Sexual experience and urethral colonization with genital mycoplasmas. A study in normal men

Differential association of ureaplasma species with non-gonococcal urethritis in heterosexual men

OBJECTIVE

To assess the role of Ureaplasma urealyticum and Ureaplasma parvum in patients with non-gonococcal urethritis (NGU) using specimens from a previously reported study of NGU.

METHODS

Species-specific PCR assays for U urealyticum and U parvum were used to detect these organisms in specimens from men enrolled in a case-control study based in a Seattle STD clinic in order to evaluate their association with NGU. Urethritis was defined by clinical examination and the presence of inflammation on Gram stained smear. Controls had normal examination findings and no evidence of inflammation on Gram stain smear or by the leucocyte esterase test.

RESULTS

U urealyticum was detected in 26% (31/119) of cases and 16% (19/117) of controls, resulting in an association with NGU (adjusted odds ratio (aOR)=2.3, 95% CI 1.04 to 4.9) after adjusting for age, race, history of prior urethritis and other NGU pathogens (Chlamydia trachomatis, Mycoplasma genitalium). The association of U urealyticum and NGU was strongest in white men <28 years of age (OR=5.4, 95% CI 1.3 to 22.2). U parvum was detected in 14% (17/119) cases and 31% (36/117 controls) and thus was negatively associated with NGU (aOR=0.4, 95% CI 0.2 to 0.8). The prevalence of U urealyticum (16%) in controls was higher than that of C trachomatis (3.4%) or M genitalium (4.3%, p<0.05, each comparison).

CONCLUSIONS

Unlike U parvum, U urealyticum was associated with urethritis. The strong effect in younger white men and high rates in controls may suggest variability in virulence among U urealyticum strains or in host innate or acquired immunity.

Prevalence of Sexually Transmitted Infections and High-Risk Sexual Behaviors in Heterosexual Couples Attending Sexually Transmitted Disease Clinics in Peru

OBJECTIVES

The objectives of this study were to determine the prevalence of sexually transmitted infection (STIs) in heterosexual couples and the sexual behaviors associated with their acquisition.

GOAL

The goal of this study was to better direct educational efforts to decrease STI among heterosexual couples in Lima, Peru.

STUDY DESIGN

We conducted a case-control study in 195 heterosexual couples without HIV infection who attended 2 sexually transmitted disease clinics in Lima, Peru. A case was defined as an individual with one or more newly diagnosed STIs such as gonorrhea, chlamydia, trichomoniasis, herpes simplex, syphilis, mycoplasma, or ureaplasma.

RESULTS

Thirty-three percent of individuals (41 men and 89 women) had at least one STI and 26 couples (13%) had the same STI detected. Men who have sex with men (MSM) accounted for 13% of all men, had higher rate of STIs and higher risk behaviors than non-MSM. Ureaplasma infection was the most prevalent STI found in both men and women and was associated with oral sexual contact. In heterosexual pairs, condom use during anal sex occurred less than 10% of the time.

CONCLUSIONS

The heterosexual couples in sexually transmitted disease clinics have high-risk behaviors and STIs are frequent. The educational effort concerning prevention of STIs requires higher effort.

Mycoplasma genitalium

Mycoplasma genitalium was initially isolated from men with nongonococcal urethritis in 1980. Subsequent studies to assess the association of M. genitalium with human disease were inhibited however because on repeated attempts the organism proved extremely difficult to culture. Fortunately, the development and use of specific polymerase chain reaction assays allowed progress in this arena and provided evidence of the association between M. genitalium and urethritis, cervicitis, and endometritis. A serologic association has also been noted between M. genitalium antibody and salpingitis and tubal factor infertility. In addition, sexual transmission of M. genitalium in heterosexual partners has also been demonstrated. Currently, studies are underway to further assess these associations and provide additional information about the significance of this organism with regards to sexual transmission, infertility in women, and its association with other genital tract disease processes. Recent studies have suggested that M. genitalium-associated infections are best treated with azithromycin.

Effectiveness of female and male condoms in preventing exposure to semen during vaginal intercourse: a randomized trial

OBJECTIVES

Comparison of male condom (MC) vs. female condom (FC) with respect to self-reported mechanical and acceptability problems and semen exposure using prostate-specific antigen (PSA) as an objective biological marker and evaluation of the effect of an educational intervention on self-reported problems and semen exposure, by condom type.

DESIGN

Randomized crossover trial.

METHODS

Four hundred women attending a family planning clinic in Brazil were randomized and either received in-clinic instruction or were encouraged to read the condom package insert; all used two FCs and two MCs. We measured the rates of self-reported user problems with MC and FC use and the rates of semen exposure during use (assessed by testing vaginal fluid for PSA).

RESULTS

The educational intervention group reported fewer problems with either condom as compared with the control group (p = .0004, stratified by condom type). In both groups, self-reported problems were more frequent with FC use than with MC use (p < .0001, stratified by intervention). The educational intervention did not significantly reduce semen exposure. Overall, semen exposure occurred more frequently with FC use (postcoital PSA, > 1 ng/mL; 22%) than with MC use (15%); the difference, however, was small and nonsignificant for high PSA levels (> or = 150 ng/mL; 5.1% for FC vs. 3.6% for MC).

CONCLUSIONS

In this study, the FC was less effective than the MC in preventing semen exposure during use and led more frequently to self-reported user problems. Both devices were highly protective against "high-level" semen exposure, as measured by postcoital PSA levels in vaginal fluid. In-clinic education may reduce user problems and increase acceptability and use of both devices.

Recombination in Mycoplasma hominis

Mycoplasma hominis has been previously described as a heterogeneous species, and in the present study intraspecies diversity of 20 M. hominis isolates from different individuals was analyzed using parts of the unlinked gyrase B (gyrB), elongation factor Tu (tuf), SRalpha homolog (ftsY), hitB-hitL, excinuclease ABC subunit A (uvrA) and glyceraldehyde-3-phosphate dehydrogenase (gap) genes. The level of variability of these M. hominis genes was low compared with the housekeeping genes from Helicobacter pylori and Neisseria meningitidis, but only few M. hominis isolates had identical sequences in all genes indicating the presence of recombination. In order to test for intergenic recombination, phylogenetic trees were reconstructed for each of the genes but no well-supported bifurcating phylogenetic trees could be obtained. The genes were tested for intragenic recombination using the correlation between linkage disequilibrium and distance between the segregating sites, by the homoplasy ratio (H ratio), and by compatibility matrices. The gap gene showed well-supported evidence for high levels of recombination, whereas recombination was less frequent and not significant within the other genes. The analysis revealed intergenic and intragenic recombination in M. hominis and this may explain the high intraspecies variability. The results obtained in the present study may be of importance for future population studies of Mycoplasma species.

Partner type and condom use

OBJECTIVES

To examine the association between type of sexual partnership and condom use consistency.

DESIGN

A prospective follow-up study of women attending two urban clinics for sexually transmitted diseases (STD).

METHODS

Sexual diaries recording barrier method, partner initials and partner type for each act of intercourse were kept by 869 women. Condom use by partner type was evaluated in three ways in the entire group: among women who encountered multiple partners, during months in which women encountered multiple partners, and within sexual partnerships that changed status during the study.

RESULTS

Consistency of condom use was higher with new and casual partners than with regular partners in the entire group and among women who encountered multiple partners. In months in which partners of different types were encountered, condom-use consistency was higher with new and casual partners than with regular partners. Consistent condom use decreased in partnerships that changed status from new to regular. The female condom was used more often with regular partners than with new or casual partners in the entire study group, among women who encountered multiple partners, and during months in which a woman achieved consistent use with her regular partner.

CONCLUSIONS

This study provides strong evidence that condom use behavior is modified by partner type. Observations about condom use and partner type made in cross-sectional or retrospective surveys also hold in the present longitudinal analyses of individual women and of partnerships that change status. The female condom may be an important option for achieving consistent protection within stable partnerships.

Detecting urethral and prostatic inflammation in patients with chronic prostatitis

OBJECTIVES

Diagnosis of urethral and prostatic inflammation can represent a challenge. We compare the accuracy of diagnostic methods for detecting inflammation in lower urinary specimens/samples.

METHODS

A standardized protocol was used to evaluate urethral smear, first-void urine (VB1), midstream urine (VB2), expressed prostatic secretions (EPS), and postmassage urine (VB3) in urologic patients with no symptoms or signs of urethritis who were attending our prostatitis clinic.

RESULTS

Of 235 subjects, 60 (26%) had leukocytes detected by the Gram-stained urethral smear, 44 (18%) by the VB1, and only 14 (6%) by the VB2. Compared with the urethral swab, VB1 had 0% to 22% sensitivity and 81% to 98% specificity, and VB2 had 8% to 11% sensitivity. Of 83 subjects with prostatic inflammation, the EPS detected 63 (76%) and the VB3 detected 68 (82%).

CONCLUSIONS

VB1 or VB2 examinations had low sensitivity for detecting urethral inflammation. Examining both the EPS and VB3 proved best for detecting prostatic fluid inflammation. Combining the urethral smear with lower urinary tract localization ("four-glass test") represents an optimal approach for detecting urethral and prostatic inflammation.

Prospective study of barrier contraception for the prevention of sexually transmitted diseases: study design and general characteristics of the study group

BACKGROUND AND OBJECTIVES

The AIDS epidemic has brought barrier contraceptives to the forefront of public health research. A comprehensive evaluation of the efficacy of barrier contraceptive use in preventing sexually transmitted diseases (STDs), including AIDS, is necessary to inform both potential users and public health policy makers. This study was undertaken to evaluate the efficacy of condoms and vaginal spermicide products, used alone or in combination, in preventing gonorrhea and chlamydia among women attending an STD clinic.

GOAL OF THIS STUDY

To describe the general characteristics of the study group and its follow-up experience.

STUDY DESIGN

Women who met the eligibility criteria were invited to participate. The initial visit included an interview, a behavioral intervention promoting barrier methods, a physical examination, and instructions to complete a sexual diary. Participants received free barrier contraceptives and returned for six monthly follow-up visits. DESIGN RESULTS: Participants (n = 1,122) were low income, single (74%) black (89%) women with a median age of 24. The behavioral intervention led to the use of barrier protection in more than 70% of reported acts of vaginal intercourse. Barriers were used consistently (100% of sexual acts) during 51% of the months of follow-up. A total of 148 cases of gonorrhea (28 per 1,000 months) and 122 cases of chlamydia infection (23 cases per 1,000 months) were diagnosed during follow-up.

CONCLUSION

This study represents a practical solution to a complex set of design considerations. The study protocol was successful in promoting consistent and proper use of barrier methods.

Etiology of nongonococcal nonchlamydial urethritis

The majority of cases of acute nongonococcal urethritis (NGU) are due to causes other than infection with Chlamydia trachomatis. Pathogens implicated as causes of nonchlamydial nongonococcal urethritis (NCNGU) include Mycoplasma genitalium, Ureaplasma urealyticum, Trichomonas vaginalis, and primary infection with herpes simplex virus. In a majority of cases of acute NCNGU, no pathogen can be isolated. The etiology of chronic NCNGU is unknown.

An association between non-gonococcal urethritis and bacterial vaginosis and the implications for patients and their sexual partners

OBJECTIVES

The aetiology of non-gonococcal urethritis (NGU) in a considerable proportion of men remains unaccounted for. We wished to investigate the possible aetiological role of bacterial vaginosis (BV), the commonest cause of abnormal discharge in women, in this condition.

METHODS

We carried out two studies. In the first, case-control, study, we recruited men with and without NGU and examined their female partners for evidence of BV. The second, cohort design, study which ran concurrently with the first study involved recruiting women with and without BV and examining their male partners for evidence of NGU. The diagnoses of both NGU and BV were made microscopically to include symptomatic and asymptomatic individuals in both disease categories.

RESULTS

In the case-control study 51 couples were recruited. Of these 39 men had NGU and 12 (31%) of their female contacts had BV. In contrast, of 12 men without NGU, only one (8%) of the female partners had BV (odds ratio 4.89, 95% CI: 0.51-42.27). When only Chlamydia trachomatis negative patients were considered, the odds ratio for an association between BV and NGU was increased to 6.77, 95% CI: 0.73-62.68). Thirty eight couples were recruited to the cohort design study. Of 17 women with BV, 12 (71%) of their male partners had NGU. In contrast, of 21 women without BV, seven (33%) of their male partners had NGU (p = 0.049, odds ratio 4.8). When only C trachomatis negative patients were considered, the significance of the association was increased (p = 0.037; odds ratio 5.42).

CONCLUSIONS

An association exists between NGU and BV, and vice versa. If BV arises de novo the findings could help to explain the development of urethritis in stable sexual relationships.

Ultrastructural characteristics of Gardnerella vaginalis infection in the heterosexual couple

Adhesion and penetration of Gardnerella vaginalis into the male urethral and female vaginal epithelial cells were evaluated in a prospective cohort study of infected females and their sexual partners. Vaginal secretions of 10 women with culture proven G. vaginalis infection and semen samples of their asymptomatic husbands were analyzed with conventional optical and electron microscopy. G. vaginalis was isolated in 50% of the male sexual partners of women harboring the microorganism. G. vaginalis adheres to the plasmatic membrane and penetrates into the cytoplasm of both vaginal and urethral epithelial cells. The ability of G. vaginalis to colonize the male lower genital tract may have clinical relevance with respect to the role of the male partner in the reinfection of women.

Barrier methods of contraception, spermicides, and sexually transmitted diseases: a review

OBJECTIVE

To understand whether barrier methods of contraception (BMC) and/or spermicides lower the risk of acquiring sexually transmitted disease (STD) and to quantify the protection.

DESIGN

Review of published experimental studies, in vitro and in vivo evidence on the issue.

SUBJECTS

We reviewed 22 papers that examined the impermeability of BMC in vitro against STD agents or the effect of spermicides, and 60 papers reporting results of epidemiological studies on the risk of STD in users of BMC.

RESULTS

There was in vitro evidence that both BMC and spermicides were effective against most sexually transmissible agents. Doubts remain on the effectiveness of BMC and spermicides in normal conditions of use, particularly against human papilloma virus. Natural membrane condoms are not impermeable and pores are seen by electron microscopy. Epidemiological studies show a consistent reduction in the risk for use of condoms against gonococcal (most studies giving relative risk, RR, estimates around 0.4 to 0.6) and HIV infection (RRs between 0.3 and 0.6 in most studies). Spermicides protect women against gonorrhoea and trichomoniasis; their role against other STDs is less clear and there is some indication of an irritative effect on the vaginal mucosa that is likely to be dose-dependent.

CONCLUSIONS

A large amount of evidence indicates that BMC reduce the risk of gonorrhoea and HIV transmission, but the results are--at least in quantitative terms--less consistent for other diseases. Implications for individual choices and public health approaches should relate to frequency of exposure and severity of the disease too.

Increase in resistance of Mycoplasma hominis to tetracyclines

Isolates of Mycoplasma hominis collected from patients in Boston and New York between 1976 and 1989 were studied. Minimal metabolism-inhibiting concentrations (MMCs) were determined by use of a terminal color change-broth dilution method, as well as by an agar inoculum-broth dilution method. Both methods gave comparable results. Tetracycline MMCs for 3 (7.0%) of 43 isolates of M. hominis collected from 1976 to 1979 were 8 micrograms/ml or more, but they were 8 micrograms/ml or more for 11 (20.3%) of 54 isolates collected from 1980 to 1983 (P = 0.083) and 16 (26.6%) of 60 isolates collected from 1984 to 1989 (P = 0.019). Similarly, doxycycline MMCs for 0 of 43 isolates of M. hominis collected from 1976 to 1979 were 8 micrograms/ml or more, but they were 8 micrograms/ml or more for 8 (14.8%) of 54 strains isolated from 1980 to 1983 (P = 0.0082) and 10 (16.6%) of 60 strains isolated from 1984 to 1989 (P = 0.0047). The susceptibility of M. hominis to clindamycin did not change. We conclude that isolates of M. hominis in the northeastern United States have become more resistant to tetracycline and doxycycline over the past decade.

Extragenital Mycoplasma hominis infections in adults

PURPOSE

To heighten awareness of the role of Mycoplasma hominis as an extragenital pathogen in adults.

PATIENTS AND METHODS AND RESULTS

Patients ranged in age from 14 to 76 years. Thirteen patients were immunosuppressed, including nine organ transplant recipients; three were receiving steroids, and two had an underlying malignancy. The remainder were immunocompetent. Thirteen patients had prior surgery at or near the site of infection. M. hominis was isolated from normally sterile sites such as blood or cerebrospinal, pleural, abdominal and joint fluids, and bone. Non-sterile sites of isolation included surgical wounds and pulmonary secretions. The organism was detected in anaerobic cultures of clinical specimens sent to the laboratory for routine bacteriologic culture. Gram stains of fluids or wound drainage revealed neutrophils but no bacteria. Anti-mycoplasmal therapy was effective in eradicating the organism in 13 of 15 patients who were treated. Of those in whom treatment failed, one patient had an antibiotic-resistant isolate and the other had M. hominis isolated from the lung at postmortem after just 2 days of therapy.

CONCLUSION

Our experience suggests that significant infections due to M. hominis, although uncommon, are not rare, and methods to isolate and identify this organism should be available for general adult medical and surgical populations.

Sexual behavior of college women in 1975, 1986, and 1989

To compare sexual practices in college women before and after the start of the current epidemics of Chlamydia trachomatis, genital herpesvirus, and human immunodeficiency virus type 1 infection, we surveyed 486 college women who consulted gynecologists at a student health service in 1975, 161 in 1986, and 132 in 1989 at the same university. There were no statistically significant differences in age, age at menarche, or reason for visiting the gynecologist. The percentages of women in this population who were sexually experienced were the same in all three years (88 percent in 1975, 87 percent in 1986, and 87 percent in 1989). Oral contraceptives were used by 55 percent of the women in 1975, 34 percent in 1986, and 42 percent in 1989; the use of condoms as the usual method of birth control increased (6 percent in 1975, 14 percent in 1986, and 25 percent in 1989; P less than 0.001). In 1975, only 12 percent reported the regular use of condoms during sexual intercourse, in some cases in conjunction with other methods of contraception, as compared with 21 percent in 1986 and 41 percent in 1989 (P = 0.0014). No significant differences were found in the three surveys in the number of male sexual partners or the frequency of fellatio, cunnilingus, or anal intercourse. An additional sample of 189 college women who did not consult the health service was surveyed in 1989, and similar sexual behavior was reported by those who were sexually experienced (65 percent). We conclude that in this population there has been little change in sexual practices in response to new and serious epidemics of sexually transmitted diseases, with the exception of an increase in the use of condoms (which still does not reach 50 percent).

Microflora of the urethra in adolescent boys: relationships to sexual activity and nongonococcal urethritis

Urethral cultures were obtained from 90 adolescent youth, 16 of whom denied previous sexual activity. Among the sexually active boys was a group of 32 with clinically significant pyuria, consistent with the diagnosis of urethritis, on a first-part urinalysis (FPU) specimen. To relate differences in urethral microflora to sexual activity, 42 sexually active patients with a negative FPU were compared with the never sexually active group. The profile of anaerobic, but not aerobic, bacteria isolated from the urethra was related to the presence or absence of previous sexual activity. Mycoplasma species and Ureaplasma urealyticum were isolated from sexually active patients only, and may be markers of sexual activity in adolescent boys. Of the 32 patients with FPU evidence of urethritis, 22 (69%) had cultures positive for Chlamydia trachomatis, and an additional three (9%) had cultures positive for Neisseria gonorrhoeae. The findings in sexually active patients with a positive FPU were otherwise similar to those of sexually active patients without evidence of urethritis. C. trachomatis appears to be the most important agent of urethritis among adolescent boys with a positive FPU.

Enhancement of colonization of Ureaplasma urealyticum in the mouse genital tract by estrogen treatment

Experimental colonization by Ureaplasma urealyticum in the vagina of Balb/c mice was greatly enhanced by administration of estrogen, whereas it was not affected by treatment with progesterone. Ureaplasma was recovered from almost half of the estrogen-treated animals 7 days after inoculation, and the organism persisted in all of these animals until 21 days after inoculation; on the other hand, the organism was isolated in less than 20% of the untreated, progesterone-treated, or danazol-treated mice 7 days after inoculation and was no longer isolated in any of these groups 21 days after inoculation. At least a hundredfold more organisms were recovered from the estrogen-treated mice as compared to the untreated mice 14 days after inoculation and thereafter. U. urealyticum was also isolated from the uterine cavity and salpinx in approximately half of the mice in which the organism was isolated from the vagina.

Personal protection against sexually transmitted diseases

Primary prevention of sexually transmitted diseases has received little emphasis in control programs. To evaluate the effectiveness of prevention strategies, we reviewed the world's literature on this topic. Use of condoms and spermicides greatly reduces the risk of gonorrhea, and barrier methods are practical and acceptable. Certain systemic antibiotics are effective, but for practical reasons, their use cannot be recommended. Washing or urinating after sexual exposure does not appear to protect against infection. Although the effectiveness of modifying sexual behavior to reduce the risk of sexually transmitted diseases has not been evaluated, many people have changed or are willing to change their behavior. Even if preventive measures are used consistently by only a minority of persons at risk, rates of sexually transmitted diseases would decline rapidly. In this era of sexually transmitted diseases that are not readily cured by antibiotics, use of effective preventive measures should be strongly encouraged.

Ureaplasma urealyticum serotypes in urinary tract disease

Ureaplasma urealyticum cultures from 124 patients with urinary tract disease were serotyped by indirect immunofluorescence, using antisera to serotypes I to VIII. A similar range of serotypes was recovered from first-voided, midstream, and bladder-aspiration (SPA) urine, upper urinary tract samples, and vaginal swabs. Serotype VI was predominant (44/124) among the samples, whereas serotypes V (1/124 samples) and VII (0/124 samples) were uncommon. Twenty of 124 cultures contained more than one serotype, and three cultures were untypeable. Serotypes cultured from bladder urine were also present in vaginal and urethral samples, although these samples often carried additional serotypes. Consecutive SPA samples from the same patient invariably contained the same serotype, whereas some consecutive midstream urine samples showed a loss or gain of serotypes with time. One patient carried the same serotype in SPA urine over a period of 13 months. The pattern of serotypes recovered from the urinary tract was similar irrespective of the sampling site, the site of infection, the clinical diagnosis and renal function of the patient, and the presence or absence of other microorganisms. Colonization above the urethra and association with urinary tract disease appeared to be serotype independent.

A microbiological study of non-gonococcal proctitis in passive male homosexuals

In a study of 180 male homosexual patients attending a venereal disease clinic, a correlation was sought between symptoms and signs of proctitis and the isolation of Neisseria gonorrhoeae, group B streptococci, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis and herpes simplex virus. Faecal specimens were examined for enteric pathogens and serological tests for hepatitis B virus, syphilitic and chlamydial infections were performed.

There was no association between proctitis, as diagnosed by examination of a Gram-stained rectal smear, and the isolation of any micro-organism or detection of a positive serological test. There was, in addition, no association between any symptom or abnormal physical sign and any positive microbiological findings. Since 23% of patients from whom N. gonorrhoeae was isolated had no abnormal physical signs, it is difficult to assign a pathogenic role to other micro-organisms isolated from patients with and without clinical signs of proctitis. Approaches to further investigation of the problem are discussed.

Genitourinary infection with Ureaplasma urealyticum in women attending a sexually transmitted diseases clinic

Ureaplasma urealyticum was detected in the cervix of 49·9% and in the urine of 47·7% of women attending a department of genitourinary medicine. Isolation of U urealyticum was not related to diagnosis, nor was there any association between the presence of the organism and any symptoms or signs of genital tract disease. Fewer organisms were detected in the cervix of women who had a concurrent infection with Chlamydia trachomatis than in women who had not. A pathological role for U urealyticum has not been established.

Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries

Pelvic inflammatory disease is used herein synonymously with acute salpingitis. In modern industrialized countries, the annual incidence of PID in women 15 to 39 years of age seems to be 10 to 13 per 1,000 women, with a peak incidence of about 20 per 1,000 women in the age group 20 to 24 years. Since 1960 an increase in incidence by a factor of 1.6 to 1.9 has been observed in the age group 20 to 29 years. The incidence of PID is correlated strongly with the prevalence of sexually transmitted diseases, although a fraction of the infections might be of endogenous origin. Use of intrauterine contraceptive devices and operations for legal abortions contribute to the increase in incidence. The prevalence of women in the post-PID state has increased by a factor of about 1.5 since 1960. Women in the post-PID state have a tenfold increased risk for ectopic pregnancy and 25% of the increase in ectopic pregnancy can be accounted for by the increase in post-PID women. Infertility after PID ranges between 5.8% and 60% depending on severity of infection, number of infections, and age of the women. The fraction of women rendered infertile because of PID has increased by a factor of about 1.6 since 1960.

The microbiology and therapy of acute pelvic inflammatory disease in hospitalized patients

We examined microbial isolates from the endocervical and peritoneal cavity of 30 women hospitalized with acute PID. Patients were randomly assigned to one of two antibiotic regimens: amoxicillin, 6 gm by mouth every 24 hours, or aqueous penicillin G, 30 million units and gentamicin, 180 to 240 mg intravenously every 24 hours. We measured response by quantifying physical examination findings. Neisseria gonorrhoeae was isolated from the cervix of 24 patients (80%) and from the peritoneal cavity of 10 (33%). Other peritoneal isolates included Enterobacteriaceae in five patients, Ureaplasma urealyticum in five, Mycoplasma hominis in six, and Chlamydia trachomatis in three. Bacteroides melaninogenicus, the most frequent anaerobe, was isolated in 11 cases. Bacteroides fragillis was not isolated from any specimen. The cure rates were the same for both regimens: three patients failed on each. Four women required total abdominal hysterectomy and unilateral or bilateral salpingo-oophorectomy.

Asymptomatic bacteriospermia in infertile men

The aerobic and anaerobic flora of the semen was examined in 109 men visiting our infertility clinic. Not one specimen was sterile and 107 specimens contained two or more different bacterial species. Anaerobic organisms were found in 63.3% of specimens. We were able to isolate various organisms that have been shown to be spermicidal in vitro (viridans and hemolytic streptococci, Proteus vulgaris and Escherichia coli) from a large number of samples. If the presence of microorganisms in the semen is associated with infertility, it is likely that only certain organisms are involved or that the numbers of organisms must be high for an effect to be seen. The presence of organisms in the semen may also be related to gynecologic infections.

Nongonococcal urethritis

The nongonococcal urethritis (NGU) syndrome is a group of sexually transmitted infections that together exceed the frequency of gonorrhea in men in most urban areas of Europe and the United States, and probably in much of the remainder of the world. "Nongonococcal" is preferred to the term "non-specific" urethritis because the latter is less precise and carries the inaccurate implication that the causes are unknown and perhaps unknowable.