Treatment of gonococcal urethritis in men with a rifampicin-erythromycin combination

A group of men with uncomplicated gonococcal urethritis were treated with a single oral dose of rifampicin (900 mg) and erythromycin stearate (1 g). Neisseria gonorrhoeae was isolated from four of 108 men at the first follow-up examination, and from none of 68 who attended a second follow-up examination. It is concluded that this rifampicin-erythromycin combination may be useful for the therapy of gonorrhea. It may be of particular value in the treatment of infections due to penicillin-resistant N. gonorrhoeae, since in vitro studies showed that both rifampicin and erythromycin were active against 20 strains of beta-lactamase-producing N. gonorrhoeae. The effect of this rifampicin-erythromycin combination against associated infections with Chlamydia trachomatis was disappointing. This organism was isolated from five of nine patients who had yielded isolates of C. trachomatis before treatment.

Provision of a chlamydial culture service to a sexually transmitted diseases clinic

Urethral specimens from 215 men were inoculated on to McCoy cell cultures, both at the local laboratory and at a central reference laboratory, Chlamydia trachomatis was isolated from 58 (28%) patients; 12 of these isolates were, however, obtained only at the local laboratory. The results show the feasibility and convenience of a central laboratory supplying a peripheral laboratory with uninoculated prepared cell cultures. Such a service is not only more cost effective but obviates the problems of transporting specimens to a central laboratory.

Rosaramicin and tetracycline in the treatment of non-gonococcal urethritis. A comparison of clinical and microbiological results

The clinical and microbiological outcome of the treatment of 94 men for uncomplicated non-gonococcal urethritis (NGU) was studied. Rosaramicin 250 mg six hourly for seven days was given to 46 men and tetracycline 250 mg six hourly for seven days to 48 men; the follow-up period was up to six weeks. Complete resolution of the clinical signs of infection was seen in 40 (87%) of the men treated with rosaramicin and in 37(77%) of those treated with tetracycline. Chlamydia trachomatis was eliminated from 17 of the 18 men treated with rosaramicin and from all of the 16 men treated with tetracycline. Ureaplasma urealyticum was eliminated from 12 of the 14 men treated with rosaramicin and from 15 of the 19 receiving tetracycline. Clinical recovery correlated well with the elimination of C trachomatis but less well with that of U urealyticum. The two antimicrobial agents were equally effective in the therapy of NGU, but gastrointestinal side effects were significantly more common in men treated with rosaramicin.

Epidemiology of chlamydial infection of the human genital tract: evidence for the existence of latent infections

A group of 536 women attending a clinic for sexually transmitted diseases was investigated for cervical infection by Neisseria gonorrhoeae and Chlamydia trachomatis. Conclusions have been reached concerning the existence and significance of latent and subclinical chlamydial infection of the female genital tract, and on the sexual infectivity of Chlamydia trachomatis to women. The results of the study indicate (1) demonstrable chlamydial infection in 25% of all women attending the clinic for the first time, and in 11% of those with unknown contact history; (2) sexual transmission of Chlamydia trachomatis; 45% of women exposed to chlamydiae contract the infection compared with 75% of those exposed to Neisseria gonorrhoeae; (3) the possibility of reactivation of latent chlamydial infection by Neisseria gonorrhoeae in some women.

Data processing in microbiology: an integrated, simplified system

A MUMPS based computer system is described for the processing of data in a microbiology laboratory. The system uses visual display units and mnemonic codes for data input. All functions are carried out within the department by the medical, technical, and clerical staff. While the system described is integrated with other user-systems in the hospital, it is readily adaptable, and portable to a stand-alone system.

Single-dose minocycline in the treatment of gonococcal urethritis. Clinical efficacy in relation to bacterial resistance and its effects on associated Chlamydia trachomatis infections

Seventy-two men with gonococcal urethritis were given a single 300-mg dose of minocycline. The failure rate was 13% and the trial was terminated at an early stage. Failure was correlated with increased resistance of Neisseria gonorrhoeae to minocycline. The activity of penicillin, spectinomycin, erythromycin, tetracycline, sulphamethoxazole, cefuroxime, cefotaxime, rosamicin, thiamphenicol, and piperacillin against N. gonorrhoeae were examined in vitro. With the exception of spectinomycin, parallel patterns of resistance to the other antibiotics and minocycline were found. Resistance to spectinomycin was not found, confirming the usefulness of this antibiotic in the treatment of gonorrhoea. The incidence of PGU was significantly lower after a single dose of minocycline than in previous studies.

Use of the ultracentrifuge vertical rotor in the detection of rubella-specific IgM on a sucrose density gradient

A comparison was made of the performance of swing-out and vertical ultracentrifuge rotors in the detection of rubella-specific IgM on a sucrose density gradient. Tests were performed on 30 sera, of which 11 were found to contain rubella-specific IgM by both methods. The centrifugation time for the swing-out rotor was 16 hours at 35,000 rpm. This was reduced to 2 hours using the vertical rotor at 50,000 rpm. Routine use of the vertical rotor would allow a reduction in the time taken to perform the test, increase the number of sera tested each time, and reduce wear on the ultracentrifuge.

The antimicrobial susceptibility of Chlamydia trachomatis in cell culture

The action of 22 antimicrobial agents against the SA2f strain of Chlamydia trachomatis has been studied by the use of a simple cell culture technique. Tests for bactericidal activity were undertaken with some of the agents, and latency of infection was demonstrated. The susceptibilities of 10 clinical strains of C. trachomatis and of SA2f to oxytetracyline, erythromycin, and spectinomycin in cell culture were found to be identical.

Role of Chlamydia trachomatis and HLA-B27 in sexually acquired reactive arthritis

Inflammatory arthritis, tendinitis, and fasciitis after non-specific urethritis ("sexually acquired reactive arthritis" (SARA)) was studied prospectively in 531 men with non-specific urethritis, with particular reference to the frequency of isolation of Chlamydia trachomatis and the presence of HLA-B27. Satisfactory cultures were obtained from the urethral swabs from 384 patients; and HLA typing was performed on 482, of whom 30 (6%) were HLA-B27-positive. Arthritis developed in 16 patients, and five of the 14 (36%) with satisfactory cultures were positive for C trachomatis; 135 of the patients without arthritis were also positive for C trachomatis, an identical proportion. Seven of the 15 patients (40%) with arthritis who were HLA-typed were HLA-B27-positive. Six of the 30 patients with HLA-B27 developed peripheral arthritis in contrast to only nine of the 452 patients lacking the antigen, suggesting a tenfold increase susceptibility. C trachomatis, however, was no more prevalent in cultures from HLA-B27-positive men than from the others. Thus carriage of C trachomatis is unlikely to be influenced by HLA-B27. C trachomatis may be an important pathogen in some cases of SARA but does not appear to be an exclusive trigger factor for this condition.

Comparison of erythromycin stearate and oxytetracycline in the treatment of non-gonococcal urethritis: their efficacy against Chlamydia trachomatis

The effectiveness of Oxytetracycline 250 mg. 6 hourly for 2 weeks and erythromycin stearate 500 mg. 12 hourly for 2 weeks in the treatment of non-gonococcal urethritis (NGU) have been compared; cell culture for Chlamydia trachomatis was performed before and after treatment. There was no significant difference between the results obtained with the two antimicrobials. Both were clinically effective in the treatment of Chlamydia-positive NGU. Response to therapy was rapid; 2 weeks after treatment began, only 5 (14%) of 35 men treated with Oxytetracycline and 4 (13%) of 30 men treated with erythromycin stearate still had urethritis. Clinical improvement was accompanied in the majority of cases by failure to re-isolate C. trachomatis, but a small number of men who had not been exposed to the risk of reinfection yielded chlamydiae after therapy with Oxytetracycline or erythromycin stearate.

The results of treatment of men with NGU from whom C. trachomatis had not been isolated were similar to those obtained in isolation-positive patients; again, there was no significant difference in the efficacy of the two antimicrobials. It is concluded that erythromycin stearate is a useful alternative to tetracyclines in the treatment of NGU.

Interrelationship of Chlamydia trachomatis and other pathogens in the female genital tract

The isolation of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and Candida albicans in the female genital tract was studied in 1323 patients attending a venereal disease clinic. Disruption of the cell monolayers use for the isolation of C. trachomatis was significantly associated with the presence of T. vaginalis; this effect was markedly reduced by the addition of vancomycin to gentamicin and amphotericin B in the transport and growth media. The only significant positive association was the more frequent isolation of C. trachomatis in the presence of N. gonorrhoeae. There was a negative association between N. gonorrhoeae and C. albicans and between T. vaginalis and C. albicans, the fungus being isolated significantly less frequently when these microorganisms were present.

Spectinomycin hydrochloride in the treatment of gonorrhoea: Its effect on associated Chlamydia trachomatis infections

Sixty-three heterosexual men were successfully treated with a single injection of spectinomycin hydrochloride 2 g for urethral infections with Neisseria gonorrhoeae. Chlamydia trachomatis was recovered from the urethra of 11 of these men both before and after treatment. In six men, the organism was isolated after but not before treatment. No isolates were obtained from the remaining men either before or after treatment. All 17 of the men who yielded C. trachomatis developed post-gonococcal urethritis. Eight of 46 men from whom no isolate was obtained in their cultures developed post-gonococcal urethritis. Seventeen of 50 women successfully treated with spectinomycin for cervical infections with N. gonorrhoeae yielded isolates of C. trachomatis both before and after treatment. The organism was isolated from five women before but not after treatment, and from four women after but not before treatment. In 24 women culture for C. trachomatis was negative both before and after treatment. Spectinomycin hydrochloride in the dosage used rarely eliminated C. trachomatis from the genital tract of either men or women; in this respect it resembled two other drugs commonly used for the treatment of gonorrhoea-pencillin and ampicillin.

The lack of effect of ampicillin plus probenecid given for genital infections with Neisseria gonorrhoeae on associated infections with Chlamydia trachomatis

Forty-six men were successfully treated with a single oral dose of ampicillin (2 g) plus probenecid (1 g) for urethral infections with Neisseria gonorrhoeae. Chlamydia trachomatis was isolated from cultures of cells obtained from 11 of these men both before and after treatment; C. trachomatis was isolated from one man before but not after treatment and from three men after but not before treatment. No isolates were obtained from the remaining 31 men either before or after treatment. Of the 15 patients whose cultures yielded C. trachomatis, 12 developed postgonococcal urethritis; of the 31 patients from whose cultures no isolate was obtained, five developed postgonococcal urethritis. Of 44 women successfully treated with ampicillin plus probenecid for cervical infections with N. gonorrhoeae, 18 had C. trachomatis isolated from the cervix both before and after treatment. C. trachomatis was isolated from five women before but not after treatment and from two women after but not before treatment. No isolates were obtained from the remaining 19 women either before or after treatment. Thus ampicillin plus probencide in the dosage used rarely eliminated C. trachomatis from the genital tract of either men or women. Whereas men with a persisting chlamydial infection will probably develop postgonococcal urethritis and thus receive appropriate treatment, such an infection in women is not likely to be suspected unless attempts are made to isolate C. trachomatis.