Sexually Transmitted Infections

doi: 10.1136/sti.64.3.147pmid: 3137148

The sensitivity to penicillin of about 25,000 gonococcal isolates tested in Australia during the five years to 30 June 1986 was assessed in a collaborative multicentric study. Increasing resistance to the penicillin group of antibiotics was observed during the course of this study and was manifested both as increased levels of chromosomally mediated intrinsic resistance and by an increasing incidence of penicillinase producing strains of Neisseria gonorrhoeae (PPNG). Pronounced regional differences in the levels of intrinsic resistance, the incidence of infections with PPNG, and the endemic spread of PPNG strains were observed.

Ansink-Schipper, M C; Bygdeman, S M; van Klingeren, B; Sandström, E G

doi: 10.1136/sti.64.3.152pmid: 3137149

In 1982 an increase of penicillinase producing strains of Neisseria gonorrhoeae (PPNG), carrying the 4.5 megadalton Asian type plasmid and the 24 megadalton transfer plasmid (Asia+), was observed in Amsterdam. The main auxotypes were proline requiring (Pro-) and proline and hypoxanthine requiring (Pro-Hyx-). Using two monoclonal antibody systems, it was shown that the serovars of strains with these auxotypes isolated in 1981 were different from those isolated in 1982, which indicated the start and end of microepidemics. Different serovars were also observed in Pro- and non-requiring (NR) Asia- PPNG strains isolated in 1981-2 and 1985 respectively. Only one serovar (Aedih/Arst) was common in strains isolated in 1981-2 as well as in 1985.

Péc, J; Moravcík, P; Kliment, J; Fetisov, I

doi: 10.1136/sti.64.3.156pmid: 3137150

The authors examined three urine specimens from each of 24 men with acute gonococcal urethritis. Gonococcal concentrations in urine were 7 X 10(3)/ml to 9 X 10(8)/ml in first samples, 1 X 10(2)/ml to 5 X 10(6)/ml in midstream samples, and, in the terminal samples from only 22 men, 8 X 10(4)/ml. A further 17 men with symptomless gonococcal urethritis were examined. Seven of them yielded 1 X 10(2)/ml to 2.5 X 10(5)/ml in first samples and 5 X 10(5)/ml in midstream samples, and only two yielded 5 X 10(1)/ml in final samples. All 24 men with acute gonococcal urethritis, and seven of the men with symptomless gonococcal urethritis who had yielded N gonorrhoeae in midstream urine samples, were examined by suprapubic puncture before morning voiding. Four of the 24 men with acute gonococcal urethritis were found to have infection that had ascended into the bladder.

Wagenvoort, J H; Suchland, R J; Stamm, W E

doi: 10.1136/sti.64.3.159pmid: 3410465

The distribution of serovars in 208 Chlamydia trachomatis strains of urogenital origin isolated from 185 patients attending a sexually transmitted disease clinic in Rotterdam, The Netherlands, was assessed. Typing by monoclonal antisera using a dot enzyme linked immunosorbent assay (ELISA) showed that the most common serovars were E (found in 45 strains), F (39), D (34), and K (28). Other serovars detected were H (21), G, I, I', J (two to 12), and B (one strain). Mixed infection with two serovars was detected in two patients. These results indicate that most genital infections with C trachomatis result from a small number of serovars, and that those serovars are similar in The Netherlands and Seattle, USA.

Phillips, L E; Faro, S; Smith, P B; Martens, M G; Riddle, G D; Goodrich, K H

doi: 10.1136/sti.64.3.165pmid: 3044976

A new direct fluorescent antibody reagent, Monofluor, was evaluated for detecting Chlamydia trachomatis in fresh specimens. Monofluor was compared with Micro Trak and with cultivation in McCoy cells. Both direct systems were slightly less sensitive than culture, but no significant differences in specificity or sensitivity were noted between culture, Monofluor, or Micro Trak results.

Demes, P; Gombosová, A; Valent, M; Jánoska, A; Fabusová, H; Petrenko, M

doi: 10.1136/sti.64.3.176pmid: 3261708

The ability of complement in human menstrual blood and cervical mucus to kill Trichomonas vaginalis was compared with that of complement in serum, and 95 fresh trichomonal isolates obtained from vaginal wash material were evaluated for susceptibility to complement immediately after isolation. Only serum and menstrual blood with haemolytic activity produced total cytolysis of T vaginalis. The cytolytic abilities of these fluids were totally inactivated by treatment with heat or edetic acid (EDTA), which confirms the role of complement in cytolysis. Most cervical mucus samples had no detectable trichomonal cytotoxic properties. The cytotoxic activity in the remaining samples was not due to complement, as it was heat stable. Fresh isolates of T vaginalis and subpopulations of fresh isolates differed in their susceptibility or resistance to complement mediated lysis in serum. Resistance to complement did not remain stable after trichomonads were grown in vitro.

Ching, L Q; Borchardt, K A; Smith, R F; Beal, C B

doi: 10.1136/sti.64.3.180pmid: 3044977

A new plastic envelope culture test that is selective for Gardnerella vaginalis was compared with a conventional method. Vaginal specimens from 92 women were cultured. Results from both methods were compared with the results of pelvic examinations and clinic screening tests used to diagnose bacterial vaginosis (BV). G vaginalis was isolated more often in the envelope than by the conventional method from patients with BV and those without, though the difference was not significant. Isolation and identification of G vaginalis was completed in 18-24 hours by the envelope method; the conventional method took a mean of 72 hours (range two to six days). Polymorphonuclear leucocytes (PMNLs) occurred significantly more in specimens from the patients without BV than from those with BV. Both clue cells and a positive amine test reaction were found significantly more in specimens from patients with BV than from those without BV. Clue cells and G vaginalis isolation correlated best with BV (in 47 women), followed by clue cells and positive amine test results (in 39). Adherence of G vaginalis in the envelope also correlated more with BV, clue cells, and positive amine test results (32) than with patients without BV (14). When there were no clue cells and amine test results were negative the results correlated totally with a prediction of no BV. The use of the rapid envelope culture test would have confirmed BV in 20% of the cases where clue cell and amine test results were discordant.

Casin, I; Sanson-Le Pors, M J; Felten, A; Perol, Y

doi: 10.1136/sti.64.3.185pmid: 2970427

Sixty strains of Haemophilus influenzae were isolated from the genitourinary tracts of adults: 19 from cervicovaginal secretions, one from a woman with bartholinitis, 37 from urethral exudates, and three from urine. Non-capsulated strains were recovered predominantly, and biotype III accounted for 28 isolates and biotype IV for 25. Many of the H influenzae strains were found to be resistant to one or more of the antibiotics commonly used against sexually transmitted diseases. Resistance to tetracycline was prevalent and was found in 17 of the strains. Ten strains were ampicillin resistant and beta lactamase producing. Kanamycin resistance was less common (two strains). Trospectomycin (U-63366), a new spectinomycin analogue, was eight to 16 times more active than spectinomycin. All the quinolones tested were very active against all strains and may provide an effective alternative for the treatment of resistant H influenzae in genitourinary infections.

Naamara, W; Kunimoto, D Y; D'Costa, L J; Ndinya-Achola, J O; Nsanze, H; Ronald, A R; Plummer, F A

doi: 10.1136/sti.64.3.189pmid: 3044978

Increasing resistance of Haemophilus ducreyi to antimicrobials necessitates further trials of new antimicrobial agents for treating chancroid. Enoxacin has excellent in vitro activity against H ducreyi, and a randomised clinical trial of three doses of enoxacin 400 mg at intervals of 12 hours compared with a single dose of trimethoprim/sulphametrole (TMP/SMT) 640/3200 mg was therefore conducted. Of 169 men enrolled in the study, 86 received enoxacin and 83 received TMP/SMT. Ulcers were improved or cured in 65/73 men treated with enoxacin and 57/70 men treated with TMP/SMT. This difference was not significant. At 72 hours after treatment, H ducreyi was eradicated from ulcers of 72/77 men treated with enoxacin and of 67/74 of those treated with TMP/SMT. Patients with buboes responded equally well to both treatments. Of 100 H ducreyi strains tested, all were susceptible to both 0.25 mg/l enoxacin and the combination of 0.25 mg/l TMP and 5 mg/l SMT. Although most men treated with either regimen were cured, neither regimen appeared to be the optimum treatment for chancroid. This study shows the efficacy of enoxacin for a soft tissue infection caused by Gram negative organisms.

Philpot, C R; Harcourt, C; Edwards, J; Grealis, A

doi: 10.1136/sti.64.3.193pmid: 3410467

One hundred and thirty two female prostitutes and 55 non-prostitutes who were tested for antibodies to human immunodeficiency virus (HIV) were surveyed by questionnaire at this centre. The two groups were well matched for age and were very similar in other except for numbers of their sexual partners. Questions were asked about drug taking, sexual practices, general health, and episodes of sexually transmitted diseases (STDs). None of the women in the survey was found to be seropositive, but both groups were found to be seriously at risk of HIV infection through using intravenous (IV) drugs, having unprotected sexual intercourse with men who used IV drugs, having unprotected sexual intercourse with bisexual men, or exposure to several STDs.