Occult chlamydial ophthalmia in men with non-gonococcal urethritis

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Latent oculogenital infection with Chlamydia trachomatis

Thirty patients attending a sexually transmitted disease clinic were evaluated for genital and ocular infection with chlamydia. Eight patients had positive conjunctival immunofluorescent staining. This represents an asymptomatic, latent carrier state with important epidemiologic considerations.

Acute nongonococcal epididymitis. Aetiological and therapeutic aspects

In this study, 20 men suffering from acute nongonococcal epididymitis were treated with ofloxacin 200mg bid given orally for 2 weeks. Patients were re-examined after 2, 6, and 12 weeks. The outcome was assessed both clinically and microbiologically. Two weeks after start of therapy, the causative agent (Chlamydia trachomatis) was still present in only 1 patient, although local painful swelling of the epididymis persisted in 14 men. During the follow-up period, local signs of epididymitis decreased. After 12 weeks, an eradication of the causative micro-organisms was found in 16 of 20 cases. In 4 men, infection by the primary pathogen persisted: Escherichia coli (2); Pseudomonas aeruginosa (1) and C. trachomatis (1). Local pain and swelling was still detected in 6 of 20 men.

Factors associated with microhematuria in asymptomatic young men

The prevalence of asymptomatic microhematuria (two to four or more erythrocytes per high-power field) in 1341 male Air Force personnel was 5.4%. The most powerful predictor of microhematuria (nearly 15-fold increased prevalence) was a history of recurrent microhematuria during the previous five years. Recurrent microscopic hematuria was present in 14.5% (8/55) of men with a history of urethritis, accounting for 26% (8/31) of the cases of recurrent microscopic hematuria. The prevalence of microhematuria was not affected by physical exercise, flight duty, or sexual intercourse during the 24 h preceding the urinalysis.

Urinary tract infection and dysuria. Cost-conscious evaluation and antibiotic therapy

Recent research into the pathogenesis and treatment of urinary tract infection (UTI) clearly indicates that our traditional approach has overestimated the need for extensive evaluation and prolonged antibiotic therapy. The great majority of UTIs can be managed adequately with urinalysis and single-dose or three-day antibiotic regimens; only complicated UTIs or those occurring in unusual hosts require cultures and longer courses of treatment.

Gonococcal tysonitis

A case of gonococcal urethritis with bilateral tysonitis is discussed. The patient was treated successfully with oral tetracycline 500 mg 6 hourly for 10 days, with a complete resolution.

Isolation of Chlamydia trachomatis from men with urethritis: relative value of one vs. two swabs and influence of concomitant gonococcal infection

Two successive urethral swabs were used to obtain specimens for culture of Neisseria gonorrhoeae and Chlamydia trachomatis from 136 heterosexual men with urethritis. The first swab was used to culture N. gonorrhoeae and then C. trachomatis; the second was used to culture C. trachomatis only. C. trachomatis cultures from the second swab were positive more often (30 of 31 pairs) than were cultures from the first swab (22 of 31 pairs) (P less than .05). In addition, cultures from swab 2 had greater numbers of inclusions per coverslip more frequently (23 of 31 pairs) than did cultures from the first swab (six of 31 pairs) (P = .003). Numbers of chlamydial inclusions per coverslip were lower in specimens positive for both C. trachomatis and N. gonorrhoeae than in specimens positive for C. trachomatis only (P less than .02). In addition, the presence of N. gonorrhoeae in a specimen adversely affected the quality of the McCoy cell monolayer. In 17 of 21 instances of monolayer toxicity, cultures for N. gonorrhoeae were positive (P less than .01). These results demonstrate that when specimens from men with urethritis are cultured for N. gonorrhoeae and C. trachomatis, use of a second swab will improve rates of recovery of C. trachomatis. Material present in specimens that contain N. gonorrhoeae may adversely affect rates of isolation of C. trachomatis.

[Chlamydia trachomatis infection in a patient with condylomata acuminata]

Chlamydia trachomatis cervical infection was observed in a 19-year-old woman with genital condylomata acuminata. To isolate C.trachomatis, cycloheximide-treated McCoy cells and a culture-independent monoclonal antibody were used. In addition, a single-antigen immunofluorescence test was made to determine the chlamydia antibody titer. Condylomata acuminata are induced by human papillomaviruses (HPV), predominantly types 6 and 11. This case shows that simultaneous genital infection of C.trachomatis and HPV requires special attention.

Reiter's syndrome--a comparative study of patients with the complete and the incomplete syndrome

Eighty patients with Reiter's syndrome (RS) were studied retrospectively. A comparison was made between patients with the complete syndrome and patients with the incomplete syndrome. A comparison was also made between patients with and without HLA-B27. There were no major differences in severity and duration of the arthritic symptoms or in mucocutaneous involvement between the complete and incomplete groups, which indicates that they, in fact, represent the same disease. Most of the patients with sacroiliac joint involvement belonged to the HLA-B27 positive group; otherwise there was no difference in arthritic symptoms between the HLA-B27 positive and the HLA-B27 negative group.

Ureaplasma urealyticum causing persistent urethritis in a patient with hypogammaglobulinaemia

Ureaplasma urealyticum organisms (ureaplasmas) were isolated in large numbers (up to 10(8) colour changing units (ccu)/ml) over a period of four years from the urethra of a man with hypogammaglobulinaemia and non-gonococcal urethritis. Elimination of Mycoplasma hominis by antibiotic treatment early in the course of the urethritis did not diminish the severity of his condition, which indicated that this mycoplasma was not a cause. Courses of treatment with tetracyclines, spectinomycin, erythromycin, rosaramicin, and clindamycin on each occasion reduced the numbers of ureaplasma isolated from the urethra and the severity of disease. The organisms were not eliminated, however, sometimes due to the development of antibiotic resistance, and the urethritis recurred. Though netilmicin was not particularly effective in vitro, it was effective clinically, the disease resolving and the organisms disappearing for five months. Recurrence of urethritis, accompanied by epididymitis, was associated this time with the recovery of a different (tetracycline sensitive) ureaplasma strain; the urethritis and epididymitis were treated successfully with a combination of netilmicin and doxycycline. The administration of ureaplasma antiserum did not seem to be instrumental in eradicating the ureaplasmas. The various antibiotics had a greater influence on the mycoplasmas in the urethra than on those in the throat and joints, perhaps because the antibiotics were concentrated in the urogenital tract. The close association between the occurrence of urethritis and the ureaplasmas suggests strongly that they were responsible for it.

Gynecologic and urodynamic evaluation of women with urinary incontinence

One hundred women with urinary incontinence were evaluated at the urodynamic investigation unit. Sixty-seven percent of the patients in this series were found to have significant gynecologic disease underscoring the importance of simultaneous gynecologic and urologic investigation. Incontinence surgery was determined to be indicated in 44 of the 87 patients who had the symptom of stress urinary incontinence, suggesting that accurate evaluation of the lower urinary tract in women complaining of incontinence does allow a careful selection of patients for surgical therapy. Discussion is given regarding the determination of the amount of patient evaluation necessary before instituting therapy.

Lymphocytes from the site of disease but not blood lymphocytes indicate the cause of arthritis

The [3H]thymidine uptake procedure for measuring lymphocyte responses was applied to lymphocytes derived concurrently from synovial effusions and from peripheral blood. The stimulating antigens were crude preparations of those micro-organisms that are related to the enteritis and the non-gonococcal urethritis that precipitate reactive arthritis. Salmonella, shigella, and campylobacter antigens stimulated synovial but not peripheral blood lymphocytes in eight cases of enteric reactive arthritis. Ureaplasma or chlamydia antigens, or both, stimulated synovial lymphocytes in all 12 cases of sexually transmitted reactive arthritis, whereas peripheral blood lymphocytes were only stimulated in four of the 12 cases. In 14 cases of rheumatoid arthritis reactions to either enteric or ureaplasma/chlamydia antigens were minimal from either synovial or peripheral blood lymphocytes. It is concluded that synovial rather than peripheral blood lymphocytes indicate the microbiological cause of reactive arthritis and that similar studies of lymphocytes from the site of local disease might be productive in other diseases.

Multiple co-existing sexually transmitted diseases in a bisexual man

The authors report an interesting and instructive case of a bisexual man with four concurrent sexually transmissible infections: secondary syphilis, genital herpes, gonococcal proctitis, and asymptomatic chlamydial urethritis. The case illustrates the necessity for a systematic approach to the diagnosis and management of multiple co-existing sexually transmitted diseases, and it underscores the importance and difficulty of contact-tracing in this patient population.