Ciprofloxacin, 500 mg, was introduced as the first-line therapy for gonorrhea at St. Mary's Hospital, London, in 1989, when a surveillance program was initiated to detect the emergence of resistance. Isolates of Neisseria gonorrhoeae from consecutive patients attending the Jefferiss Wing, Genitourinary Medicine Clinic at St. Mary's Hospital, between 1989 and 1997 have been tested for susceptibility to ciprofloxacin by using an agar dilution breakpoint technique. Isolates considered potentially resistant (MIC, >0.12 microg/ml) were further characterized by determination of the MICs of ciprofloxacin, nalidixic acid, and penicillin, auxotyped and serotyped, and screened for mutations in the DNA gyrase gene, gyrA, and the topoisomerase IV gene, parC. A total of 4,875 isolates were tested. While the majority of isolates were highly susceptible (MIC, =0.008 microg of ciprofloxacin/ml), there was a drift toward reduced susceptibility in N. gonorrhoeae isolated between 1993 and 1996 (P < 0.001). In 1997 this drift was reduced but remained above pre-1993 levels. Isolates from 18 patients were classed as potentially resistant (MIC, >0.12 microg/ml); all of these belonged to serogroup B, and NR/IB-1 was the most common auxotype/serovar class. The infections in 14 of the 18 patients were known to be acquired abroad, and 5 were known to result in therapeutic failure. The surveillance program has established that ciprofloxacin is still a highly effective antibiotic against N. gonorrhoeae in this population. However, it has identified a drift in susceptibility which may have resulted from increased usage of ciprofloxacin. High-level resistance has now emerged, although treatment failure is still uncommon.

Objective: To compare partner notification practice and outcomes at a provincial and a metropolitan clinic.Design: Prospective study, following standardisation of partner notification policy.Settings: Sheffield Department of Genitourinary Medicine, Royal Hallamshire Hospital and Jefferiss Wing Centre for Sexual Health, St Mary's Hospital, London.Subjects: Consecutive patients with culture positive gonorrhoea between October 1994 and March 1996 who were interviewed by a health adviser.Results: In Sheffield, 235 cases reported 659 outstanding contacts, of whom 129 (20%) were subsequently screened, and 65 (50%) had gonorrhoea. At St Mary's 510 cases reported 2176 outstanding contacts, of whom 98 (5%) were known to have been screened, and 53 (54%) had gonorrhoea. Patient or provider referral agreements appeared more productive in Sheffield, where 60% resulted in contact attendance, compared with 13% at St Mary's. Provider referral was used more frequently in Sheffield, for 44% of referrals, compared with 1% at St Mary's. Multivariate analysis showed that partner notification was less effective for casual and short term (<7 days) partnerships in both centres, and for homosexual men at St Mary's.Conclusion: Partner notification outcomes were better in the provincial setting where contact attendance could be recorded more reliably and provider referral was used more extensively. The high proportion of contacts who remained untraced in both settings indicates the need for complementary screening and prevention initiatives.

We aimed to describe and compare sexual links among people with gonorrhoea, by studying patients in 2 UK departments of genitourinary medicine. Interviews were completed for 510 and 235 cases in London and Sheffield respectively. There was a greater proportion of cases in men, homosexual men, non-white and non-British people and fewer female sex workers in London. Total networks of 1738 people in London and 570 people in Sheffield were described. Large linked heterosexual networks identified in Sheffield were associated with local contact, including men with higher numbers of sexual partners. Condom use for vaginal sex was reported for 11% of heterosexual partnerships in Sheffield, and 27% in London, with little difference between regular and casual partners. It was more difficult to define networks in London due to a high proportion of relatively anonymous contacts. These difficulties suggest that research and interventions may profitably focus upon venues for meeting partners as well as partner notification.

Lactobacilli are the predominant organisms in the healthy vagina whereas there are few or none in the vagina of women with bacterial vaginosis (BV). In a study of 155 women, these organisms were isolated from the vagina of 47 (88 . 6 per cent) of 53 healthy women, and from 30 (29 . 4 per cent) of 102 women with BV, the dominant species being L. acidophilus and L. plantarum. The proportion of hydrogen peroxide (H2O2)-producing strains of these two species, 31 (72 per cent) of 43 isolated from healthy women, was similar to the proportion of such strains, 14 (77 per cent) of 18 isolated from women with BV. Furthermore, the total number of H2O2-producing lactobacilli isolated from the healthy women, that is 38 (61 per cent) of 62 isolates of H2O2-producers, was not greatly different from 31 (73 per cent) of 42 isolates recovered from the women with BV. Overall, the number of colonies of lactobacilli isolated on Rogosa agar and the amount of H2O2 produced by them were not much different whether the organisms were recovered from healthy women or women with BV.Bacteria-free supernates containing H2O2 produced by growth of several strains of lactobacilli, in addition to micro-molar solutions of H2O2 and known concentrations of lactic acid and urea, had no inhibitory effect on Bacteroides ureolyticus, Pievotella melaninogenica (B. melaninogenicus) and Bifidobacterium spp. However, Gardnerella vaginalis and Mobiluncus spp. were weakly-inhibited by the cell-free supernates and G. vaginalis by solutions of nitrate and catalase. As these organisms were also resistant to known concentrations of analytical H2O2, the positive inhibitory reaction from these fluids was probably due to an inhibitory substance in the supernate other than H2O2 which deserves further investigation. These observations suggest that H2O2 per se may be less bactericidal than previously thought in the control of intra-vaginal proliferation by BV-related bacteria in vivo.

Conference Abstract| February 01 1995 Comparative Study of Small Intestinal and Colonic Permeability in Human Immunodeficiency Virus (Hiv) Infected Homosexual Men F Obinna; F Obinna 1Dept of G.U.M. and Infectious Diseases, Northwick Park Hosp. London Search for other works by this author on: This Site PubMed Google Scholar G Cook; G Cook *Dept Radiology, St Mary's Hosp. London Search for other works by this author on: This Site PubMed Google Scholar T Beale; T Beale *Dept Radiology, St Mary's Hosp. London Search for other works by this author on: This Site PubMed Google Scholar D Cunningham; D Cunningham *Dept Radiology, St Mary's Hosp. London Search for other works by this author on: This Site PubMed Google Scholar S Fleming; S Fleming ++Dept Clin Biochem, University of Newcastle, Newcastle-upon-Tyne Search for other works by this author on: This Site PubMed Google Scholar E Claydon; E Claydon +Dept G.U.M/HIV Medicine, St Mary's Hosp. London Search for other works by this author on: This Site PubMed Google Scholar J Harris; J Harris +Dept G.U.M/HIV Medicine, St Mary's Hosp. London Search for other works by this author on: This Site PubMed Google Scholar M Kapembwa M Kapembwa 1Dept of G.U.M. and Infectious Diseases, Northwick Park Hosp. London Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1995) 88 (s32): 16P–17P. https://doi.org/10.1042/cs088016Pc Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Citation F Obinna, G Cook, T Beale, D Cunningham, S Fleming, E Claydon, J Harris, M Kapembwa; Comparative Study of Small Intestinal and Colonic Permeability in Human Immunodeficiency Virus (Hiv) Infected Homosexual Men. Clin Sci (Lond) 1 February 1995; 88 (s32): 16P–17P. doi: https://doi.org/10.1042/cs088016Pc Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1995 The Biochemical Society and the Medical Research Society1995 Article PDF first page preview Close Modal You do not currently have access to this content.

ObjectivesTo investigate both small and large intestinal permeability in HIV-positive subjects, and correlate variation in intestinal mucosal abnormality with immunological and nutritional markers of HIV disease. MethodsSmall and large intestinal permeability studies were performed in 14 HIV-seropositive patients and eight healthy men. Eight out of the 14 patients had diarrhoea and all subjects were negative for enteropathogens. Small intestinal permeability was determined using the lactulose-mannitol test and large intestinal permeability using the colonic absorption of 51Cr-EDTA. In addition, CD4 cell count, β2-microglobulin, C-reactive protein estimation and anthropometry were carried out in all subjects. ResultsHIV-seropositive subjects had higher lactulose-mannitol ratios (LMR; 0.084±0.007 versus 0.013±0.0008) and lower 51Cr activity (1.986±0.066 versus 3.115±0.560) than controls (P<0.0004 and P<0.05, respectively). Colonic uptake of 51Cr-EDTA was no different between subjects with and those without diarrhoea (2.04±0.124 versus 1.92±0.143; P> 0.05). A negative correlation was found between LMR and 51Cr-EDTA, but only for patients with diarrhoea (r=-0.81; P=0.015). ConclusionRegional variation affecting intestinal absorptive function occurs in patients with HIV-related diarrhoea and is characterized by increased LMR and reduced colonic uptake of 51Cr-EDTA. The pathogenesis and clinical significance of such changes are unknown.

s of the British Nuclear Medicine Society Autumn Meeting: MANCHESTER, 6-7 OCTOBER 1994 SESSION 3: GASTROINTESTINAL SYSTEM: PDF Only

Eighty-seven inpatients were treated for 93 episodes of Pneumocystis carinii at St Mary's Hospital between January 1989 and December 1990. During this period, 298 patients with the acquired immunodeficiency syndrome (AIDS) were treated at this hospital. Sixteen episodes of pneumothorax occurred and 12 of these, occurring in ten patients, were unrelated to procedure. In six of 12 (50%), the pneumothoraces occurred concurrently with Pneumocystis carinii pneumonia (PCP) and in ten (83%) cases there was a past history of PCP. Bilateral pneumothorax occurred in five cases (42%). In seven (58%) of the cases, patients had been using aerosolized pentamidine as prophylaxis for PCP. This retrospective study confirms the association of pneumothorax with current PCP and also shows an association with previous infection. The use of aerosolized pentamidine was not associated with pneumothorax development. It is important to suspect pneumothorax in a patient with PCP who deteriorates acutely. The high incidence of bilateral pneumothorax means that pleurodesis should be considered early.

We present the case of a homosexual male patient with the acquired immune deficiency syndrome (AIDS) who developed disseminated infection with Pneumocystis carinii. He presented with symptoms and signs of thyroid disease, and developed thyroid gland calcification. This was later histologically proven to be due to P. carinii infection. Disseminated P. carinii infection is rare, and this case represents the first report to our knowledge of thyroid gland involvement causing both hypothyroidism and calcification.

The risk of contracting HIV infection as a result of rape is unknown. We describe 4 female patients who were found to have antibodies to HIV-1 following rape, only one of whom had another recognized risk factor for HIV infection. The need for careful follow-up of rape victims, and the potential for HIV acquisition by the assailant is discussed.