Presence of two strains of Neisseria gonorrhoeae in both the cervix and pharynx of a patient with disseminated infection caused by a single strain

Neisseria gonorrhoeae was cultured from the cervix, pharynx and blood stream of an 18-year-old woman who had a disseminated gonococcal infection. Two different phenotypes of N. gonorrhoeae, distinguished on the basis of their protein I serovar, whole-cell protein profile, lectin-type and antibiotic susceptibility, were isolated from both the cervix and pharynx, whereas only one of these phenotypes was isolated from the blood. This finding stresses the importance of blood cultures as a prelude to determining appropriate antimicrobial therapy in cases of disseminated gonococcal infection.

[Comparative evaluation of herpes virus detection using fluorescence-labeled monoclonal antibodies and electron microscopy negative contrast technic in dermatovenereologic diseases. Results of a pilot study of 30 patients]

Thirty patients with different dermatologic and venereal symptoms apparently indicating herpes were examined for the presence of viruses. Two different procedures were compared: electron-microscopic analysis of negatively stained material and light-microscopic analysis of direct smears using fluorescence-labelled monoclonal mouse antibodies against herpesvirus type 1 and type 2. In 12 of the patients herpesvirus was demonstrated by at least one of the two methods: in 9 patients the specimens were positive with both methods; in 2 patients only light microscopy yielded evidence of virus material; in 1 case virus material was revealed only by electron microscopy. If electron-microscopic analysis of negatively stained clinical material is considered the standard method, the fluorescence test had a sensitivity and specificity of 90%. Thus, in the near future the latter technique may supersede the highly laborious electron-microscope method of investigation.

Plasmid content, auxotype and protein-I serovar of gonococci isolated in the Gambia

Twenty-nine strains of penicillinase-producing Neisseria gonorrhoeae (PPNG) and 30 non-penicillinase-producing strains, all isolated in the Gambia, were characterized in terms of their plasmid content, auxotype and protein-I serovar. Sixty-two per cent of the PPNG strains contained the 3.2 MDa penicillinase-coding plasmid, and 38% had the 4.4 MDa plasmid. All the PPNG strains contained the 2.6 MDa cryptic plasmid but lacked the 24.4 MDa conjugative plasmid. In contrast, 46.7% of the non-PPNG strains harboured only the cryptic plasmid while 16.7% contained both the cryptic and conjugative plasmids. Seventeen per cent of the non-PPNG strains contained the conjugative plasmid only and 20% lacked plasmids. The PPNG and non-PPNG strains also differed in terms of their protein-I serovar. Eighty-six per cent of the PPNG strains belonged to serogroup 1 A, whereas the majority (60%) of non-PPNG strains belonged to serogroup 1 B. There was no significant difference in the auxotypes of the PPNG and non-PPNG strains, with both groups consisting predominantly of prototrophic and proline-requiring strains, with a minority of strains requiring arginine. When the 59 strains were each characterized in terms of their combined plasmid profile, auxotype and serovar, 39 different combinations were noted, which indicates the heterogeneous nature of the gonococcal population found in the Gambia.

[Pathogen-host relations in sexually transmitted diseases]

The host-parasite relationship between the major causative agents of sexually transmitted diseases, e.g. Neisseria gonorrhoeae, Treponema pallidum and Trichomonas vaginalis, and their target cells in the urogenital tract can generally be studied in suitable cell and organ cultures. Experience with N. gonorrhoeae predominantly gained from fallopian-tube organ cultures shows that there are several prerequisites for adherence as the first step of pathogenesis. They range from the type of bacterial pili to the type of epithelial cell. Later the function of these cells is damaged by subcellular toxins of a lipopolysaccharide nature. The cocci are phagocytosed, which eventually leads to definite (ultra-) structural alterations. These processes are not only described in detail but also compared with those found with other bacterial species and target cells. Possible predisposing factors in the host are also taken into account. Finally the need for investigating the effect of antibiotics on the host-parasite relationship is stressed.

Evaluation of cefotetan in uncomplicated gonorrhea

Cefotetan is a newly developed cephamycin especially resistant to bacterial beta-lactamase. Therefore both its in vitro activity against Neisseria gonorrhoeae and its clinical efficacy in uncomplicated gonorrhea are investigated. The minimal inhibitory concentrations (MIC) lie in the range of 0.016-2 micrograms/ml, 90% of the strains being inhibited by 0.5 microgram/ml. Of 52 finally evaluable patients who were treated by a single intramuscular injection of 1 g, 48 (92.3%) were cured bacteriologically. Thus the present treatment protocol may prove useful in individual cases. It should, however, not be advocated for gonorrhea treatment in general.

The susceptibility of Neisseria gonorrhoeae strains to different cephalosporins and penicillin G depends on the auxotype

The relatively broad range of minimum inhibitory concentrations (MICs) of different cephalosporins and penicillin G with Neisseria gonorrhoeae results from the differing susceptibility of various subsets, i.e. auxotypes. While prototrophic and proline-dependent strains are especially resistant (p less than or equal to 0.001), AHU strains are especially susceptible. The bimodality of MIC values with penicillin G and the older cephalosporins, cephalothin and cefazoline, results from quite a big subset of relatively resistant prototrophic strains. As the newer cephalosporins from generation (e.g. cefotiam) to generation (e.g. cefmenoxime and ceftizoxime) tend to have less special problems with these strains, the general distribution of MIC values changes to monomodality.

Gonoblennorrhoea adultorum (gonococcal conjunctivitis)--a "disappearing disease" which does not disappear

Gonoblennorrhoea adultorum (GA) still occurs in spite of contrary statements. During the last 10 years, 4 cases were seen in the Munich Clinic of Dermatology (constituting 0.19% of all patients with gonorrhoea). While the conjunctivae alone were involved in 3 of them, in 1 the cornea showed alterations as well. Thus, the disease has not lost its potential danger. Yet the newer cephalosporins seem to cure GA rapidly, even if given in a single dose (together with local treatment).

Zur Bedeutung der Auxotypisierung von <i>Neisseria gonorrhoeae</i> für die Auswertung von Gonorrhoe-Therapiestudien

So far, there was no absolutely reliable way to distinguish between failure and reinfection in clinical trials on the treatment of gonorrhoea. If one, however, analyzes the auxotypes of the gonococcal strains isolated before and after application of the drug from non-cured patients, reinfection can clearly be demonstrated in cases with a changed auxotype. Thus, in a trial on the single intramuscular application of cefotiam 1 g for uncomplicated gonorrhoea, the bacteriological cure rate increased from 90 to at least 95%.

Cultural proof of Neisseria gonorrhoeae in synovial fluid in disseminated gonococcal infection

Disseminated gonococcal infection is not too rare, and joint involvement is one of its prominent features. Although diagnosis in general is based on clinical findings and microbiological examination of the genitals and sometimes blood, there are cases in which exact diagnosis can only be made after the investigation of synovial effusion. An observation of this kind is presented, and the general value of the aspiration of synovial fluid in disseminated gonococcal infection is discussed. Special interest is also given to the possible coincidence of disseminated gonococcal infection and other sexually transmitted diseases as for example trichomoniasis, both of which were found in our case.