Current Literature on Venereal Disease, 1972. Number One

DOCUMENT RESUME

ED 084 258 SP 007 494

AUTHOR Lea, Mildred V., Ed. TITLE Current Literature on Venereal Disease, 1972. Number One. Abstracts and Bibliography. INSTITUTION Center for Disease Control (DHEW/PHS), Atlanta, Ga. PUB DATE 72 NOTE 39p.

EDRS PRICE MF-$0.65 HC-$3.29 DESCRIPTORS *Communicable Diseases; *Diseases; *Health Services; Infectious Diseases; *Public Health; *Venereal Diseases ABSTRACT Presented are abstracts of documents and research pertaining to the clinical description, laboratory diagnosis, management, and therapy of syphilis and gonorrhea. Abstracted case studies of other minor venereal and related diseases are also included, as are bibliographies on current research and evaluation, public health methods, and behavioral studies. Also presented is a list of current books in print.(Related documents: SP 007 495 and SP 007 496.) (JB) CURRENT LITERATURE ON

Abstracts and Bibliography

NT OF NEwl5EL71 5 OF PAVINAF AWE EDUCATION KNElv NATIONAL iNSTil EDUCATION

NUMBER ONE

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

FILMED FROM BEST AVAILABLE COPY Prepared by Center for Disease Control State and Community Services Division Technical Information Services Editor: Mildred V. Lee Atlanta, Georgia 30333

ii FOREWORD

Current Literature on Venereal Disease presents a survey of recently published literse in the field. Effort is made to keep the abstracts as current as possible and sufficiently informative to enable the reader to decide whether the original article would be of interest to him. For the benefit of the reader, where possible the address of the first author is included with each abstract. Publication of the abstract does not necessarily imply endorsement by the U.S. Public Healt. Service of the original article or of commercial products or other drugs or methods of therapy mentioned therein.

In compiling these abstracts we utilize the Medical Literature Analysis and Retrieval System (MEDLARS) of the National Library of Medicine. Under this system, 2,300 foreign and domestic biomedical periodicals are searched for material dealing with or related to venereal disease. We also utilize the libraries of Emory University, the Center for Disease Control and other federal agencies. From time to time, as new books appear which deal with the venereal diseases, a list will be appended. Again, publication of such a list does not imply endorsement by the U.S. Public Health Service.

Current Literature on Venereal Disease is published three or four times each year and is indexed annually. Distribution is made to medical and other interested personnel and institutions throughout the United States and in 70 additional countries. Individuals desiring to be placed on the mailing key to receive Current Literature on Venereal Disease on a regular basis should write to the Center for Disease Control, Attention: Technical Information Services, State and Community Services Division, Atlanta, Georgia 30333.

J.D. Millar, M.D. Chief, Venereal Disease Branch State and Community Services Division Center for Disease Control Atlanta, Georgia 30333

Trade names rare used for identification only and do not represent an endorsement by the Public Health Service or the Q.J.S. Department of Health, Education, and Welfare. iii CONTENTS

FOREWORD iii

DIAGNOSIS AND MANAGEMENT 1

SYPHILIS 1

Clinical 1 Laboratory Diagnosis Therapy 8 Selected Bibliography 9

GONORRHEA 13 Clinical 13 Laboratory Diagnosis 13 Therapy 14 Selected Bibliography 17

MINOR VENEREAL AND RELATED DISEASES 19 Selected Bibliography 24

RESEARCH AND EVALUATION 26 Selected Bibliography 30

PUBLIC HEALTH METHODS 32 Selected Bibliography 34

BEHAVIORAL STUDIES 33 Selected Bibliography 35 DIAGNOSIS AND MANAGEMENT

SYPHILIS In the case presented, the infant's mother Clinical received prenatal care but an STS was not done afterthefirsttrimester andhersyphilitic INFANTILE CONGENITALSYPHILIS.infection was not detected. The infant was PRESENTING WITH BILATERAL ORCHITIS.apparently healthy at birth. Two months later RattanSingh,DevinderKaur,and M.the infant was admitted to the hospital because ParameswaranDepartmentsofDermatologyofpersistentdiarrheaanddehydration. A andVenereology,MaulanaAzadMedicalperianalrashwasnoted andthediscnargf; College, New Delhi 1, India. BR JVENER DISdiagnosiswas viralgastritis. Soon afterthe (London) 47:206-208, June 1971. mother noted an eruption on her palms, and when lesions appeared over other areas of her A caseisreported of infantile congenitalbody she sought medical advice. She was seen in syphilis manifested bybilateralorchitis andthe outpatient department for two months, and hyperostotic lesions of both humeri, particularlythe eruption was diagnosed as German measles, involving the upper end of the left humerus. Atneurodermatitis, and toxic erythema. When seen the age of 15 days, hyperostosis appeared aloneinthe dermatology clinic,T. pallidum were andwas notaccompanied byevidenceoffound in a darkfield preparation from a perianal osteochondritis. The child was given injectionslesion, One day after diagnosis of secondary of PAM 150,000 units intramuscularly daily forsyphilis was made on the mother, a rash was 16 days. There was a dramatic reduction of thenoted on theinfant.Darkfield examination size of the testicular swelling, but there was noshowed T. pallidum, FTA-ABS and VDRL were appreciative change in the left shoulder. Eightpositive, and periosteal thickening of the femurs monthslater,skiagramsoftheskullandcompatible with congenital syphilis was found shoulders were normal, the hyperostosis seenon x-ray. earlier at the upper ends of the humeri had completelyresolved, and VDRL tests were * * * normal. A long-term follow-up of this case -is planned. DI AGNOSTIC CYTOLOGY OF THE * * * STOMACH IN GASTRIC SYPHILIS. REPORT OF TWO CASES.JoaoC.Praia,Seibi Kobayashi, Yuri Yoshii, Yasutaka Yamaoka, and CONGENITAL SYPHILIS.WilliamH.TatsuzoKasugaiDepartmentofMedicine, EaglsteinNaval Dispensary, Washington, D.C.University of Chicago, Illinois. ACTA CYTOL 20360.ARCH DERMATOL(Chicago)(Baltimore) 14:333-337, May 1970. 103:524-526, May 1971. Authors' summary: The cytology of two cases "The increasing incidence of acquired syphilisof gastric syphilis is presented. The presence of in our young population makes mandatory amultinucleated giant cells of Langhans' type, thorough knowledge of congenitai syphilis." Inepithelioid and fibroblastlike cells were the the case presented, the diagnosis should haveprominentfeaturesinbothcases.The been obvious to one aware of the skin findingsdifferentialdiagnosis with malignantcellsis of congenitalsyphilis.However,therecentemphasized and discussed. A review of the incidence of congenital syphilis has been so lowliteraturedidnot reveal any other previous thatin man!hospitalsthere have been nocytologic review of gastric syphilis. examples of florid infantile congenital syphilis for a period of years. * * *

1 SYPHILISLESIONS OF THE STOMACHfeaturesofsarcoidosis.Thelesions had TREATED SURGICALLY (POLISH). A. Kuliczappreared insidiously over the past 18 years, and J. RudzkiBytom, ul. Piekarska 15, Poland.theywereasymptomaticand hadnever POL PRZEGL CHIR (Warszawa) 43:641-643,ulceratedor exuded. They were distributed 1971. symmetrically on the buttocks, arms, legs, and involved both extensor and flexual areas. The English summary: "A woman patient, forty-VDRL test was positive, and there was rapid seven years of age, had felt pains in epigastriumcure with penicillin treatment. for a year. Radiological examination and gastro- scopy revealedtl.e presence of gastric ulcer. * * * Despite the treatment the complaints became more and more intense. A partial gastrectomy was then performed. Histopathological examination of the excised specimen revealed that the morbid lesions were of syphilis origin." WITKOP DISEASE. TWO "FAVOID" CASES DUE TO SYPHILIS. P. S. JainDepartment of * * * Surgery, A. B. U. Hospital, Zaria, Nigeria. BR J CLINICO-ROENTGENOLOGIC MANIFESTA-VENER DIS (London) 47:216-217, June 1971. TIONS OF GUMMATOUS SYPHILIS IN- VOLVING THE SOFT TISSUES (RUSSIAN). Author's summary: In recent years witkop P. D. Khasov. VESTN DERMATOL VENFROL(white head) has been authoritatively described (Moskva) 45:85-87, February 1971. as being due to favus and not, as formerly believed, to syphilitic infection. Two cases in English summary: "at .:o-roentgenologicalboys aredescribed,inwhichthere was no analysis was madefor498patientswithevidence of a fungal cause. In both there was different tumor and tumor-like diseases of softserological evidence of syphilis and there was tissues. Among them 4 subjects were found withprompt healing after antisyphilitic therapy. So syphilitic gummas in the stage of ulceration. Thefar as the author can discover, witkop has not importance of contrast-free roentgenography inpreviouslybeendescribedasoccurringin differentialdiagnosis of syphilitic gummas isNorthern Nigeria. emphasized. The presence of uneven intensive darkening on the site of the ulcer with extensive * * * clearing inthe center differentiates syphilitic ulcer from cancerour ulcer in which a nev'ly formed tissue dominates over ulceration. RapidSYPHILITIC OSTIAL CORONARITIS. and significant increase of induration in softANALYSIS OF 6OBSERVATIONS.P. tissues and appearance of disintegration within aMichaud,H.Tennet,J.Chassignolle,J. P. short period of time is characteristic for syphili-Rassat, G. Dureau, and F. TenerielloClinique ticgumma.Introphiculcerthereisnode Chirurgie Cardiaque, Faculte de Medecine de significant increase of soft tissues around theLyon, Lyon, France. J CARDIOVASC SURG ulceration, no fungoid outgrowths, and no deep(Torino) 12:254-263, May-June 1971. infiltration of underlying soft tissues are noted." Authors'conclusionsandsummar:/: The * * * clinical and anatomic characteristics of syphilitic ostial coronary disease and the possibilities of its surgical treatment were studied, analyzing five SARCOIDAL REACTION OF THE SKIN INpersonal observations. SYPHILIS. Rattan Singh, Devinder Kaur, and M. ParameswaranDepartmentofDermatology, Syphilitic angina is characterized by a rapidly Maulana Azad Medical College, New Delhi1,developing anginal syndrome and resistance to India. BR J VENER DIS (London) 47:209-211,medical therapy. Aortic involvement is always June 1971. presentald may requireaprostheticvalve replacement. The ECG showssings of left A case is reported of late syphilis with skinventricularhypertrophyandofmycardial lesions having the clinical and histopathologicalischemia.

2 The extentof the occlusioninthe two syjptoms had completely disappeared, and the orifices may be equal or different, with coronary totalbilirubin was 0.4 mg per 100 ml, the blood flow reduced to less than one half of its alkaline phosphatase 16.4 Bodansky U, and the normal volume. The anatomic lesions are sus- serumglutamicoxalacetictransaminase 320 ceptible to be corrected with endarterectomy; Karmen U. Three weeks later the transaminase operative difficulties may be encountered if a and alkaline phosphatase had also returned to completely obstructed orifice is invisible. normal. Warthin-Starry silver stains were done on the liver and rectal biopsy tissue. The rectal Localcooling andperfusion through the lesions were packed with spirochetes, but none disobliterated left coronary ostium protects the were seen in the liver. myocardium and facilitates the prompt resump- tion of cardiac function. * * * In this series, one patient died postoperatively following a technically difficult valve replacement with a Starr prosthesis. LIVER DISEASE ASSOCIATED WITH SECON- DARY SYPHILIS. Richard V. Lee, George F. Immediate and lasting relief of anginal pain Thornton, and Harold 0. Conn-Yale University was obtained in all survivors; the ECG signs of School of Medicine, 333 Cedar Street, New ischemia disappeared as well. Simi la: to the few Haven, Connecticut 06510. N ENGL J ME0 casesreportedintheliterature,theresults (Boston) 284:1423-1425, June 24, 1971. obtainedin typeof disorder may be considered among the best that direct coronary Authors point out that jaundice occurring as artery surgery can offer. an unusual complication of early syphilis has been recognized for 400 years. However, knowl- * * * edge of the liver disease associated with secondary and early latent stages of syphilis is very inadequate. Since 1943, the authors have been LIVER DISEASE ASSOCIATED WITH EARLY able to find in the literature only six patients SYPHILIS. Alfred L. Baker, Marshall M. Kaplan, with this complication. A case is reported of a Hubert J. Wolfe, and John A. McGowanTufts- patient who presented with inflammatory liver New England Medical Center,171Harrison disease characterized by jaundice, hepatomegaly, Avenue, Boston, Massachusetts 02111. N ENGL and hepatic tenderness. The features appeared J MED (Boston) 284:1422-1423, June 24, 1971. promptly after penicillin was started. This case report is an example of a patient The laboratorj pattern, which showed modest with early syphilis who presented with jaundice. elevationof serumbilirubinandglutamic A 36-year-old homosexual was admitted with oxalacetic transaminase, was characterized by a j;.undice, dark urine and clay-colored stools of disproportionate elevation alkaline phosphatase. two, days' duration. Physical examination was This enormous increase declined progressively within normal limits except for mild icterus, a after treatment: but the alkaline phosphatase slightly enlarged liver, and a faint macular rash was still elevated long after other liver-function over the buttocks. Laboratory evaluation in- tests had returned to normal values. The propor- cluded a positive VDRL test; liver-function tests tionate elevation of 5'-nucleotidase levels late in showed a bilirubin of 6.4 mg total. Hepatitis- theillness reinforced the impression that the associated antigen was not present. Proctoscopy increased alkaline phosphatase was of hepatic revealed several shallow ulcers, 1 to 3 mm in origin. size, with overlying clotted blood 5 to 10 cm from the anus. Punch biopsy showed a dense Inadditiontoliverdisease,patient had lymphocytic and histiocyticinfiltratein the evidence of a renal lesion, with proteinuria and tunica propria, consistent with a primary syphili- cylindruria,andnonspecificurethritis.The tic lesion. Further VDRL, RPCF and FTA-ABS urethritis and nephritis clearedrapidly with tests were all positive. Treatment with 800,000 penicillin therapy. units intramuscular pen:ciilin was given daily for 10 days. One week after the last injection the * * *

3 ACUTE CHOROIDORETINITIS IN SECON- METRONIDAZOLE AS A POSSIBLE CAUSE DARY SYPHILIS. PRESENCE OF SPIRAL OF DIFFICULTIES 1N DIAGNOSIS OF SYPHI- ORGANISMS IN THE AQUEOUS HUMOUR. LIS (RUSSIAN). I. I. Ilyin, R. G. Rostova and P. A. MacFaul and R. D. CatterallDepartment V. A. Pasechnik. VESTN DERMATOL (Moskva) of Ophthalmology, Middlesex Hospital, London, 45:74-76, February 1971. England. BR J VENERDIS (London) 47:159-161,June 1971. English summary: "Eleven patients suffering simultaneously from secondary relapsing syphilis A case is described of bilateral, acute, syphili- and urogenital trichomoniasis were given anti- ticchoroidoretinitisinapatient with late trichomonal treatment with metronidazole in a secondary syphilis, in whom spiral organisms dose of 0.25 g 4-5 times daily for 5-6 days were detected in the aqueous humor. At the (the course dose 5-7 g). In addition to cure of time of the first examination only the right eye trichomoniasis there was flattening and reduc- was abnormal, with a dense anterior vitreous tion in size of hypertrophic papules the surface haze associated with a patch of active choroi- of which became dry and there occurred epithe- doretinitis in the lower nasal quadrant. After 7 lization of erosion elements. The number of T. days' treatment with)cal corticosteroid drops pallidum in the exudate decreased (down to and mydriatics, the uveitis was more marked. complete disappearance by the 6th day of Systemiz prednisolone was then started; after treatment in 9 out of 11 patier tsi, their move- one week there was slight improvement of the ment slowed down and some spocimms changed visual acuity in the right eye. After a further 17 their form. After administration of penicillin days the vision in the left eye was blurred. spiorchaetal fever was either modified of was Examination revealedthat visualacuity was absent completely. Thus, antitrichomonal treat- reduced to less than 6/60 in both eyes. Thement with metronidazole in mixed infection uveitis in the right eye was more marked, but may make detection of syphilis difficult." the leCt eye now showed dense vitreous haze and macular edema. Patient was then admitted to * * * thehospitalfor furtherinvestigation. Apart from the visual findings, physical examination revealedenlarged inguinal lymphathic nodes, discreteandnontender,andseveralfleshy lesionsontheprepucesuggestive of Laboratory Diagnosis condylomata lata. Wassermann, RPCF, VDRL and FTA gists were positive. The dose of pre inisolone was increased because of the pro- VALIDITY OF THE VDRL TEST ON aidvisualloss, and within 48 hours the CEREBROSPINAL FLUID CONTAMINATED itreous haze had subsided, revealing widespread BY BLOOD. N. N. Izzat, J. K. Bartruff, J. M. multifocalchorcidoretinallesions.Followirg Glicksman, W. R. Holder, andJ. M. Know treatment with daily intramuscular injections of Department of Dermatology and Syphilology, 600,000 units procaine penicillin for 14 days Baylor College Of Medicine, Houston, Texas and, in addition to the systemic corticosteroids, 7 7 0 25. BR J VENER DIS(London) the daily atropine drops and prednisolone drops 47:162-164, June 1971. 3 times daily, the condylomata lata disappeared and eyes improved rapidly. Authors comment Authors' summary: The "bloody tap" was that in the present state of knowledge itis experimentally reproduced as it might occur in probablydesirabletogiveantitreponemal syphilis patients by adding known quantities of therapysimultaneously with or immediatelyVDRL reactive blood to nonreactive cerebro- after the use of systemic or local corticosteroid:,, spinalfluid. The quantities of whole blood riot only inlatesyphilis but alsoinearly required to convert 1 ml. cerebrospinal tluid to infectious syphilis. seropositive ranged from 50 lambda [1 lambda = 0.001 ml.] for1:1 titre blood to 3 lambda for 1:256 titre blood. Three lambda of whole blood per ml. of cerebrospinal fluid caused a definite * * * blood color, whereas 1 lambda did not. With

4 VDRL titres of 1:256 or below, sufficient wholeSENSITIVITY AND SPECIFICITY OF AUTO- blood to cause afalsepositive cerebrospinalMATED SEROLOGIC TESTS FOR SYPHILIS. fluid VDRLtestproducesvisiblybloodyThomas R. Cate, Georganne G. Tiemann, and cerebrospinal fluid. JosephineFrinceDepartmentofMedicine, Duke University Medical Center, Durham, North * * * Carolina. AM J CLIN PATHOL (Baltimore) 55:735-739, June 1971. Authors' abstract: Sensitivity and specificity of the automated reagin and automated Kolmer tests for diagnosing syphilis were compared with those of the Venereal Disease Research Laborz- tory (VDRL) slide test and the manual Kolme: test, and the feasibility of using the automated procedures for routine hospital serologic tests was evaluated. All sera submitted for routine EVALUATION OF THE AUTOMATED FLUO- serologictestingforsyphilisina 2-month RESCENT TREPONEMAL ANTIBODY TESTperiod, 4,212 in number, were studied with FOR SYPHILIS. Joel H. Hornstein, Cornelius W. automatedreagin,automatedKolmer,and Gates, and Sue M. BrandonSerology Section,VDRL slide tests. Each serum reactive in one or Georgia Depa, tment of Public Health, 4i Trinitymore of these tests (227) and the preceding Avenue, S.W., Atlanta, Georgia 30334. J LABnonreactive serum (227) were studied with the CLIN MED (St. Louis) 77:885-890, May 1971.manual Kolmer and fluorescent treponemal antibody absorption (FTA-ABS) tests. Reactivity in "The need for increased serologic testing forthe FTA-ABS test was the criterion for diag- syphilis has placed added importance on thenosing syphilis, and all cases were late or latent fluorescenttreponemalantibodyabsorption (FTA-ABS) test as a confirmatory tool of theon review of the patients' hospital records. The diagnostician. However, the daily workload isautomatedreaginand VDRL tests were of comparablesensitivity(71%vs.73%)and limited by the availability of qualified personnel,specificity (97% vs. 96%), whereas the auto- complexity of the procedure, and expense ofmated Kolmer test appeared less satisfactory operation. This study was made in order tothan the manual Kolmer test (sensitivities, 60% evaluatethe automated fluroscent treponemal antibody (AFTA) test by comparing it to the vs. 66%; specificities, 67% vs. 73%). FTA-ABS test and clinical diagnosis. According * * * tothepatients'clinical diagnosis, fresh and frozenspecimens wereclassifiedasnormal, disease other than syphilis, and syphilis." On samples (741) from 219 specimens there wasTHE VALUE OF CONTEMPORARY SERO- 93.4percentcompleteagreementbetween LOGICAL TESTSIN DIAGNOSIS OF methods. Greater agreement between tests was ASYMPTOMATIC SOURCES OF INFECTION obtained with fresh, as opposed to frozen serum AND CONTACTS OF EARLY SYPHILIS (95.3% and92.5%respectively),andnon- (POLISH).W. Manikowska-LesinskaandK. syphilitic compared to syphilitic serum (97.6%Pudic).PRZEGL DERMATOL(Warszawa) and89.7%). Measurement to determinethe 58:157-162, March-April 1971. abilityof eachtesttoagreewith clinical diagnosis sht, wed comparable results with English summary: "The authors performed serum serological examinations of 901 persons without ofpatientswithprimary,secondary,early latent, and tertiary syphilis. Least comparability clinical manifestationswhowerereported occurred with late latent syphilis; the AFTA test sources of infection of contacts of patients with showed 81.8 percent in agreement with clinicalearly syphilis. Almost 2/3 of tire sercpositive diagnosis, the FTA-ABS showed 99.1 percentcases showed consistentlypositive results of agreement. bothcardiolipintests, which, together with anamr7isis, allowedthediagnosis. In there- * * * maining 1/3 of the patients the diag,__,sis was

5 made on the basis of positive results of the A PRELIMINARY STUDY OF THETre- FTA-ABS test. ponemal pallidumHAEMAGGLUTINATION TEST (TPH A). SodsaiVejjajiva, R utai "In the opinion of the authors, immediate Sk ulramrung,andSuphatraSuvanamilix performance of the FTA-ABS test for all persons De partmentofMicrobiology,Facultyof suspected of contact with early syphilis, at least Medicine, Chulalongkorn University. Bangkok, in centers of big cities, would be an optimal Thailand.J MED ASSOC THAI (Bangkok) organizational solution in the present epidemio- 54:256-259, Apiil 1971. logical .;ituation." Authors'summary: Thepassivehaemag- * * * glutination test fot the serodiagnosis of syphilis withanantigenderivedfrompathogenic Treponema pallidum has been evaluated. The methodissimple and highlysensitive. The results agreed well with FTA-ABS test in 28 syphiliticpatients.However,in62 patients suspected to be cases of syphilis, 9.26 percent

showed a positive resultt s the ''.PHA test but negative to the FTA-AB her those posi- INTHE THE ROLE OF SORBENT tive sera were truly syph: _ ,or merely gave ABSORBED FLUORESCENT TREPONEMAL false positive results,is ertain. The TP1A ANTIBODY (FTA-ABS) TEST. A. E. Wilkinson testin18serafro )ruralsubjects war. and C. C. WisemanVenereal Diseases Reference non-reactive. iioweNr,further studies of sera Laboratory(PHLS),TheLondonHospital, from patients with s\ pilis and those belonging Ashfield Street, London El, England. PROC R to the biological:se positive group, together SOC MED (London) 64:422-425, April 1971. with investigatio nto the reagents and techniques employc jve to be assessed before the Authors'summaryandconclusions:The significance of IPHA as a routine serodiagnostic sorbent used in the FTA-ABS test to remove test for syphilis can be accepted. group-reactiveanti-treponemalantibodyhas been shown to contain antigenic material from * * * Reiter treponemes. While this may act by a true antigen-antibody reaction, nonspecific effects, due to higho...molarityof the sorbent, are THESIGNIFICANCE OF CARDIOLIPIN thought to play an important part. I MMUNOFLUORESCENCE(CLF).D. J. M. Wrightand D. DoniachDepartmentof Sorbent does not necessarily remove all group Venereology,Guy'sHospital, London SE1, antibody from syphilitic sera, especially whe Englana.PROC R SOC MED (London) these are strongly reactive. The importanc:- of64:419-422, April 1971. the demonstration of the complete removal of group antibody from sera giving borderline or Authors previously describeda new anti- cardiolipin antibody which may be detected by weakly reactive results in the FTA-ABS test isthe indirect immunofluorescent technique on stressed. tissue substrates. This antibody was designated An ultrasonicate of Reiter treponemes wasas cardiolipin F (CLF) (Wright et al,1970). found to be a more effective and more reliable"The two types of cardiolipin antibodies found reagent than sorbent. Unfortunately difficulties in syphilis behave differently in that the classical WR and VDRL reagins tend to persist into the intheproductionof sonicateinsufficient quantities limitits use in practice. The idealchronic stages of the disease, while the CLF reagent should be one which will specificallyantibodyispresent mainly in the acute in- remove ail group-reactive antibody from sera,fectious phase, The maximal incidence and the this would permit quantitation of results and sohighest titres of CLF were found in early active enhance the value of the FTA-ABS test. syphilis, especially in the secondary stage of the disease. The early latent casIs gave similar titres * * * since many of the patients had hidden chancres.

6 .When the class of immunoglobulin in CLF NEON, :TAL CONGENITAL SYPHILIS. DIAG- was examineditwas found that, in primaryNOSIS BY THE ANTI IgM TREPONEMAL syphilis,IgM antibodies were detected niore FLUORESCENCE TL: Jacob Kipnis, Matio often than IgG....In secondary and early latent E.Camargo, Celestel'ilVdNetto, A. Walter cases, cardiolipin F titres were roughly equal Ferreira, and Dante B. Guarnieri- Departamento with both conjugates. Itis also of interest that de Ortopedia da Faculdade de Medicina da serveral cases of infectious relapse were first U.S.P., Sao Paulo,Brazil. REV INST MED detected by using the CLF with anti-IgM con- ROP SAO PAULO (Sao Paulo) 13:179-183, jugate." Au:hors conclude that the cardiolipin May -June 1971. fluorescencetest may be clinically usefulin deciding if a latent syphilitic should be regarded Authors' summary: In 20 cases of congenital as having early (infectious) or late latent (non- syphilis,IgM treponemalantibodieswere infectious) syphilis. The test can also be helpful searchedfor,ininfant serums, through the in the diagnosis of early seronegative primary immunofluorescence absorption test (FT. \ -ABS) syphilis and infectious relapsing cases. using anti IgM conjugates. The scope was to evaluatethetestas a possible guide to the * * * diagnosis of active infection and to the prescrip- tion of antisyphilitic therapy. Positive results were foundin13 cases, doubtful in 4 and negative in 3. Cardiolipin tests were positive in QUANTITATIVE DETERMINATION AND all, as well as anti IgG treponemal fluorescence SEROLOGICAL ACTIVITY OF 19SAND tests. In 4 cases which showed positive IgM tests, 7SIMMUNOGLUBULINS IN SECONDARY negative or doubtful results were seen in samples SYPHILIS(GERMAN). E. Kuwert,H. J. obtained a few weeks later,after treatment. Ititmann andK.Noll.Z IMMUNITAETS- Possible causes of the failure of the anti IgM FORSCH EXP KLIN IMMUNOL (Stuttgart) treponemal fluorescence test in 35 percent of 141:303-316, April 1971. our cases are discussed. English summary: "The concentrations of immunoglobulins M, G, and A were significantly * * * increasedinthe sera of 20 patients with an hitherto untreated secondary syphilis as compared to a control group of 30 healthy subjects. CLINICAL, IMMUNOCHEMICAL AND SERO- The mean values of IgM, and IgG were approxi- LOGICAL STUDIES OF DEMENTIA PARA- mately 50 percent higher than those of the LYTICA (GPI). H. Schmidt, E. Dein, E. Boje controls, whereas the difference in IgA was only Rasmusen,andJ.ClausenDepartment of 25percent. There wasalinear correlation Dermatology and Venereology, Odense Univer- betweenTreponema-specificantibodytiter sity Hospital, Odense, Denmark. ANTI ARCH (FTA-test) and increase of IgG. The de novoALLERGY APPL IMMUNOL(Basel) synthesis of IgG in syphilitic patients, therefore, 40:851-860, 1971. can beat least partlyinterpreted as a specific reaction towards the causative agent. By frac- Authors'abstract:Seraand cerebrospinal tionating (sucrose density centrifugation) the fluids from 32 patients (25 males and 7 females) sera of 3 more patients before, during, and after suffering from dementia paralytica, were assayed penicillin therapy it could be demonstrated that for seroreactivity by standard immunological cf. and precipitating lipoid antibodies in the tests, including the Wassermann reaction, Kahn's secondary stage of the disease occur in the 19S andMeinicke'sreactions,aswellasthe and 7S serum fractions, whereas Treponema- Treponema pallidum immobilization test. The specific antibodies are mainly found in the 7S data obtained were compared to the albumin fraction. The significance of this type of experi- and IgG content of serum and spinal fluid, ments using different Treponema- and tissue- assayedbythe quantitativeradial immuno- specific antigens for the elucidation of the diffusion. The data obtained were also compared pathogenesis of the disease is discussed." toerythrocytesedimentationrateandthe number of leucocytes in the blood and spinal * * * fluid specimens. Compared to normal adults, no

7 change occurredinsenim IgG and albumin Authors review the literature on the use of contentof patients with neurosyphilis. The cephaloridine in the treatment of syphilis and albumin and IgG levels were, however, increased briefly discuss the treatment of gonorrhca with inthespinalfluid.This increase showed a the two drugs. statisticalsignificantcorrelationto the total number of leucocytes in serum. The IgG level of * * * thespinalfluidwas not correlatedtothe st..roreactions or the results of the TPI test of the spinalfluid. On the other hand, a mutual TREATMENT OF EARLY SYPHILIS AND correlation was found between the results of the VENEREAL LYMPHOGRANULOMATOS IS individualserotests of thespinalfluid. The WITH DOXYCYCLINE (SPANISH). Hem= results obtained were discussed on a basis of the Hevia, Juan Honeyman, and Marcos De la literature available. ParraUridad de Dermatologia, Departmento de Especiadades, Hospital JJ. Aguirre, Universidad de Chile, Santiago de Chile. REV MED CHIL * * * (Santiago) 99:0.02-405, June 1971.

Englishsummary:"Doxycycline 200 mg initially and then 100 mg daily for 9 days was Therapy administered to 21 individuals with early syphi- CEPHALOSPORIN ANTIBIOTICSIN lis.Ten patients with venereal lymphogran- VENEREAL DISEASE. W. Christopher Duncan ulomatosis and5othersaffectedby both and John M. KnoxDepartment of Dermatologydiseases received 200 mg for 3 consecut;. - days and Syphilology, Baylor College of Medicine,and 100 mg/day during the following 12 days. Houston, Texas 77025. POSTGRAD MED J Ultramicroscopic study of lesions became nega- (London) 47:Supp1:1 19 -122, February 1971. 'Aveinthe course of thefirst 72 hours of therapy. Most cases showed negative Kahn test This report presents data from a study under earlierthansixmonths afterinitiationof wayatthe Houston Social Hygiene Clinic therapy. Results are rated as 'good' in all but evaluating cephalexin as an alternative antibiotic one instance of mixed infection characterized by for the treatment of syphilis. The study includes a slow disappearance of1( sions. Side effects 24 patients with primary and secondary syphilis. werenotsignificant.However, Herxheimer Two treatment regimens were followed. In 18 reactions accompanied the treatment in one- patients treated with 250 mg cephalexin 4 timesthird of the cases. A final word of recommenda- daily for 15 days, there were 9 failures-3 at 3tion for the use of this agent is given by the months post-treatment, 2 at 5 months, 1 each at authors." 6 and 7 months, and 2 at 8 months. Three patients presented eruptions of secondary syphi- * * * lis at follow-up. In all of the failures a decrease in titer occurred promptly and lesions healed in the usual time. Six patients have been treated with 500 mg q.i.d. for 15 days and have been followed for at least three months; at the time of this report the serological response appeared adequate.Fivepatients were known to 1.,e allergic to penicillin; however, none of these five noted any untoward effects from cephalexin. Authors suggest that the treatment failures at thelower dose couldrepresent poor drug absorbers; or, another possible reason for the persistence of infection may be related to the phenomenon of decreased antibacterial activity observed when cephalexinistested against a high inoculum of organisms.

8 Selected Bibliograpt2x *Jain PS: Witkop disease. Two "favoid"cases due to syphilis. BR J VENER DIS, London Syphi3is - Clinical 47:216-217, Jun 1971.

Anonymous:Syphilis.CALIF MED, San *Khazov PD: Clinico-roentgenologic manifesta- Francisco 115:47-60, Aug 1971. tions of gummatous syphilis involving the softtissues(RUSSIAN). VESTN DER- Andrejevic B, Jovioc D: Charcot's syphilitic MATOL VENEROL, Moskva 45:85-87, Feb n euro-arthropathy(CROATIAN).LI JEC 1971. VJESN, Zagreb 92:1039-1048, 1970. *Kulicz A, Rudzki Syphilis lesions of the *Baker AL, Kaplan MM. Wolfe Hi,et al: Liver stomach treated surgically (POLISH). POL diseaseassociated with earlysyphilis. N PRZEGL CHI R,Warszawa43:641-643; ENGL J MED, Boston 284:1422-1423,Jun 1971. 24, 1971. Le Clair, RA: Earlysyphilitic hepatitis. A Bo ldtI, Bucheler E: Luetic thoraco-lumbar possible case. BR .1 VENER DIS, London aorticaneurysmwitherosionofthe 47:212, Jun 1971. veitebralbody. (GERMAN) FORTSCHR GEB ROENTGENSTR NUKLEARMED, Stuttgart 114:846-849, Jun 1971. *Lee RV, Thornton GF,Conn HO: Liver disease associated with secondarysyphilis. N ENGL Co lomb D, Brunet C, Valignat P: A ghost: Soft J MED, Boston 284:1423-1425,Jun 24, chancre.Aproposof2 recentcases 1971. (FRENCH). LYON MED, Lyon 225:647-648, Apr 11, 1971. Lepercq G, Saada R, Steinschneider R: Study of 2 cases of congenital syphilitic hepatitis Dereux J, Dereux JF, Leuridan M: Tabetic withbiopsy(FRENCH). ANN MED Parinaud's syndrome (FRENCH).J SC1 INTERNE, Paris 122:633-638, May 1971. MED LILLE, Lille 88:173 -176, Mar 1970. intheage of Desmond FB: The diagnosisof infectious Luger A: Syphilis diagnosis antibiotics(GERMAN), WIEN KLIN syphilis. NZ MED J, Wellington 73:135-138, WOCHENSCHR, Vienna 83:241-245, Apr 9, Mar 1971. 1971. *EaglsteinWH: Congenialsyphilis. ARCH DERMATOL, Chicago103:524-52t., May *MacFaul PA, Catterall RD: Acute choroido- 1971. retinitis in secondary syphilis. Presence of spiral organisms in the aqueous humour. BR Fayala H: Congenital nasal syphilis repaired by J VENER DIS, London 47:159-161, Jun rhinoplasty (FRENCH). TUNIS MEI), Tunis 1971. 48:335-338, Sep-Oct 1970. M enk h au sG:Syphilisandpregnancy Heuillet G, Prudhomme F, Bailie Y: Aneurysm (GERMAN). ZENTRALBL GYNAEKOL, of the aorta and block of the right branch in Leipzig 92:625-627, May 16, 1970 a22yearoldman.Syphiliticorigin (FRENCH). BULL SOC FR DER.MATOL SYPHILIGR, Paris 76:482-436, 1969. *Michaud P, Termet H, Chassignolle J, et al: Syphilitic ostial coronaritis. Analysis of 6 *Win II, Rostova RG, Pasechnik VA: Metro- observations.JCARDIOVASC SUNG, nidazole as a possible reason for difficulty in Torino 12:254-263, May-Jun 1971. diagnosis of syphilis (RUSSIAN). VESTN DERMATOL VENEROL, Moskva 45:74-76, Mizuoka K: Syphilis (JAPANESE). NAIKA, Feb 1971. Tokyo 27:1256-1260, Jun 1971.

9 *Abstracted Morucci M, Placanica A, Forti G: Neonatal*Singh R, Kaur D, Parameswaran M: Sarcoidal osseous syphilis: Radiological diagnosis and reactionof theskininsyphilis. BR J evolu tiveaspects.(ITALIAN).NUNT VENER DIS,London 47:209-211, Jun RADIOL, Rome 35:213-231, Mar 1969. 1971.

Nikolov G: Myocarditis of syphilitic etiology Sowmini CN, Chellarnuthiah C: Horny syphi- (RUSSIAN). SOV MED, Moskva 33:50-55, lid e BR J VENERDIS,London Dec 1970, 47:213-215, Jun 1971. Perrot H, Beyvin AJ, Etienne R: Reappearance Storck H: Clinical and therapeutic aspects of of soft chancre (5 cases) (FRENCH). LYON syphilis(GERMAN). PRAXIS, Bern MED, Lyon 225:649-650, Apr 11, 1971. 60:412-419, Mar 30, 1971.

Petrovic J:fhe detection of lues by radio- Tozzo PJ: 0-chitis. MOD TREAT, New York photography(CROATIAN). PLUCNE 7:1044-1048, Sep 1970. BOLESTI TUBERK, Beograd 22.229-232, Jul-Sep 1970.

Poilpre E, Morin P, Piton M: Apropos of 2cases Syphilis - Laboratory Diagnosis ofauricularsyphilis(FRENCH). REV OTONEUROOPHTALMOL, Paris Basset A, Maleville J, Faye 1: New Survey of 43:136-140, Apr 1971. endemic syphilisin Senegal. Clinical and epidemiologicalstudy.Sero!ogicalstudy, *ProilaJC,KobayashiS,Yoshii Y, etal: isolation of a treponema strain (FRENCH). Diagnostic cytology of the stomach in gas- BULL SOC PATHOL EXOT,Paris tricsyphilis. Report of two cases. ACTA 62:1017-1034, Nov-Dec 1969. CYTOL, Baltimore 14:333-337, May 1970. Belli L, Cordero AA, Garranchan LE: Serology Rabello FE: Course and forms of syphilis ofsyphilis.Development andconcepts. (PORTUGUESE). AN BRAS DERMATOL, Study on 50 patients (SPANISH). PRENSA Rio de Janeiro 457255-266, Jul-Sep 1970. MED ARGENT, Buenos Aires 58:720-725, Jun 4, 1971. RabelloFE:Congenitalsyphilis.(PORT- UGUESE). AN BRAS DERMATOL, Rio de Blaurock G, Eh G, Krell L: Principle and Janeiro 45:377-388, Oct-Dec 1970. effectof anti-Treponema pallidaspecific syphilistests FTA and TPI (GERMAN). RuszelKB: Caseofsyphilisof thelung DTSCH GESUNDHEITSW,Berlin (POLISH).POL TYG LEK,Warszawa 26:1152-1156, Jun 17, 1971. 26:645-646, Apr 26, 1971. Brun R: Syphilis serodiagnosis and its clinical Sehgal VN, Rege VL, Vadiraj SN: Someun- interpretation. (FRENCH). PRAXIS, Bern usualmanifestationsofsyphilis.Con- 59:233-237, Feb 17, 1970. dylomata lata of the face. A retrospective diagnosis.BRJVENER DIS, London*Cate TR, Tiemann GG, Prince J: Sensitivity 47:204-205, Jun 1971. and specificity of automated serologic tests

forsyphilis.AMJ CLINPATH(); , Singh A, Katiyar BC, Ganguly SP: Paraplegia: Baltimore 55:735-739, Jun 1971. An aetiologicalsurvey.J INDIAN MED ASSOC, Calcutta 56:219-223, Apr 16, 1971. Fiumara NJ: A laboratory test is not a diagnosis. JAMA, Chicago 217:71, Jul 5, 1971. *Singh R, Kaur D, Parameswaran M: Infantile congenital syphilis. Prfsenting with bilateral GarofoliC: Serologicdiagnosisoflees orchitis. BRJ VENER DIS,London (ITALIAN). POLICLINICO (Prat), Roma 47:206-208, Jun 1971. 78:452-460, Jun 1, 1971.

'Abstracted 10 Georgescu M, Pogaceanu P, Israil A: Modern*Manikowska-Lesinska W, Pucilo K: The value serology of syphilis. II Preparation for pro- of contemporary serological tests in diag- ductionofacardiolipinantigen of the nosis of asymptomatic sources of infection VDRL typeforserodiagnosis of syphilis and contacts of early syphilis (POLISH). withaflocculationreaction. Value and PRZEGL DERMATOL, Warszawa methods of use. (RUMANIAN). MICRO- 58:157-162, Mar-Apr 1971. BIOL PARAZITOL EPIDEMIOL, Bucaresti 16:263-273, May-Jun 1971. Meyer-Rohn J: Serology of venereal infections (GERMAN). Z ALLGEME1NMED, Stuttgart Glenn JH, Turnbull AR: Automation of tic 47:887-890, Jun 20, 1971. Wassermann complement-fixation test using adiscreteanalyser. BR J VENER DIS, Morgenstern H: Results of the FTA test as a London 47:200-203, Jun 1971. routineexaminationinsyphilis serology (GERMAN). WIEN KLIN WOCHENSCHR, Heitmann HJ. Cerebrospinalfluid immuno- Vienna 82:155-156, Feb 27, 1970. globulins IgGinsyphilis. A quantitative studyofsyphilisaffectingthenervous Rocz I: Serologic tests for syphilis diagnosis in system (GERMAN). HAUTARZT, Berlin generalpractice(HUNGARIAN). ORV 21:477, Oct 1970. HETIL, Budapest 112:630-631, Mar 1971.

Heitmann HJ: Immunoglobulins in cerebro-*Schmidt H, Dein E, Rasmusen EB,etal: spinal fluid. Syphilis and IgG (GERMAN). Clinical,immunochemicalandserological DTSCH MED WOCHENSCHR, Stuttgart studies of dementia paralytica (GPI). INT 96:966-967, May 28, 1971. ARCH ALLERGY APPL IMMUNOL, Basel 40:851-860, 1971. *Hornstein JH, Gates CW, Brandon SM: Evalua- tionoftheautomatedfluorescent Scott JG, Weed RI, Swisher SN: Membrane treponemal antibody test for syphilis. J LAB destructionin paroxysmal cold hemoglo- CLIN MED, St.Louis 77:885-890, May binuria. VOX SANG, Basel 13:308-313, Oct 1971. 1967. *lzzat NN, Bartruff JK, Giicksman JM, et al: Validity of the VDRL test on cerebrospinal SkripkinIUK, ReznikovEK:Clinico- fluid contaminated by blood. BR J VENER prognostic significance of the Treponema DIS, London 47:162-164, Jun 1971. pallidum immobilization reaction in patients withseroresistaritsyphilis(RUSSIAN). VESTN DERMATOL VENEROL, Moskva *Kipnis J, Camargo ME, Fava Netto C, et al: 45:58-62, Jan 1971. Neonatal congenital syphilis. Diagnosis by the anti IgM treponemal fluorescence test.*Vejjajiva S, Sakulramrung R, Suvanamalix S: REV INST MED TROP SAO PAULO A preliminary study of theTreponema 13:179-183, May-Jun 1971. pallidum haemagglutination test (TPHA). J MED ASSOC THAI, Bangkok 54:256-259, Kozakiewicz J, Muszkowska-Penson J: Signifi- Apr 1971. cance of the Nelson reaction in the diagnosis of syphilitic organ involvement (POLISH). POL TYG LEK, Warszawa 26:706-708, May*Wilkinson AE, Wiseman CC: Therole of 10, 1971. sorbentinthe absorbedfluorescenttre- ponemal antibody (FTA-ABS) test. PROC R *Kuwert E, Heitmann HJ, Noll K: Quantitative SOC MED, London 6:422-425, Apr 1971. determination and serologicalactivity of 19S- and 75-immunoglobulins in secondary *Wright JM, Doniach D: The significance of syphilis (GERMAN). Z IMMUNITAETS- cardiolipinimmunofluorescence(CLF). FORSCH EXP KLIN IMMUNOL, Stuttgart PROC R SOC MED, London 64:419-422, 141:303-316, Apr 1971. Apr 1971.

11 *Abstracted Syphilis - Therapy Kleinhans D: Blood level studies on the depot effect of clemizole-penicillin G in antiluetic therapy (GERMAN). Z HAUT GESCHLECHTSKR, Berlin 46:359-365, Jun *Duncan WC, Knox, JM: Cephalosporin anti- 1, 1971. bioticsinvenerealdisease. POSTGRAD MED J, London 47:SUPPL:119-122, Feb Luger A: Site of action of efficacy of anti- 1971. syphilitic treatment with penicillin. II Prob- lemsofpenicillindosage(GERMAN). HeiteHJ:Therapy of venerealinfections HAUTARZT, Berlin 22:1-6, Jan 1971. (GERMAN). Z ALLGEMEINMED, Stuttgart 47:457-462, Mar 31, 1971. Luger A, Pavlik F: Effect of corticosteroids on theJarisch-Herxheimerreaction *Hevi3 H, Honeyman J, De La Parra M: Treat- (GERMAN). WIEN KLIN WOCHENSCHR, ment of early syphilis and venereal lympho- Vienna 83:208-212, Mar 26, 1971. granulomatosiswithdoxycyclines (SPANISH). REV MED CHIL, Santiago Marill FG, Alline M, Ysmail-Dahlouk M: Non 99:402-405, Jun 1971. orinsufficientactionof discontinuous penicillino-bismuth treatments on the sero- Danner M: Treatment of venerealdiseases logy of ancient syphilis (FRENCH). BULL (GERMAN). Z ALLGEMEINMED, Stuttgart SOC FR DERMATOL SYPHILIGR, Paris 47:891-899, Jun 20, 1971. 77:900-902, 1970.

*Abstracted 12 GONORRI-i EA group;onlyonehadknowledgeofbeing exposed to gonorrhea; three were pregnant. The frequently asymptomatic nature of gonorrhea in Clinical females, combined with a definable incidence of infection in this patient group, suggests that DISSEMINATED GONOCOCCAL INFECTION. morefrequentuseofculturalmethods King K. Holmes, George W. Counts, and Harry employing TM medium would help control this N. BeatyDepartment of Medicine, U.S. Public rapidly increasing disease. Cultures are parti- Health Service Hospital, Seattle, Washington. cularly recommended for women under 30 years ANN INTERN MED (Philadelphia) 74:979-993, who aresingle, pregnant, or manifest acute June 1971. vaginitis. * * * Authors' abstract: The recent marked increase in incidence of gonorrhea prompted this analysisGONOCOCCAL VULVOVAGINITIS AND of the systemic manifestations of gonococcal POSSIBLE PERITONITIS IN PREPUBERTAL infection.Of 42 patients with disseminated GIRLS.VirgilF.BurryChildren'sMercy infection, 79 percent were women. Most had Hospital, 24th at Gillham Road, Kansas Ci'y, asymptomatic anogenitalinfections, anddis- Missouri 64108. AM J DIS CHILD (Chicago) semination arose during pregnancy or menstrua- 121:536-537, June 1971. tion in 71percent. Arthritis occurred in 38 patients,in whom acharacteristicclinical Casehistories arepresented of four pre- picture was seen. An initial "Bacteremic stage," pubertal girls, one 10-year-old and three 6-year- with polyarthralgias, skin lesions, and positive olds, who presented with signs and symptoms blood cultures, was followed by a "septic joint compatible with peritonitis. These four repre- stage," with positive synovial fluid cultures or sent approximately 10 percent of the young girls joint destruction. Blood cultures were positive in seenat the Children's Mercy Hospital. Each 9 of 13 patients seen within 2 days of the onset child had fever, diffuse abdominal pain, rebound of symptoms, and cell-wall-deficient gonococci tenderness,anddecreasedbowelsounds. were isolated from a "sterile" septic joint. These Vomiting or anorexia was present in all four. findings discount anyroleof cross-reactive Rectal examination showed diffuse tenderness in antigens and antibodies in the pathogenesis of every child. Laboratory results were supportive "sterile" gonococcalarthritis.Liver function or compatible to peritonitis in all instances. In abnormalities were detected in 14 patients, and each case, the response to penicillin therapy was myocarditisorpericarditisoccurredin10 most dramatic. Author concludes that in view of patients. Meningitis occurred in two patients, the general increase in gonorrhea this condition and endocarditis led to death in one patient and may become more common in children in the to valve replacement in another. future. * * * * * *

GONORRHEA IN WOMEN. Martin HartLaboratoryDiagnosis Center for Disease Control, Venereal Disease Research Laboratory, Atlanta, Georgia 30333.CARBOHYDRATE FERMENTATION JAMA (Chicago) 216:1609-1611, June 7, 1971. PATTERNS OFNeisseriameningitidisDe- TERMINED BY A MICROTITER METHOD. Author's abstract: Two hundred thirty-one J. A. Davies,J. R. Mitzel, and W. E. Beam, femalepatientsof private obstetricians andJr.Naval Medical Field Ref arch Laboratory, gynecologists were examinedfor gonorrhea,Camp Lejeune, North Carolina 28542. APPL using cultural techniques. Specimens wre takenMICROBIOL (Baltimore) 21:1072-1074, June from the cervix and rectum of all patients and 1971. culturedonThayer-Martin(TM)selective medium. Six, or 2.6 percent, were found posi- Authors' abstract: A carbohydrate fermenta- tive. Of these, all were in the 20- to 29-yea- age tion technique has been developed and com-

13 pared to the standard fermentation test with gonorrheal urethritis received a course dose of cystine-trypticase-semisolid agar for the identifi- the drug of 2,400,000 Units (2 injections of cationofNeisseriameningitidis.This new 1,200,000 U. each). In total urethritis compli- method utilizes Mueller-Hinton broth as a basal cated by epididymitis and prostatitis the course substrateand isperformedwithmicrotiter dose was increased to 3,000,000-3,600,000 U. methods. By using Mueller-Hinton broth with or more. The injections of the drug were given at and without the addition of antibiotics, the 72-hour intervals each of 1,200,000 U. The method can be adjusted to test the fermentation patients with complicated gonorrheal urethritis patterns of allof theNeisseriaincludingN. were givenadditionaltherapy(autohemo- gonorrhoeae. therapy, pyrogenale, etc.). As a result of the treatment,gonococcidisappearedfromthe * * * urethral secretion in all 64 patients. The follow- up demonstrated stable etiological cure of 60 THE IMPORTANCE OF CULTURAL IDENTI-men. A relapse of the disease was observed in 4 FICATION OFNeisseria gonorrhoeaeFOR THEmen.In6 out of 60 curedpatientspost- DIAGNOSIS OF PROBLEMATIC CLINICALgonorrheal urethritis was observed. The treat- CASES (GERMAN). Erika Friedrich and Sabinement was well tolerated by the patients." Zaumseil HautklinikderMartin-Luther- * * * UniversitatHalle-Wittenberg,Ernst-Kromayer- Str.5-8, 402 Halle (Saale), West Germany. DTSCH GESUNDHEITSW (Berlin) 26:401-404, February 25, 1971. GENTAMYCIN IN THERAPY OF VENEREAL DISEASE (ITALIAN). C. Pelfini and L. Bruni English summary: "The results of tests withInstituto de Clinica Dermatologic dell'Universita gonococci cultures made in the years betweende Pavia, Italy. G ITAL CHEMIOTER (Milano) 1967 and1969incases of diseases of the16:341-344, Jan-Sep 1969. urinary passage where the microscopy findings were not clear or negative, are made known. In Englishsummary:"Gentamycinwas 501of2117 examinedpatientsgonorrheaemployed during the second half of 1968 in the could be diagnosed culturally.There was just amanagement of a series of out-patients at the slight change in the proportion of the positiveDepartment of Clinical Dermatology of the andnegativeculturefindings. However, theUniversity of Pavia. These included 18 forms of number of men who were examined culturally,gonococci urethritis (8 of which were resistant and alsothe number of men with positivetoother antibiotics), 20 forms of bacterial findings increased considerably. The discussion(non-gonococci)urethritis and two forms of deals with the importance of the cultural identi-primary syphilis. Six of the 10 non-antibiotic- fication ofNeisseria gonorrhoeae." resistant gonococci urethritis cases responded to * * * gentamycin, while the remaining 4 cases were subsequentlyresolved withpenicillin.Six resistant cases (penicillin or tetracycline) gave a positive response to gentamycin. Prompt cure Therapy was obtained in18 aspecific urethritis cases. Paraboloid assessment showed that gentamycin BICILLIN-6 THERAPY OF GONORRHEA INhad no effect in the two cases of syphilis. It is MEN (RUSSIAN).V. E.Grigoriev,F. V.submitted that gentamycin is only slightly effec- Potapney, A. A. Skuratovich, Yu. I. Grachev,tive against gonorrhea and useless against tre- andG. A.Voskresenskaya.VESTN DER-ponema. On the other hand, it attacks some MATOL VENEROL (Moskva)45:74-77,gonococcus strains that are resistant to penicillin January 1971. or tetracycline and is valuable in the management of aspecific bacterial urethritis. English summary: "Treatment with bic n-6 was given to 64 men with complicated and uncomplicatedgonorrhealurethritis.The patients with uncomplicated acute and subacute * * *

14 RIFADIN (RIFAMPICIN) IN THE TREAT- Because of its large antibiotic range Sulmycin is MENT OF GONORRHOEA IN UGANDA. A the remedy of choice for treatment of mixed CONTROLLED TRIAL. 0. P. Arya, S. K. Rao, infectionswith N. gonorrhoeae andpenicil- andE.NnochiriDepartment of Preventive linase-producing microorganisms. The authors MedicineandMedical Microbiology. Makere warnagainstsubliminalSulmycintherapy. University, Kampala, Uganda. BR J VENER DIS Raising the daily dose or shortei,ing the time of (London) 47:184-18i, June 1971. therapy is discussed.

Authors'summary: A trialofRi:adin * * * (rifamp:cin) compared withpenicilliiinthe treatment of 203 cases of gonorrhea isde- scribed. Six capsules each of 150 mg. given in a SENSITIVITY TO ANTIBIOTICS OF GONO- single dose yielded a cure rate of 87.1 percent, COCCA LSTRAINSISOLATED FROM comparedtothe 89.5 percent achieved by SAILORS AT ROTTERDAM. A. Wols-Van der procaine penicillin 2.4 m.u. Rifadin appeared to WielenDepartmentof Dermatologyofthe be free from toxic effects in the dosage used. Rotterdam Medical Faculty, Rotterdam, The There was evidence that it did not mask con- Netherlands.BRJ VENER DIS (London) currentsyphiliticinfection.Inviewofits 47:190-191, June 1971. potential in the treatment of tuberculosis, the authors advise that this drug should be used in Author's summary: Gonococcal strains from gonorrhea onlyasan alternativeinspecial cases of gonorrheain201 seamen and 216 circumstances. patients of other occupations in Rotterdam were investigated for sensitivity to penicillin and to * * * four other antibiotics. For all the antibiotics tested, the proportion of less sensitive strains TREATMENT OF GONORRHEA WITH SUL- was significantly higher in the seamen. A major MYCIN (GERMAN).D.HantschkeandJ. cause of the difference between infectionF in Maus sA k a d Oberrat,Derm.Kliniku. seamen and in the indigenous population was Poliklinik Essen der Ruhr-Universitat, Bochum, the factor of selection by previous unsuccessful Germany. Z HAUT GESCHLECHTSKR (Berlin) treatment inthe cases in seamen. When this 45:407-412, May 15, 1970. factorwasexcludedby a comparisonof untreated cases in seamen and in the indigenous English summary: "Because of increasing in- group, there was still a significant preponderance sensitivity of Neisseria gonorrhoeae strains to of partially resistant organisms in the cases in penicillin and the rising rate of penicillin allergy, seamen. Further analysis of untreated cases in 23 patients with gonorrhea were treated with seamen failed to reveal a significant difference Sulmycin (gentamycin). For three days, male between infections acquired in Europe and those patients received 2 x 80 mg, female patients 3 x caught overseas. 89 mg Sylnr.--inintramuscularly. After th' * * * second and,ntidday of treatment, micro- scopical and cultural conro!s followed. Under this treatment 22 patients were cured. In only APROPOS OF THE STUDY OF THE SENSI- one female patient was N. gonorrhoeae found in TIVITY TO ANTIBIOTICS OF GONOCOCCI the cervical smear after the first and second STRAINS ISOLATED AT YAOUNDE. EPI- culture-control.This patient made tap-waterDEMIOLOGIC, BACTERIOLOGIC AND irrigations of her vagina during treatment four toTHERAPEUTIC CONSIDERATIONS five times a day. She was cured with penicillin (FRENCH). Jacques Milian and Maurice Huet G-Na. No sideeffects were noted afterTravail de l'Institut Pasteur du Cameroun, B. P. Sulmycin. 888, Yaounde, Cameroon, Africa. BULL SOC PATHOL EXOT (Paris) 63:642-652, November- "If a concurrent syphilis is suspected, therapy December 1970. with Sulmycinispossible immediately. The syphilis will not be masked, because Treponema Englishsummary: "The author makes a pallidum is not affected at all by this antibiotic. survey of the gonorrhea incidence at Yaounde

15 and studies the sensitivity of the N. gonorrhoeae strainsisolatedat Yaounde testedwith the method of gel diffusion from discs, against 19 antibiotics and one sulfonamide. The results were as follows: 8 strains out of 18 show a decreased sensitivity to penicillin; 42 strains out of 49 are streptomycin-resistant; there does not exist any significant decrease of sensitivity to the other antibiotics generally used in gonorrhea treatment; 7 strains oat of 14 have a low or no sensitivitytosulfamethoxypyridazine.The author draws practical conclusionas to the application of anti-gonorrhea treatments in the Public Health dispensaries in Cameroon." * * *

16 Selected Bibliography Russo E.Resurgence of gonorrhea and its diagnosisbythegonoreaction (PORTU- Gonorrhea - ClinIcal GUESE). REV BRAS MED, Rio de Janeiro 28:99-103, Mar 1971.

Gonorrhea - Therapy *BurryVF: Gonococcalvulvovaginitisand possible peritonitis in prepubertal girls. AM DIS CHILD, Chicago121:536-537, Jun Anonymous: Choice of penicillins for gonor- 1971. rhoea. BR MED J, London 2:485, May 29, 1971. *Hart M: Gonorrhea in women. JAMA, Chicago 216:1609-1611,Jun 7, 1971. *Arya OP, Rao SK, Nnochiri E: Rifadin (rifampicin) in the treatment of gonorrhoea in *Holmes KK, Counts GW, Beaty HN: Dis- Uganda. A controlledtrial. BR J VENER seminatedgonococcalinfecti:m.ANN DIS, London 47:184-187, Jun 1971. INTERN MED, Philadelphia 74:979-993, Jun 1971. Fernandes M: Gonorrheal Urethritis [Review article]. MOD TREAT, NewYork Krunic R, Arneric S, Jankovic D: Gonorrheal 7:1002-1010, Sep 1970. and non-gonorrheal urethritis (SERBIAN). SRP ARK CELOK LEK,Beograd *Grigoriev VE, Potapnev FV, Skuratovich AA, 98:919-924, Jun 1970. et al: Bicillin-6 therapy of gonorrhea in men (RUSSIAN).VESTN DERMATOL. Meyer-Rohn J: Diagnosis of gonorrhea (GER- VENEROL, Moskva 45:74-77, Jan 1971. MAN). Z ALLGEMEINMED,Stuttgart 47:883-886, Jun 20, ;971. *Hantschke D, Mauss J: Treatment of gonorrhea withsulmycin(GERMAN). Z HAUT Pazin GJ Schmale JD: Gonorrhea. AM FAM GESCHLECHTSKR,Berlin45:407-412, PHYSICIAN, Kansas City 3:124-137, Jun May 15, 1970. 1971. Liden S, Hammar H, Hillstrom L: Treatment of Vlasis G: Treatment of Bartholin cysts. AM uncomplicated gonorrhoea with a single oral FAM PHYSICIAN, Kansas City 3:85-86, Jun doseofdoxycycline.ACTA DERM 1971. VENEREOL, Stockholm 51:22i-224,1971.

Loza-Tulimowska M, Duda B: Treatment of Gonorrhea gonorrhea in younggirls (POLISH). Laboratory Diagnosis PRZEGL DERMATOL, Warszawa 58:183-186, Mar-Apr 1971. *Davies JA, Mitzel JR, Beam WE, Jr: Carbo- hydrate fermentation patterns of Neisseria *Milian J, Huet M: Apropos of the study of the meningitidisdeterminedbyamicrotiter sensitivitytoantibio''csof gonococcic method. APPL MICROBIOL,Baltimore strains isolated at Yaounde. Epidemiologic, 21:1072-1074, Jun 1971. bacteriologic and therapeutic considerations (FRENCH) BULL SOC PATHOL EXOT, *Friedrich E, Zaumseil S: The importance of Paris 63:642-652, Nov-Dec 1970 culturalidentification of Neisseria gonor- rhoeaeforthediagnosis of problematic Ongom 'IL: A "single dose" treatment of clinicalcases(GERMAN). DTSCH gonococcal urethritis with rifampicin. BR J GESUiNDHEITSW, Berlin 26:401-404, Feb VENER DIS,London47:188-189, Jun 25, 1971. 1971.

17 *Abstracted *Pelfini C, Bruni L: Gentamycin in therapy of venerealdiseases(ITALIAN). G ITAL CHEMIOTER, Milano 16:341-344, Jan-Sep 1969.

Peter M, Uuvary E, Laszlo I: On the antibiotic sensitivityofstraits of Neisseria gonorrhoeae (RUMANIAN). MICROBIOL PARA- ZITOL EPIDEMIOL. Bucaresti 16:153-157, Mar-Apr 1971. *Wols-Van r Wielen A: Sensitivity to anti- bio ics of gonococcal strains isolated from sailors at Rotterdam. BR J VENER DIS, London 47:190-191, Jun 1971.

Abstracted 18 MINOR VENEREAL AND RELATED DISEASES

INCIDENCE OF CANDIDA ALBICANS ,N monas infestation exists among the western and WOMEN USING ORAL CONTRACEPTIVES, young Israeli -horn women as compared to those H.KalundJensen,P. A.Hansen, and Jens originating from eastern countries. This observa- Blom--Depart men tofGynaecologyand tion is of considerable interest in view of the Obstetrics,theCentral-lospital,Naestved. higher standardc ing, higher educational Denmark. ACTA OBSTET GYNECOL SCAND backgrounds and better sanitary conditions pre- (Lund) 49:293-296, 1970. vailing in the former groups. These differences in the incidence of trichomoniasis could be related Authors' abstract: An attempt was made to to the particularly strict observance on the part evaluate, by means of culture investigations. the of eastern communities of religious laws and incidence of candida albicans in 276 healthy principlesforbiddingextra-maritalsexual women of fertile age. The patients were divided relations. intothree groups asfollows: Group P (80 subjects), users of oral contraceptives: groups NP The cytopathologic findings showed a higher (158 subjects) non-users; group AP (38 sub- frequency of dysplasias and endocervical hyper- jects), former users. Group P included 15 per- plasias in the presence of tric.iomoniasis as well cent with candida albicans and 56 percent with asa close association of this infection with erosion, as against 5 percent and 24 percent. benign lesions of the cervix. The regression of respectively,in group NP. The difference in these cellular patterns upon treatment indicates incidenceof candidaalbicansanderosion acausalrelationshipbetween thecytologic between groups P and NP is significant at the 5 abnormalities and trichomoniasis. No evidence percentlevel. No significantdifference was for a higher incidence of malignancy of the foundbetweengroupsNPandAP. The cervix in patients with benign dysplastic lesions incidence of candida albicans, trichomonas and and with T. vaginalis infections was obtained. erosion is discussed and compared with previous reports. * * * * * * COMPARATIVE MICROSCOPY, CULTURE AND SEROLOGY STUDIES ON Trichomonas THE EPIDEMIOLOGY OF TRICHOMONIASIS vaginalis (GERMAN). K. J. Beck, M. Saathoff, . ND THE ROLE OF THIS INFECTION IN H. M erk 1 UniversitatsFrauenklinikBonn, THE DEVELOPMENT OF CARCINOMA OF Bonn,Germany. GEBURTSHILFE THE CERVIX. B. Bertini, and M. Hornstein FRAUENHEILKD (Stuttgart) 31:551-560, June Central Laboratory of Endocrinology and Cyto- 1971. logy, Kupat Holim Health Insurance Institution, Tel-Aviv,Israel. ACTA CYTOL (Baltimore) English summary: "A comparative study in 14:325-332, May 1970. 600 consecutive patients by wet-mount, culture :Ind serology was done for Trichomonas vaginalis Authors' summary: Epidemiologic and cyto- inwomen. Compared to our culture in the logic aspects of1,450 cases of T.vaginalis Asami-medkanonly,70.7percentofthe infections and of 1,153 cases of non-parasitic existing infections were diagnosed by the un- inflammations were investigated. It was found stained wet-mount preparation and only 63.8 that a significantly higher frequency of Tricho- percent of the infections were diagnosed in the

19 routinecytologicsmearaccordingto is an antibacterial and antifungal compound, is Papanicolaou. also endowed with trichomonacidal properties demonstratedinvitroonpurecultures of "The serologic diagnosis of aT.vaginalis Trichomonas vaginalis. The minimal concentra- infectionis more of scientificinterest. The tion inhibiting the growth of the culture is 0.125 complementfixationreactionof Hennessen ug/ml; the minimal lethal concentration on a showed antibodies in approximately 75 percent two days old culture is 1.0 ug/ml. This activity of the infections. In some cases it was found is, however, less effective in vivo on trichomonas that positive serologyis not necessarily diag- implanted experimentally in Rat vagina since the nostic of an existing infection since antibodies best conditions (topical applications in a hydro- may be found for some time following the cure soluble excipient of a daily dose of 10 mg per of a trichomonas vaginitis. The Asami-medium animal duringsixdays),thepercentage of was alsousefulfor the diagnosis of vaginal animals freed from parasites hardly attains 50 mycosis. The unstained fresh preparation and per 100." the Papanicolaou smear were insufficient for the diagnosis of fungi. In our unselected series 10.3 * * * -'ent of the women were found to have T. ails and 14 percent of the patients showed HERPES GENITALIS IN WOMEN ATTEND- ING PLANNED PARENTHOOD OF NEW YORK CITY. Wanda H. Wolinska and Myron R. * * * MelamedMemorial Hospitalfor Cancer and STRAINS OF Trichomonas vaginalis RESIS- Allied Diseases, New York, New York 10021. TANT TO METRONIDAZOLE (RUSSIAN). ACTA CYTOL (Baltimore)14:239-242, May L. M. Korik. VESTN DERMATOL VENEROL 1970. (Moskva) 45:77-80, January 1971. Authors' summary: During a 30 month in- English summary."It was shown experi- terval, cytologic evidence of herpes genitalis was mentally that strains of Trichomonas vaginalis foundin37 women from a population isolatedfrompatientstreatedwith metro- 43,318 who were attending various centers of nidazole were less sensitive than trichomonads PlannedParenthoodof NewYorkCity originating from untreated patients. As a result (PPNYC). The overall rate of 0.09 percent for of passages of trichomonad strains in media with this disease was within the range reported from graduallyincreasing concentrations of metro- comparablecenterselsewhere. Women using nidazole strains were obtained with sensitivity various forms of contraception had lower rates reduced 2.5 to 2000-fold as compared to the of herpes than did women who were using no original strains. Failures of metronidazole treat- contraceptive. The reason for this is not clear ment in the majority of cases may be explained from this study but it does appear that the use by poor sensitivityof trichomonads to this of steroid and other contraceptives does not add drug." to the risk of disease and may in some way minimize it. * * * * * *

STUDY OF THE TRICHOMONACIDAL PROP- ERTIES OF PYRITHIONE (SODIUM SALT OF TRANSPORT OF HERPES SIMPLEX VIRUS I HYDROXY-2 (1,H)PYRIDINETHIONE) IN STUART'S MEDIUM. P. Rodin, M. J. Hare, (FRENCH). R. Cavier and J. CenacLaboratoire C. F. Barwell, and M. J. WithersDepartments deParasitologie,FacultedePharmacie,4, of Venereology and Bacteriology, The London avenuedeL'Observatoire,F.75-Paris-06, Hospital, London, England. BR J VENER DIS France. ANN PHARM FR (Paris) 29:211-214, (London) 47:198-199, June 1971. March 1971. Authors'summary:Stuart'stransport English summary: "Pyrithione, the sodium medium is compared with a plain swab and a salt of 1-hydroxy-2 (1,1-1)-pyridinethione, which virus transport medium for transporting speci-

20 mens fromgenitallesionsforherpes virus were 17 positives. Of these 17 patients, 7 males culture. Stuart's medium proved satisfactory and and5 females were positive also for T-strain can be used in cases in which thearrival of the mycoplasma. specimen at the laboratory may be delz ;ed. For general useithastheadvantage over virus * * * transport medium thatitisalso suitable for transporting bacteria. Mycoplasmahominis AND POSTPARTUM * * FEBRILE COMPLICATIONS.HerbertJ. Harwick, Robert H. Purcell, Bruce luppa, and F. STUDY OF MYCOPLASMA IN UNIVERSITY Robert Fekety, Jr.Research Service, Veterans STUDENTS WITH NON-GONOCOCCAL Administration Center, Los Angeles, California URETHRITIS. SuzanneSueltmann, Virginia 90073.OBSTET GYNECOL (NewYork) Allen, S. L. Inhorn, and J. M. BenforadoState 37:765-768, May 1971. Laboratoryof Hygiene, The Universityof WisconsinMedicalCenter, 437 Henry Mall, Authors' abstract: The role played by large Madison, Wisconsin 53706. HEALTH LAB SCI colony mycoplasmas was assessedin patients (New York) 8:62-66, April 1971. with nonspecific postpartum fever. The overall rateof feverafter delivery was 7percent. A total of 650 specimens were cultured from Mycoplasma hominis was recovered from the 339 students (250 symptomatic, 89 control genital tract of 12 of 37 febrile patients, four of patients).Using asimple technique for the 37 postpartum controls and four of 25 third- culture of T-strain mycoplasma from urethral trimester prepartum patients. Frequency of anti- swabs as well as urine specimens, it was possible body response to M. hominis was also higher in to isolate both the T-strains and M. hominis. febrile patients. Whereas M. hominis may play a role in the etiology of the nonspecific fever seen The media usedfor T-strain mycoplasma after delivery, frequency of antibody response consisted of commercial PPLO agar and broth, to T-strain mycoplasmas was similar in both supplemented with 10 percent horse serum, 10 febrile and control groups. percentyeastextract,withtheadditional supplement,infinalconcentration, of 1000 unite /ml penicillin, 0.05 percent urea, and 0.002 * ** percent phenol red. While these were the media uses. in this current investigation, authors report that subsequent study has shown thatpercent THE EFFECT OF ANTIBIOTIC THERAPY ON yeast extract concentration in broth is sufficient MYCOPLASMA IN THE FEMALE GENITAL to support good growth, and frequently itis TRACT. IN VITRO AND IN VIVO STUDIES superior.The mediafor M.hominis were ON THE SENSITIVITY OF Mycoplasma essentially the same, differing only in final pH, hominis AND T-Mycoplasmas TO TETRA- theomissionof urea, andtheadditionof CYCLINES AND OTHER ANTIBIOTICS. Lars thalium acetate. Westrom and Per-Anders MardhDepartment of Obstetrics and Gynaecology, University Hospital T-strain mycoplasma was isolated from 68 ofLund,Lund,Sweden. ACTA OBSTET percent of the symptomatic males (132 of 193) GYNECOL SCAND (Lund) 50:25-31, 1971. andfrom 63percentofthesymptomatic females (36 of 57). The isolation rates among Authors' abstract: The susceptibility of M. controlpatientswere 25 percent and 35.8 hominis and T-mycoplasmas to different anti- percent respectively. M. hominis was isolated in bioticsinvitro has been studied. A clinical 24 of the symptomatic males and 19 of the assessmentof metacychne,lincomycinand females. On occasion, both T-strain and M. chloramphenicc'lingenitalinfectionsinthe hominis were isolated from the same individual. female, with special reference to M. hominis and T-mycoplasmas isal:xi.presented. After treat- Of the cultures from 122 individuals in whom ment withmetacyclineorlincomycin, M. cultures for N. gonorrhoeae were made, there hominis was rarely isolated and in the majority

21 of cases such therapy was followed by a dis- CEPHALEXIN MONOHYDRATE IN THE appearance of symptoms and signs of infection TREATMENT OF URINARY TRACT and a rapid re-establi,:hment of a vaginal flora INFECTIONS AND URETHRITIS.Heonir dominated by Doderlein's bacillus. In patients RochaandFranciscoPeltierQueiroz who hadreceivedchioramphemcol, cultures Department of Medicine, Faculty of Medicine, yielded in most cases growth of M. hominis, and University of Bahia, Salvador (Bahia), Brazil. signs of infection persisted after treatment. The PRENSA MED MEX (Mexico City)56-60, effect of treatment with metacycline, lincomy- Sep-Oct. 1970. cin or chloramphenicol on M hominis correlated well with the susceptibility of this organism Authors' summary: A total of 44 patients foundinvitro.CulturesforT-mycoplasmas with urinary tract infections or urethritis were showed that these organisms could be recovered subjected to treatment with cephalexin mono- in about the same frequency before and after hiJrate. Of the 30 with urinary tract infections therapy. (including acute, chronic recurrent, and chronic * * * infection) 23 (76.6%) showed a satisfactory response. All14 cases of urethritis (acute or COMP L EM ENT-F1 XINGANTI BODIES TO chronic) responded well to cephalexin. The drug BEDSONIA IN REITER'S SYNDROME, TRIC was very well tolerated. Mild, usually transitory, AGENT INFECTION, AND CONTROL gastro-intestinal complaiAts were recorded in six GROUPS.JuliusSchachterTheGeorge patients (nausea, vomiting, diarrhea), but in no WilliamsHooper Foundation,Universityof instance did therapy have to be discontinued. California at San Francisco, California 94122. Laboratorytoxicity studies referrable to the AM J OPHTHALMOL (Chicago) 71:857-860, hematopoietic system liver, and kidneys showed April 1971. no consistent or significant alternations. Author's summary: Serum complement fixing * * * (CF) antibody levels to bedsoniae were deter- mined in patients with Reiter's syndrome, TRIC agent infecti(.,11, and control populations. Of E4 men withReiter's syndrome, 18 (21%) had significar: CF levels. This rate was higher than the 15 percent (3/20) seen in men with TRIC agent urethritis, but lower than the 53 percent (20/38) found in men with TRIC oculogenital disease. Men withReiter's syndrome, if CF positive, tended to have higher titers. CF reactor MENINGOCOCCI IN VAGINITIS. James E. rates were approximately 3 percent for normals Gregoryand Ellen Abramson-2600N. and in the Arthritis Clinic, and 7.8 percent in a LawrenceStreet,Philadelphia,Pennsylvania venerealdiseaseclinic.When patientswith 19133. AM J DIS CHILD (Chicago) 121:423, Reiter's syndrome were compared to age-sex May 1971, matched controls with nongonococcal urethritis orgonorrheatheCFrateswere: Reiter's The presence of Neisseria meningitidis in the syndrome, 18/77 (28.4%); gonorrhea, 14/154 vagina is a rare occurrence and has not been well (9.1%), x2 8.78, p < 0.01; .,.ndfor non- documented. The organism was recovered in gonococcal urethritis, 8/154 (5.2%), x2 = 16.99, pure culture from a 5-year-old patient with p <0.001. Itis concluded that CF reactors for laboratory techniques that would have revealed bedsonia in Reiter's syndrome do not merely aerobic or anaerobic pathogens that could have reflect TRIC agentinfectioninasexually been associated with vaginitis had they existed. promiscuous group.Itispossible that these N, meningitidis was not recovered from either titers may reflect a casual relationship in some the throat or the nasopharynx of the patient. patients with Reiter's syndrome, or an indica- The infection was, essentially, self-limited, since tionthat these patients are hyperreactive to thesymptomssubsided withoutspecific certain infectious insults. therapy. * * * * * *

22 TREATMENT OF EPIDIDYMITIS. Joseph E. DavisDepartmentofUrology,New York Medical College, New York, New York 10029. MOD 'TREAT(NewYork)7:1036-1043, September 1970. Author's summary: (1) Epididymitis is the most common intrascrotal inflammatory process. (2) Epididymitis, particularly in children, should be differentiated from other important conditions requiring surgery, such as tumors of the testicle, torsion of the spermatic cord, or appendages of the testis. (3) Acute, nonspecific epididymitis usually will respond within several days to treatment with broad-spectrum antibiotics, bed rest, sexual abstinence and scrotal support. In some instances, it may progress to a chronic state which may require surgery. (4) Prophylacticvasectomymayreducethe incidenceof epididymitisinpatients who require urethral instrumentation and prostatec- tomy. (5) Tuberculous epididymitis is a reflection of tuberculosis in other parts of the body and usually responds to a prolonged (2-3 years) period o!' triple-drug therapy including streptomycin, PAS and isoniazid. (6) Epididymitis is often a reflection of disease in other portions of the urinary tract. Following the acute disease period, careful investigation of the entire genito- urinary tract is recommended. * * *

BEJEL OR NON-VENERAL ENDEMIC S PHI- LIS. M. Wadi Kanan and Ezzat KandilP. 0. Box 6050, Hawalli,Kuwait,Arabia. BR J DERMATOL (London) 84:461-464, May 1971.

Authors' summar,: The case of a negroid man from Trucial Oman on the Arabian Gulf with vitiligoid bejel and several juxta-articular nodules is reported. The clinical picture and the histopathological features have been described. The failure to find the treponema in the smears and sections has been attributed to the late phase of presentation and previous therapy with penicillin. It is concluded that pintid bejel, pintid yaws andpintacan be differentiated only on a geographical basis. * * *

23 Selected Bibliography De Carneri I: Perspectives in the treatment of protozoaldiseasesresistanttometro- nidazole. TRANS R SOC TROP MED HYG, Minor Venereal London, 65:268-270, 1971.

and Related Diseases DelgadoUrdapilletaJ,CastroCarvajalF, Ramirez Soto E: Evaluation of a new oral trichomonicide(SPANISH).GINECOL OBSTET MEX, Mexico 29:515-519, May 1971. Anonymous: Management of nonspecific urethritis. BR MED J, (London) 3:62, Jul 10, Dubois P, Lambotte R, Plomteux G: Clinical 1971. therapeutic trial of fasigyn in vaginal trichomoniasis (FRENCH). REV MED LIEGE, Arizaga Cruz JM, Cigala Cano JL, Berumen C: Liege 25:586-590, Sep 15, 1970. Incidenceofvaginaltrichomoniasis and microbial flora in hysterectomized patients*Gregory JE, Abramson E: Iv!ernngococci in (SPANISH).GINECOL OBSTET MEX, vaginitis.AM JDISCHILD,Chicago Mexico 29:271-274, Mar 1971. 121:423, May 1971. *Beck KJ, Saathoff M, Merkl H: Comparative Grgurevic M: Viruses and cervical carcinoma microscopy, culture and serology studies on (CROATIAN). LI JEC V JESN, Zagreb Trichomonasvaginalis.(GERMAN) 92:103-107, 1970. GEBURTSH1LFE FRAUENHE1LKD, Stuttgart 31:551-560, Jun 1971. Gwiezdzinf:ki Z, Pekowski M, Kozlowski J: Caseofbalanoposthitistrichomonadosa *Bertini B, Hornstein M: The epidemiology of (POLISH).POL TYG LEK,Warszawa trichomoniasis and the role of this infection 26:642-643, Apr 26, 1971. inthe development of carcinoma of the cervix.ACTA CYTOL,Baltimore*Harwick HJ, Purcell RH, luppa JB, etal: 14:325-332, May 1970. Mycoplasma hominis and postpartum febrile complications. OBSTET GYNECOL, New Brugerolle G: Demonstration of the endo- York 37:765-768, May 1971. cytosis process and lysosome structures in trichomonasvaginalis(FRENCH). C R ACAD SCI (D), Paris 272:2558-2560, May*Jensen HK, Hansen PA, Blom J: Incidence of 17, 1971. Candida albicans in women using oral contraceptives. ACTA OBSTET GYNECOL *Cavier R, Cenac J: Study of the trichomo- SCAND, Lund 49:293-296, 1970. nacidal properties of pyrithione (sodium salt of I -hydroxy-2(I,H)-pyridinethione) *Kanan MW, Kandil E: Bejel or non-venereal (FRENCH). ANN PHARMFR,Paris 28:21I-214,Mar 1971. endemicsyphilis.BRJ DERMATOL, London 84:461-464, May 1971. Cohen L: Nitrimidazine in the treatment of trichomonasvaginalisvaginitis. BR J Khaidarly IN, Bilik VG: The mucous mem- VENER BIS,London 47:177-178, Jun braneofthe urogenitaltractintricho- 1971. moniasisandgonorrhea(RUSSIAN). AKUSH GINEKOL, Moskva 46:55-58, Oct Csonka GW, Murray M: Clinical evaluation of 1970. carbenoxolone inbalanitis. BR J VENER DIS, London 47:179-181, Jun 1971. *Korik LM: Strains of Trichomonas vaginalis resistanttometronidazole(RUSSIAN). *Davis, JE: Treatment of epididymitis. MOD VESTN DERMATOL VENEROL, Moskva TREAT, New York 7:1036-1043, Sep 1970. 45:77-80, Jan 1971.

*Abstracted 24 Mardh PA, Stormby N, Westrom L: Myco- Schmor J: Sterility in urogenital trichomoniasis plasma and vaginal cytology. ACTA CYTOL, (GERMAN). WIEN MED WOCHENSCHR, Baltimore 15:310-315, May-Jun 1971. Vienna 120:808-812, Nov 14, 1970.

CB: Moffett M, McGill MI,Schofield SierpM: Treatment of acute and chronic Nitrimidazine in the treatment of trichomo- prostatitis.MOD TREAT, NewYork niasis. BR J VENER D1S, London 7:1020-1032, Sep 1970. 47:173-176, Jun 1971.

Montemezzi L, Fulco G: Vaginal trichomo-*Sueltmann S, Alien V, Inhorn SL, et al: Study niasis: Epidemiologic, statistical and clinical of mycoplasma in university students with data in relation to the mass screening for non-gonococcalurethritis. HEALTH LAB uterineneoplasms(ITALIAN). SCI, New York 8:62-66, Apr 1971 FRACASTORO, Verona 63:833-844, Nov- Dec 1970. Thimm R: The significance of trichomoniasis Nicol CS: Other sexually transmitted diseases. inthe diagnosis and treatment of inflam- II. BR MED J, London 2:507-509, May 29, matory processes of the excretory urinary 1971. tract (GERMAN). Z AERZTL FORTBILD, Jena 64:642-643, Jun 15, 1970. Nilsson IM, Rausing A, Denneberg T: Intra- vascular coagulation and acute renal failure Thygeson P: Historical review of oculogenital in a child with mycoplasma infection. ACTA disease. AM J OPHTHALMOL, Chicago MED SCAND, Stockholm189:359-365, 71:975-985, May 1971. May 1971.

Racouchot JE,Rivoire J, JosephJY: The Van Gijsegem M: Treatment of gynecologic and dermatologistandpruritusall. AM J infectionbycombinedtetracycline PROCTOL, New York22:19i -195, Jun amphotericin B (FRENCH). BRUX MED, 1971. Bruxelles 51:391-393, May 1971.

*Rocha H, Peltier Queiroz F: Cephalexin mono- Volter D: Treatment of prostatitis (GERMAN). hydrate inthe treatment of urinary tract DTSCH MED WOCHENSCHR, Stuttgart infectionsandurethritis. PRENSA MED 96:1091-1093, Jun 18, 1971. MEX, Mexico City 56-60, Sep-Oct 1970.

*Rodin P, Hare MJ, Barwell CF, et al: Transport *Westrom L, Mardh PA: The effect of antibiotic of herpes simplex virus in Stuart's medium. therapy on mycoplasma in the female genital BR J VENER DIS, London 47:198-199, Jun tract.In vitroand in vivo studies on the 1971. sensitivityofMycoplasma hominisand T-mycoplasmasto tetracyclines and other ACTA OBSTET GYNECOL Rodriguez Arguelles J, Garay Salinas E, Arceo antibiotics. Cardenas 0: Nitrimidazine in the treatment SCAND, Lund 50:25-31, 1971. ofvaginaltrichomoniasis(SPANISH). GINECOL OBSTET MEX,Mexico Wolin LH: On the etiology of epididymitis. J 27:713-718, Jun 1970. UROL, Baltimore 105:531-533, Apr 1971.

*Schachter J: Complement-fixing antibodies to Bedsonia in Reiter's syndrome, TRIC agent *Wolinska WH, Melamed MR: Herpes genitalis in infection,andcontrolgroups. AM J women attending planned parenthood of OPHTHALMOL, Chicago 71:857-860, Apr New York City. ACTA CYTOL, Baltimore 1971. 14:239-242, May 1970.

25 *Abstracted RESEARCH AND EVALUATION

TRANSFER OF GONOCOCCAL URETHRITIS ments. The antigen or anti-IgE in presence of FROM MAN TO CHIMPANZEE. AN ANIMAL hypersensitivepatients'seraelicitedspecific MODEL FOR GONORRHEA. Charles T. Lucas, degranulation of the mast cells while the control Francis Chandler, Jr., lohn E. Martin, Jr., and (newborn serum or anti-IgG, A and M) failed to John D.SchmaleVeneral Disease Research elicitany degranulation above that of back- Laboratory, Center for Disease Control, Atlanta, ground (rat mast cells plus suspending medium). Georgia303033.J AMA (Chicago) 216:1612-1614, June 7, 1971. Our findings indicate that immediate hyper- sensitivityreactionstopenicillincouldbe Authors'abstract:Urethral exudate fromdetectedusingthissytemandthatthese human males with gonococcal urethritis was reactions are IgE mediated. They also indicate transferredtotheurethrasof threemalt: that the drug rash observed with ampicillin is chimpanzees. The chimpanzees developed gono-not mediated by IgE. coccalurethritis,asdemonstratedby 't/se presence of a purulent urethral exudate con- * * * taininggram-negativeintracellulardiplococci and the recovery of Neisseria gonorrhoeae on THE USEFULNESS OF IMMEDIATE SKIN bacteriological culture media. The gonococcal TESTS TO HAPTENES DERIVED FROM PEN- urethritis was then transferred from chimpanzee ICILIN. A STUDY IN PATIENTS WITH A tochimpanzee. One chimpanzee developed HISTORY OF PREVIOUS ADVERSE REAC- gonococcal conjunctivitis, presumably by auto-TIONS TO PENICILLIN. MichaelJ.Feltner, inoculation. All animals developed complement- AbrahamI.Weidman, Maria V. Klaus, and fixiilg antibodies to N. gotzorrh:Tae in their sera. Rudolf L. BaerDepartment of Dermatology, It appears, therefore, that an animal model of New York University School of Medicine, 550 gonococcal urethritis has been established. First Avenue, New York 10016. ARCH DER- * * * MATOL (Chicago) 103:371-374, April 1971.

Authors'abstract:Twenty-ninepatients In vitro STUDIES ON THE MECHANISM OF with histories of allergy to pencillin require PENICILLIN AND AMPICILLIN DRUG RE-therapy withpenicillinfor severeinfections. ACTIONS. Z. H. Haddad and J. L. KorotzerThree had had anaphylaxis; 12, exanthems late Pediatric Allergy and Immunology Training and in onset; 8, urticaria; and nine had a variety of ResearchProgram,LosAngelesCounty-othercutaneousmanifestations. One had a UniversityofSouthernCaliforniaMedical historyofeosinophiliafollowingpenicillin Center, Los Angeles, California 90033. INT therapy. All 29 had negative immediate skin ARCH ALLERGY APPL IMMUNOL (Basel) tests;nondevelopedimmediateurticarial 41:72-78, 1971. adverse reactions following reinst;'ution of peni- cillintherapy. However, fiveaeveloped gen- Authors' summary: An In vitro method is eralizedmaculopapular eruptions within 24 described involving rat mast cells, serum fromhours to 21 days after initiation of therapy. patients with suspectedallergicreactionstoIndications for treatment with penicillins were penicillin or ampicillin and the respective anti-subacute bacterial endocarditis (five), septicemia gen or anti-IgEin a controlled set of experi-(two), pneumonia (two), rheumatic heart disease

26 (three), and a variety of other infectious diseases (homogeneous pattern), or intermittent beads of includingsyphilis,osteomyelitis,and gas fluorescence are present along the length of the gangrene. The results indicate that a history of tirponeme (beaded pattern).In LE sera, the allergyto pencillinis not as reliable as skin factor responsible for the homogeneous pattern testing with haptenes derived from penicillin to was an lgG antibody occurring in titers up to predict whether an immediate adverse effect is 1:1280. Antibodies that produced the headed likely to ensue. pattern were present in similar titers, but they were distributed among immunoglobulin classes * * * lgG, IgA and 1gM. The occurrence of beaded FTA-ABS fluorescence was statistically associated with the presence of anti-nucleoprotein, SPECIFIC HYPOSENSITIZATION IN anti-DNA and LE cell factors. The reaction that ALLERGIC'SYNDROMES CAUSED BY resultsin beaded FTA-ABS fluorescence was DRUGS (ITALIAN).E.Errigo- Institutede inhibitedbyincubatingserawith DNA or Patologia Speciale Medica, Metodologia Clinica nucleoprotein or by treating the T pallidum ( ).Universitadi Roma,Italy.FOL1A antigen with DNAse. Anti-DNA antibody there- ALLERGOL (Rome)17:282-294, May-June fore appears to he responsible for the beaded 1970. FTA-ABS fluorescence reactons with sera from certain LE patients. In this general review of the literature on hyposensitizationinallergic syndromes isin- * * * cluded a paragraph (complete with table) on the gradual adaptation to penicillin by starting with one unit of penicillin, at first every half hour CELL-MEDIATED IMMUNITY AND LYMPHO- and then every hour, subcutaneously then intra- CYTE TRANSFORMATION IN SYPHILIS. G. muscularly,increasingthedosage with Pack M. Levene, D. J. M. Wright, and J. L. Turk injection until therapeutic levels are obtained Institute of Dermatology, St. John's Hospital for and even exceeded (on the 4th day 50 million Diseases of the Skin, London WC2, England. units were given). Authors state this technique PROC R SOC MED (London) 64:426-428, April may be used also with other drugs, including 1971. streptomycin and isoniazid; however, this tech- niquecarriesconsiderablerisk and therefore "In certain chronic infectious diseases in should be used only in a hospital environment. which there is widespread dissemination of the tests gives evidence of defective cell-mediated * * * immunity (CMI). ...It was therefore thought of interesttoinvestigate CMIinpatients with congenital and secondary syphilis. Information ATYPICAL FLUORESCENCE IN 'THE FLUO- regarding CMI can be obtained by consideration RESCENT TREPONEMAN-ANTIBODY- ofthehistologicalappearance of lymphoid ABSORPTION (FTA-ABS) TEST RELATED tissue, the results of skin tests and the results of TO DEOXYRIBONUCLEIC ACID(DNA) lymphocyte transformation experiments in vitro ANTIBODiES. StephenJ.Kraus,JohnR. using phytohemagglutinin (PHA) and specific Haserick,LeslieC.Logan,andJaniceC. antigens as agents to induce transformation." BullardVenereal Disease Research Laboratory, Center for Disease Control, Atlanta, Georgia The histological appearances of spleens of 37 30333. J IMMUNOL (Baltimore) infants who died from congenital syphilis were 10611665-1669, June 1971. reviewed. It was shown that such infants had a relative depletion of lymphocytes around the Authors' abstract: Two distinct patterns of central arterioles of the spleen. Examination of fluorescentt reponemal-antibody-absorption enlarged inguinal lymph nodes from 20 patients (FTA-ABS) test fluorescence have been observed with untreated secondary syphilis showed that in sera from certain presumably nonsyphilitic these patients had some depletion of lympho- patients with lupus erythematosus (LE); the cytes in the paracortical areas, and their peri- entire Treponema pallidum antigen fluoresces pheral blood lymphocytes showed an impaired

27 response to PHA in vitro apparently caused by a pallidum were disrupted by one or a combina- plasmafactor. Thepatientsalso responded tion of physical and chemical procedures. Cells poorly or not at all to specific skin tests. and cellular fragments were then observed in the electron microscope by means of three tech- "These finding are consistent with the view niques:negative staining, thin sectioning, and that there is impaired cell-mediated immunity in freeze-etching. Changes in typical morphology congenital and secondary syphilis and that this werenotedandindividualorganelles were impairment may be related to the widespread isolated for detailed structural analysis. dissemination of the infective organism in the early stages of the disease." 2. The cell envelope, a triple-layered struc- * * * ture, was sensitive to trypsin, sodium deoxycho- late,sodiumlaurylsulfate,diethylether, CRYOGLOBULIN AND RHEUMATOID hyaluronidase and a combination of lysozyme FACTOR DURING PRIMARY AND SECON- and rapidfreeze-thawing. The envelope con- DARY SYPHILIS (FRENCH). H. Perrot,.1. tained polygonal subunits that consisted of at Thivolet,and G. FradinService de Derma- least three components. tologie, Hopital Antiquaille, rue de l'Antiquaille, F-69-Lyon,France.PRESSE MED (Paris) 3.The cover of the protoplasmic cylinder 7:1059 -1060, May 8, 1971. was composed of two unit membrances inter- preted to be the cell wall and cell membrane. This study included 31 patients (21 males, The cell wall, which retained it spiral shape after 10 females) with recent syphilis (10 primary, 21 removal of the cell envelope, was sensitive to secondary).Serologictestsusedincluded lysozyme. The cell membrane was the site of hemolysis,Kahn, VDRL, FTA and,in27 attachment of the axial filaments. patients, the TPI. Rheumatoid factor was deter- mined by the latex test and the Waaler-Rose 4. A band of parallel fibrils, attached to the test. Serum cryoglobulin was investigated by the innermost layer of the cell membrane, wrapped method of Mustakallio. In all cases paper elec- around the protoplasmic cylinder ina spiral trophoresis was performed. In primary syphilis fashion. The fibrils, sensitive to trypsin, were the FTA war always positive; the other tests released from thecell membrane by sodium showed varying degree, of reactivity or non- lauryl sulfate. reactivity. In secondary syphilis the classic sero- logywas always reactive; TPI exceeded 50 * * * percent nineteen times; FTA was always positive. Cryoglobulinemia was found in eight cases, the rheumatoid factor in three instances; one A NOTE CN CONGENITAL ABNORMALI- patient had both. Immunological study of the TIES OF THE PENIS. INCIDENCE AND cryoglobulin showed it to be composed of IgIVI RELATIONSHIP TO URETHRITIS.A.I. and IgG. In the search for the rheumatoid factorMorrisonSpecial Treatment Center, Queens only the latex test was positive (3 times). These Road, Barnsley, Yorks, England. BR J VENER data are briefly discussed. DIS (London) 47:182-183, June 1971. * * * Author's summary: One hunched sixty-four cases of minor congenital abnormality of the ULTRASTRUCTURE OF Treponema pallidum penis were found among 2,407 men attending a NICHOLS FOLLOWING LYSIS BY PHYSICAL venereal diseasesclinic,an incidence of 6.8 AND CHEMICAL METHODS. I. ENVELOPE, percent.Meatalhypospadias was the most WALL, MEMBRANE AND FIBRILS.Sally frequent finding. The incidence of all types of Jackson and S. H. BlackDepartments of Der- hypospadias in 1,129 cases of gonococcal and matology and Microbiology, Baylor College of nongonococcal urethritis was 8.2 percent; it was Medicine,Houston,Texas77025. ARCH 4.1 percent in 1,745 cases without urethritis. MIKROBIOL (Berlin) 76:308-324, 1971. Conversely, 56.4 percent of cases of hypospadias were seen in association with urethral infections, Authors' summary:1. Normal cells of the whereas 43.6 percent were associated with other Nichols nor-pathogenicstrain of Treponema conditions. These findings lend indirect support

28 to the contention that hypospadias lessens the dispose of a series of specific and reproducible minor protection against infection afforded by examinationsusingeasilyavailablereagents the normal fossa navicularis. which may be kept for a long time. For most of them, the use of indirect immunofluorescence * * k permits them to recognize and titrate specific antibodies of 1gM type, the biological factor essential for the diagnosis of these congenital VIRAL CARCINOGENESiS IN VENEREALLY disorders." SUSCEPTIBLE ORGANS. AbrahamRavic- 1135-103rd.Street,MiamiBeach,Florida * * * 33154. CANCER (Philadelphia) 27:1493-1496, June 1971. Author's abstract: Recent findings of viruses in human smegma and semen, and in cancers of theprostate,cervix,andbladder,tendto confirmtheauthor'soriginal concept of a venereallytransmitted virusin such cancers. Through a unique demographc opportunity in Brooklyn, a survey of Caucasian middle class private patients from 1930 -41, showed a1.7 percent incidence of prostate cancer in the more or less sexually segregated Jews vs. 20 percent among the largely uncircumcised non-Jews. A later study also showed a lower incidence of bladder andrectalcancersinJews.Living conditions and hygienic facilities were similar. The involvement of the prostate was the key- stone of the concept, since this internal organ is commonly accessible only to ascending venereal infections. Cancers of all organs generally susceptible to VD showed lower incidences in Jews. Their practice of complete circumcision usually protects them from genital cancers, unless they practice sexual promiscuity and acquire venereal infections. * * *

TECHNIQUES OF DEMONSTRATION OF IgM TYPE ANTIBODIESINCONGENITAL INFECTIONS(FRENCH).G.Dropsy,J. Carquin and J.-C. CroixLaboratoire Central de Microbiologie,C.H.U. de Reims, Pathologie perinatale51,rueCognacq-Jay,51-Reims, France. ANN BIOL CLIN (Paris)29:67-73, 1971. English summary: "The authors present a series of techniques which they use for the diagnosis and detection of four major congenital infections: toxoplasmosis, rubella, cyto- megalic inclusion disease, and syphilis. These techniques were chosen or modified in order to

29 Selected Bibliography *JacksonS,BlackSH:UP.rastructureof Treponema pallidum Nichols following lysis Research and Evaluation byphysicalandchemicalmethods. I. Envelope, wall, membrane and fibrils. ARCH Bashmakova MA, Soldatova VM, Kononova MIKROBIOL, Berlin 76:308-324, 1971. ES: Role of myoplasma infectioninthe gensis of spontaneous abortion (RUSSIAN).*Kr. usSJ,Haserick JR, Logan LC, etal: VOPR OKHR MATERIN DET, Mosv-a Atypicalfluorescenceinthefluorescent 16:67-70, Feb 1971. treponemal-antibody-absorption (FTA-ABS) test related to deoxyribonucleic acid (DNA) Cagli V: Examination of cerebrosphinal fluid antibodies. J IMMUNOL,Baltimore (ITALIAN). POLICLINICO (PRAT), Roma 106:166:-1669, Jun 1971. 78:466-474, Jun 1, 1971. Lassus A, Johnason EA, Sonck CE: Inter- actions of antilipoidal antibodies with yolk *Dropsy G, Carquin J, Croix JC: Techniques of sacantigens. BR J VENER DIS, London demonstration of IgM type antibodies in 47:169-172, Jun 1971. congenitalin"ections(FRENCH). ANN BIOL CLIN, Paris 29:67-73, 1971. I.a Torretta G, Altucci P: Results of isolation of mycoplasmas from the female urogenital tract andtheirsensitivitytoantibiotics. *Errigo E: Specific hyposensitization in allergic (ITALIAN)i,.RCHOSTET GINECOL, syndromes causedbydrugs. (ITALIAN) Napoli 75:191-199, May-Jun 1970. FOLIA ALLERGOL, Rome 17:282-294, May-Jun 1970. *Levene GM, Wright DJ, Turk JL: Cell-mediated immunity and lymphocyte transformation in *Fellner MJ, Weidman Al, Klaus, MV, et al: The syphilis.PROC R SOC MED, London usefulnessofimmediateskinteststo 64:426-428, Apr 1971. haptenes derived from penicillin. A study in Lients with a history of previous adverse*Lucas CT, Chandler, F Jr,Martin JEJr: reactions to penicillin. ARCH DERMATOL, Transfer of gonococcal urethritis from man Chicago. 103:371-374,Apr1971. tochimpanzee.Ananimalmodelfor gonorrhea. JAMA, Chicago 216:1612-1614, Frygin C, Lewinska Z: Antibodies binding the Jun 7, 1971. complement with antigens of viluses of the ornithosis-psittacosis-lymphogranuloma*Morrison Al: A note on congenital abnormali- venereumgroupand neorickettsiaein ties of the penis. Incidence and relationship variouspopulation groups anddomestic tourethritis. BR J VENER DIS, London animals (POLISH). PRZEGL EPIDEMIOL, 47:182-183, Jun 1971. Warszawa 25:55 -62, 1971. Moss CW, Thomas ML, Lambert MA: Amino Geyman JP:Anaphylactic reactiontooral acidcompositionof treponemes.i3RJ pencillin.CALIF MED, SanFrancisco VENER DIS,London 47:165-168, Jun 114:87-89, May 1971. 1971.

*Haddad ZH, Korotzer JL: In vitro studies on*Perrot H, Thivolet J, Fradin G: Cryoglobulin the mechanism of penicillin and ampicillin and rheumatoid 'factor during primary and drugreactions.INT ARCH ALLERGY secondarysyphilis(FRENCH). PRESSE APPL IMMUNOL, Based 41:72-78, 1971. MED, Pair's 7:1059-1060, May 8, 1971;

Hewitt WL:Penicillin-historicalimpact on Petz LD: Immunologic reactions of humans to infection control. ANN NY ACAD SC!, New cep halosporins.POSTGRAD MEDJ, York 145:212-215, Sep 27, 1967. London 47:SUPPL:64-69, Feb 1971. *Abstracted 30 Postelnicu C, Branzei P: Electro-clinical cor- relations in neurosyphilis.ELECTRO- ENCEPHALOGR CLIN NEUROPHYSIOL, Amsterdam 30:361, Apr 1971.

Pullen Ampicillin rashes in glandular fever. BR MED J. London 2:653, Jun 12, 1971. *Ravich A: Viral carcinogenesis in venereally susceptible organs. CANCER, Philadelphia 27:1493-1496, Jun 1971. Werner HP, Kraft D, Wiedermann G: Inhibi- tionswithhaptensinpenicillinallergy (GERMAN). WIEN KLIN WOCHENSCHR, Vienna 83:1.94-196, Mar 19, 1971.

*Abstracted PUBLIC HEALTH METHODS

EPIDEMIOLOGY OF25,294REPORTED IMPROVED TRACING OF CONTACTS OF GONORRHEA CASES. G. Reze Najem and HETEROSEXUAL MEN WITH GONOR- Thomas N. Lynn, Jr. Department of Com- RHOEA.RELATIONSHIP OF ALTERED munity Health, University of Oklahoma Medical FEMALE TO MALE RATIOS. E. M. C. Dunlop, Center, Norman, Oklahoma 73069. Amy M.Lamb,andDorothyM. King WhitechapelClinic,TheLondonHospital, Authors' summary: The records of 25,294 London, England. BR J VENER DIS (London) reported gonorrhea casesin Oklahoma from 47:192-195, June 1971. 1965 to 1969 were reviewed. The secular trend of the cases increased from 1965 to 1969. The Authors'summary:Since1964contact- overall mean annual rate of reported gonorrhea tracers have been used at the Whitechapel Clinic cases was 202.2 per 100,000 population during to interview all men suffering from gonorrhea. theperiodofthisstudy. The geographical In1960 only twelve of thefemale sexual distribution indicated that the median rate of contacts of 100 men suffering from gonorrhea the 77 counties in Oklahoma was 35.7 cases per attended for examination butin1969, ina 100,000 population in1969, with high vari- similar series, 54 women attended. abilityin the rates ranging from 0 to 426.5 among the counties. A majority of these cases In 1960, a total of 2,110 cases of gonorrhea were from urban areas in this study. The rate of was diagnosed compared with 1,693 in 1969, a 1687.1cases per 100,000 population among declineof 20percent.Casesinmen had Negroes was remarkably higher than for other decreased by 30 percent from 1,677 to 1,171, races. There were three times more male cases but cases in women had increased by 21 percent than female. fhe age distribution of the cases from 433 to 522. The ratio of infected women was from under one to over 85 years of age, to men was 1:3.9 in 1960 and 1:22 in 1969. In with the neak in the age group 20-24 years. contrast, reported cases of gonorrhea in England There was considerable shift toward the younger and Wales increased by 33 percent between age group of under 24 years. The largest increase 1960 and 1968, for women by 73 percent, and in the reported gonor hea was in the age group for men by 23 percent. 15-19 in Oklahoma fron. 19o5-1969. The relative lack of proper specific preventive measures More effective contact tracing is not the only and education in matters of sexual behavior and factor in the changing ratio of infected women health among the most vulnerable members of to men. The relative increase in the number of society, namely the young people. Low socio- women is also observed in the total of new cases econmic groups and asymptomatic females excluding gonorrhea. In 1969, only 14 percent contribute most to the increasing number of of heterosexual men suffering from gonorrhea gonorrhea cases in Oklahoma in this study. By admitted to having acquired the infection from and large, there is an urgent need for develop- prostitutes whom they paid compared with 31 ment of satisfactory mass prevention and con- percent in1960; but 49 percent had acquired trol measures. gonlrrhea from known `girl-friends'in1969 comparedwith27percentin1960. An * * * increasing number of infections is now acquired

32 from'girl-friends'and suchgirlsare moreBehavioral Studies accessible to e,-)ntact tracing than are prostitutes. It is likely tica women will continue to provide a growing proportion of the patients attendingPSYCHOLOGICAL ASPECTS IN VENERE- clinics; even in the absence of a general increase OLOGY (CZECHOSLOVAKIAN). F. Novotny. in the numbers of persons attending the clinics,CESK DERMATOL (Praha) 46:77-82, April this increasing proportion of women will place a 1971. growing burden on the staffs of clinics and laboratories. Staffing should be reviewed with Engli,A1 summary: "Psychology in venereol- this in mind. ogy has a curative-preventative and sociological significance. The changes of the physical state of * * * venereologicalpatientsaredescribedinthe paper. The kinds of psychological approach by the doctor and of the nurse to patient and concern with the preservation of anonymity and family and social relations are elaborated. The possibilitiesofapsychological approach to venereophobicindividualsandwithundis- ciplined patients are mentioned." ANALYSIS OF HOSPITAL ADMISSION * * * ATES OF PATIENTS WITH SYPHILIS OF ".HE CFNTDAL NERVOUS SYSTEM IN :'GLAND BEFORE AND AFTER WORLD WAR II.Anatol Dowzenko and JanuszJ. ZielinskiDepartment of Neurology, Institute of Psychoneurology, Pruszkow, Poland. POL MED J (Warszawa) 10:539-546, 1971.

Authors'abstract:Inananalysis of the secondarystatisticalmaterials fromofficial sources and data obtained from 9 neurological and 9 psychiatric departments it was attempted to gain an insight into the dynamics of the admission rates of patients with syphilis of the nervous system to hospitals and departments of medical academies in Poland before nnd after World War II. A considerable gradual decrease of admissions has been observed, especially since 1960. A similardecrease was observedin venereal disease outpatient clinics. Some data suggest, however, a declining interest of the departments of Medical Academies in the problems of syphilis of the nervous system. The decrease of the admission rates of Lues nervosa patients to the hospitals coincides on the one hand with an evident decrease of admissions of new cases and with slow dying out of "old" cases on the other hand. In the light of the high incidence of syphilis the ana!ysis of these data shows that the rate of dete:tion of new cases of early syphilis is considerable and the efficacy of this treatment is high. * * *

33 Selected Bibliography *Dunlop EM, Lamb AM, King DM: Improved tracing of contacts of heterosexual men with Public Health Methods gonorrhoea. Relationship of altered female to male ratios. BR J VENER DIS, London Anonymous: Provisions for issuing premarital 47:192-195, Jun 1971. medicalceitificates.(SPANISH) SALUD PUBLICA MEX,Mexico12:245-246, Eberhartinger C:Current problemsinthe Mar-Apr 1970. treatment of venereal diseases. (GERMAN). WIEN MED WOCHENSCHR,Vienna. Anonymous: Responsibility of the physician in 120:462-463, Jun 20, 1970. the control of venereal disease. NY STATE J MED, New York 71:1717, Jul 15, 1971. Fernandez de Castro J: Epidemioiogic situation of the Northern Mexican border and the Amblard P, Ricard J, Martel J: Current aspects surveillance program. (SPANISH). SALUD of gonorrhea. Statistical study apropos of PUBLICA MEX,Mexico 12:161-182, 200 patients (FRENCH). LYON MED, Lyon Mar-Apr 1970. 223:644, Apr 11, 1971. Ferrari HE: The nurse and VD control. CAN Barton FW: Venereal disease. JAMA, Chicago NURSE, Ottawa 67:2J-30, Jul 1971. 216:1472 -1473, May 31, 1971. Foster MT Jr:Diagnosis and treatment of Biehler H: Syphilis in the Bundeswehr. Statis- venerealdisease.POSTGRAD MED, tical evaluation of documentations from the Minneapolis 50:67-73, Jul 1971. past10 years. (GERMAN). HAUTARZT, Berlin 22:206-213, May 1971. Gosset-Osuna G: Prevention of communicable diseases in Mexico. V. Pinta. Situation in Burckhardt W: Venereal diseases at present. Mexicoin1970 (SPANISH). GAC MED (GERMAN). PRAXIS, Bern60:408-411, MEX, Cauhutemoc 101:167-175, Feb 1971. Mar 30, 1971. Jonas S, Sparling PF: Eradication of syphilis. N CaldwellJG:Congenitalsyphilis:A non- ENGL J MED, Boston 285:412, Aug 12, venereal disease. AM J NURS, New v York 1971. 71:1768-1772, Sep 1971. Campos Salas A: Venereal diseases as a prob- Kanterman CB:Editorial."Let's get VD." lem of national and international health. DENT STUD, Chicago 49:20, May 1971. Problemsofcontrolofgonorrhea (SPANISH). SALUD PUBLICA MEX,King AJ: Advances in the study of venereal Mexico 13:41-52, Jan-Feb 1971. disease.BRJCT.IN PRACT, London 25:295-301, Jul 1971. Cirera P, Bouloux C, Gomila J: Occurrence of treponeriatusesinthe people of LesinskiJ, Serwatko M, KrachJ: Current Senegal (FRENCH). BULLBULL SOC PATROL EXOT, Paris 63:666-675, Nov-Dec 1970. epidemiological value of prophylactic sero- logicaltests(POLISH). PRZEGL DER- Daramula T, Oyediran MA: Venereal diseases MATOL, Warszawa 58:163-168, Mfr -Apr 1971. inLagos.ISRJ MED SCI,Jerusalem 7:"7.88-294, Feb 1971. Martin-Bouyer G, Gaignoux Y:Data con- *Dowzenko A, Zielinski JJ: Analysis of hospital cerningvenerealdiseasesinFrance admission rates of patients with syphilis of 1 9 68-1 9 69. Studyofreportedcase., the central nervous system in Poland before (FRENCH). BULL INST NATL SANTE andafter World WarII.POL MED J, RECH MED, Paris 25:1379-1404, Nov-Dec Warszawa 10:539-546, 1971. 1970.

Abstracted 34 Rouques L: Current aspects of gonococcal *Najem GR, Lynn TN, Jr.: Epidemiologyof disease (FRENCH). PRESSE MED, Paris 25,294 reported gonorrhea cases. J OKLA 7:1077, May 8, 1971. STATE MED ASSOC, OklahomaCity 64:235-240, Jun 1971. Rowe RE, Balboa RS: The St. Claire County PeelJ: The health of women. BR MED J, gonorrhea study: Private and public health London 3:267-271, Jul 31, 1971. resources combine in an effort to control gonorrhea.MICH MED,EastLansing Pereldik DL: Congenital syphilis and its pre- 70:317-318, Apr 1971. vention (RUSSIAN). FELDSHER AKUSH, Moskva 36:26-29, Apr 1971. SchirrenCG, Milbradt R: Current venereal problemsinthegynecologicalpractice Petzoldt D: Epidemiological situation of lues (GERMAN). GEBURTSHILFE andgonorrhea (GERMAN). MED KLIN, FRAUENHEILKD, Stuttgart 29:1086-1094, Munchen 66:335-338, Mar 5, 1971. Dec 1969.

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Pochkhua PE: Late results of a complex study of children born to syphiliti( mothers prop- erlytreated before and during pregnancy (RUSSIAN). VESTN DERMATOL VENEROL, Moskva 45:66-67, Feb 1971. Reznichek RC, Smartt WH, Brosman SA: Behavioral Studies Gonorrhea today: Problems of diagnosis, management, treatment. CALIF MED, San Datt Psycho-social aspects of venereal dis- Francisco 115:32-38, Aug 1971. eases in teen-agers. INDIAN J DERMATOL, Calcutta 16:27-35, Jan 1971. Rivoire J, Racouchot J: Anal venereal diseases in twopractices(1958-1968). AM J *Novotny F: Psychological aspects in venere- PROCTOL, New York 22:189-190, Jun ology (CZECHOSLOVAKIAN). CESK DER- 1971. MATOL, Praha 46:77-82, Apr 1971.

35 *Abstracted

9D9213572 U. S. G.P.O.:1971 - 74'.352/1572, Region No.-4