitted diseases during 1982 and 1983. Patients were classified into four groups by having endocervical cultures positive for Neisseria gonorrhoeae only (24), Chlamydia trachomatis only (16), both organisms (14), or neither organism (35). More women with cultures positive for N gonorrhoeae were black (p less than 0.005), had a sexual partner with gonorrhoea (p less than 0.005), and had a purulent vaginal discharge (p less than 0.05). No other significant differences were found between groups regarding age, exposure to a sexual partner with non-gonococcal urethritis, history of trichomoniasis, parity, use of antibiotics, contraceptive history, duration of abdominal pain, relation of pain to the phase of the menstrual cycle, abdominal rebound tenderness, reproductive tract signs, or febrility. In women presenting to outpatient clinics, PID tends to be mild and the diagnosis unreliable. Though C trachomatis is emerging as an important aetiological agent, we found no clinical indicators that could distinguish chlamydial from gonococcal PID.

Heinonen, P K; Teisala, K; Punnonen, R; Aine, R; Lehtinen, M; Miettinen, A; Paavonen, J

doi: 10.1136/sti.62.4.235pmid: 3089909

The best way of treating pelvic inflammatory disease (PID) is not known. The clinical response to two treatment regimens (penicillin plus metronidazole v doxycycline plus metronidazole) was studied in 33 patients with PID confirmed by laparoscopy and endometrial biopsy. The overall failure rate, according to the criteria used in this study was five of 11 (45%) women with chlamydial PID, none of six women with gonococcal PID, all of four women with chlamydial gonococcal PID, and three (25%) of 12 women with non-chlamydial non-gonococcal PID. The failure rate with penicillin plus metronidazole treatment was unacceptably high (53%), and significantly higher than that with doxycycline plus metronidazole (19%) (p = 0.038). In most cases the microbiological and histopathological evaluations identified a probable explanation for the poor response to the treatment regimen used.

Rasmussen, S E; Nielsen, M H; Lind, I; Rhodes, J M

doi: 10.1136/sti.62.4.240pmid: 3488256

In vitro cultured monolayers of normal human vaginal epithelial cells were incubated with axenic cultures of Trichomonas vaginalis. Two strains freshly isolated from patients with trichomoniasis and one strain that had been maintained in axenic culture for several years were studied. Freshly isolated trichomonads showed amoeboid movements, adherence to epithelial cell surfaces, and were cytotoxic to epithelial cells in vitro. In contrast, the laboratory strain maintained for years in axenic culture did not adhere to the epithelial cell monolayer and was only cytotoxic at a concentration 100 times that of freshly isolated trichomonads. Electron microscopy of monolayers exposed to T vaginalis for 24 hours showed that all epithelial cells in intimate contact with trichomonads had more or less disintegrated, whereas in monolayers exposed for six hours some of the epithelial cells in contact with T vaginalis were normal. T vaginalis organisms with amoeboid morphology contained a dense network of microfilaments in the part of the trichomonad that was in contact with an epithelial cell. Occasionally a pseudopodium was projected into the cytoplasm of disintegrated epithelial cells.

Barton, S E; Munday, P E; Kinghorn, G R; van der Meijden, W I; Stolz, E; Notowicz, A; Rashid, S; Schuller, J L; Essex-Cater, A J; Kuijpers, M H

doi: 10.1136/sti.62.4.247pmid: 2942457

Thirumoorthy, T; Sng, E H; Doraisingham, S; Ling, A E; Lim, K B; Lee, C T

doi: 10.1136/sti.62.4.253pmid: 3015775

In 80 patients with painful purulent penile ulcers who attended the outpatient service of Middle Road Hospital in Singapore, Haemophilus ducreyi was isolated from 18 (22%), herpes simplex virus type 2 from nine (11%), and Neisseria gonorrhoeae from eight (10%). Primary pathogens were not isolated from 45 (57%) men. Painful purulent penile ulcers were more common in uncircumcised men, and patients had often acquired the disease after sexual intercourse with prostitutes in Singapore.

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

doi: 10.1136/sti.62.4.256pmid: 3733086

A quantitative method of culture, based on a weighed sample and with results expressed as colony forming units (cfu)/g was assessed and used to investigate the vaginal flora of normal women and that of women with vaginal disease. Samples were collected by means of disposable plastic loops into modified proteose peptone water transport medium in preweighed bottles. Counts expressed as cfu/g of secretion were consistent, whereas counts expressed as cfu/ml were inconsistent. Results obtained with specimens manipulated on the open bench were the same as those from duplicate samples processed in an anaerobic chamber. The normal vaginal flora was predominantly aerobic--lactobacilli, coryneforms, and coagulase negative staphylococci--with counts of greater than or equal to 10(8) cfu/g for lactobacilli. These were also present in patients with candidosis, but the flora in patients with trichomoniasis, bacterial vaginosis, gonorrhoea, or chlamydial infection was predominantly anaerobic. The commonest anaerobes were Bacteroides spp, particularly B bivius; they were found in 55% of controls but at counts of 10(2) cfu/g lower than in the patients, most of whom had high counts of anaerobes (greater than 10(8) cfu/g). The isolation rate of Gardnerella vaginalis was not appreciably greater from patients with bacterial vaginosis, and the quantitative cultures on controls and patients who were G vaginalis positive were the same (approximately equal to 10(7) cfu/g). Quantitative studies show greater differences than qualitative cultures between normal controls and patients with vaginal infections, indicating that some symptoms and signs of such infections may be related to quantitative polymicrobial changes.