Sexually Transmitted Infections

van der Valk, P G; Kraai, E J; van Voorst Vader, P C; Haaxma-Reiche, H; Snijder, J A

doi: 10.1136/sti.64.4.223pmid: 3169752

Penicillin concentrations in cerebrospinal fluid (CSF) were measured in 40 asymptomatic patients with syphilis, 10 of whom had neurosyphilis. The patients were treated with 2.4 MIU procaine penicillin a day intramuscularly in combination with 500 mg probenecid every six hours orally. This intramuscular treatment regimen did not consistently yield treponemicidal penicillin concentrations in the CSF (subtreponemicidal CSF concentrations were found in 17 patients, four of whom had neurosyphilis). These data provide additional evidence that the cure of asymptomatic neurosyphilis is not guaranteed by intramuscular penicillin treatment.

Falk, E S; Bygdeman, S M; Birkeland, N K; Bjorvatn, B; Kallings, I; Sandström, E G

doi: 10.1136/sti.64.4.226pmid: 2844651

The phenotypes and genotypes of 26 beta lactamase (penicillinase) producing strains of Neisseria gonorrhoeae (PPNG) from African countries were investigated. Using the restriction enzyme technique nine different restriction enzyme patterns were found, two of them in 15 strains. Of the 26 strains, 16 belonged to serogroup WI (containing protein type IA) and 10 to serogroup WII/III (containing protein IB). Among the IA strains four different serovars were represented, whereas six serovars were found among the IB strains. Five different auxotypes were identified, of which proline requiring (found in 12 strains) and prototrophic (found in 10 strains) dominated. Twelve strains harboured a 4.4 megadalton as well as a 24.5 megadalton plasmid. A 3.2 megadalton plasmid was found in 14 strains, one of which also harboured a 24.5 megadalton plasmid. The 2.8 megadalton cryptic plasmid was present in all 26 strains. The MICs of doxycycline ranged from 0.25 to 2.0 mg/l; the MIC 50% for WI strains was 0.25 mg/l and for WII/WIII strains 1.0 mg/l. A total of 10 different combinations of restriction enzyme pattern, serovar, auxotype, and plasmid were seen in the 16 WI strains compared with eight such combinations in the 10 WII/WIII strains. As expected, the restriction enzyme technique and serological classification gave better differentiation than plasmid profiles and susceptibility to doxycycline. More relevantly, however, these techniques also compared favourably with auxotyping. When the different systems were combined, the sensitivity was greatly increased.

Abeck, D; Johnson, A P; Alexander, F; Korting, H C; Ballard, R C

doi: 10.1136/sti.64.4.233pmid: 3139546

The susceptibility of 119 strains of Neisseria gonorrhoeae isolated in Munich in 1986 to eight antibiotics was assessed. Although some degree of resistance to penicillin and tetracycline, as well as high minimum inhibitory concentrations (MIC) of spectinomycin, were observed, all the strains were sensitive to ciprofloxacin, enoxacin, fleroxacin, cefotaxime, and FCE 22250.

Bewley, S

doi: 10.1136/sti.64.4.241pmid: 3169753

A study of patients with gonorrhoea showed that those who defaulted most from follow up were male, heterosexual, and had multiple sexual partners. A prospective, blind, randomised controlled trial showed that a leaflet giving information about gonorrhoea had a positive effect on follow up attendance by women, but no appreciable effect on rates of defaulting overall. This has implications for the initial treatment schedules.

Ciotti, R A; Sondheimer, S J; Nachamkin, I

doi: 10.1136/sti.64.4.245pmid: 3049302

We compared two different methods of collecting endocervical samples for examination by direct immunofluorescence for Chlamydia trachomatis. A cervical Cytobrush gave better results than a dacron swab. Further studies should be performed to assess the value of alternative sampling methods to detect this organism.

Cramers, M; Kaspersen, P; From, E; Møller, B R

doi: 10.1136/sti.64.4.247pmid: 3169754

In a randomised single blind study, pivampicillin was compared with erythromycin in women with urogenital Chlamydia trachomatis infections. The pivampicillin dosage was 700 mg twice a day and the erythromycin dosage 500 mg twice a day for seven days. Follow up took place on days 7 and 14 after the start of treatment. All 26 women treated with pivampicillin were culture negative for chlamydiae at the first and second follow up visits. All 23 women who received erythromycin were culture negative at the first follow up visit, but one was culture positive at the second follow up visit. Gastrointestinal side effects were recorded in five patients receiving pivampicillin and in nine receiving erythromycin. Two patients receiving erythromycin were withdrawn from treatment because of gastrointestinal disturbances, compared with none receiving pivampicillin.

Folkers, E; Oranje, A P; Duivenvoorden, J N; van der Veen, J P; Rijlaarsdam, J U; Emsbroek, J A

doi: 10.1136/sti.64.4.249pmid: 3169755

In 126 patients with anogenital lesions, in which herpes simplex virus (HSV) infection was suspected or included in the differential diagnosis, the results of cytodiagnosis of herpetic infection (Tzanck smear) were compared with virus culture. Cervical lesions were excluded from this study. HSV infection was proved by culture in 78 patients and was absent or non-active in 41 patients. Excluded from this study were seven patients who did not yield the virus on culture but had positive Tzanck smear results from three investigators. The characteristic cytopathic effect of herpetic infection was found in 78 patients who yielded HSV on culture. Tzanck smear sensitivity for skin lesions was 79% and for mucous membrane lesions was 81% in men and 52% in women. Tzanck smear specificity for the 41 patients without herpetic infection proved by virus culture was 93%. Differences in sensitivity and specificity between the results found by three investigators (double blind screening) were not significant. The Tzanck smear is reliable, inexpensive, and easy and quick to perform; it is suitable for office diagnosis because it does not require a specialised laboratory.

Tait, I A; Alawattegama, A B; Rees, E

doi: 10.1136/sti.64.4.255pmid: 3169756

In 632 patients attending a sexually transmitted disease (STD) clinic who were colposcoped because they were in certain high risk groups for cervical neoplasia, and irrespective of cytological findings, 13 out of 51 biopsied had false negative cytology results. Human papilloma virus (HPV) was the most important sexually transmitted agent associated with cervical intraepithelial neoplasia (CIN), but HPV was also present in most patients with false negative (11/13) and false positive (11/14) cytology results. Screening by colposcopy, as well as cervical cytology, is therefore mandatory and must be available for certain STD clinic patients.