Sir, Recent studies of anaerobic bacteria in both the male and female genital tracts have included techniques for the isolation of Clostridium difficile. 1-3 Hafiz et al isolated Cl difficile from 71 of vaginal specimens from patients attending a sexually transmitted disease (STD) clinic and 18% of women attending a family planning clinic, and from all of 42 men with non-specific urethritis (NSU).4 The results of more recent studies have been contradictory. Cl difficile was isolated from only two out of 79 patients with balanoposthitis, and not at all from 24 men with NSU, 19 men with both NSU and balanoposthitis, or from 28 asymptomatic controls.2 Moreover, Moss failed to isolate Cl difficile from 20 men and 34 women attending an STD clinic. A vaginal carriage rate of I% in consecutive female patients attending an STD clinic and 1807 in pregnant women was reported by O'Farrell et al using a selective broth medium.3 In this laboratory 206 vaginal swabs from 187 women, and urethral swabs from 20 men attending a special clinic were examined for Cl difficile. Swabs were broken off into cooked meat broth and incubated at 370C for five days before subculture on to modified CCFA medium,5 6 but Cl difficile was not isolated from any specimen. There exists an apparent dichotomy between the high carriage rates observed in both symptomatic and asymptomatic populations,3 4 and the negligible isolation rates encountered in this and other laboratories.1 2 This discrepancy might be explained by the use of isolation techniques of differing sensitivities, but the methods of Mossl and Masfari et a12 were essentially similar to those employed by Hafiz et al,4 and all recent investigations including the present one used enrichment culture and a highly efficient selective medium. The existence of a geographical variation in urogenital carriage of Cl difficile remains a possibility and requires further study.
It has hitherto been customary to use ampicillin in the treatment of acute salpingitis and acute epididymitis. In recent years it has become clear that Chlamydia trachomatis infection may be an important factor in these diseases,' 2 but to our knowledge no report on the efficacy of ampicillin in the treatment of chlamydial infections has been published, although the in vitro activity of ampicillin against C trachomatis (MIC 0 25 mg/l) indicates possible efficacy. We treated 15 patients who had chlamydia positive non-gonococcal urethritis with pivampicillin (500 mg by mouth three times daily for seven days), pivampicillin being an ampicillin which is almost completely absorped. Urethral specimens were cultured for C trachomatis on days 10 and 17 after the start of treatment. Of the 14 patients who completed the study, seven became chlamydia negative, while seven still harboured C trachomatis in the urethra. Of the seven treatment failures, three were negative at the first follow up, while in two only one inclusion was found in the cell cultures, probably indicating suppression of the infection. All seven were positive at the second follow up, but denied the possibility of reinfection. The results are unfavourable when compared with the effect of tetracyclines and erythromycin in similar treatment regimens.4 The role of C trachomatis in the aetiology of acute salpingitis and acute epididymitis necessitates a re-examination of present treatment guidelines. In addition, the frequent association of C trachomatis and Neisseria gonorrhoeae should influence the choice of treatment for gonococcal disease.
We report a case of early syphilis with multiple bone lesions which all resolved after treatment with penicillin. We discuss why bone lesions may be more prevalent than generally believed and why 99m-Tc-MDP-bone scintigraphy is more sensitive than radiography in detecting syphilitic periostitis.
A previously described toxic factor associated with Treponema pallidum (Nichols) and found in extracts of syphilitic rabbit testes has now also been detected in syphilitic rabbit serum. The toxic factor, which inhibits DNA synthesis in baby rabbit genital organ (BRGO) cells in vitro, is present in rabbit serum up to 30 days after infection with T pallidum.
An enzyme immunoassay (EIA) for the detection of immunoglobulin M (IgM) antibodies to Treponema pallidum was investigated for specificity and sensitivity. Using the results in serum from 1192 patients with successfully treated syphilis, the assay was calculated to be about 97% specific. As in any other IgM enzyme linked immunosorbent assay (ELISA), rheumatoid factor played an important part in causing false positive results. Pre-absorption of serum with aggregated IgG was therefore necessary to perform the test. Evaluation of the results in serum from 385 patients with untreated primary, secondary, and latent syphilis as well as patients with untreated reinfections showed that the sensitivity of the assay depended on the stage of infection and varied between 98% and 93%. IgM antibody titres were about ten times higher in the EIA than in the indirect immunofluorescence assay using the IgM fractions of serum. From the results it may be concluded that the EIA is an appropriate technique not only for rapid and sensitive measurement of IgM antibodies in most patients with untreated syphilis but also for selecting treponemal IgM non-reactive patients.
We measured the activity of rosoxacin, fosfomycin, cefotiam, and spectinomycin against 51 isolates of beta-lactamase producing Neisseria gonorrhoeae, all of which were susceptible to each drug at sufficient concentrations. The development of strains of penicillinase producing N gonorrhoeae (PPNG) which are resistant to spectinomycin can therefore be avoided, as there are alternative drugs.
Between August and November 1983, seven new patients with AIDS were seen at this hospital; two with disseminated Kaposi's sarcoma, and five with opportunist infections, of whom three have died. We present the case histories of the five patients with opportunist infections, which show the wide clinical range of AIDS and suggest that the pattern of infection in the UK may differ from that reported in the USA.
The therapeutic efficacy of a single dose 500 mg tablet of clotrimazole was compared with two 300 mg tablets of isoconazole in an open randomised study of 100 patients with vaginal candidosis confirmed by mycological culture. One week after treatment 100% of the clotrimazole treated patients and 98% of the isoconazole treated group gave mycologically negative results. Five weeks after treatment these figures were 74% and 78% respectively, showing that both regimens were equally effective.
Sir, The importance of Chlamydia trachomatis in genital tract infections is well established.1-4 The humoral immune responses during chlamydial infections have been examined with several serological techniques,5 and in vitro cellular immune responses to chlamydial antigens in man have been studied with different assays.6-8 We report on the immune response after local and more severe chlamydial infections. One group of patients consisted of 10 women who had had acute salpingitis 1-2 years before, probably caused by C trachomatis. The women had had a positive chlamydial culture from the cervix and a fourfold or more rise in chlamydial IgG antibody titre during the disease. The other group consisted of 10 women who 1-2 months earlier had had chlamydial cervicitis, with only lower genital tract symptoms. T cells and non-T cells were prepared from defibrinated blood, as described previously.8 A suspension of partially purified C trachomatis subtype LGV-2 was used as antigen throughout the study.8 An enzyme
Immunisation of ddY mice with the purified ribosomal fraction of Neisseria gonorrhoeae was found to protect against intravaginal challenge with homologous organisms. This protection correlated with the presence of bactericidal antibody to purified ribosomal fraction in serum as well as in vaginal secretions. Analysis of the vaginal fluids from control mice and those immunised with purified ribosomal fraction showed that the enhanced elimination of gonococci in immune mice might be because of an early response of leucocytes generated by the reaction mediated by antibody and complement. Absorption studies showed that there was at least one major protective antigen in purified ribosomal fraction, other than cell surface substances such as lipopolysaccharide, outer membrane proteins, and pili. Bactericidal assays mediated by antibody and complement showed that matched samples of serum and vaginal fluid from immune mice had comparable gonococcidal activity, which was augmented by the effect of progesterone. Although delayed hypersensitivity was produced in immune mice that were resistant to N gonorrhoeae, the exact role of cellular immunity could not be clarified in this study. These results suggest that antibody to purified ribosomal fraction plays a major part in protection against gonococcal infection in the genital tract, and that such protection may entail both cellular immunity and hormonal changes.
Using a simple and rapid microassay, we tested 100 strains of Neisseria gonorrhoeae isolated from 81 patients (41 men and 40 women) for their sensitivity to killing by normal human serum (NHS). The reproducibility of the test was good when the bactericidal end points were taken as the dilution of fresh NHS that killed more than 95% of the test organisms. The bactericidal end points of strains isolated either from different anatomical sites or from sexual partners correlated well with the levels of sensitivity to serum of corresponding isolates, as well as with auxotypes. When the strains were not highly resistant to killing by NHS, this marker gave a precise definition of each strain and permitted the differentiation of isolates belonging to common auxotypes.
Objectives: The purpose of this study was to define magnetic resonance imaging (MRI) correlates of normal brain ageing, with the specific objective of investigating whether the size of the hippocampus is selectively correlated with age related memory performance in non-demented individuals in their ninth and tenth decades of life. Methods: Hippocampal size was estimated using MRI based volumetry and qualitative visual assessment in 102 community dwelling individuals aged between 81 and 94 years. Participants were evaluated on a variety of clinical and experimental instruments, including a comprehensive neuropsychological test battery. All participants underwent neurological examination, an extensive medical history was obtained, and an informant confirmed details of each participant’s functional ability. Results: Both visual and volumetric hippocampal measures were identified as robust predictors of memory performance, even when the influence of age related illnesses and sociodemographic variables was accounted for. When the sample was reduced to include the most cognitively healthy participants who were rated by an informant as showing no evidence of cognitive decline, the left hippocampal measures remained significant predictors of delayed retention of verbal material. Conclusions: These findings suggest that hippocampal volumes are selectively correlated with memory functioning in both normal and successful ageing.
A 24 year old woman with Crohn's disease presented initially with a severe primary genital herpes infection. After the first attack frequent recurrences occurred on the hands, feet, and genitalia. The patient was treated with oral acyclovir for 12 weeks, during which time she had two brief minor recurrences. After treatment was stopped lesions recurred at the same sites.
TABLE Results of treatment No (%o) cured No (%o) No (%) treatment developing Treatment Day 3 Day 10 failures PGU* Amoxycillin 3 g + probenecid 1 g: -Men (n = 43) Women (n = 42) Total (n = 85) Procaine penicillin 2-4 MU + probenecid I g Men (n = 51) Women (n = 87) Total (n = 87) 42 (97 7) 41 (97 6) 83 (97 6) 49 (96-1) 35 (97 2) 84 (96 6) 42
The growth of Candida spp from vaginal specimens in Bushby's liquid medium for T vaginalis was compared with that on Sabouraud's agar medium, and isolation was significantly greater in Bushby's medium (p less than 0.001). Isolations missed (4.43%) in Bushby's medium probably represented vaginal carriage of small numbers of Candida spp.
1. Webster ADB, Taylor-Robinson D, Furr PM, Asherson GL. Chronic cystitis and urethritis associated with ureaplasmal and mycoplasmal infection in primary hypogammaglobulinaemia. Br J Urol 1982;54:287-91. 2. Asherson GL, Webster ADB. Diagnosis and treatment of immunodeficiency diseases. Oxford: Blackwell Scientific Publications, 1980. 3. Webster ADB, Taylor-Robinson D, Furr PM, Asherson GL. Mycoplasmal (ureaplasma) septic arthritis in hypogammaglobulinaemia. Br Med J 1978; i: 478-9.
A group of 25 controls and 30 women with lesions of the cervix associated with papillomavirus were studied prospectively by colposcopy and cytology for up to two years to investigate the relation between human papillomavirus (HPV) infection of the cervix and resolution or progression of cervical intraepithelial neoplasia (CIN). We found that the viral changes were transient and that active infection, as judged by repeated colposcopic and cytological examination, resolved in 83% of the patients. Resolution or persistence of the viral infection did not appear to affect the development of the CIN lesion. The proportion of CIN lesions that resolved and persisted were the same for the study group and the controls. Possible reactivation of latent papillomavirus was noted in three control group patients. Our findings indicate that changes in the cervix associated with papillomavirus should not influence the clinical management or follow up of patients with CIN.
