Lymphocyte transformation in repeated gonococcal urethritis

In an attempt to ascertain whether cell-mediated hypersensitivity develops in the course of a naturally acquired gonorrhea infection, lymphocytes from men with gonococcal urethritis were cultured in vitro with a gonococcal antigen. The lymphocyte response was quantitated by a radioactive assay of deoxyribonucleic acid synthesis. Lymphocytes from subjects without gonorrhea were cultured in a similar manner to determine the specificity of the reaction. The recurrent nature of many gonococcal infections allowed a concurrent evaluation of whether the intensity of the in vitro lymphocyte response is related to the history of previous exposure to the antigen concerned. This study revealed a significantly greater lymphocyte response to the gonococcal antigen in those with gonorrhea infections than in the nongonorrhea subjects (P < 0.01). The intensity and timing of the response were also consistent with specific lymphocyte stimulation.

Genitourinary imaging in children

Genitourinary imaging in children has gone through a metamorphosis in the past 30 years, paralleling technical advances in sonography, CT scanning, and MR imaging. The imaging sequences for hydronephrosis and UTI are still controversial and require outcomes analysis to determine which studies are most beneficial and efficacious.

A combination benzoyl peroxide and clindamycin topical gel compared with benzoyl peroxide, clindamycin phosphate, and vehicle in the treatment of acne vulgaris

A topical gel combining 5% benzoyl peroxide and 1% clindamycin as phosphate was evaluated in a 10-week randomized double-blind trial involving 287 patients with moderate to moderately severe acne. The combination agent demonstrated significantly greater reductions in inflammatory lesions than either of its active constituents (5% benzoyl peroxide and 1% clindamycin) or vehicle when used alone. Significantly greater reductions in comedos and improvements, as measured by both physicians' and patients' global evaluations, were obtained with the combination agent than with clindamycin or vehicle. The reduction in comedos and the global improvements were similar between the combination agent and benzoyl peroxide. The combination agent was well tolerated; the incidence of dry skin was similar to that found with benzoyl peroxide, and other adverse events were similar to that with vehicle. The improved efficacy obtained with combination therapy was accompanied by a safety profile similar to that of either constituent used alone.

The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia

BACKGROUND

Data suggest that androgenetic alopecia is a process dependent on dihydrotestosterone (DHT) and type 2 5alpha-reductase. Finasteride is a type 2 5alpha-reductase inhibitor that has been shown to slow further hair loss and improve hair growth in men with androgenetic alopecia.

OBJECTIVE

We attempted to determine the effect of finasteride on scalp skin and serum androgens.

METHODS

Men with androgenetic alopecia (N = 249) underwent scalp biopsies before and after receiving 0.01, 0.05, 0.2, 1, or 5 mg daily of finasteride or placebo for 42 days.

RESULTS

Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56. 5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively. Serum DHT levels declined significantly (P <.001) by 49.5%, 68.6%, 71.4%, and 72.2% in the 0.05, 0.2, 1, and 5 mg finasteride treatment groups, respectively.

CONCLUSION

In this study, doses of finasteride as low as 0.2 mg per day maximally decreased both scalp skin and serum DHT levels. These data support the rationale used to conduct clinical trials in men with male pattern hair loss at doses of finasteride between 0.2 and 5 mg.

Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children

CONTEXT

Limited computed tomography with rectal contrast (CTRC) has been shown to be 98% accurate in the diagnosis of appendicitis in the adult population, but data are lacking regarding the accuracy and effectiveness of this technique in diagnosing pediatric appendicitis.

OBJECTIVE

To determine the diagnostic value of a protocol involving ultrasonography and CTRC in the diagnosis and management of appendicitis in children and adolescents.

DESIGN, SETTING, AND PARTICIPANTS

Prospective cohort study of 139 children and adolescents aged 3 to 21 years (2 patients were older than 18 years) who had equivocal clinical findings for acute appendicitis and who presented to the emergency department of a large, urban, pediatric teaching hospital between July and December 1998. Interventions Children were first evaluated with pelvic ultrasonography. If the result was definitive for appendicitis, laparotomy was performed; if ultrasonography was negative or inconclusive, CTRC was obtained. Patients who did not undergo laparotomy had telephone follow-up at 2 weeks and medical records of all patients were reviewed 4 to 6 months after study completion.

MAIN OUTCOME MEASURES

Specificity, sensitivity, positive predictive value, negative predictive value, and accuracy of tests based on final diagnoses; surgeons' estimated likelihood of appendicitis on a scale of 1 to 10 for each case and their case management plans before imaging, after ultrasonography, and after CTRC.

RESULTS

A total of 108 patients underwent both ultrasonography and CTRC examinations. The protocol had a sensitivity of 94%, specificity of 94%, positive predictive value of 90%, negative predictive value of 97%, and accuracy of 94%. A normal appendix was identified by ultrasonography in 2 (2.4%) of 83 patients without appendicitis and by CTRC in 62 (84%) of 74 patients. A negative ultrasonography result did not change the surgeons' clinical confidence level in excluding appendicitis (P= .06), while a negative CTRC result did have a significant effect (P<.001). Positive results obtained for either ultrasonography or CTRC significantly affected surgeons' estimated likelihood of appendicitis (P=.001 and P<.001, respectively). Ultrasonography resulted in a beneficial change in patient management in 26 (18.7%) of 139 children while CTRC correctly changed management in 79 (73.1%) of 108.

CONCLUSIONS

These data show that CTRC following a negative or indeterminate ultrasonography result is highly accurate in the diagnosis of appendicitis in children.

Mupirocin cream is as effective as oral cephalexin in the treatment of secondarily infected wounds

BACKGROUND

Topical antimicrobials have been considered for treatment of secondarily infected wounds because of the potential for reduced risk of adverse effects and greater patient convenience. We compared mupirocin cream with oral cephalexin in the treatment of wounds such as small lacerations, abrasions, or sutured wounds.

METHODS

In 2 identical randomized double-blind studies, 706 patients with secondarily infected wounds (small lacerations, abrasions, or sutured wounds) received either mupirocin cream topically 3 times daily or cephalexin orally 4 times daily for 10 days.

RESULTS

Clinical success at follow-up was equivalent in the two groups: 95.1% and 95.3% in the mupirocin cream and the cephalexin groups, respectively (95% confidence interval [CI], -4.0% to 3.6%; P = .89). The intention-to-treat success rate was 83% in both groups. Bacteriologic success at follow-up was also comparable: 96.9% in the mupirocin cream and 98.9% in the cephalexin groups (95% CI, -6.0% to 2.0%; P = .22). The occurrence of adverse experiences related to study treatment was similar for the 2 groups, with fewer patients in the mupirocin cream group reporting diarrhea (1.1% vs 2.3% for cephalexin).

CONCLUSIONS

Mupirocin cream applied topically 3 times daily is as effective as oral cephalexin given 4 times daily for the treatment of secondarily infected wounds and was well tolerated.

Oral famciclovir for suppression of recurrent genital herpes simplex virus infection in women. A multicenter, double-blind, placebo-controlled trial. Collaborative Famciclovir Genital Herpes Research Group

OBJECTIVE

To evaluate the efficacy and safety of oral famciclovir in the suppression of genital herpes.

METHODS

In this randomized, double-blind, placebo-controlled trial that was performed at 11 university and 9 private ambulatory care referral centers, 375 women who were 18 years of age or older and had a history of 6 or more episodes of genital herpes during 12 of the last 24 months in the absence of suppressive therapy were treated for 4 months with oral famciclovir, 125 mg once daily or twice daily, 250 mg once daily or twice daily, 500 mg once daily, or placebo. The primary outcome measures included the time to first clinically and virologically confirmed recurrences, and safety as measured by clinical laboratory tests and adverse experiences.

RESULTS

The median time to first recurrence was 82 days in the placebo group, 114 days in those receiving famciclovir, 125 mg once daily, and more than 120 days in the other treatment groups. When compared with placebo recipients, the time to the first clinical recurrence was significantly prolonged in subjects who received famciclovir, 125 mg twice daily (hazard ratio, 1.8; 95% confidence interval, 1.0-3.0; P = .03), and in those who received famciclovir, 250 mg twice daily (hazard ratio, 3.6; 95% confidence interval, 1.9-6.9; P < .001). Treatment was well tolerated, and there was no evidence of emergence of resistance during or after suppressive famciclovir therapy.

CONCLUSIONS

Oral famciclovir, 250 mg, given twice daily for 4 months is an effective, well-tolerated treatment for the suppression of genital herpes in women with frequent recurrences, but single daily doses produced less complete suppression of genital herpes.

The heritability of characteristics associated with dispositional empathy

This investigation used data from Loehlin and Nichols's (1976) study of over 800 sets of twins to examine evidence for the heritability of three facets of empathy: empathic concern, personal distress, and perspective taking. Expert judges first identified sets of adjectives, included within Loehlin and Nichols's original data, which reflected each empathy construct; these items were then validated in an independent sample. Comparisons of the responses given to these items by identical and fraternal twins in the Loehlin and Nichols investigation revealed evidence of significant heritability for characteristics associated with the two affective facets of empathy--empathic concern and personal distress--but not for the nonaffective construct of perspective taking. This pattern is consistent with the view that temperamental emotionality may underlie the heritability of affective empathy.

Management of genital infection caused by human papillomavirus

Recent studies of genital wart therapy have evaluated laser surgery, interferon, and 5-fluorouracil. On the basis of considerations of efficacy, cost, adverse effects, and recurrence rates, cryotherapy with liquid nitrogen remains the recommended therapy for most sexually transmitted warts. None of the treatment methods eradicates the papillomavirus, and genital wart recurrences are seen with each method. The influence of treatment of genital warts on the natural course and sequelae of genital papillomavirus infection is unknown.

Diagnosis and management of acute genital ulcers in sexually active patients

Sexually transmitted genital ulcer diseases include herpes simplex, chancroid, granuloma inguinale, lymphogranuloma venereum, and syphilis. Each of these infections has a characteristic clinical picture, but an accurate diagnosis usually requires the support of laboratory tests. The diagnosis will determine the appropriate therapy as well as sexual partner management.

Treatment of external genital warts: a randomised clinical trial comparing podophyllin, cryotherapy, and electrodesiccation

Four hundred and fifty patients were enrolled into a randomised clinical trial in a public sexually transmitted diseases clinic to evaluate the efficacy of podophyllin, cryotherapy, and electrodesiccation for treatment of external genital warts. Complete clearance of warts was observed in 41%, 79%, and 94% of patients who received up to six weekly treatments of podophyllin, cryotherapy, and electrodesiccation, respectively. Relapses occurred in 25% of all patients, yielding 3 month clearance rates of 17%, 55%, and 71% for podophyllin, cryotherapy, and electrodesiccation, respectively. Wart volume and duration did not influence treatment outcome. Response to therapy was greater in women than in men, and did not differ by treatment modality. Electrodesiccation and cryotherapy were more effective than podophyllin for the treatment of external genital warts, but none of these three treatments were highly successful.

Evaluation of six media for the growth of Trichomonas vaginalis from vaginal secretions

Many media have been formulated for the growth of Trichomonas vaginalis, but the relative sensitivities of these media have not been determined. We evaluated the ability of six media, including all five media commercially available in the United States, to grow Trichomonas vaginalis from vaginal secretions. In a first experiment, we evaluated the ability of five media to grow T. vaginalis from vaginal secretions of 375 women and determined the optimal days on which to read culture tubes, by inoculating aliquots of secretions into each medium and reading the tubes 1, 2, 3, 4, and 7 days later. Sixty-five patients (17%) had a positive wet-mount examination for T. vaginalis, and all the positive results were confirmed by growth in at least one medium. Of 310 wet-mount-negative specimens, 37 (12%) grew T. vaginalis; overall, 102 women (27%) had a positive culture. Diamond and modified Diamond media (the latter being the only medium not commercially available) detected 99 (97%) and 92 (90%) isolates, respectively, compared with three formulations of Kupferberg medium, which detected 77 (75%), 50 (49%), and 43 (42%) isolates. The optimal single day to read wet-mount-negative cultures was day 7, but 4 (11%) of the 37 positive specimens were positive only before day 7. In a second study, we compared the ability of modified Diamond medium with that of a sixth medium, Lash medium, to grow T. vaginalis from 48 wet-mount-positive specimens; modified Diamond medium supported growth in all cases, whereas Lash medium supported growth in only 26 (54%) cases. We conclude that formulations of Diamond medium are superior to formulations of Kupferberg or Lash medium for growth of t. vaginalis.

Therapy of uncomplicated gonorrhea due to antibiotic-resistant Neisseria gonorrhoeae

Antibiotics available to treat uncomplicated anogenital infections due to beta-lactamase-producing Neisseria gonorrhoeae include spectinomycin, ceftriaxone, and clavulanic acid added to aqueous procaine penicillin G or amoxicillin. Important variables in deciding which antibiotic regimen to use include effectiveness against urethral, cervical, pharyngeal, and rectal infections; cost; eradication of coexisting incubating syphilis; adverse effects; efficacy against strains of N. gonorrhoeae with chromosomally mediated resistance to antimicrobial agents; ease of administration; patient acceptance; and the potential for inducing resistance to antimicrobial agents in pathogens other than those causing sexually transmitted diseases. This review outlines the advantages and disadvantages of the various regimens.

Gonococcal urethritis diagnosed from enzyme immunoassay of urine sediment

First-catch urine specimens were obtained before clinical examination from 101 sexually active men who attended a sexually transmitted diseases clinic with a complaint of urethral discharge. Urethral swab specimens were used for preparation of smears and were then cultured on Martin-Lewis medium. Enzyme immunoassay (EIA) tests were performed on (1) uncentrifuged urine, (2) urine sediment, and (3) urine sediment diluted 1:6 with detergent buffer. Urethral cultures from 65 (64%) of the 101 men were positive for N. gonorrhoeae. EIA performed on urine sediment diluted 1:6 yielded the highest sensitivity: 98.5% (64/65). Sensitivity of EIA for uncentrifuged urine was only 66% (43/65). Specificity of all samples tested exceeded 97.2%. Overall agreement between results of EIA on diluted urine sediment and culture was 98% (99/101). Discordant culture and EIA results were unrelated to urine volume, time since prior urination, quantity of gonococcal growth on Martin-Lewis medium, duration of urine storage (less than 72 hours) before testing, or immunotype. EIA tests using urine sediment are highly sensitive and specific, and they offer an alternative means of diagnosing gonorrhea in men who refuse urethral manipulation. They also provide a means of screening men at high risk for gonorrhea who have submitted a urine specimen for other reasons.

Chancroidal ulcers that are not chancroid. Cause and epidemiology

Hemophilus ducreyi was isolated from the ulcer of one of 33 patients in whom chancroid had been diagnosed clinically. Herpes simplex virus was isolated from 16 of these patients. A presumptive diagnosis of chancroid was made in one of three sexual partners of the only index patient with culture-proved chancroid. No chancroidal lesions were found in any of 39 sexual partners of the other 32 index patients. Genital cultures for herpes simplex virus were positive from four of 14 sexual partners of index patients with genital herpes simplex infection. The differential diagnosis of chancroidal genital ulcers is facilitated by herpes simplex virus cultures and a new selective H ducreyi culture medium.

Evaluation and management of acute genital ulcers in sexually active patients

The causes of genital ulcers vary with the age of the patient. Although sexually related genital ulcers can be seen at any age, they are most common between the ages of 15 and 30. The differential diagnosis includes syphilis, chancroid, genital herpes, lymphogranuloma venereum, granuloma inguinale, fixed drug reactions, and traumatic ulcers.

A preliminary evaluation of the Gonozyme test

Gonozyme is a solid-phase enzyme immunoassay that detects antigens of Neisseria gonorrhoeae in clinical specimens. The test was 100% sensitive and 96.8% specific when applied to 71 urethral specimens from men with symptomatic urethritis, and 89.5% specific for 19 urethral specimens from men examined after eradication of gonorrhea by antibiotics. For cervical specimens obtained before therapy from 368 women with gonorrhea, the Gonozyme test had a sensitivity of 88.5% and a specificity of 94.3%. The test was 100% specific when used for testing of 37 cervical specimens obtained after therapy of gonorrhea. The predictive values of a positive Gonozyme test were 90.5% for cervical specimens from women attending a sexually transmitted disease clinic and 97% for urethral specimens from men with urethritis. The predictive values of negative Gonozyme tests in these same circumstances were 100% for urethral specimens and 93.6% for cervical specimens.

Cefoxitin vs. penicillin in the treatment of uncomplicated gonorrhea

Four hundred six men and women with gonorrhea were randomly assigned to receive either 2 g of cefoxitin or 4.8 X 10(6) units of aqueous procaine penicillin G intramuscularly. All patients also received 1 g of probenecid orally. There was no statistically significant difference in the failure rate between patients treated with penicillin (4.3%) and those treated with cefoxitin (5.1%). Twelve (92%) of 13 homosexual men with gonococcal proctitis who received penicillin and 19 (95%) of 20 who received cefoxitin were cured. Adverse reactions were infrequent and mild in the cefoxitin-treated group. Three patients who received penicillin developed reactions consistent with procaine toxicity. It is concluded that cefoxitin is a safe and effective alternative to penicillin for treating uncomplicated anogenital gonorrhea in men and women.

Isolation of Haemophilus species from the genital tract

Haemophilus influenzae was isolated from the urethra of three of 85 men attending a sexually transmitted diseases clinic. These isolates of H. influenzae were nonencapsulated; one was biotype III, and two were biotype IV. Haemophilus parainfluenzae was isolated from the urethra or coronal sulcus of five men; three isolates were biotype II, and two were biotype III. Neither H. influenzae nor H. parainfluenzae was isolated from the genital secretions of 84 women. Haemophilus ducreyi and Haemophilus equigenitalis (contagious equine metritis bacterium) were not isolated from any of the 169 patients.

Diagnosis of gonorrhea using a genetic transformation test on mailed clinical specimens

The genetic transformation test (GTT), a technique used for the detection of gonococcal DNA in clinical specimens, was compared with culture testing for the diagnosis of gonorrhea. At the De Kalb County Venereal Disease Clinic, Decatur, Ga., 454 cervical and 160 rectal specimens from women and 191 urethral specimens from men were collected in duplicate. One of each of the two specimens from each anatomic site was immediately plated on Martin-Lewis medium and incubated; the other specimen was mailed to Philadelphia for a GTT. Using culture results as a standard, the GTT had a specificity of 98.1% although some "false-positive" GTT results were probably a reflection of false-negative culture results. The sensitivity of the GTT was greater than 96% except when specimens were collected with Culturettes (Marion Laboratories, Kansas City, Mo.). In situations where Gram staining is not appropriate or where on-site culture facilities are not available, GTT may be the method of choice for the diagnosis of gonorrhea.

Pseudogranuloma inguinale caused by haemophilus ducreyi

We used a new selective culture medium to isolate Haemophilus ducreyi from a penile ulcer that had the clinical appearance of granuloma inguinale. The isolation of the organism in pure culture permitted us to make a definitive diagnosis and obtain antimicrobial susceptibility data in a relatively short period. As a result, we were able to change therapy from sulfamethoxazole to erythromycin, and the infection rapidly healed.

Factors affecting the performance of smear and culture tests for the detection of Neisseria gonorrhoeae

The probability of gonorrhea in men attending the DeKalb County, Georgia, clinic for sexually transmitted diseases with the chief complaint of urethral discharge and/or dysuria and whose urethral smears contain intracellular gram-negative diplococci is 94.8%. Absence of intracellular gram-negative diplococci from smears of the same men in associated with a 92.6% probability that they have nongonococcal urethritis rather than gonorrhea. There is a 97.3% probability of gonorrhea in our female patients at high risk of being infected and whose cervical smears contain intracellular gram-negative diplococci. Absence of intracellular gram-negative diplococci is associated with a probability of only 51.2% that these women do not have gonorrhea. The probability of gonorrhea in our male patients, whose smears contain intracellular gram-negative diplococci, drops from 94.8% to 34.9% when specimens are obtained from sexually active men without urethritis and to 53.9% when an inexperienced technician interprets smears from patients with urethritis. Vancomycin . HCl, which is included in Neisseria gonorrhoeae--selective media for suppression of microbial contaminants, also inhibited 2.4% of our gonococcal isolates and resulted in a falsely negative test. Awareness of these and other limitations of tests for gonorrhea, and of the magnitude and means of control of these limitations is essential to determining the presence or absence of gonococcal disease.

Resources needed to culture Chlamydia trachomatis in laboratories of clinics for sexually transmitted diseases

Genital infections with Chlamydia trachomatis may be more prevalent than infection with Neisseria gonorrhoeae and may have serious sequelae such as epididymitis and pelvic inflammatory disease in adults and conjunctivitis and pneumonia in neonates. A culture of the organism is the most sensitive and specific means for detecting C. trachomatis in the genital tract, yet this procedure is available only in specialized centers and universities. Establishment of a chlamydia laboratory as part of a clinic for sexually transmitted diseases (STD) requires major technical and financial resources. Technical resources include the expertise of technicians as well as specialized equipment, glassware, and reagents. The current (August, 1981) minimal cost of performing a chlamydial culture is estimated to be $14.69.

Treatment of uncomplicated gonococcal infection with trimethoprim-sulfamethoxazole

The efficacy of trimethoprim-sulfamethoxazole (TMP-SMZ; 80 mg of TMP and 400 mg of SMZ per tablet; nine tablets taken once daily for three days; total, 27 tablets) was compared with the U.S. Public Health Service recommended regimen of 2 g of tetracycline daily for five days for the treatment of uncomplicated genital gonorrhea. Fourteen (3%) of the 461 patients treated with tetracycline and 24 (5%) of the 477 patients treated with TMP-SMZ failed to be cured; the difference between the two groups was not significant. Treatment of patients with TMP-SMZ was more likely to fail if the isolates of Neisseria gonorrhoeae had MICs of > or = 0.5 microgram of TMP/ml and > or = 9.5 micrograms of SMZ/ml. Adverse effects were more often reported by patients receiving TMP-SMZ. The results show that TMP-SMZ is an effective therapy for uncomplicated gonococcal infections in men and women and may also eliminate agents causing postgonococcal urethritis. The utility of this drug combination may be limited by the adverse effects that are associated with the large dose used.

Specificity, sensitivity, and reproducibility among the fluorescent treponemal antibody-absorption test, the microhemagglutination assay for Treponema pallidum antibodies, and the hemagglutination treponemal test for syphilis

Using 920 sera, we compared the specificity and reproducibility of the hemagglutination treponemal test for syphilis with those of the fluorescent treponemal antibody-absorption test and the microhemagglutination assay for Treponema pallidum antibodies; we found all three tests to be comparable. However, the hemagglutination treponemal test for syphilis, like the microhemagglutination assay for T. pallidum antibodies, lacked sensitivity in sera from patients with primary syphilis.

Molluscum contagiosum

Molluscum contagiosum, a benign cutaneous infection of children and young adults, occurs throughout the world. Infectious virions apparently are transferred from the visible lesions to the skin of susceptible persons, either by direct contact or by fomites. Circumstantial evidence suggests that this infection is transmitted between young adults during sexual intercourse. The lesions of molluscum contagiosum are usually small, firm, umbilicated papules located on exposed skin of children or on genital skin in young adults. Such lesions are pathognomonic. Molluscum lesions resolve spontaneously; however, various treatments that remove the infected epidermis may be used to minimize transmission of the disease or for cosmetic reasons. In vitro culture techniques that have been successful for other viruses fail to propagate this virus. Successful inoculations of humans were reported early in the 20th century, but attempts to repeat these experiments have failed. Consequently, precise knowledge of this infection is lacking.

Metronidazole for vaginal trichomoniasis. Seven-day vs single-dose regimens

This randomized, double-blind evaluation of metronidazole therapy for trichomonal vaginitis compared the efficacy and side effects of a single 2-g dose and the standard seven-day regimen (250 mg three thimes daily). Eighty (86%) of the 93 women examined seven to 21 days after therapy with the 2-g regimen, and 76 (91.6%) of 83 examined after the seven-day regimen, were cured. These cure rates were not significantly different. In addition, symptom duration and the occurrence of side effects and yeast infection were not significantly different for the two treatment groups. Because the efficacy and side effects of the two regimens are comparable and the 2-g dose is easier to administer and less expensive, we recommend the 2-g dose as standard treatment for trichomoniasis.

Isolation and identification of Haemophilus ducreyi in a clinical study

Seventeen strains of Haemophilus ducreyi were isolated from genital lesions which were negative for syphilis by dark-field examination. Media used for primary isolation at various times during the study were enriched chocolate agar, chocolate agar plus vancomycin (3 microgram/ml), rabbit blood agar plus vancomycin (3 micrograms/ml), fetal bovine serum agar, and fetal bovine serum agar plus vancomycin (3 micrograms/ml). H. ducreyi was isolated on chocolate agar plus vancomycin from 10 of 14 patients found to be positive on one or more media, on rabbit blood agar plus vancomycin from 16 of 17 patients, and on fetal bovine serum agar plus vancomycin from 9 of 11 patients. Sera from six animal species were tested to determine if any would support the growth of H. ducreyi. Horse and rabbit sera supported light growth of some strains. Fetal bovine serum supported good growth of all strains included in the study. Biochemical and physiological tests were done on the 17 isolates, a reference strain of H. ducreyi, and two reference strains of Haemophilus haemoglobinophilus. The results agreed with those reported by Kilian, except that H. ducreyi produced alpha-hemolysis in stabs on rabbit blood agar and was oxidase positive, three strains were urease positive, and CO2 improved the growth of seven strains. All 17 isolates were beta-lactamase positive. The reference strains were beta-lactamase negative.

Resistance to gonorrhea possibly mediated by the genital microbial flora

The proximal male urethra is normally sterile, but microorganisms exist in the distal urethra. The members of the distal urethra flora change with sexual activity. Components of the urethral flora may include aerobic bacteria, anaerobic bacteria, fungi, and mycoplasmas. These microorganisms may function in the urethra's resistance to some pathogens. Certain patients with urethral meningococci and staphylococci resisted infection following exposure to women with gonococcal cervicitis. In vitro assays showed these bacteria capable of inhibiting Neisseria gonorrhoeae. The inhibition also occurred in vivo, using the animal subcutaneous chamber model of gonococcal infection.

Trichomonas vaginalis: reevaluation of its clinical presentation and laboratory diagnosis

Vaginal discharge is the most common complaint and Trichomonas vaginalis vaginitis the most frequently diagnosed problem among women attending the DeKalb County Georgia, Veneral Disease Clinic. Despite this prevalence, the 1837 observations of Donné are the criteria frequently used in the clinical and laboratory diagnosis of trichomoniasis. Our study shows that a purulent, frothy discharge is indeed a characteristic of trichomonal vaginitis, but if it is used as the sole diagnostic criterion, 88% of women with trichomonal vaginitis will not be identified and 29% will be erroneously diagnosed as infected. Donné's wet-mount test remains highly specific, but culture will detect twice as many trichomonas infections. There is a positive association between trichomoniasis and gonococcal cervicitis, failure to use contraceptive techniques, and lack of yeast in the wet mount of vaginal secretions.

Culture methods for Neisseria gonorrhoea

Cultures on an appropriate medium are both highly sensitive and specific, but false-negative cultures can occur because of sampling procedures, laboratory errors, sensitivity of certain gonococci to the vancomycin contained in selective mediums, or loss of bacterial viability in transport.

Persistent urethral leukocytosis and asymptomatic chlamydial urethritis

Chlamydia trachomatis was isolated from 47% of asymptomatic, sexually active men whose urethral smears contained four or more polymorphonuclear leukocytes (PMN) per high-power field (hpf) one week after their sexual activity was restricted. C. trachomatis was not detected in any of 23 asymptomatic, sexually active men having less than 4 PMN/hpf in two urethral smears obtained one week apart. Semiquantitation of urethral PMN in the urethral Gram-stained smear is useful in the evaluation of asymptomatic men without gonorrhea who are concerned about the possibility of harboring a urethral pathogen.

Experimental infection of the chimpanzee urethra and pharynx with Chlamydia trachomatis

An isolate of Chlamydia trachomatis obtained from a man with nongonococcal urethritis was used to produce experimental urethral and pharyngeal infections in chimpanzees. After urethral inoculation of 8 X 10(1) inclusion-forming units (IFU), infections were established in three of three animals; urethral discharges developed in two. The infections persisted for five to nine weeks. Larger inocular (7 X 10(2) and 1 X 10(5) IFU) produced pharyngeal infections in two animals. The third animal's pharynx was not infected by 1 X 10(5) IFU. Chlamydial complement-fixing antibodies increased significantly in sera of two of three animals. This study provides an animal model for study of mucosal infection by C. trachomatis. The relative resistance of the chimpanzee pharynx to infection parallels clinical observations in man.

Diagnosis and etiology of nongonococcal urethritis

The observation of more than four polymorphonuclear cells (PMN) per high-power field (hpf) in gram-stained smears of urethral secretions was found to differentiate patients with urethritis from patients without urethritis. A urethral discharge was present in 78% of patients with nongonococcal urethritis (NGU). Dysuria without demonstrable urethral discharge and with fewer than four PMN/hpf did not appear to fit into the NGU spectrum. NGU is now defined to include men who have negative urethral cultures for Neisseria gonorrhoeae with a urethral discharge and/or more than four PMN/hpf in their urethral smears. The findings of more than four PMN/hpf in the urethral smears of 22%of asymptomatic sexually active men with more than one sexual partner (polygamous controls) suggests that asymptomatic NGU is not uncommon. Chlamydia trachomatis was isolated significantly more frequently from the NGU study group than from the control group (P less than 0.001). This study adds Corynebacterium vaginale (Haemophilus vaginalis), group B streptococci, and yeasts to the list of sexually transmitted microorganisms that are not etiologic determinants of NGU.

Experimental animal infections with Mycoplasma hominis and Ureaplasma urealyticum

Subcutaneous tissue cavities in mice and guinea pigs were infected with human isolates of Ureaplasma urealyticum and Mycoplasma hominis. The minimal infective dose for M. hominis was as low as less than 10 color-changing units (CCU) for mice and 10(2) CCU for guinea pigs. The minimal infective dose for U. urealyticum was as low as less than 10 CCU for mice and 10(4) CCU for guinea pigs. Mouse infections with either U. urealyticum or M. hominis persisted for 1 day to greater than 4 months. Guinea pigs remained infected for up to 4 weeks. Two M. hominis isolates were similar in their ability to infect subcutaneous tissue cavities but two U. urealyticum isolates varied in their ability to infect the cavities. The histopathology of the M. hominis and U. urealyticum infections was similar: an initial intense polymorphonuclear response with giant cells, followed in 4 weeks by histiocytes and giant cells with some plasma cells and lymphocytes.

Isolation and characterization of a rough colony type of Neisseria gonorrhoeae

A new colony type of Neisseria gonorrhoeae was detected in the primary cultures from 8 of 180 men with gonococcal urethritis. This colony type contrasts with those previously described by having a rough and irregular surface. In six of the eight cases, the rough form predominated. The distinctive morphology of the rough colony variant could be maintained indefinitely by selective subculture. By electron microscopy, organisms taken from rough colonies of each of the eight isolates were piliated. Antimicrobial susceptibilities of type 1 and rough clones derived from the same patients were identical for ampicillin, penicillin, tetracycline, and spectinomycin. After inoculation of rough colonies into subcutaneous chambers in mice and guinea pigs, type 1 colonies predominated in cultures of material obtained from the chambers. This new piliated colony type of N. gonorrhoeae may provide an opportunity to investigate factors other than pili that contribute to gonococcal virulence.

Interference by Neisseria gonorrhoeae growth by other bacterial species

Growth of Neisseria gonorrhoeae from clinical specimens has been enhanced by the use of selective media that inhibit the simultaneous growth of other microorganisms. One explanation for this enhancement could be that certain other bacteria inhibit gonococcal growth. This hypothesis was examined by testing 167 bacterial isolates for in vitro gonococcal inhibition; 34.1% of the isolates failed to inhibit the gonococcus, but 12.0% produced weak inhibition and 53.9% strongly inhibited N. gonorrhoeae. The pattern of in vitro gonococcal inhibition was consistently the same for all the individual isolates within some species, but individual isolates within other bacterial species varied in their ability to inhibit the gonococcus. Consistently strong in vitro N. gonorrhoeae inhibitors were Citrobacter diversus, Enterobacter cloacae, Serratia marcescens, and Pseudomonas. The in vivo significance of gonococcal interference was demonstrated in the subcutaneous chamber model of N. gonorrhoeae infection.

Increased serum immunoglobulin E concentrations in venereal diseases

Total serum immunoglobulin E (IgE) concentrations were determined by a competitive solid phase radioimmunoassay technique in serum samples from patients with a variety of venereal diseases. The mean IgE concentrations for groups of normal persons without venereal diseases was significantly lower then the means for groups of appropriately matched patients with primary syphilis and gonorrhoea. There were also relatively higher IgE values in patients with trichomoniasis. Our data indicate that patients with urogenital infections have higher concentrations of IgE in the serum than matched control patients without such infections.

The crab louse-review of physiology and study of anatomy as seen by the scanning electron microscope

Effective control of a parasitic infestation is aided by a thorough understanding of the parasite and it interaction with the host. The external anatomy of Phthirus pubis and its egg were studied by scanning electron microscopy and the structures visualized were reviewed to determine their function. The pathophysiology of the insect-host interaction and current treatment recommendations were also reviewed.

Quantitation of Neisseria gonorrhoeae from women with gonorrhea

The number of infecting organisms has been shown to be an important variable in animal models of infection with Neisseria gonorrhoeae. This variable may also be important in the natural transmission of gonorrhea in humans. The number of gonococci in the cervicovaginal area of women with gonorrhea is unknown, as are the effects of certain physiologic or therapeutic variables on the number of gonococci. In this study a semiquantitative technique for the enumeration of N. gonorrhoeae was used; 10 ml of phosphate-buffered saline was directed against the cervix and vaginal wall, and the number of colony-forming units (cfu) of N. gonorrhoeae in the aspirate was determined. The number of N. gonorrhoeae recovered ranged from 4.0 X 10(2) to 1.8 X 10(7) cfu. The geometric mean number was 1.45 X 10(5) cfu, with a standard deviation of 1.04 X 10(1) cfu. Statistical analyses showed that the number of gonococci was not influenced by the use of oral contraceptives, concurrent infection with Trichomonas vaginalis and/or Corynebacterium (Haemophilus)vaginalis, time of douche prior to examination, or phase of the menstrual cycle at which the women were examined. The results indicated a wide range in the number of N. gonorrhoeae recoverable by vaginal irrigation but failed to define the reason for this variability.

Pathological features of experimental gonococcal infection in mice and guinea pigs

The histopathological and immunofluorescent findings in tissues within and surrounding artificially created subcutaneous tissue cavities infected with Neisseria gonorrhoeae for 1 to 30 days were studied in mice and guinea pigs. Findings in the tissue cavities of the animal models were similar to the findings of disseminated gonococcal infection in humans. These similarities included an intense persistent polymorphonuclear leukocytic response with tissue necrosis, hemorrhage into the early lesion, a perivascular leukocytic response in adjacent tissue, difficulty in detecting large numbers of discrete morphologically typical gonococci by the tissue Gram stain and direct fluorescent antibody techniques, a decrease in the number of identifiable gonococci with duration of the infection, and moderate amounts of extracellular and intracellular immunofluorescent gonococcal debris. Studies into the pathogenesis of the animal infections may enhance our understanding of the pathogenic mechanism (s) associated with gonococcal infection in humans.