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West, B; Changalucha, J; Grosskurth, H; Mayaud, P; Gabone, R M; Ka-Gina, G; Mabey, D
doi: 10.1136/sti.71.1.9pmid: 7750963
OBJECTIVE--To study the antimicrobial susceptibility, plasmid content, auxotype and serogroup of strains of Neisseria gonorrhoeae isolated from an urban population of STD clinic attenders in Northern Tanzania. METHODS--The minimum inhibitory concentrations of nine common antimicrobial agents were measured by the agar dilution method against 130 strains of Neisseria gonorrhoeae isolated in a free government STD clinic in Mwanza town. The auxotype, plasmid content and serogroup of these strains were also determined by conventional techniques. RESULTS--65 strains (50%) were penicillinase producers (PPNG), and 34 (26%) exhibited chromosomally mediated resistance to penicillin. Seven (5%) were sensitive to tetracycline; 78 (60%) showed intermediate levels of resistance, and 45 (35%) had high level plasmid mediated resistance (TRNG), all of which carried a 25.2 MDa plasmid. 79 strains (61%) showed decreased sensitivity to trimethoprim-sulphamethoxazole, and five (4%) were resistant to this agent. All isolates were fully sensitive to spectinomycin, azithromycin, cefotaxime, cefuroxime, norfloxacin and ciprofloxacin. One hundred and one strains (78%) were of type W11/111, 22 type W1, and seven cross reacting strains. The W1 strains were significantly more likely to be carrying plasmid mediated resistance to both penicillin and tetracycline. Six different auxotypes were present, the major type requiring proline. Plasmid profiles showed the presence of both the 3.2 MDa and the 4.4 MDa beta-lactamase encoding plasmids. CONCLUSION--a high proportion of gonococcal isolates remain resistant to penicillin in this region, and most isolates are now also resistant to tetracycline, with the emergence of plasmic mediated tetracycline resistance. Trimethoprim-sulphonamide sensitivity is also decreasing. The population of strains is heterogeneous, and both African and Asian beta-lactamase encoding plasmids are present.
Lewis, D A; Ison, C A; Livermore, D M; Chen, H Y; Hooi, A Y; Wisdom, A R
doi: 10.1136/sti.71.1.13pmid: 7750947
OBJECTIVES--To collect epidemiological data on gonococcal infection in an east London genitourinary medicine (GUM) clinic; to perform antibiotic susceptibility testing on Neisseria gonorrhoeae isolates and relate results to patient data; to assess the efficacy of current first-line antibiotic therapy for treating gonorrhoea. METHODS--Gonococcal isolates were collected from 113 patients attending the GUM clinic at Newham General Hospital over a one year period. Isolates (104) were tested for susceptibility to various antibiotics. Plasmid profiles were obtained for penicillinase producing gonococci (PPNG) and isolates exhibiting high-level tetracycline resistance (TRNG). Epidemiological information was collected from clinic attenders by routine note-taking. RESULTS--PPNG (16) accounted for 15% of isolates tested, only three being acquired outside the United Kingdom (U.K.). Plasmid typing showed three types of beta-lactamase-encoding plasmids were represented (2.9 MDa, 3.2 MDa and 4.4 MDa). Amongst the non-PPNG isolates, high-level chromosomal resistance to penicillin (CMRNG) was found in 3.5%, intermediate resistance in 57.5% and full susceptibility in 39%. One isolate showed decreased susceptibility to ciprofloxacin (MIC = 0.06 mg/l). Three PPNG isolates also possessed a 25.2 MDa plasmid and expressed high-level tetracycline resistance encoded by tetM. All isolates were susceptible to cefixime, cefotaxime, azithromycin and spectinomycin. Most gonorrhoea (90%) was seen in local residents. The male:female case ratio was 2:1 with homosexually-acquired gonorrhoea accounting for only 3.5% of the total. Most patients (96%) had acquired gonorrhoea in the U.K.. A past history of gonorrhoea was more frequent in male patients. Concurrent chlamydial infection was seen in 31% females and 16% males. CONCLUSIONS--The high PPNG rate supports a previous decision to change first-line therapy from amoxycillin with probenecid to ciprofloxacin. There was no evidence of clinical treatment failure with ciprofloxacin. Cefixime, cefotaxime, azithromycin and spectinomycin all appear to be suitable alternative therapies. Acquisition of gonorrhoea abroad was associated with isolates exhibiting penicillin resistance but such isolates were also obtained from patients infected locally and without a history of foreign travel.
Munday, P E; Thomas, B J; Gilroy, C B; Gilchrist, C; Taylor-Robinson, D
doi: 10.1136/sti.71.1.24pmid: 7750948
OBJECTIVE--To determine how often Chlamydia trachomatis cervical infections are detected in women following completion of a currently recommended treatment regimen and the reason for recurrence. METHODS--A longitudinal follow-up study of 43 initially C trachomatis-positive women for periods of up to two years. RESULTS--C trachomatis was detected in three women, 19, 16 and about four months, respectively after completion of treatment. All specimens from the other 40 women which were taken during visits two to seven, that is periods of three to 700 days after treatment, were chlamydia-negative. CONCLUSION--Although C trachomatis is usually eradicated from the genital tract by conventional treatment, occasionally it may be found again. It is difficult to determine whether detection after treatment is due to persistence or reinfection and further studies are required.
Kumar, B; Sharma, R; Rajagopalan, M; Radotra, B D
doi: 10.1136/sti.71.1.32pmid: 7750950
OBJECTIVE--To evaluate the clinicopathological features and response to circumcision in patients with plasma cell balanitis. SUBJECTS AND METHOD--32 uncircumcised men with penile lesions typical of plasma cell balanitis. Twenty specimens were available for histopathology. RESULTS--Lesions involved prepuce and glans in 17, prepuce only in 10 and in 5 were localised to glans alone or extended to coronal sulcus. Histopathology showed variable features but were consistent with the diagnosis of plasma cell balanitis. Haemosiderin pigment could be detected in only three specimens of patients with shorter duration of the disease. Twenty seven patients were treated with circumcision and no recurrence was noticed in 3 years of follow up. CONCLUSION--Circumcision is an effective treatment modality in plasma cell balanitis. Absence of haemosiderin pigment in majority of tissue sections is difficult to explain but may be related to longer duration of the disease.
Walzman, M; Kundu, A; Fraser, I
doi: 10.1136/sti.71.1.43pmid: 7750953
A case of pyogenic granuloma of the prepuce is presented. This to our knowledge, is the first reported case of this condition affecting this site.
Neri, I; Bardazzi, F; Fanti, P A; Guidetti, M S
doi: 10.1136/sti.71.1.45pmid: 7750954
Metastatic Crohn's disease is a rare inflammatory condition characterised by cutaneous granulomatous lesions separated from the affected bowel by normal intact skin. Involvement of the genitalia in Crohn's disease is rare and consists of ulcerated lesions in almost all of the cases reported in the literature. We describe a case of penile involvement in a 27 year old man with a 5 year history of Crohn's disease. Should genital involvement precede the bowel disease, patients may consult the sexually transmitted disease service for this problem and the dermatovenereologists may be the first to formulate the diagnosis.
doi: 10.1136/sti.71.1.47pmid: 7750955
Whenever a child is seen in a genitourinary clinic the possibility that the child is the victim of child sexual abuse must be considered. This article considers the definition and postulated prevalence of child sexual abuse in England and Wales. A proposed management plan is then detailed with a review of the significance of the medical findings. Finally consideration is given to the ethical dilemmas which such cases pose.
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