Br J Vener Dis: first published as 10.1136/sti.53.5.328 on 1 October 1977. Downloaded from British Journal of Venereal Diseases, 1977, 53, 328-336

Abstracts

These selected abstracts and titles from the world literature are arranged in the following sections:

Syphilis and other treponematoses Trichomoniasis (Clinical and therapy; serology and biologicalfalse Candidosis positive phenomenon; pathology and experimental) Genital herpes Gonorrhoea Other sexually transmitted diseases (Clinical; microbiology; therapy) Public health and social aspects Non-specific genital infection Miscellaneous Reiter's disease

The RST is thought to offer the ad- Syphilis and other Syphilis (Serology and biological vantage of a stable antigen which gives a treponematoses (Clinical and false positive phenomenon smooth background with negative sera therapy) compared with the slightly coarse back- Evaluation of reagin screen, a new ground with the particulate RPR antigen.copyright. A. E. Wilkinson Infectious syphilis mimicking neoplastic serological test for syphilis disease J. D. DYCKMAN, R. D. WENDE, [Reprinted from Abstracts on Hygiene, by of the L. M. DRUSIN, C. SINGER, A. J. VALENTI, D. GANTENBEIN, AND R. P. WILLIAMS (1976). permission Editor.] AND D. ARMSTRONG (1977). Journal of Clinical Microbiology, 4, 145-150 Archives ofInternal Medicine, 137, Fluorescent treponemal antibody 156-160 The reagin screen test (RST) is carried out absorption (FTA-ABS) tests using blood on unheated serum on cards with a samples collected on filter paper The case histories are given of five lipoidal antigen stained with a blue dye. D. R. HOPKINS (1977). patients with lesions at first thought to be Its performance is compared with the American Journal of Tropical Medicine http://sti.bmj.com/ neoplasms but which were later shown to VDRL, RPR card, and FTA-ABS tests. and Hygiene, 26, 188-189 be due to early syphilis. The first patient The sera tested were from 243 patients complained of persistent headache, and with untreated syphilis at various stages, Specimens of blood were collected by the presence of unilateral papilloedema 345 patients with treated syphilis, 257 venepuncture from 111 patients known to raised suspicions of an intracranial presumed normal persons, and 175 have, or suspected of having, syphilis. growth. Two patients had rectal lesions patients with various conditions which Two or three drops of blood were placed thought to be carcinomas, one an ulcer of may produce biological false positive on Whatman no. 3 filter paper to give a on October 2, 2021 by guest. Protected the tongue, and one enlarged cervical (BFP) reactions. These included 11 yaws circle 1 cm in diameter and allowed to lymph nodes and lesions of the nose and sera which do not really belong in this dry overnight. The blood was eluted in skin thought to be due to lymphoma. Four category. From the results it appears that 0-2 ml sorbent to give an approximately I of the patients had skin lesions of secon- the RST was rather less sensitive than the in 8 dilution of serum. FTA-ABS tests dary syphilis and one gave a history of VDRL or RPR test in the syphilitic sera, were carried out on this in parallel with these. Biopsies had been carried out on particularly those from treated patients. tests on inactivated serum at a dilution of three patients before positive serological In this group the RPR was reactive in 1 in 5 in sorbent. Sixty-two sera and 56 tests showed the correct diagnosis. 86%, the VDRL in 85 5%, and the RST eluates gave reactive tests. Qualitatively, Early infectious syphilis is still common in 78-8%. A comparison of quantitative fluorescence was brighter with the sera and there should be more general aware- tests showed that the RST tended to give than with the eluates, but the use of blood ness of its often diverse manifestations. slightly lower titres than the RPR or collected on paper from fingerpricks is Osler's dictum that syphilis simulates every VDRL. None of these three tests was thought to be practicable in the FTA-ABS other disease is still true today. reactive with the normal sera and the test, especially in field studies. A. E. Wilkinson specificity was about equal with the sera The difference in serum dilution favours [Reprinted from Abstracts on Hygiene, by from conditions associated with BFP the test on serum. The circles of absorbent permission of the Editor.] reactions. paper (rondelles) described by Guthe, 328 Br J Vener Dis: first published as 10.1136/sti.53.5.328 on 1 October 1977. Downloaded from

Abstracts 329 1966 (Acta dermato-venereologica, 46, 72) get lower readings with syphilitic sera but in an atmosphere of 95 % N2 and 5 % CO2 which take up a reproducible volume of higher readings with some sera from or the addition of reducing agents blood would be more suitable for collect- patients judged not to have syphilis. The (glutathione, cysteine, sodium thioglycol- ing specimens by this method. proportion of borderline readings was late, dithiothreitol). Incubation beyond A. E. Wilkinson similar in the two laboratories and these 48 hours was detrimental to the survival [Reprinted from Abstracts on Hygiene, by did not correlate well with a diagnosis of of the cell monolayers. In an atmosphere of permission of the Editor.] syphilis. At the reference centre 71 of 76 1 part air and 6 parts of the N2-C02 patients with reactive FTA-ABS tests mixture, corresponding to 30% oxygen, were considered to have syphilis and five the cells were found to survive for between Borderline and reactive FTA-ABS results to have given false positive FTA-ABS two and three weeks. In tests under this in lupus erythematosus tests. At the local laboratory only 71 atmosphere normal rabbit serum or fetal R. N. SHORE AND J. A. FARICELLI (1977). (62-8 %) of 113 patients with reactive bovine serum promoted treponemal sur- Archives of Dermatology, 113, 37-4 FTA-ABS tests were thought to have vival better than preparations of bovine syphilis; the remainder were classed as serum albumen. Serological tests for syphilis were per- false positive reactions. Various cell lines were used; some of formed on sera from 43 patients with lupus The use of the FTA-ABS test as a these, mainly derived from animals other erythematosus. Four of the patients had screening procedure in a population with a than rabbits, produced local skin reactions clinical evidence of syphilis and a positive low prevalence of syphilis is thought in- when injected without treponemes. These result in the TPI test. Among the remain- advisable. Its use should be limited to non-specific lesions did not increase in ing 39, reactions which were probably non- patients with reactive VDRL tests and to size or ulcerate and could be distinguished syphilitic were seen as follows: reactive those suspected to have late syphilis. The from the infectious lesions caused by FTA-ABS tests (10 patients), positive use of the Treponema pallidum haemag- treponemes. One cell line, derived from VDRL (11 patients), positive rapid plasma glutination test as an initial confirmatory rabbit epidermis, appeared to promote reagin card tests (5 patients), positive test should be considered, keeping the survival of treponemes better than other microhaemagglutination Treponema palli- FTA-ABS test as an arbiter in problem lines. When these cells were incubated dunm assay tests (4 patients). It was noted cases. with treponemes in medium containing that seven of the 10 positive FTA-ABS [The FTA-ABS test is widely used; this glutathione and cysteine under an atmo- tests were of borderline reactivity and in report shows its limitations and the need sphere of 30% oxygen and dithiothreitol none was there a 'beaded' pattern of for caution in the interpretation of added at intervals, there was no apparentcopyright. fluorescence. The titres of the presumed results.] decrease in the number of virulent tre- non-syphilic positive microhaemagglutina- A. E. Wilkinson ponemes for up to six days. At this time, tion tests were < 1 in 320. [Reprinted from Abstracts on Hygiene, by lesions developed at all inoculated sites (Perhaps reactive FTA-ABS tests in permission of the Editor.] after a mean interval of 4-7 days. lupus erythematosus should be evaluated A. E. Wilkinson by the use of Reiter's sonicate rather than by the sorbents used by the authors. A further study on the specificity of the Syphilis (Pathology and Selective response of lymphocytes from microhaemagglutination assay test in Treponema pallidum-infected rabbits to http://sti.bmj.com/ lupus erythematosus may be needed.) Experimental) mitogens and Treponema reiteri D. J. M. Wright C. S. PAVIA, J. B. BASEMAN, AND J. D. Interaction if Treponema pallidum FOLDS (1977). Infection and Immunity, 15, (Nichols strain) with cultured mammalian 417-422 The FTA-ABS test: a diagnostic help or cells; effects of oxygen, reducing agents, hindrance? serum supplements and different cell types Rabbits were infected intratesticularly P. E. DANS, F. N. JUDSON, S. A. LARSEN, T. J. FITZGERALD, R. C. JOHNSON, J. A. with the virulent Nichols strain of

AND M. A. LANTZ (1977). SYKES, AND J. N. MILLER (1977). Treponema palliduim. Animals infected on October 2, 2021 by guest. Protected Southern Medical Journal, 70, 312-315 Infection and Immunity, 15, 444-452 with treponemes killed by heating at 56°C for an hour provided a control group. This study was carried out on 1043 patients Virulent Nichols strain Treponema palli- Peripheral blood lymphocytes were col- attending a venereal disease clinic who dum was harvested from the testes of lected at weekly intervals for 12 weeks were suspected of having syphilis. FTA- infected rabbits into modified Eagle's after inoculation and cultured for 60 ABS and VDRL tests were carried out at minimal medium with various supple- hours at 37°C in the presence of phyto- the local laboratory and sera from 226 ments, and added to cell monolayers. haemagglutinin, pokeweed mitogen, goat patients which were reactive in either or After incubation, 0-1 ml volumes of the anti-rabbit immunoglobulins IgG and IgM, both tests were sent to a reference labora- supernatant fluid or the resuspended and washed Reiter treponemes. [3H] tory for checking. Although there was cells with adherent treponemes was in- thymidine was then added and its uptake 97 5 % agreement (+ one dilution) in the jected intradermally into rabbits. The time measured after incubation for a further VDRL results, those of the FTA-ABS taken for lesions to develop was used as 16 hours. test showed some marked discrepancies. an index to the number of surviving and Lymphoblastic response to phytohae- When compared with the intensity of virulent treponemes. magglutinin and pokeweed mitogen were fluorescence recorded at the reference The presence of cells prolonged the depressed during the first three to four centre, the local laboratory appeared to survival of treponemes as did incubation weeks in the animals infected with living Br J Vener Dis: first published as 10.1136/sti.53.5.328 on 1 October 1977. Downloaded from 330 British Journal of Venereal Diseases T. pallidum compared with the values for Gonococcaemia in pregnancy limbs. Both wrists and ankles were the control group. No differences between W. G. WATRING AND D. L. VAUGHAN (1976). swollen, warm, and tender. There was a the groups were found in the lympho- Obstetrics and Gynecology, 48, 428-430 purulent vaginal discharge. Attempts to blastic response to anti-rabbit IgG, IgM, aspirate the affected joints were un- or Reiter treponemes. The results are As gonorrhoea is asymptomatic in 30 to successful. interpreted as showing a temporary im- 75 % of women, diagnosis is often delayed. A vaginal smear showed an excess of pairment of thymus-derived (T) lympho- This may result in the development of a pus cells with Gram-negative intracellular cytes but not of bursa-equivalent (B) cells generalised infection, which should be diplococci, but Gram-stained smears and during the early phase of syphilis in the recognised clinically before a laboratory cultures of the skin lesions were negative rabbit. Other workers have reported diagnosis is made. as were cultures from the pharynx and the depression ofblastogenesis by T. refringens A 25-year-old woman, 34 weeks preg- rectum. A vaginal culture and two blood- and T. reiteri in early syphilis in man. nant, complained of arthralgia, fever, and cultures grew Neisseria gonorrhoeae. There A. E. Wilkinson a rash on the limbs. She had a purulent was rapid response to treatment with intra- cervical discharge. Urethral and cervical venous aqueous penicillin G (8 megaunits smears and cultures showed gonococci, daily for six days) and oral ampicillin (2 g but blood cultures and smears and daily for a further four days). Automation of the rapid plasma reagin cultures from skin lesions and patellar It is generally assumed that the endo- test using the autotape system effusion were negative. Electrocardio- cervix is the primary site for dissemination J. R. BOOTH, P. J. L. SEQUEIRA, W. grams were abnormal but not diagnostic ofgonococci from the female genital tract, WAGSTAFF, I. HOPKINSON, D. GIBBS, AND of pericarditis or myocarditis. Skin but this case demonstrates that such dis- E. BENNETT (1977). biopsies showed perivasculitis. The semination can occur from a primary Journal of Clinical Pathology, 30, 171-176 symptoms improved rapidly with intra- vaginal focus. The authors point out, venous penicillin. however, that a urethral culture was not In pregnancy, gonococcaemia occurs in performed in this case and therefore this the late second or third trimester, and this site could also be a potential focus of Gonorrhoea (Clinical) diagnosis must be considered when septic infection. arthritis and/or a maculopapular rash is C. S. Ratnatunga present. As cultures from blood, joints, Clinical spectrum of gonococcal infection and skin lesions are positive in only 16 to copyright. in women 24% of cases, realistic criteria proposed W. M. MCCORMACK, R. J. STUMACHER, for the diagnosis of systemic gonococcal Gonococcal gum abscess in a 10-week-old K. JOHNSON, A. DONNER, AND R. disease are: 1. Positive local cultures and/ infant RYCHWALSKI (1977). Lancet, 1, 1182-1185 or fluorescent antibody test; 2. Classical M. URBAN and A. R. HERVADA (1977). clinical manifestations; 3. Response to Clinical Pediatrics, 16, 193-194. The medical records of278 women infected penicillin therapy. More universal testing with Neisseria gonorrhoeae during a six- of skin biopsy with fluorescent antibody month period were reviewed. These is recommended. Gonococcal fetal scalp abscess-Case represented 75 % of the infections in N. A. Durham report women at Boston City Hospital during F. J. PLAVIDAL AND A. WERCH (1977). http://sti.bmj.com/ this time. Women who presented to the (Note: this abstract appeared in the British American Journal of Obstetrics and venereal disease clinic because they had Journal of Venereal Diseases (1977), 53, Gynecology, 127, 437-438 had contact with an infected man, and 206 with a line inadvertently omitted. The women who were found to be infected above is the correct version). during routine examinations in the Oropharyngeal gonorrhea during obstetrics and gynaecology clinic were pregnancy usually free of symptoms or had non- Disseminated gonococcal infection in a D. R. STUTZ, M. R. SPENCE, AND C. on October 2, 2021 by guest. Protected specific symptoms such as vaginal dis- patient with prior total abdominal DUANGMANI (1976). Journal of the charge. However, these women accounted hysterectomy American Venereal Disease Association, for only 108 (39%) of the 278 infections. R. N. WOLFE, P. OILL, T. T. YOSHIKAWA, 3, 65-67 Most ofthe infections were in women who AND L. B. GUZE (1977). Obstetrics and presented to the emergency care areas of Gynaecology, 49, 1 (Supplement) the hospital with symptomatic gonococcal 22s-23s infections. At least 86 (31 %) of the 278 Condyloma-like lesions possibly caused by infections were in women who had pelvic A 37-year-old woman was admitted to Neisseria gonorrhoeae. Report of a case inflammatory disease. These data indicate hospital with a six-day history of fever, S. HAIM AND 0. LEVI (1977). Dermatologica, that the clinical spectrum of gonococcal chills, and skin rash and a two-day history 154, 45-48 infection varies according to the clinic in ofswelling ofthe wrists, knees, and ankles. which the patients are seen and that the She had undergone a total hysterectomy widely held concept that most gonococcal and salpingectomy two years previously. Asymptomatic gonorrhea-Prevalence in infections in women are asymptomatic She was febrile and had purpuric a population of urban adolescents may be erroneous. lesions as well as a maculopapular rash K. HEIN, A. MARKS, AND M. I. COHEN (1977). Authors' summary with pustular or necrotic centres on the Journal ofPediatrics, 90, 634-635 Br J Vener Dis: first published as 10.1136/sti.53.5.328 on 1 October 1977. Downloaded from Abstracts 331 Antenatal screening for gonorrhoea in different authors purporting to demon- Out of 661 isolates tested, only 80% were Christchurch strate a gonococcal capsule. The authors positively identified in CTA medium, A. B. MACLEAN, S. PALTRIDGE, AND W. M. of this paper, from Virginia, found Mueller-Hinton agar allowed 88 % identi- PLATTS (1977). New Zealand Medical encapsulation in four of five freshly fication, while guinea-pig serum agar Journal, 85, 136-137 isolated strains with the indian ink tech- yielded 100% identification. In a second nique. A capsule was also identified in series of experiments, 102 cultures of N. one strain by the quellung reaction, using gonorrhoeae were used to compare Flynn A retrospective study on the effectiveness thin-section electron microscopy on and Waitkins' medium with guinea-pig of a screening effort to reduce the material treated with hyperimmune serum. serum agar. Only 91 of these were complications of gonorrhea The capsular layer appeared during the identified with Flynn and Waitkins' A. H. STAGE, G. G. BROOKS, Z. G. SANDERS, log phase of growth and was promoted by medium while guinea-pig serum agar AND J. W. WATERFALLEN (1976). Journal the addition of casein hydrolysate to the identified all the 102 isolates. Guinea-pig of the American Venereal Disease broth medium. Human polymorpho- serum provides adequate growth of Association, 3, 61-64 nuclear neutrophil leucocyte response to fastidious N. gonorrhoeae essential for encapsulated gonococci of colony type 4 detecting specific enzymes. Since guinea- was examined in two strains: organisms pig serum does not contain maltase were cell-associated and apparently in- activity, it does not interfere with the Gonorrhoea (Microbiology) gested after 30 minutes' incubation with biochemical activities tested. Guinea-pig 10% hyperimmune serum, but not after serum agar is easy to prepare, does not similar treatment with 10% preimmune require a heavy inoculum and gives Production of a capsule by Neisseria rabbit serum. definite colour change in the medium. gonorrhoeae B. A. Evans Author's summary W. P. RICHARDSON AND J. C. SADOFF (1977). Infection and Immunity, 15, 663- 664 A comparison of brain heart infusion Rapid carbohydrate fermentation test for blood agar sterilised by ifitration and heat confirmation of the pathogenic Neisseria The authors observed the production of a on the growth of N. gonorrhoeae using a Ba(OH), indicator 'capsule' after accidental contamination A. D. SETH AND A. E. WILKINSON (1976). M. SLIFKIN AND G. R. POUCHET (1977). of a gonococcal culture by a strain of Journal of Clinical Pathology, 29, 1091- Journal of Clinical Microbiology, 5, 15-19copyright. microaerophilic 'viridans streptococci' 1093 (SV). This capsule was visualised by A method of detecting carbohydrate exclusion of indian ink in a wet prepara- The growth of Neisseria gonorrhoeae on fermentation by Neisseria is described. tion, and occurred both in laboratory brain heart infusion blood agar in which The system depends on the release of strains and fresh isolates, and both TI and the base was sterilised by filtration has carbon dioxide which is precipitated by T4 colony types. The technique employed been compared with growth on the same barium hydroxide as the carbonate. This is was to grow SV on enriched chocolate medium sterilised by heat. Colonies were measured in arbitrary optical density units agar and then inoculate the inverted larger on the unheated medium, and by a spectrophotometer. medium with log phase gonococci. autoclaving at 115°C or 121°C for 15 The following Neisseria were tested: N. Neisseria sicca and N. subflava produced minutes was accompanied by a progressive gonorrhoeae (65 isolates), N. meningitidis http://sti.bmj.com/ small, well-defined capsules which, unlike decrease in colony size. Viable counts on (75 isolates), N. lactamica (5 isolates), N. the gonococcal capsule, resisted mechani- the three media showed no difference in subflava (2 isolates), N. flavescens (2 cal removal, whereas N. meningitidis did end points. Colonies on the unheated isolates). not require SV to produce a capsule. The medium were usually large enough to be (It is probable that the reliability of this slide test for polymorphonuclear neutro- easily recognisable after overnight incuba- test will be no greater than those com- phil leucocyte phagocytosis described by tion. monly employed to detect carbohydrate Swanson demonstrated that capsule for- that Authors' summary utilisation, with the added drawback on October 2, 2021 by guest. Protected mation greatly increased attachment and a spectrophotometer is required to read ingestion by peripheral blood leucocytes. each sugar reaction. For technical details Elucidation of the nature of the capsule is Neisseria gonorrhoeae identification in the reader is advised to consult the awaited with the greatest interest. carbohydrate medium containing guinea original paper.) B. A. Evans pig serum D. J. M. Wright A. C. MANIAR (1977). Health Laboratory Science, 14, 26-29 Demonstration of a capsule on Neisseria Bactericidal antibody in genital infection gonorrhoeae Clinical isolates of Neisseria gonorrhoeae due to Neisseria gonorrhoeae J. 0. HENDLEY, K. R. POWELL, from Manitoba were tested for their D. I. KASPER, P. A. RICE, AND W. M. R. RODEWALD, H. H. HOLZGREFE, AND carbohydrate degradation activity in MCCORMACK (1977). Journal ofInfectious R. LYLES (1977). New England Journal of cystine trypticase agar (CTA) medium, Diseases, 135, 243-251 Medicine, 296, 608-612 Mueller-Hinton agar, and guinea-pig serum agar. Each isolate was tested using An assay of bactericidal antibody has been This is one of two similar papers published two carbohydrates (for example, glucose developed to study the host response to within a short time of each other by and maltose) in the above three media. infection with Neisseria gonorrhoeae. This Br J Vener Dis: first published as 10.1136/sti.53.5.328 on 1 October 1977. Downloaded from 332 British Journal of Venereal Diseases test for antibody was performed on the infection. Complement-fixation titres gonococcal antibodies as determined by sera of women who were exposed to N. changed significantly in only three of the the radioactive pili antigen binding assay gonorrhoeae but who did not become six patients. with rabbit antiserum to baboon immuno- infected, of patients with various types of Authors' summary globulin G. Two baboons showed an genital infection with N. gonorrhoeae, and increase in antibody lasting five weeks of a small number of individuals with no after epididymal injection, two earlier history of gonorrhoea. Antibody was Role of urinary solutes in natural urethral inoculations failing to produce a found in the sera of 31 % of men and immunity to gonorrhoeae response whereas an amnestic response women with uncomplicated gonococcal J. A. MCCUTCHAN, A. WUNDERLICH, AND was obtained to a urethral inoculation infection. Prolonged mucosal infection A. I. BRAUDE (1977). In.fection and performed six weeks after epididymal with the gonococcus ( > 33 days) correlated Immunity, 15, 149-155 inoculation. Parenteral injection sensi- with the presence of bactericidal antibody. tised the baboons to urethral inoculation Bactericidal antibody was not detected This paper examines the self-evident fact of gonococci. in 95 % of the specimens of acute-phase that urine, normally acidic, provides an As gonococcal urethritis could not be serum obtained from women with gono- environment hostile to gonococci. Twenty- produced, the baboon is an unsuitable coccal pelvic inflammatory disease. The nine urine specimens from 15 healthy male model. convalescent-phase sera of 70 % of women and female subjects were examined, and N. A. Durham with clinically severe pelvic inflammatory it was found that 15 specimens were disease showed a rise in titre of bac- bacteriocidal to gonococci and the tericidal antibody to the infecting strain remainder bacteriostatic; the authors Penetration of penicillin into human of N. gonorrhoeae, whereas only 11 % of favour the terms 'killer' and 'non-killer' phagocytes containing Neisseria the convalescent-phase sera of women urines. Killer urines were more acidic gonorrhoeae: Intracellular survival and with mild or moderately severe disease (pH 5-4 against pH 6 4) and more con- growth at optimum concentrations of showed a similar rise. centrated (861 against 717 mmol/kg) than antibiotic Authors' summary non-killer urines. Urea and sodium D. R. VEALE, H. FINCH, AND H. SMITH chloride were also found to be bacterio- (1976) Journal of General Microbiology cidal factors. Both virulent (colony type 95, 353-363 T2) and avirulent (colony type T4) gono-

Quantitation of serum antibodies to cocci were equally affected. Urine may Phagocytes obtained from fresh humancopyright. surface antigens of Neisseria thus not only prevent retrograde spread in buffy coat (predominantly polymorpho- gonorrhoeae with radiolabeled protein A the urinary tract, but also provide some nuclear phagocytes) or from human buffy of Staphylococcus aureus protection against initial infection. coat which had been incubated on a glass K. V. CHRISTENSEN, P. CHRISTENSEN, B. A. Evans surface for one to three days (pre- P.-A. MARDH, AND L. WESTROM (1976). dominantly mononuclear phagocytes) Journal of Infectious Diseases, 134, were allowed to ingest gonococci, and 317-322 Genital inoculation of male baboons with then incubated with penicillin. More intra- Neisseria gonorrhoeae cellular gonococci were killed at high than Antibodies in human sera against surface R. F. DI GIACOMO, J. L. GALE, K. K. HOLMES, at low penicillin concentrations, indicating antigens of Neisseria gonorrhoeae were AND T. M. BUCHANAN (1977). Infection that penicillin penetrated the phagocytes. http://sti.bmj.com/ detected with use of 1251-labelled protein A and Immunity, 15, 670-671 This was supported by autoradiography from Staphylococcus aureus. Serum was experiments with radiolabelled penicillin. allowed to react with a suspension ofwhole On grounds of expense and convenience, A pilated, small-colony-forming gono- gonococci, and the antibodies attached male baboons were used instead of coccal strain survived and multiplied for to the bacteria were quantitated with chimpanzees to study the pathogenesis, at least 15 h in polymorphonuclear protein A, which reacts with the Fc virulence, and immunogenicity of gono- phagocytes which were incubated with fragment of IgG. Tests with five human coccal infection and to provide a system penicillin at the optimum concentration sera with a gonococcal complement- of vaccine evaluation. for killing the extracellular bacteria but on October 2, 2021 by guest. Protected fixation titre of >1: 30 revealed no Eight male baboons received one to four not the intracellular ones; whereas a non- difference between use of freshly isolated inoculations, inocula consisting of fresh pilated, large colony-forming strain sur- gonococci and use of strains subcultured gonococcal urethral discharge, first and vived for only 10 h. The former strain daily on artificial medium for 10 years. repeatedly passaged type 1 gonococcal survived for at least 6 h in similar experi- Antibodies cross-reacting with N. gonor- colonies and a type 1 strain (Mel) used ments with mononuclear phagocytes. rhoeae and N. meningitidis were found in successfully in the production of urethritis Intracellular survival and growth may be human sera. The results of the test with in chimpanzees. an important facet of the pathogenicity of labelled protein A varied with the serum The urethra was inoculated 14 times, gonococci. titre of complement-fixing antibody to N. the conjunctiva four times, and the Authors' summary gonorrhoeae. Acute and convalescent sera pharynx, rectum, and epididymis twice from six of seven patients, including one each. In no case was N. gonorrhoeae grown with disseminated gonococcal infection, or a discharge noted from an inoculated The ecology of the genus Neisseria showed significantly larger differences in site, although there was swelling of the J. MCL. GRIFFISS AND M. S. ARTENSTEIN antibodies to N. gonorrhoeae than did epididymis and cord after local injection. (1976). Mount Sinai Journal of Medicine, sera of women without evidence of genital Paired sera showed no increase in 43, 746-761 Br J Vener Dis: first published as 10.1136/sti.53.5.328 on 1 October 1977. Downloaded from

Abstracts 333 Diagnosis of gonorrhea in male patients each with distinct advantages and dis- by culture of uncentrifuged first-voided Gonorrhoea (Therapy) advantages. urine Authors' summary W. C. FENG, A. A. MEDEIROS, AND E. S. Tetracycline in the treatment of MURRAY (1977). Journal of the American uncomplicated male gonorrhea Treatment of gonorrhea-is penicillin Medical Association, 237, 896-897 F. N. JUDSON AND R. ROTHENBERG (1976). passe? Journal of the American Venereal Disease W. M. MCCORMACK (1977). (Editorial). Association, 3, 56-58 New England Journal of Medicine, 296, Evaluation of a new gonorrhea culture 934-936 detection system-microcult GC A clinical trial was performed to test a J. S. LEWIS (1977). Health Laboratory loading dose regimen of tetracycline Science, 14, 22-25 (1 5 g orally immediately and 0-5 g orally four times a day for four days) against a Non-specific Genital Infection no-loading dose (0.5 g orally four times a Field evaluation of New York City day for 44 days) in the treatment of 477 Chlamydia trachomatis infection in medium in the biological environment- cases of uncomplicated male urogenital patients with acute salpingitis CO2 chamber in recovery of Neisseria gonorrhoea. The regimens were equivalent, P-A. MARDH, T. RIPA, L. SVENSSON, AND gonorrhoeae and urogenital mycoplasmas with an overall cure rate of 96 %. A cross- L. WESTROM (1977). New England Journal Y. C. FAUR, M. H. WEISBURD, M. E. WILSON, over pharmacokinetic study in 10 healthy of Medicine, 296, 1377-1379 AND P. S. MAY (1977). Journal of Clinical volunteers demonstrated higher blood Microbiology, 5, 137-140 levels during the first day on the loading We examined the prevalence of Chlamydia regimen, but equivalence thereafter. Tetra- trachomatis in the cervix and the Fallopian cycline, in a total dose of 9-5 g, is highly tubes of patients with acute salpingitis. effective treatment, and a loading dose is Cycloheximide-treated McCoy cells were Identification of Neisseria gonorrhoeae by not necessary. used as the growth medium. For purposes genetic transformation: A clinical Authors' summary of comparison, women with infections laboratory evaluation confined to the lower genital tract and R. E. BAWDON, E. JUNI, AND E. M. BRITT women without signs of genital infection (1977). Journal of Clinical Microbiology, were also studied. C. trachomatis wascopyright. 5, 108-111 Spectinomycin versus tetracycline for the isolated from the cervix in 19 of 53 treatment of gonorrhea patients with acute salpingitis, in one of W. W. KARNEY, A. H. B. PEDERSEN, 18 lower-genital-tract infections, and in M. NELSON, H. ADAMS, R. T. PFEIFER, AND none of 12 without signs of genital infec- Pyocin sensitivity of Neisseria K. K. HOLMES (1977). New England tion. C. trachomatis was recovered from gonorrhoeae and its feasibility as an Journal of Medicine, 296, 889-894 six of the 20 valid specimens from the epidemiological tool Fallopian tubes of the patients with acute H. D. SIDBERRY AND J. C. SADOFF (1977). Spectinomycin and tetracycline are salpingitis. Our results indicate that

Infection and Immunity, 15, 628-646 alternative drugs to penicillin in the treat- Chlamydia is a common aetiological agent http://sti.bmj.com/ ment of gonorrhoea. To compare the in acute salpingitis. efficacy of these agents and their propen- Authors' summary Degeneration of the gonococcus (in sity to select resistant gonococci, we various media) treated 4043 patients randomly with either L. OLMOS (1976). Archives for 2 or 4 g of spectinomycin once or gave Respiratory tract colonization and a Dermatological Research, 256, 305-318 them 9 g of oral tetracycline for four distinctive pneumonia syndrome in days. Minimum cure rate for anogenital infants infected with Chlamydia gonorrhoea was 94% with either drug. trachomatis on October 2, 2021 by guest. Protected Resistant gonococcus from the Ivory Oropharyngeal infection responded poorly M. 0. BEEM AND E. M. SAXON (1977). New Coast (Letter) to spectinomycin in men, with failure of England Journal of Medicine, 296, 306- P. PIOT (1977). Lancet, 1, 857 treatment in six of 11. Postgonococcal 310 urethritis in men was less common after tetracycline than after spectinomycin The authors describe a pneumonia (p<0-005). Spectinomycin failure was not syndrome observed among Black infants Antibiotic sensitivity of gonococci in related to drug resistance. Tetracycline at the Wyler Children's Hospital of the South Australia 1974-75 failure correlated with resistance (p < University of Chicago. Symptoms began A. FINGER AND G. HANDKE (1977). 0 0002); one-fifth of the isolates resistant in the second or third week of life and Medical Journal of Australia, 1, 133-136 to 10 [g/ml of tetracycline were not were dominated by tachypnoea and spells eradicated. For several reasons, including of coughing which sometimes led to the appearance of ,B-lactamase-producing cyanosis and vomiting. Systemic reaction Transferable drug resistance in the gonococci, it is no longer clear that was minimal. Radiology of the chest gonococcus penicillin G is the 'drug of choice' for showed hyperexpansion with patchy J. R. SAUNDERS (1977). Nature, 266, 586 gonorrhoea. Spectinomycin and tetra- infiltration. Serum IgG and IgM were cycline are equally acceptable alternatives, constantly raised and some of the infants Br J Vener Dis: first published as 10.1136/sti.53.5.328 on 1 October 1977. Downloaded from 334 British Journal of Venereal Diseases had a mild eosinophilia. Having noted a Improvement was not maintained, trachomatis and U. urealyticum at 4°C history of postnatal inclusion conjuncti- however; cough and tachypnoea returned, was examined by means of reference vitis in two patients with the syndrome, the and the chest radiograph showed per- strains. The inactivation of C. tracho- authors considered the possibility that sistent infiltrates. Viral culture from the matis was similar in both 2SP and U-9 Chlamydia trachomatis might be the cause tracheal aspirate now yielded a rhinovirus media, but the number of inclusions was of the pneumonia. and the urine grew cytomegalovirus consistently greater in the 2SP medium. Six of eight infants with the syndrome (CMV). At the age of eight weeks, open In contrast, the number of colony- studied retrospectively and all of 12 lung biopsy was performed. Microscopy forming units of U. urealyticum actually $tudied prospectively yielded C. tracho- revealed giant cells containing eosino- increased over a 24-hour period in both matis from nasopharyngeal or tracheal philic nuclear inclusions diagnostic of media. We conclude that 2SP is the best aspirates, the predominant immunotype CMV. Both C. trachomatis type F and medium for the combined recovery of C. being ED. In contrast, only two of 15 CMV were isolated from lung tissue. trachomatis and genital Mycoplasma. The infants from the same population with Serological studies showed an appreciable use of one transport medium and hence a various other illnesses had respiratory titre of antibodies to both C. trachomatis single swab culture has the obvious shedding of C. trachomatis. All infants type F and CMV. advantages of saving time and expense with the pneumonia syndrome showed The rhinovirus isolated from the for both physician and laboratory, and sustained high immunofluorescent anti- tracheal aspirate suggests an intercurrent for the patient it will eliminate the possible body titres to lymphogranuloma venereum infection, but the role of CMV in mixed discomfort of having multiple cultures type 1; the geometric mean titre (GMT) infections is uncertain. The authors taken. of20 infants with the pneumonia syndrome suggest that C. trachomatis should be Authors' summary was 24 833, and of 11 infants with various considered in the differential diagnosis of other illnesses was 512. chronic pneumonitis ofinfants. Conjunctival specimens were not avail- [This report and the article by Beem and able from the eight infants with the Saxon, above, should be studic4d together. Simple, direct broth-disk method for pneumonia syndrome who were studied See also Schachter, J., Lum, I[, Gooding, antibiotic susceptibility testing of retrospectively, but among the 12 studied C. A. et al. (1975). Pneumonitiis following Ureaplasma urealyticum prospectively, seven had positive con- inclusion blennorrhea. Journeal of Pedi- M.S. SPAEPEN AND R. B. KUNDSIN (1977). junctival cultures for C. trachomatis. Of atrics, 87, 779-780.] Antimicrobial Agents and Chemotherapy,

12 infants with persistent inclusion J. D. Oriel 11, 267-270 copyright. blennorrhoea confirmed by culture, 10 yielded C. trachomatis from the naso- pharynx. The GMT of these 12 patients A simple, direct broth-disc test, utilising was 1024. Recovery of Chiamydia and gei iital urine sediment as the inoculum and The authors suggest that respiratory- mycoplasma transported in suca rose impregnated paper discs as the source of tract colonisation with C. trachomatis is phosphate buffer and urease col[or test antibiotic, was developed and used to test common in the neonatal period; this may medium the susceptibility of 54 isolates of Urea- be without clinically evident effects but T. F. SMITH, L. A. WEED, G. R. P'AlERSEN, plasmaurealyticum (T-strainmycoplasmas) may sometimes result in a lower respira- AND J. W. SEGURA (1977). HeaiIth to minocycline, doxycycline, demeclo- tory tract illness with distinctive clinical Laboratory Science, 14, 30-34 cycline, tetracycline, and erythromycin. http://sti.bmj.com/ characteristics. The concentration of each antibiotic was J. D. Oriel calculated to approximate the attainable Urethral swabs from 75 rmales with blood level. Resistance or susceptibility urethritis were extracted intto tryptose to each antibiotic was determined by phosphate broth and then eqi aal aliquots growth, indicated by a colour change of Isolation of Chlamydia trachomatis from were dispensed into vials containing the medium in each tube, comparable to infant lung tissue sucrose phosphate buffer (2SP) and that of a control culture without anti- on October 2, 2021 by guest. Protected G. T. FROMMELL, F. W. BRUHN, AND J. D. urease colour test medium (U-9). No biotic. Of the 54 T-mycoplasmas tested, SCHWARTZMAN (1977). New England antibiotics were present in the media. 46 (85 2%) were inhibited by 1 ,ug/ml of Journal of Medicine, 296, 1150-1152 After transport to the laboyratory, the minocycline, 45 (83-3%) were inhibited recovery of Chlamydia trachomatis and by 1 {ug/ml of doxycycline, 38 (72-2%) This case report is from the Department Ureaplasma urealyticum was evaluated were inhibited by 1 lAg/ml of demeclo- of Paediatrics, University of Colorado after inoculation into Mc:Coy's cell cycline, 18 (33-3%) were inhibited by Medical Centre, Denver. The authors cultures and agar medium resp)ectively. C. I ,ug/ml of tetracycline, and only 2 describe an infant who developed cough trachomatis was recovered from sig- (3 7 %) were inhibited by 3 t±g/ml of and tachypnoea at the age of two weeks. nificantly more patients (17 versus 12, erythromycin. Seven (13%) of the 54 A chest radiograph showed diffuse bi- p = 0-03) with higher inclusion counts T-mycoplasmas tested were resistant to lateral interstitial infiltrates; bacterial and (p <0-01) in specimens transported in 2SP all five antibiotics. There was good corre- viral cultures from the nasopharynx, as compared with those in U--9 medium. lation between results obtained by this including cell cultures for Chlamydia No significant differences b4etween the direct broth-disc method and minimal trachomatis, were negative. The infant isolation rate of U. urealyticumiand that of inhibitory concentrations obtained by the was treated with ampicillin and genta- Mycoplasma hominis were foulnd with the direct broth dilution method. micin and appeared to recover. two media. The rate of inactiv(ation of C. Authors' summary Br J Vener Dis: first published as 10.1136/sti.53.5.328 on 1 October 1977. Downloaded from Abstracts 335 keratin layers of normal skin adjoining Reiter's disease Other sexually transmitted the molluscum contagiosum lesion was diseases observed. The virus-specific antibody Reiter's disease response was induced in a few patients A. E. GOOD (1977). Postgraduate Medicine, Action de la vaccination par le BCG sur after treatment. 61, No. 1, 153-157 les verrues et les vegetations venfriennes Authors' summary (Effect of BCG vaccination on warts and venereal growths) Reiter's syndrome Lymphogranuloma venereum with hepatic J. THIVOLET, A. CLAUDY, J. P. ORTONNE, involvement A. CALIN (1977). Medical Clinics of North B. BOUCHET, AND J. BATHIAS (1975). America, 61, 365-376 J. R. BJERKE AND G. HOVDING (1977). Acta Bulletin de la Societe francaise de dermato-venereologica, 57, 90-91 dermatologie et de syphiligraphie, 82, 20-23 Reiter's syndrome following Shigella Miscellaneous flexneri 2a: A sequel to traveler's It has been suggested that the real reason diarrhea for the spontaneous regression of warts Aetiology of acute epididymitis A. E. GOOD AND J. S. SCHULTZ (1977). is the operation ofcell-mediated immunity. Arthritis and Rheumatism, 20, 100-104 On these theoretical grounds the authors J. P. HARNISCH, R. E. BERGER, E. R. have studied the non-specific immuno- ALEXANDER, G. MONDA, AND K. K. HOLMES stimulant effect of BCG on the regression (1977). Lancet, 1, 819-822 Candidosis of warts in 56 patients, of whom 50 had A group of 24 patients with acute epi- common, plane or plantar warts, two didymitis underwent urethral cultures for had vulval, three had penile, and one had Neisseria gonorrhoeae, Chlamydia tracho- The role of metabolic energy in the lethal anal warts. BCG vaccination was per- matis, Ureaplasma urealyticum, Herpes action of basic proteins on Candida formed by scarification, either of the simplex virus (HSV) and cytomegalovirus albicans warts themselves, or of an adjacent area (CMV), and urine cultures for aerobic gut V. L. OLSON, R. L. HANSING, AND D. 0. (for example, the inguinal regions). bacteria and Pseudomonas species. Six MCCLARY (1977). Canadian Journal of Vaccination was performed up to five men were over 45 years old and the Microbiology, 23, 166-189 times at 15-day intervals. remaining 18 were under 32. copyright. Regression occurred in 11 of the 45 E. coli, Klebsiella spp., or Pseudomonas patients with cutaneous warts and in two spp. were isolated from the urine in of the six patients with anogenital warts. Genital herpes concentrations > 105 per ml from four of The authors believe that BCG vaccination the men over 45, but from none of the may be of value for the treatment of men under 32. In contrast N. gonorrhoeae BCG immunoprophylaxis of recurrent lesions resistant to routine therapy. was recovered from six, C. trachomatis herpes progenitalis [This study was uncontrolled, and from six, and both organisms from one S. M. BIERMAN (1976). Archives of further trials of this technique, as the of the men under 32; urethral discharge authors themselves out, should Dermatology, 112, 1410-1415 point was present in all the men with gonorrhoea http://sti.bmj.com/ include a placebo-treated group.] and in six of seven men with C. tracho- Thirty-eight patients with severe, recurrent J. D. Oriel matis infection. Neither N. gonorrhoeae herpes progenitalis were treated by nor C. trachomatis was recovered from the immunoprophylaxis with repeated BCG Observations on the antibody responses in six men over 45. inoculations. Results of the study demon- moliuscum contagiosum Among the 18 younger men, U. urea- strated no significant prophylactic benefit P. V. SHIRODARIA AND R. S. MATTHEWS plasma was recovered from seven; it was of BCG when contrasted to other homolo- (1977). British Journal of Dermatology, associated with N. gonorrhoeae in two, gous or heterologous antigens or to control 96, 29-34 and with C. trachomatis in two. Of the on October 2, 2021 by guest. Protected patients receiving placebos. remaining three men yielding U. urealyti- Authors' summary A survey of the incidence of molluscum cum, two had urethritis and one did not. contagiosum virion antigens in patients HSV and CMV were each recovered from with single or multiple lesions showed that only one patient. Anorectal Herpesvirus hominis infection all lesions contain virus antigen. The The authors suggest that in young men, in men virion antigens were detected in the prickle sexually transmitted organisms which M. A. WAUGH (1976). Journal of the cell, granular, and keratin layers. Hyper- cause urethritis may also lead to epi- American Venereal Disease Association, immune sera against vaccinia, rabbit-pox, didymitis, whereas in older men coliforms 3, 68-70 and mouse-pox failed to stain the inclusion and Pseudomonas appear to be the pre- bodies in molluscum contagiosum lesions. dominant cause. They point out that Virus-specific antibodies were present in understanding of the pathogenesis of Photodynamic inactivation of herpes 69 % of the patients. Although virus- epididymitis would be improved by simplex virus: A status report specific IgG antibody was predominant, sampling from the epididymis as well as J. L. MELNICK AND C. WALLIS (1977). virus-specific IgM and virus-specific IgA from the urethra, and perhaps by the use Annals of the New York Academy of were found in a few patients. An IgM of quantitative cultures for U. urealyticum. Sciences, 284, 171-181 staining in the prickle-cell, granular, and J. D. Oriel Br J Vener Dis: first published as 10.1136/sti.53.5.328 on 1 October 1977. Downloaded from 336 British Journal of Venereal Diseases Genital infections in pregnancy Psoriasis of the penis: Koebner reaction M. R. SPENCE (1977). Medical Clinics of following oral genital exposure Notice North America, 61, 139-151 N. J. FIUMARA (1976). Journal of the The Editors wish to congratulate Dr C. S. American Venereal Disease Association, Nicol on his receiving the CBE in the 3, 59-60 Queen's Birthday Honours. Dr Nicol has served on the Editorial Committee for many years.

venereal infection and why men visit of statements in the text which cannot pass Book Review prostitutes. Entrenched moralistic atti- entirely unchallenged and these sound tudes of both medical and lay persons are rather disturbing especially when quoted Sexual Maladjustment and Disease: An blamed for the poor treatment facilities out of context. Here are some examples: Introduction to Modern Venereology. for STD (in the United States), the low G. Hart, 1977. Pp. 229. 21 tables, 4 figs. status of venereologists and hence the 'In countries with a comprehensive 17 plates. Nelson-Hall, Chicago ($15.00) high morbidity of venereal disease. This health service syphilis is virtually con- assertion may be partly true but reminds fined to underprivileged or socially I have always favoured a holistic approach one of the argument of the protagonists deprived groups' to venereology and the concept of regard- of the British National Health Service in 'Individuals indulging in frequent homo- ing patients as people with sexual prob- the 1940s-comprehensive (and free) sexual behaviour may have no homo- lems rather than merely people with medical care should produce a healthier sexual tendencies whatsoever' sexually transmitted disease is an attract- nation with consequent reduced demand 'The most common cause of penile ive one. Hence I opened Dr Hart's book for medical services and therefore in- ulceration is simple trauma' with a good deal of eager anticipation. If creased cost effectiveness-it hasn't. 'Candidiasis is rarely transmitted by my enthusiasm was not maintained it was Not that Dr Hart has no original views: sexual contact' perhaps because I expected too much. In he advocates clinics where all types of Having said this it is only fair to say a work with this title I would like to have sexual problems-such as, venereal dis- that it is certainly gratifying to know that seen discussion on the management of ease, dyspareunia, or contraceptive diffi- there is such an ardent apostle for the sexual difficulties-organic or psycho- culties-could be collectively handled and monospeciality of venereology across thecopyright. logical-and more emphasis on modem here his thinking is along sound lines. Atlantic. The book is obviously directed methods of sex education, such as the Good points are made on screening pro- mainly at the American reader however use of television and audiovisual aids. cedures for syphilis and gonorrhoea and and most British venereologists are not Instead the reader is bombarded by a the author suggests further study of likely to learn a great deal from it although lot oftruisms, many of which are very old promiscuous persons who do not contract the epidemiologist without special know- indeed. W'e are informed that the best STD which might provide data on as yet ledge of STD will find the text useful. way to control sexually transmitted unknown prophylactic measures. There are some excellent black and white disease is to have clinics specialising in the The various venereal diseases are briefly photographs, and the quotations in small treatment of sexually transmitted diseases. dealt with in a single chapter and in a type and the arrangement of the refer- http://sti.bmj.com/ We are told why teenagers, soldiers, sea- straightforward manner. It must be ences are well presented. men, and immigrants are unduly prone to admitted however that there are a number J. Davidson Parker on October 2, 2021 by guest. Protected