J Mol Evol, 1996 Dec, 43(6), 631 - 40 A comparison of the nucleotide sequences of the adk and recA genes of pathogenic and commensal Neisseria species: evidence for extensive interspecies recombination within adk; Feil E et al.; The sequences of the adenylate kinase gene (adk) and the RecA gene (recA) were determined from the same isolates of Neisseria gonorrhoeae, N . meningitidis, N . lactamica, N . polysaccharea, N . cinerea, N . mucosa, N . pharyngis var . flava, N . flavescens, and N . animalis . The patterns of sequence divergence observed at adk and recA were very different . Dendrograms constructed from the recA data using two different algorithms were statistically robust and were congruent with each other and with the relationships between the species previously proposed using other data . In contrast, the dendrograms derived from the adk data were noncogruent with each other, and with those from the recA data, and were statistically poorly supported . These results, along with the uniform distribution of pairwise sequence divergences between the species at adk, suggest there has been a history of interspecies recombination within the adk gene of the human Neisseria species which has obscured the phylogenetic relationships between the species . This view was supported by Sawyer's runs test, and the Index of Association (IA) between codons, which provided significant evidence for interspecies recombination between the adk genes from the human Neisseria species, but no evidence of interspecies recombination between the recA sequences. FEMS Immunol Med Microbiol, 1996 Dec 1, 16(2), 127 - 39 Fimbrial adhesins: similarities and variations in structure and biogenesis; Smyth CJ et al.; Fimbriae are wiry (2 to 4 nm diam.) or rod-shaped (6 to 8 nm diam.), fibre-like structures on the surfaces of bacteria which mediate attachment to host cells . Much has been learned in recent years about the biogenesis, structure and regulation of expression of these adhesive organelles in Gram-negative bacteria . Analyses of the genetic determinants encoding the biogenesis of fimbriae has revealed that the adhesive interaction of fimbriae can be mediated by major subunits (CFA/I and CS1 fimbriae) or minor subunits (P, S, and type 1 fimbriae), with the adhesin being located either at the tip of the fimbria or along the length of the fimbrial shaft . Minor subunits can also act as adapters, anchors, initiators or elongators . Post-translational glycosylation of the type 4 pilins of Neisseria gonorrhoeae, Neisseria meningitidis and Pseudomonas aeruginosa has been demonstrated . The structures of the PapD chaperone of Escherichia coli and of N . gonorrhoeae type 4 fimbrin have been resolved at 2.0-2.6 A . Rod-shaped fimbriae should not be thought of as being rigid inflexible structures but rather as dynamic structures which can undergo transition from a helicoidal to a fibrillar conformation to provide a degree of elasticity and plasticity to the fimbriae so that they can resist shear forces, rather like a bungee cord . At least four mechanisms have been identified in the assembly of fimbriae from fimbrin subunits, namely the chaperone-usher pathway (e.g., P-fimbriae of uropathogenic E . coli), the general secretion assembly pathway (e.g., type 4 fimbriae or N-methylphenylalanine fimbriae of P . aeruginosa, the extracellular nucleation-precipitation pathway (e.g., curli of E . coli) and the CFA/I, CS1 and CS2 fimbrial pathway. Eur J Epidemiol, 1996 Dec, 12(6), 651 - 4 Neisseria gonorrhoeae RNA/DNA hybridization and culture for screening of gonococcal infections in a low-prevalence population; Sednaoui P et al.; Gonorrhea is still a major sexually transmitted disease (STD) worldwide . Its etiologic diagnosis is based on identification of the causative agent, Neisseria gonorrhoeae, by culture of genital secretions, which is often hampered by difficulties of sample collection and transport . Alternatively, nucleic acid hybridization techniques for routine diagnosis of N . gonorrhoeae appear to be useful by eliminating problems associated with bacterial viability, particularly for surveillance of low-prevalence populations . Our study among 1,508 outpatients undergoing routine examination for common STDs used RNA/DNA hybridization with a DNA probe specific for N . gonorrhoeae (Gen Probe Pace 2) and classical culture . Of the 1,750 specimens tested, 12 were positive by DNA probe and culture . In 8 cases, only DNA probe was positive while culture was negative . In 3 of these discrepant cases clinical and epidemiological data suggested true N . gonorrhoeae infection . Thus, DNA probe assay for N . gonorrhoeae may greatly improve screening of N . gonorrhoeae among low-prevalence populations . However, culture remains mandatory for testing antimicrobial resistance of these highly communicable infectious agents. Epidemiol Infect, 1996 Dec, 117(3), 423 - 8 An 18 year clinical review of septic arthritis from tropical Australia; Morgan DS et al.; A retrospective study of 191 cases of septic arthritis was undertaken at Royal Darwin Hospital in the tropical north of Australia . Incidence was 9.2 per 100,000 overall and 29.1 per 100,000 in Aboriginal Australians (RR 6.6; 95% CI 5.0-8.9) . Males were affected more than females (RR 1.6; 95% CI 1.2-2.1) . There was no previous joint disease or medical illness in 54% . The commonest joints involved were the knee (54%) and hip (13%) . Significant age associations were infected hips in those under 15 years and infected knees in those over 45 years . Seventy two percent of infections were haematogenous . Causative organisms included Staphylococcus aureus (37%), Streptococcus pyogenes (16%) and Neisseria gonorrhoeae (12%) . Unusual infections included three melioidosis cases . Polyarthritis occurred in 17%, with N . gonorrhoeae (11/23) more likely to present as polyarthritis than other organisms (22/168) (OR 6.0; 95% CI 2.1-16.7) . Univariate and multivariate analysis showed the hip to be at greater risk for S . aureus than other joints . Open arthrotomy was a more successful treatment procedure than arthroscopic washout or needle aspiration. Clin Chem, 1996 Dec, 42(12), 1915 - 23 COBAS AMPLICOR: fully automated RNA and DNA amplification and detection system for routine diagnostic PCR; DiDomenico N et al.; The COBAS AMPLICOR system automates amplification and detection of target nucleic acids, making diagnostic PCR routine for a variety of infectious diseases . The system contains a single thermal cycler with two independently regulated heating/cooling blocks, an incubator, a magnetic particle washer, a pipettor, and a photometer . Amplified products are captured on oligonucleotide-coated paramagnetic microparticles and detected with use of an avidin-horseradish peroxidase (HRP) conjugate . Concentrated solutions of amplicon or HRP were pipetted without detectable carryover . Amplified DNA was detected with an intraassay CV of < 4.5%; the combined intraassay CV for amplification and detection was < 15% . No cross-reactivity was observed when three different target nucleic acids were amplified in a single reaction and detected with three target-specific capture probes . The initial COBAS AMPLICOR menu includes qualitative tests for diagnosing infections with Chlamydia trachomatis, Neisseria gonorrhoeae, Mycobacterium tuberculosis, and hepatitis C virus . All tests include an optional Internal Control to provide assurance that specimens are successfully amplified and detected. FEMS Microbiol Lett, 1996 Dec 1, 145(2), 201 - 7 The prevalence of gentamicin 2'-N-acetyltransferase in the Proteeae and its role in the O-acetylation of peptidoglycan; Clarke AJ et al.; The prevalence of aac(2')-Ia, a gene coding for gentamicin 2'-N-acetyltransferase in Providencia stuartii, among species of the Proteeae was investigated to determine if it is a common resistance factor and whether the correlation observed in P . stuartii between its expression and the levels of peptidoglycan O-acetylation represents a general feature of bacteria producing this form of modified peptidoglycan . An evaluation of the MICs of gentamicin for each of the species of the Proteeae did not reveal any apparent relationship between resistance and the degree of O-acetylation of peptidoglycan . The entire aac(2')-Ia gene was used as a probe in Southern hybridization experiments against genomic DNA from each species of the Proteeae . A sequence with strong homology to aac(2')-Ia was present only in Proteus penneri while weak hybridization was also observed to the restriction digested DNA from Providencia rettgeri . Other bacteria that O-acetylate peptidoglycan were also screened with this probe and a homologous DNA sequence was only found in Neisseria subflava . These data suggest that AAC(2')-Ia may contribute to the O-acetylation of peptidoglycan in P . stuartii, but a more specific enzyme must also be produced for this function. FEMS Microbiol Lett, 1996 Dec 1, 145(2), 173 - 9 Genome plasticity in Neisseria gonorrhoeae; Gibbs CP et al.; The pathogenic Neisseria have exploited the processes of horizontal DNA transfer and genetic recombination as mechanisms for the generation of extensive protein variation and modulation of gene expression . Localized recombinations have been well documented in members of multigene families as have alterations in short repetitive sequences . Here we report an analysis of the chromosomal structure of a defined lineage of Neisseria gonorrhoeae strain MSl1 pilin variants . This study reveals the occurrence of large rearrangements, including the amplification of a 26 kb region and an inversion involving more than a third of the chromosome . Additionally, a restriction site polymorphism that correlates with pilin expression has been observed . These findings highlight the flexibility of the gonococcal genome. Infect Dis Clin North Am, 1996 Dec, 10(4), 797 - 809 Acute bacterial meningitis; Segreti J et al.; Despite improvements in antibiotic therapy and the use of vaccines and chemoprophylaxis, acute bacterial meningitis remains a significant cause of morbidity and mortality in the United States . Early diagnosis and therapy are important once the condition has been considered and the appropriate available specimens collected . Changes in epidemiologic frequencies and antimicrobial susceptibilities suggest that therapy will become more uniform across all age groups . Rapid, specific diagnostic modalities for all etiologic agents and improved vaccines for Neisseria meningitidis type B and Streptococcus pneumoniae are urgently needed. Infect Immun, 1996 Dec, 64(12), 5263 - 8 Outer membrane protein of Neisseria meningitidis as a mucosal adjuvant for lipopolysaccharide of Brucella melitensis in mouse and guinea pig intranasal immunization models; Van De Verg LL et al.; A mucosal vaccine against brucellosis consisting of the lipopolysaccharide (LPS) of Brucella melitensis complexed with the outer membrane protein (GBOMP) of group B Neisseria meningitidis was tested in small-animal models of intranasal immunization . Mice given two doses of the vaccine developed high levels of immunoglobulin G (IgG) and IgA antibodies specific for B . melitensis LPS in lung lavages and specific IgG and IgA antibody-secreting cells in the lungs and spleen . Similarly, in guinea pigs immunized twice intranasally, IgG and IgA LPS-specific antibodies were detected in lung lavages, and specific antibody-secreting cells were isolated from the spleen and cervical nodes . In mice immunized with LPS only, pulmonary responses consisted mostly of IgM antibodies, while guinea pigs given LPS alone developed local antibody of all three isotypes, but at lower levels compared to animals given the complex vaccine . Both mice and guinea pigs also developed high levels of serum IgG and moderate levels of IgA as a result of intranasal immunization with the complex vaccine . The serum antibodies in both cases were found to cross-react with the LPS of B . abortus, which shares an immunogenic epitope with B . melitensis LPS . In mice given the complex vaccine, there was a prominent serum IgG1 response that was absent in the mice given LPS alone . In conclusion, the N . meningitidis GBOMP was an effective mucosal adjuvant for secretory IgA and IgG responses in the lungs of both mice and guinea pigs . The IgG1 subclass response in mice suggests that GBOMP may have favored a Th2 type of response to the LPS . A vaccine capable of stimulating high levels of antibody at local sites has the potential to protect against brucellae, since these pathogens gain entry to the host via mucosal routes. J Clin Microbiol, 1996 Dec, 34(12), 3214 - 7 Comparative assessment of Etest for testing susceptibilities of Neisseria gonorrhoeae to penicillin, tetracycline, ceftriaxone, cefotaxime, and ciprofloxacin: investigation using 510(k) review criteria, recommended by the Food and Drug Administration; Biedenbach DJ et al.; We evaluated the ability of the Etest (AB Biodisk, Solna, Sweden) method to accurately and reproducibly determine the antimicrobial susceptibility of Neisseria gonorrhoeae . One hundred gonococcal isolates were used to evaluate the diagnostic performance of the Etest compared with the reference agar dilution method for penicillin, tetracycline, ciprofloxacin, and ceftriaxone . Between 92 and 99% of Etest MIC results for all drugs were within +/- 1 log2 dilution of the reference MIC . According to recommended interpretive criteria, ceftriaxone, cefotaxime, and ciprofloxacin had 100% categorical agreement, while penicillin (86%) and tetracycline (85%) categorical agreement percentages were lower because of the large number of strains that were within 0.5 to 1 log2 dilution of the susceptible or resistant breakpoints . Reproducibility data also demonstrated that the Etest was precise (99.1%) when subjected to replicate testing . On the basis of these data, the Etest method provides an effective, simple alternative to the reference agar dilution method for the direct quantification of N . gonorrhoeae susceptibility. J Infect Dis, 1996 Dec, 174(6), 1238 - 48 Experimental immunization with a monoclonal anti-idiotope antibody that mimics the Neisseria gonorrhoeae lipooligosaccharide epitope 2C7; Gulati S et al.; An anti-idiotope monoclonal antibody (MAb), called CA1 (Ab2), was produced in mice against MAb 2C7, which recognizes a widely in vivo-expressed gonococcal lipooligosaccharide (LOS) epitope . Mice immunized with MAb CA1 initially had a 2.5-fold increase in IgG (12-fold after a booster) but no increase in IgM anti-LOS (Ab1') antibody . Control mice immunized with LOS had a 4.5-fold rise in IgG and 4-fold rise in IgM anti-LOS antibody . In rabbits, MAb CA1 elicited a 9-fold rise in IgG and a 3.3-fold rise in IgM anti-LOS (Ab1') antibody . Ab1' antibody bactericidal activity was 1-2 logs greater than that produced by immunization with LOS . Ab1' mediated complete human polymorphonuclear leukocyte phagocytosis of 2C7 epitope-positive (but not 2C7 epitope-negative) gonococci . MAb CA1 acts as a molecular surrogate (Ab2beta) for the nominal LOS antigen and may form the basis for vaccine candidates for human immunization against Neisseria gonorrhoeae. J Infect Dis, 1996 Dec, 174(6), 1223 - 37 Immunogenicity of Neisseria gonorrhoeae lipooligosaccharide epitope 2C7, widely expressed in vivo with no immunochemical similarity to human glycosphingolipids; Gulati S et al.; Natural infection with Neisseria gonorrhoeae may elicit a substantial antibody response directed against gonococcal lipooligosaccharide . Monoclonal antibody (MAb) 2C7 recognized a gonococcal lipooligosaccharide epitope, identified the epitope directly in 94% of 68 consecutive culture-positive genital secretions, and recognized 95% of 101 randomly chosen fresh (second-passage) gonococcal isolates . The epitope was stably maintained after multiple in vitro passages and did not compete with any of the known cross-reactive human glycosphingolipid structures . MAb 2C7 mediated in vitro killing and phagocytosis by human polymorphonuclear leukocytes of 1 serum-sensitive (sialylated or not) and 1 stably serum-resistant gonococcal isolate that expressed the epitope . Gonococcal endometritis and disseminated infection elicited increases (6.5-fold IgM, 4.4-fold IgG; 18-fold IgM, 17-fold IgG, respectively) in anti-2C7 epitope antibody . Immunization with a gonococcal outer membrane vaccine elicited a mean 44.5-fold increase in IgG anti-2C7 epitope antibody in 20 of 28 subjects . The epitope identified by MAb 2C7 may represent an excellent target for a potentially protective gonococcal vaccine candidate. J Biol Chem, 1996 Nov 8, 271(45), 28271 - 6 Cloning of the lipooligosaccharide alpha-2,3-sialyltransferase from the bacterial pathogens Neisseria meningitidis and Neisseria gonorrhoeae; Gilbert M et al.; The genes encoding the alpha-2,3-sialyltransferases involved in lipooligosaccharide biosynthesis from Neisseria meningitidis and Neisseria gonorrhoeae have been cloned and expressed in Escherichia coli . A high sensitivity enzyme assay using a synthetic fluorescent glycosyltransferase acceptor and capillary electrophoresis was used to screen a genomic library of N . meningitidis MC58 L3 in a "divide and conquer" strategy . The gene, denoted lst, was found on a 2 . 0-kilobase fragment of DNA, and its sequence was determined and then used to design probes to amplify and subsequently clone the corresponding lst genes from N . meningitidis 406Y L3, N . meningitidis M982B L7, and N . gonorrhoeae F62 . Functional sialyltransferase was produced from the genes derived from both L3 N . meningitidis strains and the N . gonorrhoeae F62 . However, the N . meningitidis M982B L7 gene contained a frameshift mutation that renders it inactive . The expression of the lst gene was easily detected using the enzyme assay, and the protein expression could be detected when an immunodetection tag was added to the COOH-terminal end of the protein . Using the synthetic acceptor N-acetyllactosamine-aminophenyl-(6-(5-(fluorescein-carboxamido)-hexan oic acid amide), the alpha-2,3 specificity of the enzyme was confirmed by NMR examination of the reaction product . The enzyme could also use synthetic acceptors with lactose or galactose as the saccharide portion . This study is the first example of the cloning, expression, and examination of alpha-2,3-sialyltransferase activity from a bacterial source. Gene, 1996 Nov 7, 179(1), 147 - 55 The molecular genetics of type-4 fimbriae in Pseudomonas aeruginosa--a review; Mattick JS et al.; Type-4 fimbriae (or pili) are filaments found at the poles of a wide range of bacterial pathogens, including Neisseria gonorrhoeae, Moraxella bovis, Dichelobacter nodosus and Pseudomonas aeruginosa . They are composed of a small subunit which is highly conserved among different species and appear to mediate adhesion and translocation across epithelial surfaces via a phenomenon termed "twitching motility' . These fimbriae are key host colonisation factors and important protective antigens . We have analysed the genetics and biosynthesis of type-4 fimbriae in P . aeruginosa, which is an opportunistic pathogen of compromised individuals, including those suffering cystic fibrosis, AIDS or burns . A library of P . aeruginosa transposon mutants was constructed which exhibited loss of twitching motility, as determined by altered colony morphology . Analysis of these mutants, and of similar collections by other groups, have revealed that there are at least 22 genes involved in type-4 fimbrial assembly and function . A large number (pilA, B, C, D, E, M, N, O, P, Q, T, U, V and Z) appear to be involved in the biogenesis of the fimbriae and to represent a subset of a supersystem involved in the assembly of surface-associated protein complexes . Homologs of at least some of these genes have subsequently been identified in other type-4 fimbriate bacteria . In P . aeruginosa, the system is also regulated via two signal transduction pathways-a classic sensor-regulator system (encoded by pilS, pilR and rpoN) which controls transcription of the fimbrial subunit, presumably in response to host cues, and a chemotactic system (encoded by pilG, H, I, J, K and L) which may be involved in the directional or rate control of twitching motility in response to local environmental variables. Mem Inst Oswaldo Cruz, 1996 Nov-Dec, 91(6), 789 - 93 Agar dilution method for susceptibility testing of Neisseria gonorrhoeae; de Castillo MC et al.; The antibiotic susceptibilities of Neisseria gonorrhoeae isolates obtained from patients attending a clinic for sexually transmitted diseases in Tucuman, Argentina, were determined by the agar dilution method (MIC) . 3.5% of the isolates produced beta-lactamase . A total of 96.5% of beta-lactamase negative isolates tested were susceptible to penicillin (MIC < or = 2 micrograms/ml-1); 14.03% of the tested isolates were resistant to tetracycline (MIC < or = 2 micrograms/ml-1), and 98% of the tested isolates were susceptible to spectinomycin (MIC < or = 64 micrograms/ml-1) . The MICs for 95% of the isolates, tested for other drugs were: < or = 2 micrograms/ml-1 for cefoxitin, < or = 0.06 microgram/ml-1 for cefotaxime, < or = 0.25 microgram/ml-1 for norfloxacin, < or = 10 micrograms/ml-1 for cephaloridine, < or = 10 micrograms/ml-1 for cephalexin, and < or = 50 micrograms/ml-1 for kanamycin . Antibiotic resistance among N . gonorrhoeae isolates from Tucuman, Argentina, appeared to be primarily limited to penicillin and tetracycline, which has been a general use against gonorrhoeae in Tucuman since 1960 . Periodic monitoring of the underlying susceptibility profiles of the N . gonorrhoeae strains prevalent in areas of frequent transmission may provide clues regarding treatment options and emerging of drug resistance. Rev Clin Esp, 1996 Nov, 196(11), 741 - 6 {Neisseria meningitidis: isolation from low respiratory tract secretions of adult patients}; Ferrer Marcelles A et al.; OBJECTIVE: A bibliographic research was made using the Medline system of the clinico-microbiological features of reported cases of Neisseria meningitidis (NM) bronchopulmonary infection, as well as a retrospective study of NM isolation from lower respiratory tract secretions from adult inpatients . MATERIALS AND METHODS: All specimens from respiratory secretions were Gram stained and cultured onto blood . MacConkey and chocolate (quantitative) agar plates; a BCYE-alpha agar plate was also used when pneumonia was diagnosed . Fifty-five clinical records were retrospectively reviewed of patients with positive cultures for NM, for a 12-year period (1983-1994) . RESULTS: A total of 67 samples were positive among the 55 patients studied; sputum and tracheobronchial samples predominated . NM was recovered in pure culture from 48 specimens (71.6%) and with counts higher than 10(6) colony forming units/ml (CFU) . Twenty-seven isolates (40.3%) corresponded to serogroup B and 21 isolates (31.3%) did not group with serogroups A, B and C . Twenty-two patients were diagnosed of pneumonia; eleven of these 22 patients had an underlying chronic lung disease . Ten patients had a respiratory overinfection, in eight cases an episode of acute bronchitis was recorded and, finally, in 15 patients there was NM colonization only . CONCLUSION: The pathogenic role of NM in lower respiratory tract infections is probably underestimated because its isolation is difficult, particularly when there is oropharyngeal flora present, since in our study, in which only conventional culture media were used, samples which had NM recovered had a high number of colonies, in pure culture in most cases. Int J STD AIDS, 1996 Nov-Dec, 7(7), 513 - 7 Determinants of the gonococcal serovar pattern in Edinburgh, Scotland: a multivariate analysis; Ross JD et al.; The geographical and temporal variety of gonococcal serovar patterns are well described but it remains uncertain what characteristics possessed by the organism, or sexual behaviour pattern in the patients, determine the particular serovar pattern in a given area at a given time . This study was designed to assess the relative contribution of various demographic and clinical features of infection to the observed pattern of serovars in Edinburgh between 1990 and 1993 . Five hundred and eight isolates were included in a multivariate analysis model to control for potential interactions between variables . Associations were noted between certain serovars and an asymptomatic clinical presentation, method of acquisition and site of infection . Certain physical characteristics of Neisseria gonorrhoeae in conjunction with the sexual behaviour patterns of patients are partially responsible for observed serovar patterns but more detailed analysis requires further sub-classification of serovars using molecular techniques. Hum Reprod Update, 1996 Nov-Dec, 2(6), 519 - 29 Chlamydial pelvic inflammatory disease; Paavonen J et al.; Pelvic inflammatory disease (PID) is the most important complication present in the female lower genital tract, causing major medical, social and economic problems . Although PID can be caused by multiple microorganisms, it results most frequently from the ascent of sexually transmitted Chlamydia.trachomatis or Neisseria gonorrhoeae infections from the cervix to the upper genital tract . The importance of cervical chlamydial infection in the pathogenesis of PID is well recognized . Recent data from many developed countries have shown a striking decrease in the incidence of gonococcal infections, while the rates of chlamydial infections remain high in most countries . Complications of PID are common and usually irreversible . Emerging evidence suggests that universal or selected screening of defined populations for cervical chlamydial infection leads to a dramatic reduction in the incidence of PID . Recent technological advances should further enhance efforts to prevent chlamydial infection and PID . Gene amplification-based diagnostic tests, screening by testing first-void urine, and single dose antimicrobial therapy greatly facilitate chlamydia control programmes . Thus, screening for chlamydia is the key approach in the secondary prevention of PID . The obvious challenge is to make screening for chlamydia the standard for health care for young, sexually active individuals . Since PID is the most important consequence of sexually transmitted bacterial infections, it is also imperative to develop better treatments to prevent the long-term sequelae of this disease . The development and implementation of new and effective intervention programmes for prevention and control of PID is one of the major challenges for the year 2000 and beyond. Lett Appl Microbiol, 1996 Nov, 23(5), 355 - 8 A new species of Neisseria from the dental plaque of the domestic cow, Neisseria dentiae sp . nov; Sneath PH et al.; A new species of the genus Neisseria is proposed, Neisseria dentiae sp . nov . The organism is found in dental plaque of domestic cows . It resembles N . animalis, N . canis and N . iguanae phenotypically but is distinguished from the first two by being positive for acidification of gluconate, D-glucose and usually D-fructose, and from the third by lack of predominant tetrad arrangement, lack of distinct alpha-haemolysis and by growing on nutrient agar and usually acidifying D-fructose . It is suggested that it may have significance for dental microbiology because members of the genus rapidly utilize oxygen and this may contribute to the anaerobic microenvironment found in dental plaque. Sex Transm Dis, 1996 Nov-Dec, 23(6), 481 - 8 A tale of two sexually transmitted diseases . Prevalences and predictors of chlamydia and gonorrhea in women attending Colorado family planning clinics; Gershman KA et al.; BACKGROUND: The comparative prevalences and predictors of chlamydia and gonorrhea have not been studied in the family planning clinic population . GOALS: To determine the comparative prevalences and predictors of chlamydia and gonorrhea among Colorado family planning clinic patients . STUDY DESIGN: Cross-sectional study of public and private family planning clinic patients in Colorado tested for both chlamydia and gonorrhea (n = 12,926) . RESULTS: Among women tested for both infections, the chlamydia prevalence rate was 4.5% and the gonorrhea prevalence rate was 0.5% . Multivariate analysis showed that independent predictors of chlamydia were age younger than 25 years, black or Hispanic race-ethnicity, cervical friability, mucopus, exposure to a sex partner with chlamydia, or multiple recent sex partners . Independent predictors of gonorrhea were age younger than 20 years, black or Hispanic race-ethnicity, or exposure to a sex partner with gonorrhea; adjusted odds ratios for exposure to gonorrhea and black race were the highest for either infection . CONCLUSIONS: The gonorrhea prevalence rate was very low compared to that of chlamydia in patients at Colorado family planning clinics . Cost-effective gonorrhea testing strategies are needed for this populationPIP: In Colorado, state health department laboratory personnel used the DNA probe assay, Gen-Probe, to test specimens from 12,926 women for both Chlamydia trachomatis and Neisseria gonorrhoeae infections and from another 9416 women for Chlamydia alone . All the women had attended public and private family planning clinics state-wide during July 1994 to May 1995 . Researchers conducted a comparative analysis to determine the prevalence and the predictors of each sexually transmitted disease (STD) among the family planning clinic population in Colorado . Women tested for both chlamydia and gonorrhea had a higher chlamydia prevalence rate than those tested for only chlamydia (4.5% vs . 3.5%; p 0.001) . 64 (0.5%) of the women who were tested for both chlamydia and gonorrhea tested positive for gonorrhea . The gonorrhea prevalence was 9 times lower than that of chlamydia . Among the 64 women with gonorrhea, 25 (39.1%) also tested positive for chlamydia . Among the 577 women with chlamydia, 4.3% also tested positive for gonorrhea . The multivariate analysis revealed that variables independently associated with chlamydia included age under 20 or 20-24 years (odds ratio {OR} = 3.84 and 2.44, respectively), African-American or Hispanic race-ethnicity (OR = 2.41 and 1.65, respectively), cervical friability (OR = 2.26), mucopus (OR = 2.64), exposure to a sex partner with chlamydia (OR = 3.79), and multiple recent sex partners (OR = 1.4) . Variables independently associated with gonorrhea included age under 20 years (OR = 3.42), African-American or Hispanic race-ethnicity (OR = 12.71 and 3.07, respectively), and exposure to a sex partner with gonorrhea (OR = 39.29) . Cost-effective analyses would help determine appropriate selective screening strategies for gonorrhea . The researchers found that the criteria of urban residency, African-American race, and exposure to a sex partner with gonorrhea would involve the testing of 82% of patients, which would identify 94% of gonorrhea infections . Mol Microbiol, 1996 Nov, 22(3), 509 - 22 The size and position of heterologous insertions in a silent locus differentially affect pilin recombination in Neisseria gonorrhoeae; Howell-Adams B et al.; Gonococcal pilus antigenic and phase variation result from unidirectional, RecA-dependent recombination of DNA sequences from a silent pilin copy (pilS) into the expressed pilin gene (pilE) . To develop a quantitative assay for pilin gene recombination that is independent of phase variation, a promoterless cat gene was inserted into pilS, and recombination of "cat into pilE was detected by selection of chloramphenicol-resistant (CmR) variants expressing "cat from the pilin promoter . Although RecA-dependent CmR variants occurred, none were generated by the simple transfer of "cat into pilE . Instead, each CmR variant contained a new pilin locus that was a hybrid of sequences from the pilE and the pilS1::cat loci in addition to the two starting loci . Therefore, this system could not be used to quantify antigenic variation . However, combined studies of these hybrid loci and of recombination products generated during additional pilS mutational analyses demonstrated that both the size and position of an insertion in pilS differentially affect pilin recombination . Also, the hybrid loci appear to be intermediates of antigenic variation . This enabled the creation of molecular models for the recombination reactions that result in pilin antigenic variation. Acad Emerg Med, 1996 Nov, 3(11), 1030 - 4 High prevalence of sexually transmitted diseases in women with urinary infections; Berg E et al.; OBJECTIVE: To determine the prevalence and factors associated with unrecognized sexually transmitted diseases (STDs) in women who had pelvic examinations and were subsequently released from the ED with a sole diagnosis of urinary tract infection (UTI) . METHODS: A 3-month retrospective chart review was performed in an urban teaching hospital ED (> 70,000 visits/year) . Women aged 12-45 years who had pelvic examinations and were released from the ED with a sole diagnosis of UTI were included . Patient complaints, physical findings, and laboratory results were reviewed . Laboratory evaluations included the complete blood count, urinalysis, urine pregnancy test, and cervical cultures for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas . RESULTS: Of the 94 women who met study criteria, 53% had proven STDs (19% N . gonorrhoeae, 22% C . trachomatis, 33% Trichomonas) . There was no difference between the patients with positive and negative tests for STDs with regard to complaints, physical findings, and laboratory results (all p > 0.05) . CONCLUSIONS: Women undergoing pelvic examinations who are subsequently released from this urban ED with the diagnosis of UTI have a high (> 50%) prevalence of occult STDs . No complaint, physical finding, or laboratory result reviewed was associated with the risk of an STD . Consideration should be given to empirical antibiotic therapy in similar urban populations. Gynecol Oncol, 1996 Nov, 63(2), 258 - 60 Prevalence of mycoplasma conserved DNA in malignant ovarian cancer detected using sensitive PCR-ELISA; Chan PJ et al.; Mycoplasmas are tiny polymorphic prokaryotic organisms (0.2-0.3 microm) that lack a cell wall and reside ubiquitously at the cell membrane or internalized into the cell . The organisms have been implicated in many diseases including functioning as cofactors catalyzing the HIV disease state . The oncogenic potential of mycoplasmas was only recently realized when they were shown to cause chromosomal changes and in vitro cell transformations through gradual progressive chromosomal loss and translocations . While a recent study linked mycoplasmas with gastric cancer, the association between mycoplasmas and ovarian cancer has not been established . Recently, a commercial assay which combined polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) methods was developed for the detection of mycoplasmas . The present objective was to determine the prevalence of mycoplasmas in archived paraffin-embedded malignant ovarian cancer tissue . The combined PCR-ELISA procedure was used with consensus primers targeting for 15 species of mycoplasmas and acholeplasmas . Archived human malignant ovarian cancer tissues (N = 27 cases) embedded in paraffin blocks were processed, and DNA was extracted and the presence of DNA verified . The extracted DNA specimens were randomly divided into three groups for analyses . PCR-ELISA assays were performed on extracted DNA together with appropriate negative and positive controls . The results showed mycoplasmas were present in 59.3% of the malignant ovarian cancer specimens . PCR-ELISA analysis of Neisseria gonorrhea and Chlamydia trachomatis controls did not produce cross-reacting false-positive results . The results suggest an association between mycoplasmas and malignant ovarian cancer . A 59.3% prevalence rate was demonstrated for mycoplasmas in paraffin-embedded ovarian cancer tissues . The mechanism involved in oncogenesis by mycoplasmas remains to be elucidated. J Clin Microbiol, 1996 Nov, 34(11), 2778 - 83 Evaluation of automated COBAS AMPLICOR PCR system for detection of several infectious agents and its impact on laboratory management; Jungkind D et al.; We evaluated the COBAS AMPLICOR (CA) PCR system (Roche Diagnostic Systems) designed for automated PCR amplification and detection of nucleic acids from infectious agents in clinical samples . The Roche AMPLICOR microwell plate (MWP) PCR was the reference method . CA amplifies target nucleic acid, captures the biotinylated amplification products by using magnetic particles coated with specific oligonucleotide probes, and detects the bound products colorimetrically . For Mycobacterium tuberculosis, the correlation of the results of CA tests with those of MWP tests was 100% with 230 samples, including 20 culture-positive samples . For hepatitis C virus, the correlation was 100% with 214 samples, including 60 positive samples . MultiPlex CA analysis of 199 cervical specimens for Chlamydia trachomatis, Neisseria gonorrhoeae, and the internal control gave 100% concordance . These samples included 19 C . trachomatis and 3 N . gonorrhoeae culture-positive samples . Overall, the agreement between PCR methods for all 842 comparisons was 100% . Compared with culture, the sensitivities of the assays for C . trachomatis and M tuberculosis were > or = 95% . After spiking alternating amplification tubes in the CA system with 10(14) copies of the Chlamydia amplicon per ml, we were unable to demonstrate any carryover cross-contamination of negative samples . Using the criteria of the College of American Pathologists workload recording method, we found that the total hands-on time to produce CA PCR results was 4.4, 7.9, and 3.3 min for M . tuberculosis, hepatis C virus, and the MultiPlexed assay for chlamydia plus gonorrhea and an internal control, respectively . The CA system brings true PCR automation to laboratories . In addition to the accuracy of automated results, the CA system provides labor savings, provides containment of the amplification and detection components of PCR, and supports both MultiPlex amplification and sequential algorithm (ReFlex) detection of analytes. J Immunol, 1996 Nov 1, 157(9), 4239 - 43 Genetic bases of human complement C7 deficiency; Nishizaka H et al.; Complement C7 deficiency (C7D) is associated frequently with recurrent bacterial infections, especially meningitis caused by Neisseria meningitidis . We report in this work the molecular bases of C7D in two unrelated Japanese males . We used exon-specific PCR/single-strand conformation polymorphism analysis as a screening step for mutations . Subsequent direct sequencing of the target exons identified homozygous mutations in exon 16 of case 1 and in exon 15 of case 2 . The mutation of case 1 was a homozygous T to A transversion at nucleotide 2250, the third nucleotide of the codon TGT for Cys728, leading to a stop codon TGA (C728X) . In case 2, a homozygous 2-bp deletion (2137delTG/2138delGT/2139delTG) caused a frameshift, generating a premature termination codon 4 to 6 nucleotides downstream . Family study in case 1 confirmed the genetic nature of the defect . Moreover, we detected a novel polymorphism in intron 11 that presumably is linked to the mutation responsible for C7D in case 1 . Our results indicate that the pathogenesis of C7D is heterogeneous like most of the other deficiencies of complement components. Infect Immun, 1996 Nov, 64(11), 4630 - 7 Regulation of gonococcal sialyltransferase, lipooligosaccharide, and serum resistance by glucose, pyruvate, and lactate; McGee DJ et al.; Strain F62 of Neisseria gonorrhoeae gonococci (GC) is sensitive to normal human serum unless CMP-N-acetylneuraminic acid (CMP-NANA) is present . NANA is transferred primarily to a 4.5-kDa lipooligosaccharide (LOS) structure by a GC sialyltransferase (Stase) . We investigated LOS and Stase expression and serum resistance in strain F62 grown in different carbon sources and growth conditions . Pyruvate-grown GC expressed 1.9- to 5.6-fold more Stase activity than did glucose-grown GC, whereas lactate-grown GC generally expressed intermediate Stase activities . Broth-grown GC expressed two- to fourfold more Stase activity than did plate-grown GC in all carbon sources . Pyruvate- or lactate-grown GC expressed significantly more of the sialylateable 4.5-kDa LOS species than did glucose-grown GC . Anaerobically, the 4.5-kDa LOS species was expressed in greater quantity than the 4.9-kDa N-acetyl galactosamine-terminating species in all carbon sources . Pyruvate-grown GC also incorporated up to threefold more radiolabelled CMP-NANA onto the 4.5-kDa LOS species than did glucose-grown GC . In serum resistance studies, pyruvate-grown GC were 6.5- to 16.1-fold more serum resistant than glucose-grown GC at limiting CMP-NANA concentrations (1.56 to 12.50 microg/ml) . Taken together, these results indicate that gonococcal expression of Stase activity is up-regulated by growth in pyruvate or lactate, which correlates with enhanced expression of the sialylateable 4.5-kDa LOS and, for growth in pyruvate, correlates with enhanced sialylation of gonococcal LOS and greater serum resistance . In different in vivo niches, gonococcal LOS sialylation, serum resistance, and interaction with host cells can be highly regulated. Infect Immun, 1996 Nov, 64(11), 4472 - 9 Temperature- and medium-dependent secretion of proteins by Shiga toxin-producing Escherichia coli; Ebel F et al.; Infections due to Shiga toxin-producing Escherichia coli (STEC) are responsible for severe diarrheal disease in humans and livestock, and these bacteria have recently emerged as a leading cause of renal failure in children . In this study, we have examined medium- and temperature-dependent production of secreted proteins from a STEC O26 serotype strain . Growth of bacteria in Luria broth led to the detection of secreted polypeptides of 104, 55, 54, and 37 kDa (p104, p55, p54, and p37, respectively) . When grown in serum-free tissue culture medium, only p104, p37 and two additional polypeptides of 25 and 22 kDa (p25 and p22) were present in supernatant fluids . Production of these polypeptides was growth temperature dependent and induced in cultures grown at 37 degrees C . N-terminal amino acid sequencing revealed that p104 was homologous to the secreted p110 of enteropathogenic Escherichia coli (EPEC), and both proteins belong to a family of secreted proteins in pathogenic bacteria of which the immunoglobulin A protease of Neisseria gonorrhoeae is the prototype . The N-terminal amino acid sequences of p55 and p54 were unique to the STEC strain, while p37 and p25 were found to be highly homologous to the similarly sized EspA and EspB proteins, previously detected in culture supernatants of EPEC . Molecular cloning and sequencing of STEC espB alleles from two different serotypes showed that the encoded polypeptides were about 80% homologous . A monoclonal antibody raised against STEC EspB also cross-reacted with its EPEC analog and allowed us to demonstrate medium- and temperature-dependent production of this important virulence factor in STEC and EPEC strains of differing serotypes. Gene, 1996 Oct 31, 178(1-2), 107 - 10 Absence of periplasmic DsbA oxidoreductase facilitates export of cysteine-containing passenger proteins to the Escherichia coli cell surface via the Iga beta autotransporter pathway; Jose J et al.; The Iga beta autotransporter function of IgA1 protease from Neisseria gonorrhoeae was assessed in Escherichia coli using the Vibrio cholerae toxin B subunit (CtxB) as a heterologous passenger . N-terminal fusions with Iga beta of native CtxB or mutant CtxB protein containing no cysteines were constructed and analysed in isogenic E . coli mutants carrying defects in either or both the ompT (outer membrane protease T) and dsbA (periplasmic disulfide oxidoreductase) determinants . While export of the cystein-less CtxB passenger was independent of the dsbA genotype, the native CtxB passenger was properly translocated across the outer membrane only in the dsbA mutant background . This effect was consistent in the presence and in the absence of the OmpT protease which rather determined the release of surface-bound CtxB into the medium . Therefore, in agreement with previous observations Iga beta-dependent protein secretion requires an unfolded conformation of the passenger domain and can be blocked by disulfide loop formation in the presence of DsbA . Since DsbA acts in the periplasm, this provides evidence for a periplasmic intermediate in the Iga beta-mediated export pathway . E . coli (dsbA ompT) is highly suitable as a strain for the surface display of recombinant proteins via Iga beta, whether or not they contain cysteine residues. Arch Oral Biol, 1996 Oct, 41(10), 965 - 78 Stoichiometry of oxygen consumption and sugar, organic acid and amino acid utilization in salivary sediment and pure cultures of oral bacteria; Traudt M et al.; In each of 23 numerically or metabolically significant oral micro-organisms, and in each of the salivary sediments of 10 humans, oxygen uptake was determined quantitatively with various sugar and organic and amino acid substrates . With relatively few exceptions, the salivary sediments rapidly consumed oxygen with the array of substrates (23) tested . On the other hand, the individual pure cultures oxidized fewer substrates and did so selectively from this menu . The observation that the Gram-positive bacteria readily used oxygen when sugar substrates were provided, but were unable to use oxygen with all but one of the organic and none of the amino acids was significant . The Gram-negative bacteria, in contrast, used oxygen poorly with the sugars but most readily with many of the organic and amino acids, was significant . Only two of the Gram-positive but most of the Gram-negative micro-organisms tested showed oxygen uptake with L(+)-lactate; the Gram-negative bacteria were also active with D(-)-lactate, formate and succinate . Propionate was also tested and showed oxygen uptake only with the Gram-negative micro-organism, Neisseria subflava; acetate showed none or almost none with all of the examined bacteria . Where oxygen consumption occurred with the various pure or mixed cultures and substrates tested, the quantities of oxygen consumed were less than theoretically possible . For example, they ranged on average in the sediment results from 1.78 mumol oxygen per mumol of L(+)-lactate catabolized to 5.17 mumol oxygen per mumol of lactose . This was consistent with substrate oxidation by the oral bacteria being less than complete as in aerobic glycolysis, and with compounds other than water and carbon dioxide (such as acetate) being prominent amongst the end-products produced . The pure-culture oxygen data and other reports from this laboratory have made it possible to propose a speculative scheme as to which bacterial species might be involved in the various metabolic pathways used when different substrates are catabolized and oxidized by the mixed bacteria in salivary sediment or dental plaque . Also, it made it possible to suggest which bacteria and substrates are likely to be involved in the oxygen depletion that enables plaque to achieve anaerobiosis. East Afr Med J, 1996 Oct, 73(10), 675 - 8 High frequency of sexually transmitted diseases among pregnant women in Dar es Salaam, Tanzania: need for intervention; Mwakagile D et al.; In order to determine the prevalence and characteristics of sexually transmitted diseases (STDs) in pregnant women (PW) attending a primary health care antenatal clinic (ANC) in metropolitan Dar es Salaam, Tanzania, a randomly selected sample of PW in their second or third trimesters were invited to participate at their first visit . They were interviewed using a questionnaire and underwent genital examination . Genital swabs were obtained for microscopy and/or culture isolation of Candida albicans, Trichomonas vaginalis, and Neisseria gonorrhoeae . Blood specimens were also obtained for serological testing for syphilis and for antibodies to the human immunodeficiency virus (HIV) . A total of 777 PW aged 14 to 40 years were seen . Parities ranged from 0 to 10 . Prevalence of syphilis, trichomoniasis, gonorrhoea and HIV infection were 4.0%, 22.7%, 3.6% and 15.2%, respectively . At least one acute STD (excluding HIV infection) was found in 32.8% of the PW . The prevalence of multiple STDs (excluding HIV infection) was higher in teenagers (45.3%, 77/170) than in PW in other age groups (29.2%, 177/607) (p < 0.001) . The prevalence of HIV infection in teenage PW was 10.0% . Most STDs were least prevalent in PW who were married monogamously . Of the 732 PW who had one or more genital infections (including infection with Candida species), 669 (91.4%) had one or more genital complaints . However, most of the genital complaints were not disease specific . Since this study has shown that the prevalences of acute STDs were high in PW, especially in teenagers, it is recommended that all PW in Tanzania should be screened for STDs syndromically including the use of appropriate clinical and laboratory examination whenever possiblePIP: A survey of 777 randomly selected pregnant women attending an antenatal clinic in Dar es Salaam, Tanzania, in 1993 revealed a high prevalence of sexually transmitted diseases (STDs), particularly among teenagers . The median age of survey respondents was 23.6 years (range, 14-40 years); 170 women (22%) were teenagers and 439 (56.7%) were married . 320 women (41.2%) had 1 or more STDs (excluding human immunodeficiency virus (HIV) infection); in 32.7%, there was active infection . STD prevalence was 45.3% in teenagers compared with 29.2% in adults . In the overall sample, the prevalences of syphilis, trichomoniasis, gonorrhea, and HIV were 4.0%, 22.7%, 3.6%, and 15.2%, respectively . 80 women (10.3%) showed serologic evidence of past syphilis infection and 4% had active syphilis . Syphilis was most prevalent in pregnant women aged 35 years and above (13.8%), while trichomoniasis was most common in teenagers (34.3%) . Of the 732 pregnant women with genital infections, 63 (8.6%) were asymptomatic; when symptoms did exist, they were generally not disease-specific . The most significant risk factor for STDs, including HIV, was single marital status . These findings suggest a need for the introduction of essential clinical and laboratory facilities for STD detection to antenatal clinics in Tanzania . Biosci Biotechnol Biochem, 1996 Oct, 60(10), 1617 - 22 Biodegradation of cellulose acetate by Neisseria sicca; Sakai K et al.; Bacteria capable of assimilating cellulose acetate, strains SB and SC, were isolated from soil on a medium containing cellulose acetate as a carbon source, and identified as Neisseria sicca . Both strains degraded cellulose acetate membrane filters (degree of substitution, DS, mixture of 2.8 and 2.0) and textiles (DS, 2.34) in a medium containing cellulose acetate (DS, 2.34) or its oligomer, but were not able to degrade these materials in a medium containing cellobiose octaacetate . Biodegradation of cellulose acetate (DS, 1.81 and 2.34) on the basis of biochemical oxygen demand reached 51 and 40% in the culture of N . sicca SB and 60 and 45% in the culture of N . sicca SC within 20 days . A decrease in the acetyl content of degraded cellulose acetate films and powder was confirmed by infrared and nuclear magnetic resonance analyses . After 10-day cultivation of N . sicca SB and SC, the number-average molecular weight of residual cellulose acetate decreased by 9 and 5%, respectively . Activities of enzymes that released acetic acid and produced reducing sugars from cellulose acetate were mainly present in the culture supernatant . Reactivity of enzymes for cellulose acetate (DS, 1.81) was higher than that for cellulose acetate (DS, 2.34). Diagn Microbiol Infect Dis, 1996 Oct, 26(2), 91 - 3 Recurrent bacterial peritonitis caused by Neisseria cinerea in a chronic ambulatory peritoneal dialysis (CAPD) patient; George MJ et al.; We present an unusual case of recurrent (chronic ambulatory peritoneal dialysis) CAPD-associated peritonitis caused by Neisseria cinerea . Using DNA restriction fragment length polymorphism (RFLP) analysis, we determined that the recurrent infection was caused by reinfection with a different N . cinerea strain rather than relapse with the index strain and that the probable origin of the reinfecting organism was the patient's upper respiratory tract. Genitourin Med, 1996 Oct, 72(5), 358 - 61 Trends in sexually transmitted diseases and condom use patterns among commercial sex workers in Fukuoka City, Japan 1990-93; Tanaka M et al.; OBJECTIVE: To investigate trends in sexually transmitted diseases (STDs) among female commercial sex workers and in their condom use patterns during the period from 1990 to 1993 in Fukuoka, Japan . METHODS: The study group consisted of a total of 824 commercial sex workers who attended an STD clinic to undergo screening for STDs including chlamydia, gonorrhoea, syphilis, hepatitis B and HIV-1 infection during the period from 1990 to 1993 . For detection of Chlamydia trachomatis and Neisseria gonorrhoeae, endocervical smear specimens were taken from the women . Blood samples were obtained for serological diagnosis of syphilis, hepatitis B and HIV-1 . Commercial sex workers who visited the clinic during the period from November to December of 1993 were interviewed concerning past (1990 and 1991) and recent (1992 and 1993) condom use patterns . RESULTS: The annual detection rates of C trachomatis and N gonorrhoeae declined significantly from 16.3% in 1990 to 12.2% in 1993 (P < 0.0001) and from 1.5% in 1990 to 0.8% in 1993 (P = 0.0096), respectively . There was a remarkable reduction in the annual syphilis infection rate, from 7.5% in 1990 to 0.5% in 1993 (P = 0.0011) . The positive rate for the hepatitis B surface antigen in the women ranged from only 0.6% to 1.9% and none were found to be positive for HIV-1 during the 4-year period . During the same period, there was a significant increase in the proportion of commercial sex workers always using condoms from 6.3% in 1990-91 to 25.3% in 1992-93 (P = 0.0023) . CONCLUSION: The prevalences of chlamydia, gonorrhoea, and syphilis infections decreased significantly among commercial sex workers in Fukuoka from 1990 through 1993, and no commercial sex workers were HIV-1 seropositive . The reductions in the prevalence of major STDs may be related to the increased use of condomsPIP: A survey of commercial sex workers in Fukuoka City, Japan, during 1990-93 revealed significant declines in the prevalence of chlamydia, gonorrhea, and syphilis during the study period, presumably as a result of increased condom use . The study group consisted of 824 commercial sex workers who attended a sexually transmitted disease (STD) clinic in Fukuoka from 1990 to 1993 for voluntary STD check-ups . The annual Chlamydia trachomatis detection rate declined from 16.3% in 1990 to 12.2% in 1993; the annual detection rate for Neisseria gonorrhoeae fell from 1.5% to 0.8%, while that for syphilis dropped from 7.5% to 0.5% . None of the 791 women screened for human immunodeficiency virus was seropositive . In addition, a subsample of 79 commercial sex workers were interviewed about their condom use . The proportion of sex workers always using condoms rose from 6.3% in 1990 to 25.3% in 1993; in this period, never use of condoms decreased from 45.6% to 5.1% . Infect Immun, 1996 Oct, 64(10), 4129 - 36 Expression of sialyltransferase is not required for interaction of Neisseria gonorrhoeae with human epithelial cells and human neutrophils; McGee DJ et al.; Sialyltransferase (Stase) in Neisseria gonorrhoeae organisms (gonococci {GC}) transfers sialic acid (N-acetylneuraminic acid {NANA}) from cytidine 5'-monophospho-N-acetylneuraminic acid (CMP-NANA) mainly to the terminal galactose (Gal) residue in the Gal beta-1,4 N-acetylglucosamine (Gal-GlcNAc)-R lipooligosaccharide (LOS) structure . Sialylated GC resist killing by normal human serum, sometimes show reduced invasion of epithelial cells, and have reduced adhesion to and stimulation of human neutrophils . We questioned whether Stase itself modulates the interactions of GC with human epithelial cells and neutrophils in the absence of exogenous CMP-NANA . To that end, we treated strain F62 with ethyl methanesulfonate and grew approximately 175,000 colonies on CMP-NANA plates, and screened them with monoclonal antibody 1B2-1B7 (MAb 1B2) . MAb 1B2 is specific for Gal-GlcNAc and reacts only with asialylated GC . We isolated 13 MAb 1B2-reactive mutants, including five null mutants, that had Stase activities ranging from barely detectable to fivefold less than that of wild-type (WT) F62 . The LOS phenotype of Stase null mutants was identical to that of WT F62, yet the mutants could not sialylate their LOS when grown with CMP-NANA . The Stase null phenotype was rescuable to Stase+ by transformation with chromosomal DNA from WT F62 . Stase null mutants remained serum sensitive even when grown with CMP-NANA . One Stase null mutant, ST94A, adhered to and invaded the human cervical epithelial cell line ME-180 at levels indistinguishable from that of WT F62 in the absence of CMP-NANA . In human neutrophil studies, ST94A stimulated the oxidative burst in and adhered to human neutrophils at levels similar to those of WT F62 . ST94A and WT F62 were also phagocytically killed by neutrophils at similar levels . These results indicate that expression of Stase activity is not required for interaction of GC with human cells. Mol Microbiol, 1996 Oct, 22(1), 161 - 73 Fimbrial biogenesis genes of Pseudomonas aeruginosa: pilW and pilX increase the similarity of type 4 fimbriae to the GSP protein-secretion systems and pilY1 encodes a gonococcal PilC homologue; Alm RA et al.; Type 4 fimbriae of Pseudomonas aeruginosa are surface filaments involved in host colonization . They mediate both attachment to host epithelial cells and flagelia-independent twitching motility . Four additional genes, pilW, pilX, pilY1 and pilY2, are located on Spel fragment E in the 5 kb intergenic region between the previously characterized genes pilV and pilE, which encode prepilin-like proteins involved in type 4 fimbrial biogenesis . The phenotypes of a transposon insertion and other mutations constructed by allelic exchange show that these genes are involved in the assembly of type 4 fimbriae . The PilW and PilX proteins are membrane located, possess the hydrophobic N-terminus characteristic of prepilin-like proteins, and appear to belong to the GspJ and GspK group of proteins that are required for protein secretion in a wide range of Gram-negative bacteria . These findings increase the similarities between the fimbrial biogenesis and the Gsp-based protein-secretion supersystems . PilY1 is a large protein with C-terminal homology to the PilC2 protein of Neisseria gonorrhoeae, thought to be a fimbrial tip-associated adhesin, and which, like PilY1, is involved in fimbrial assembly . PilY1 appears to be located in both the membrane and the external fimbrial fractions . PilY2 is a small protein that appears to play a subtle role in fimbrial biogenesis and represents a new class of protein. Mol Microbiol, 1996 Oct, 22(1), 31 - 42 Processing of the AIDA-I precursor: removal of AIDAc and evidence for the outer membrane anchoring as a beta-barrel structure; Suhr M et al.; The AIDA-I adhesin known to be responsible for the diffuse adherence (DA) phenotype of the diarrhoeagenic Escherichia coli (DAEC) strain 2787 has been shown previously to be synthesized as a precursor protein and to undergo additional C-terminal processing . Here, the C-terminal processing of the AIDA-I precursor and the outer membrane topology of the cleaved C-terminal fragment, AIDAc, were investigated . By isolation of the cleaved AIDAc fragment and N-terminal sequencing, the C-terminal cleavage site was identified between Ser-846 and Ala-847 thereby indicating a molecular mass of 47.5 kDa for AIDAc . The correct processing to AIDA-I and AIDAc in OmpT, OmpP and DegP protease-deficient E . coli strains as well as in avirulent salmonellae and shigellae points to an autocatalytic cleavage mechanism . The cleaved AIDAc was localized in the outer membrane . A leader sequence-AIDAc fusion was efficiently routed to the outer membrane . Analysis by protease digestion, secondary-structure prediction and modelling, by comparison with structurally related bacterial proteins like the IgA1 protease from neisseria, the vacuolating toxin from Helicobacter pylori, and the VirG protein of Shigella flexneri, strongly indicates that AIDAc is present in the outer membrane as a beta-barrel structure. Microbiology, 1996 Oct, 142 ( Pt 10), 2951 - 7 Proline iminopeptidase gene from Xanthomonas campestris pv . citri; Alonso J et al.; The pip gene coding for the proline iminopeptidase (Pip) of Xanthomonas campestris pv . citri was cloned in an Escherichia coli leuB strain using a selective medium containing the dipeptide D-Ala-L-Leu as the sole source of L-leucine . Nucleotide sequencing of this gene revealed a 939 bp open reading frame encoding a 312 amino acid protein (35 126 Da) . The deduced amino acid sequence showed 47% identity with the Pip from Neisseria gonorrhoeae . A lacZ-pip fusion gene was overexpressed in E . coli under the control of the Plac promoter . The Pip of X . campestris hydrolysed L-prolyl-p-nitroanilide with the highest efficiency, but was also able to hydrolyse L-alanyl-p-nitroanilide and D-alanyl-p-nitroanilide . The molecular mass of Pip was found to be 35 kDa by SDS-PAGE and 120 kDa by gel filtration, suggesting that the active enzyme is a multimer. Microbiology, 1996 Oct, 142 ( Pt 10), 2839 - 45 Uptake-sequence-independent DNA transformation exists in Neisseria gonorrhoeae; Boyle-Vavra S et al.; A DNA transformation dose-response curve of piliated (P+) gonococci with the use of cloned DNA containing a pilE2-cat fusion showed saturation at high and low levels of transforming DNA . At low DNA concentrations, transformation of the P+ strain MS11-A was effectively inhibited by a 1000-fold molar excess of the gonococcal transformation uptake sequence (GCUS) . The same molar excess of the GCUS did not inhibit transformation of MS11-A at high DNA concentrations . In MS11-B2, a nonpiliated (P-), pilin-nonproducing, isogenic variant of MS11-A, the GCUS did not inhibit transformation at any level of transforming DNA . These data suggest that two mechanisms of transformation exist in P+ cells: one which utilizes the GCUS and one which does not . In MS11-B2 P- cells, no evidence was found for the presence of the GCUS-dependent mechanism, suggesting that transformation in this background occurs solely by the GCUS-independent mechanism. J Clin Microbiol, 1996 Oct, 34(10), 2548 - 51 Detection of Neisseria gonorrhoeae from air-dried genital samples by single-tube nested PCR; Herrmann B et al.; A single-tube nested PCR method was developed for the detection of Neisseria gonorrhoeae . The optimized assay had a detection limit of less than 0.3 cell . Five different storage conditions for gonococcal specimens were compared with respect to the PCR detection of bacteria . For air-dried gonococcal slides containing three bacteria, DNA was detected after 8 weeks at ambient temperature, and for slides containing 300 bacteria, DNA could be detected after 24 weeks at ambient temperature . Air-dried storage combined with analysis by the single-tube nested PCR and a commercially available PCR (Amplicor) was used to test 350 cervical specimens from women in the West African island nation of Cape Verde . The in-house PCR detected 17 cases of N . gonorrhoeae infection, while the Amplicor system detected 14 cases of N . gonorrhoeae infection . No specimen was negative by the in-house PCR assay and positive by the Amplicor PCR . This sensitive nested PCR assay, combined with air-dried storage, allows for the detection of gonococci when specimen storage and transport times are extended and freezing conditions are not available. J Clin Microbiol, 1996 Oct, 34(10), 2395 - 400 Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by ligase chain reaction-based assays with clinical specimens from various sites: implications for diagnostic testing and screening; Buimer M et al.; Ligase chain reaction (LCR)-based tests for the diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae infections in men and women attending a sexually transmitted disease clinic were evaluated . LCR testing of urethral swab and urine specimens from men and cervical swab and urine specimens from women was compared with culture of male urethral swabs and female cervical and urethral swabs, respectively . An expanded "gold standard" was defined as a positive culture or at least one specimen confirmed to be positive by LCR testing . The prevalence of C . trachomatis infection as detected by cell culture was 7.0% among 614 men and 5.0% among 602 women . By LCR, these values increased to 11.4 and 9.9% with urethral swabs and urine, respectively, for men and 9.6 and 9.1% with cervical swabs and urine, respectively, for women . Relative to the expanded gold standard, the sensitivity of cell culture with male urethral swabs or female cervical swabs was 57.3 and 45.5%, respectively, compared with corresponding values of 93.3 and 87.9% for LCR . The sensitivity of LCR with urine specimens was 77.3 and 78.8% for men and women, respectively . The prevalence of N . gonorrhoeae infection as detected by culture was 5.9% among 220 men and 2.9% among 383 women . The corresponding values were 8.2 and 5.5%, respectively, by LCR testing of swabs . Prevalence values by LCR testing of urine were 7.3% for men and 2.9% for women . The sensitivity of culture was 72.2% for men and 50.0% for women . The sensitivities of LCR were 100% with male urethral swabs, 95.4% with female cervical swabs, 88.9% with male urine, and 50.0% with female urine . These results indicate that the LCR-based assays represent a major improvement in C . trachomatis and N . gonorrhoeae diagnostics . The sensitivity of testing of urethral or cervical swabs by LCR was markedly greater than that by culture . The sensitivity of testing female or male urine specimens was equal to or greater than that of culturing cervical or urethral specimens . LCR testing of urine specimens may prove useful for screening for C . trachomatis. J Exp Med, 1996 Oct 1, 184(4), 1233 - 41 Conservation of the lipooligosaccharide synthesis locus lgt among strains of Neisseria gonorrhoeae: requirement for lgtE in synthesis of the 2C7 epitope and of the beta chain of strain 15253; Erwin AL et al.; The present study was undertaken to examine the extent to which the lgt locus varies among strains of gonococci . This locus encodes five glycosyl transferases involved in the synthesis of the lipooligosaccharide (LOS) of Neisseria gonorrhoeae . We examined seven gonococcal strains and found that the structure of the lgt locus is conserved among six of these strains . The locus is strikingly altered in strain 15253 . This is one of the few strains where extensive structural analysis of its LOS is available, and therefore, we defined the altered lgt locus and focused on the reactivity of mAB 2C7 . We found that strain 15253 contains only two lgt genes, lgtA and lgtE . As in F62, lgtA encodes a GlcNAc transferase and is subject to phase variation . In addition, by analysis of deletion mutants, we found that lgtE, which encodes a galactosyl transferase that is required for elongating the alpha-chain, is also necessary for completing the beta chain. Biochem J, 1996 Oct 1, 319 ( Pt 1), 99 - 102 Isolation and characterization of the gene encoding an aminopeptidase involved in the selective toxicity of ascamycin toward Xanthomonas campestris pv . citri; Sudo T et al.; An aminopeptidase gene named XAP has been isolated from Xanthomonas campestris pv . citri, a plant pathogenic bacterium . The bacterium is one of the rare micro-organisms susceptible to ascamycin, an aminoacyl nucleoside antibiotic that inhibits protein synthesis . Sequence analysis reveals that the gene encodes a 311 amino acid protein with a calculated molecular mass of 35134 Da and approx . 50% identity for amino acids to the proline iminopeptidase from Neisseria gonorrhoeae . The XAP gene product, Xap, expressed in Escherichia coli has proline iminopeptidase activity as well as ascamycin dealanylating activity in vitro. J Med Microbiol, 1996 Oct, 45(4), 252 - 7 Blocking of iron uptake by monoclonal antibodies specific for the Neisseria meningitidis transferrin-binding protein 2; Pintor M et al.; The existence of epitopes common to different strains in the Neisseria meningitidis transferrin (Tf)-binding protein 2 (TBP2), combined with the ability of polyclonal anti-TBP2 antibodies to inhibit Tf binding and block iron uptake in this species, led to this study on the effect of anti-TBP1+2 monoclonal antibodies (MAbs) to determine the presence of epitopes inside the Tf-binding region . All MAbs used reacted exclusively with the homologous strain when tested by dot-blots of outer membrane vesicles, with the reaction being specific for TBP2 after SDS-PAGE and electroblotting . In contrast, ELISA and iron-uptake blocking assays were also positive with heterologous strains belonging to Rokbi's group II (high mol.wt TBP2) . The results confirmed the two group classification proposed by Rokbi and, in contrast to other studies, indicated the existence of epitopes in the Tf-binding region that are common only to strains of Rokbi's group II . These epitopes may become denatured after drying for dot-blot assays or after SDS-PAGE and electroblotting. J Infect Dis, 1996 Oct, 174 Suppl 2, S230 - 9 Impact of a gonorrhea control program, including selective mass treatment, in female sex workers; Holmes KK et al.; A gonorrhea control program initiated in 1967 in registered female sex workers (FSWs) in the Philippines involved weekly endocervical cultures for Neisseria gonorrhoeae, with treatment of FSWs found infected or named as contacts by US Navy servicemen . Gonorrhea prevalence in FSWs in Olongapo city fell from 11.9% to 4.0% within 4 months, and gonorrhea incidence in servicemen at nearby Subic Bay fell by half . Selective mass treatment (SMT) with oral ampicillin-probenecid or tetracycline was then given to registered FSWs in an attempt to further reduce gonorrhea rates . N . gonorrhoeae was isolated from 105 (4.0%) of 2640 FSWs before SMT and from 43 (1.6%) 1 week later (P < .001) . However, gonorrhea incidence among servicemen fell no lower, and gonorrhea prevalence in FSWs quickly returned to higher levels . Thus, after implementation of weekly screening and treatment of FSWs found infected or named as contacts, SMT of FSWs (without increasing condom use or treating regular partners) contributed nothing further to gonorrhea control. Ann Intern Med, 1996 Sep 15, 125(6), 465 - 70 The emergence of Neisseria gonorrhoeae with decreased susceptibility to ciprofloxacin in Cleveland, Ohio: epidemiology and risk factors; Gordon SM et al.; BACKGROUND: Until 1992, almost all strains of Neisseria gonorrhoeae that had been tested in the United States were susceptible to fluoroquinolones, including ciprofloxacin . However, among men with urethral gonococcal infections who attended one sexually transmitted disease clinic in Cleveland, Ohio, the prevalence of gonococci with decreased susceptibility to ciprofloxacin increased from 2% in 1991 to 16% in 1994 . OBJECTIVE: To describe the emergence of and risk factors for gonococcal urethritis caused by gonococci with decreased susceptibility to ciprofloxacin . Resistance to ciprofloxacin was considered to be decreased if the mean inhibitory concentration was at least 0.12 microgram/mL, and was less than or equal to 0.25 microgram/mL; this definition did not equate with the definition of clinical resistance . DESIGN: Case-control study . SETTING: An urban sexually transmitted disease clinic . PARTICIPANTS: 51 case-patients and 106 controls . MEASUREMENTS: Pulsed-field gel electrophoresis was used to identify individual genotypes of ciprofloxacin-resistant and ciprofloxacin-susceptible isolates . RESULTS: 55 of the 746 isolates of N . gonorrhoeae that were tested (7.4%) had decreased susceptibility to ciprofloxacin, and the prevalence of N . gonorrhoeae with decreased susceptibility significantly increased during the study period . Case-patients were significantly less likely to have gram-negative diplococci seen on microscopic examination of urethral discharge (P < or = 0.01) and were less likely to be treated for gonococcal urethritis than were controls (P < or = 0.001) . Molecular typing suggested the spread of a single genotype of N . gonorrhoeae . CONCLUSIONS: Strains of gonococci with decreased susceptibility to ciprofloxacin appear to have become endemic in Cleveland, Ohio . The clinical significance of these isolates is not clear, but the potential for the emergence of clinically important resistance may preclude the use of fluoroquinolones as an alternative treatment for uncomplicated gonorrhea. Bull Pan Am Health Organ, 1996 Sep, 30(3), 212 - 7 Detection of N . meningitidis group B antigens by MB-Dot-ELISA in patients with meningitis; Alkmin M das G et al.; Infection with Neisseria meningitidis group B has been difficult to detect, partly because this bacterial group's polysaccharide is a weak immunogen . This article describes work carried out to test a new procedure (MB-Dot-ELISA) employing a high-titered horse antiserum for detection of N . meningitidis group B antigens . The study assayed cerebrospinal fluid samples from 585 subjects, 574 with suspected meningitis cases and 11 with neurologic disorders . The results of the assay indicated a sensitivity of 0.991 and a specificity of 0.826 . These results were superior to those obtained with latex agglutination and in substantial agreement with the results of counterimmunoelectrophoresis and bacteriologic methods . Overall, the MB-Dot-ELISA was found to be sensitive, inexpensive, and suitable for public health laboratory investigations. Sex Transm Dis, 1996 Sep-Oct, 23(5), 425 - 8 Quinolone-resistant Neisseria gonorrhoeae isolated in Sydney, Australia, 1991 to 1995; Tapsall JW et al.; BACKGROUND AND OBJECTIVES: Quinolone antibiotics are used widely for the treatment of gonorrhea, but resistant strains appeared in Sydney in 1984, treatment failure with high-dose regimens in 1991, and isolates with very high minimal inhibitory concentrations (MICs) (16 mg/l) in 1994 . GOALS: To examine the frequency, source, and characteristics of Quinolone-resistant Neisseria gonorrhoeae (QRNG) in Sydney from 1991 to 1995 and to compare these data with those obtained from 1984 to 1990 . STUDY DESIGN: The antibiotic sensitivity, auxotype-serovar class, and geographic source of QRNG isolated in Sydney from January 1, 1991 to June 30, 1995 were analyzed . RESULTS: One hundred seven QRNG were isolated from 97 patients from 1991 to 1995 . The number, proportion, and MICs of QRNG increased slowly in the first 4 years of the study and rapidly in the last 6 months . Most QRNG were isolated from travelers entering Sydney from Asia . Twenty-seven different auxotype-serovar classes were detected including 6 auxotype-serovar classes in 14 isolates with high-level quinolone resistance (MIC, 16 mg/l) . CONCLUSIONS: QRNG isolated in Sydney during the past decade originated in Asia as multiple gonococcal subtypes and increased substantially in numbers and levels of resistance in 1995. Sex Transm Dis, 1996 Sep-Oct, 23(5), 384 - 91 Decreasing incidences of gonorrhea- and chlamydia-associated acute pelvic inflammatory disease . A 25-year study from an urban area of central Sweden; Kamwendo F et al.; BACKGROUND AND OBJECTIVES: Acute pelvic inflammatory disease (PID) affects women in their reproductive years and is often a complication of a sexually transmitted disease (STD), particularly Neisseria gonorrhoeae and Chlamydia trachomatis . Infertility, ectopic pregnancy, and chronic lower abdominal pain are common long-term sequelae to acute PID . Through different preventive measures, endemic N . gonorrhoeae is almost eliminated, and C . trachomatis has been reduced almost fourfold in Sweden . GOALS: To investigate variations in STD-associated acute PID and the extent to which this influenced the yearly incidences of patients hospitalized for this complication during a 25-year-period . STUDY DESIGN: Hospital records of 2499 patients admitted and treated for acute PID from January 1, 1970 to December 31, 1994 were analyzed for infection with N . gonorrhoeae . Routine laboratory diagnosis for C . trachomatis infection started June 1, 1980 . Detailed statistical analysis for chlamydial-associated PID in this study, therefore, covers the period January 1, 1981 to December 31, 1994 and includes 1030 patients . RESULTS: Gonorrhea occurred in 42% of patients with acute PID in 1970 and decreased continuously to zero in 1988 and beyond . Concomitant urogenital chlamydial infection reduced almost fourfold from 28.4% in 1985 to 7.7% in 1994 . Yearly admissions for acute PID fluctuated slightly (< or = 16%) in the early 1970s and early 1980s but increased greatly (> 60%) in the middle and late 1970s; the highest was 180 per year in 1976 . This coincided with high incidence rates of gonorrhea in the general population, and probably of genital C . trachomatis infection as well, coupled with an increased use of intrauterine contraceptive device in nulliparous women . The largest increase in admissions for acute PID was in the 15- to 29-year-old group . A steady decrease started in 1987 and reached the low figure of 26 admissions in 1994 . The greatest decrease occurred in the 15- to 19-year-old group, from the relative age distribution of 28.9% in the period 1970 to 1974 to 12.9% in 1990 to 1994 . Yearly admissions for the > or = 35-year-old group remained almost constant during the study period, but the relative age distribution shifted from second lowest (excluding those 14 years or younger, totaling 15 admissions for the entire study period), 9.1% at the beginning of the study period, to the second largest, 24.9% at the end of it . The study also showed that the total and relative rates of recurrence decreased . CONCLUSIONS: Measures aimed at reducing incidences of gonorrhea and genital chlamydial infection will reduce the incidences of one of the most serious complications of these STDs, acute PID, and, in turn, its long-term sequelae. Sex Transm Dis, 1996 Sep-Oct, 23(5), 378 - 83 Tetracycline-resistant Neisseria gonorrhoeae . Characteristics of patients and isolates at a London Genitourinary Medicine Clinic; Lewis DA et al.; OBJECTIVES: To compare auxotypes, serovars, and antibiograms of tetracycline-resistant Neisseria gonorrhoeae (TRNG) and non-TRNG isolated from patients attending an East London Genitourinary Medicine (GUM) Clinic . To obtain plasmid profiles for penicillinase-producing gonococci (PPNG) as well as presumptive TRNG . To identify differences in patient characteristics for the TRNG and non-TRNG patient groups . STUDY DESIGN: Gonococcal isolates were collected from 400 patients attending the GUM clinic at the Royal London Hospital GUM Clinic over a 1-year period . Isolates (378) were tested for susceptibility to various antibiotics, auxotyped, and serotyped . Plasmid profiles were obtained for PPNG and isolates exhibiting high-level tetracycline resistance (TRNG) . The presence of the tet M determinant was confirmed using the polymerase chain reaction (PCR) . The PCR product was digested with the restriction endonuclease (RE) Hpa II and electrophoresed on a 2.5% agarose gel to determine an "RE pattern." Patient data were collected by retrospective case-note review . RESULTS: TRNG (n = 42) accounted for 11% of the 378 isolates tested, and the remaining 336 (89%) isolates were non-TRNG . Non-requiring auxotrophy and P1B-2 serovar expression occurred more frequently among TRNG . PPNG accounted for 31% of TRNG and 5% of non-TRNG . Chromosomal resistance to penicillin (CMRNG) was absent among TRNG but accounted for 11% of non-TRNG . One TRNG isolate showed decreased susceptibility to ciprofloxacin (MIC 0.25 mg/l) . All isolates were sensitive to cefotaxime, cefixime, spectinomycin, and azithromycin . All TRNG possessed the 25.2 MDa plasmid and produced a PCR product of appropriate size after tet M gene sequence amplification . RE digests of the PCR product gave a single pattern . None of the TRNG in contrast to 18% of the non-TRNG were acquired homosexually . Ethnic distribution differed between the patients with TRNG and patients without non-TRNG (Afro-Caribbean 81% versus 58%; white 19% versus 36%) . Most TRNG were acquired in the United Kingdom . CONCLUSIONS: TRNG differ from the non-TRNG in their auxotype and serovar distribution . PPNG are more common among the TRNG isolates, whereas CMRNG appear absent . TRNG are isolated more commonly from Afro-Caribbean patients and were not represented among homosexually acquired isolates. Fam Med, 1996 Sep, 28(8), 580 - 3 Use of wet mount to predict Chlamydia trachomatis and Neisseria gonorrhea cervicitis in primary care; Majeroni BA et al.; BACKGROUND AND OBJECTIVES: Cervicitis is associated with salpingitis, infertility, and complications of pregnancy . Universal screening has been recommended for high-prevalence populations but may not be appropriate in the family practice setting . Leukocytes on an endocervical gram stain have been associated with infectious cervicitis due to Chlamydia trachomatis and Neisseria gonorrhea . This study sought to determine whether the finding of leukocytes in a vaginal wet mount could be used to screen for infectious cervicitis in an urban family practice . METHODS: A consecutive sample of 357 women had cultures for C trachomatis and N gonorrhea and a standardized wet mount . RESULTS: All women with infectious cervicitis were under age 35 . Thirty-six percent of infected women had more leukocytes than epithelial cells in the wet mount, compared with 23% of women without these organisms . CONCLUSIONS: Wet mount findings did not reliably predict infectious cervicitis . Study of a larger population is needed to confirm these findings. J Clin Microbiol, 1996 Sep, 34(9), 2255 - 8 Rapid detection of point mutations of the Neisseria gonorrhoeae gyrA gene associated with decreased susceptibilities to quinolones; Deguchi T et al.; Mutations in the gyrA gene resulting in amino acid changes at Ser-91 and Asp-95 are significantly associated with decreased susceptibilities to quinolones in Neisseria gonorrhoeae . To detect these mutations, we developed a rapid and simple assay based on amplification of the region of the gyrA gene containing the mutation sites by PCR and digestion of the PCR product with a restriction enzyme . A naturally occurring HinfI restriction site was present in the region containing the Ser-91 codon, and an artificial HinfI restriction site was created in the region containing the Asp-95 codon by the method of primer-specified restriction site modification . The mutations generating alterations at Ser-91 and Asp-95 were detected as restriction fragment length polymorphisms of the PCR products digested with HinfI . Fifty-five clinical strains of N . gonorrhoeae were examined for mutations in the gyrA gene by this method . Mutations at Ser-91 and/or Asp-95 were detected in all the 31 strains in which the mutations had been confirmed by DNA sequencing . Our method allows simultaneous testing of a large number of strains and provides results within 8 h . This rapid and simple assay could be a useful screening device for genetic alterations associated with decreased susceptibilities to quinolones in N . gonorrhoeae and could facilitate epidemiological studies on clinical isolates of N . gonorrhoeae with decreased susceptibilities to quinolones. Microbiology, 1996 Sep, 142 ( Pt 9), 2635 - 45 IdiA, a 34 kDa protein in the cyanobacteria Synechococcus sp . strains PCC 6301 and PCC 7942, is required for growth under iron and manganese limitations; Michel KP et al.; In the cyanobacteria Synechococcus PCC 6301 and PCC 7942 a protein with an apparent molecular mass of about 34 kDa (called IdiA for iron-deficiency-induced protein A) accumulates under iron and managanese limitation . IdiA from Synechococcus PCC 6301 was partially sequenced, showing that the N-terminal amino acid is an alanine . Moreover, the gene encoding this protein in Synechococcus PCC 6301 has been identified and completely sequenced . The idiA gene codes for a protein starting with valine and consisting of 330 amino acid residues . Thus, IdiA is apparently synthesized as a precursor protein of 36.17 kDa and cleaved to its mature form of 35.01 kDa between two alanine residues at positions 9 and 10 . IdiA is a highly basic protein having an isoelectric point of 10.55 (mature protein) . Comparison of the amino acid sequence of IdiA with protein sequences in the database revealed that IdiA has similarities to two basic bacterial iron-binding proteins, SfuA from Serratia marcescens and Fbp from Neisseria gonorrhoeae . Insertional inactivation of the idiA gene in Synechococcus PCC 7942 resulted in a mutant which was unable to grow under iron- or manganese-limiting conditions . Manganese limitation of the mutant strain led to a drastic reduction of photosystem II activity (O2 evolution) within less than 48 h, while wild-type cells required a prolonged cultivation in Mn-deficient medium before an effect on photosystem II was observed . Thus, IdiA is a protein involved in the process of providing photosystem II with manganese. Microbiology, 1996 Sep, 142 ( Pt 9), 2481 - 9 Identification of an EF-Tu protein that is periplasm-associated and processed in Neisseria gonorrhoeae; Porcella SF et al.; A 44 kDa protein is a dominant component of periplasmic extracts of Neisseria gonorrhoeae . Peptide sequence generated from a cyanogen-bromide-cleaved fragment of this protein indicated sequence homology with elongation factor-Tu (EF-Tu) . Polyclonal antiserum was made against the 44 kDa protein purified from periplasm extracts of N . gonorrhoeae . The preabsorbed antiserum was immunoblotted against whole-cell lysates on two-dimensional gels . A 44 kDa protein and a smaller 37 kDa protein were recognized by this antiserum . A N . gonorrhoeae gamma phage DNA library was screened and a clone expressing a 44 kDa protein was identified . The DNA insert in this clone contained several genes homologous to genes contained in the str operon of Escherichia coli . One ORF product with a calculated molecular mass of 43 kDa was highly homologous to the EF-TuA of E . coli . A synthetic peptide antiserum specific for a portion of the C terminus of EF-Tu confirmed that the 37 kDa protein in whole-cell lysates of N . gonorrhoeae was a processed form of EF-Tu . Deletion of the tufA gene homologue in N . gonorrhoeae was attempted but was unsuccessful. Infect Immun, 1996 Sep, 64(9), 3641 - 5 Tolerance to appetite suppression induced by peptidoglycan; Biberstine KJ et al.; Physiologically realistic peptidoglycan (PG) fragments, derived from Neisseria gonorrhoeae, were shown previously to dose-dependently suppress food consumption and body weight gain in rats following single intraperitoneal injections . The present study, examining the effects of repeated daily injection of PG, provides additional support to our underlying hypothesis, i.e., that soluble PG fragments contribute to the loss of appetite commonly associated with bacterial infections . An initial intraperitoneal injection of purified, soluble, macromolecular, extensively O-acetylated PG fragments (S-O-PG) (240 micrograms/kg of body weight) decreased overnight food consumption in male Lewis rats (150 g) by approximately 35% relative to animals receiving diluent alone (P < 0.05) . However, subsequent daily injections of S-O-PG resulted in progressively smaller effects on food consumption until, by the fourth day, rats were completely nonresponsive (tolerant) to S-O-PG-induced hypophagia . Rats that developed tolerance to the effects of S-O-PG on appetite were also tolerant to three other known hypophagic agents, lipopolysaccharide (LPS), muramyl dipeptide, and interleukin-1, when challenged one day after establishment of S-O-PG tolerance . Similarly, rats developed tolerance to repeated injections of muramyl dipeptide or LPS and were cross-tolerant to S-O-PG when challenged 1 day later . However, 30 days after establishment of S-O-PG tolerance, rats remained nonresponsive to S-O-PG but regained full responsiveness to LPS-mediated hypophagia . Thus, at least two mechanisms of tolerance to S-O-PG hypophagia exist: an early tolerance which is nonspecific and a late tolerance which is specific for S-O-PG . Late, but not early, tolerance to S-O-PG-mediated suppression of appetite was associated with an increase in specific anti-PG antibody activity as measured in an enzyme-linked immunosorbent assay. Biochim Biophys Acta, 1996 Aug 13, 1290(3), 210 - 4 Cloning and functional analysis of the pmmA gene encoding phosphomannomutase from the photosynthetic prokaryote Prochlorothrix hollandica; Dwivedi K et al.; The pmmA gene encoding a bifunctional phosphomannomutase/phosphoglucomutase (PMM/PGM) from the photosynthetic prokaryote, Prochlorothrix hollandica has been cloned and sequenced . The gene encodes a 51827 Da polypeptide 48% identical to the PMM of Azospirillum brasilense, 37% identical to the PGMs of pathogenic Neisseria sp . and 37% identical to the bifunctional AlgC PGM/PMM of Pseudomonas aeruginosa . The pmmA gene encodes an enzyme having both PGM and PMM activities as judged by both enzyme assays and complementation analysis in which the cloned gene partially corrected the pgm-1 mutation of Escherichia coli. J Natl Cancer Inst, 1996 Aug 7, 88(15), 1068 - 75 Difficulty in elucidating the male role in cervical cancer in Colombia, a high-risk area for the disease; Munoz N et al.; BACKGROUND: Epidemiologic evidence has been inconclusive in linking men's sexual behavior and genital human papillomaviruses (HPVs) with cervical cancer risk in their sexual partners in areas with a high incidence of cervical cancer . PURPOSE: This study assesses the role of men's sexual behavior and the presence of penile HPV DNA on the risk of their wives' developing cervical neoplasia in an area in Colombia with a high incidence of cervical cancer . METHODS: A total of 210 husbands of women with cervical intraepithelial neoplasia grade III (n = 118) or invasive squamous cell carcinoma of the cervix (n = 92) and a total of 262 husbands of women recruited as control subjects (173 and 89, respectively) were interviewed . Questionnaires included detailed information on sexual behavior . Exfoliated cells were obtained from the glans penis and from the distal urethra of the penis . The specimens were analyzed for HPV DNA by use of a polymerase chain reaction-based assay that included a generic probe and 25 type-specific probes . Serum specimens were collected and analyzed for antibodies to Chlamydia trachomatis, Treponema pallidum, herpes simplex virus type II, and Neisseria gonorrhoeae . RESULTS: Limited education (adjusted odds ratio {OR} = 4.4; 95% confidence interval {CI} = 1.9-9.8; for no schooling versus secondary or higher education) and presence of antibodies to C . trachomatis (adjusted OR = 2.5; 95% CI = 1.5-4.4) in husbands were the only identified risk factors for cervical neoplasia in their wives . The prevalence of HPV DNA in the penis was 25.7% among husbands of case women and 18.9% among husbands of control women (adjusted OR = 1.2; 95% CI = 0.6-2.3) . Neither the lifetime number of female sexual partners (adjusted OR = 1.0; 95% CI = 0.4-2.6; for > 50 partners versus one to five) nor the lifetime number of female prostitutes as sexual partners (adjusted OR = 1.2; 95% CI = 0.7-2.0; for > or = 21 prostitutes versus one to five) was associated with the risk of cervical cancer . CONCLUSIONS: Our results are compatible with the hypothesis that in the population of Cali, whose women are at high risk of developing cervical cancer, exposure to HPV among young men is a common occurrence and is mediated by contacts with large numbers of female sexual partners and prostitutes . These widespread sexual practices limit the power of case-control studies to detect significant associations between men's sexual behavior and the cervical cancer risk in their sexual partners . HPV DNA detection in the penis of adult men is a poor reflection of lifetime exposure or of etiologically relevant exposure to HPV . The role of C . trachomatis in cervical carcinogenesis deserves further investigation . IMPLICATIONS: Further research is needed to elucidate the male's role in cervical carcinogenesis in populations at high risk for cervical cancer . HPV DNA prevalence surveys and studies of the natural history of HPV in young men will be of great value. J Natl Cancer Inst, 1996 Aug 7, 88(15), 1060 - 7 Male sexual behavior and human papillomavirus DNA: key risk factors for cervical cancer in Spain; Bosch FX et al.; BACKGROUND: It is now established that certain types of human papillomaviruses (HPVs) are the sexually transmitted agents etiologically linked to cervical cancer . Studies assessing the contribution of the male's sexual behavior and genital HPV DNA status to the risk of development of cervical neoplasia in sexual partners have yielded inconsistent results . PURPOSE: This study evaluates the role of men's sexual behavior and the presence of HPV DNA in the penis on the development of cervical cancer in their sexual partners in Spain, a low-risk area for cervical neoplasia . METHODS: Husbands (n = 633) of women participating in two case-control studies of cervical neoplasia were interviewed to obtain information on lifestyle habits, including sexual practices . Cytologic samples were taken from the distal urethra and the surface of the glans penis of 183 husbands of case women and of 171 husbands of control women . These samples were analyzed by a polymerase chain reaction-based system using a generic probe and 25 type-specific probes for the detection and typing of HPV DNA . Serologic specimens were also obtained and analyzed for antibodies to Chlamydia trachomatis, Treponema pallidum, herpes simplex virus type II, and Neisseria gonorrhoeae . RESULTS: The presence of HPV DNA in the husbands' penis conveyed a fivefold risk of cervical cancer to their wives (adjusted odds ratio {OR} for HPV DNA positivity = 4.9; 95% confidence interval {CI} = 1.9-12.6) . The risk of cervical cancer was strongly related to HPV type (adjusted OR for HPV type 16 = 9.0; 95% CI = 1.1-77.5), to the husbands' number of extramarital partners (adjusted OR = 11.0; 95% CI = 3.0-40.0; for > or = 21 women versus one), and to the number of prostitutes as extramarital sexual partners (adjusted OR = 8.0; 95% CI = 2.9-22.2; for > or = 10 women versus none) . Presence of antibodies to C . trachomatis (adjusted OR = 2.6; 95% CI = 1.4-4.6) and an early age at first sexual intercourse of the husband (adjusted OR = 3.2; 95% CI = 1.7-5.9; for < or = 15 years versus > or = 21 years) were also associated with cervical neoplasia in the wife . After adjustment for these variables and for the wife's pack-years of smoking, the husband's smoking was moderately associated with cervical cancer in his wife (adjusted OR = 2.5; 95% CI = 1.4-4.4; for > or = 26.2 pack-years versus none) . CONCLUSIONS: The study supports the role of men as vectors of the HPV types that are related to cervical cancer . Life-time number of female sexual partners, number of female prostitutes as sexual partners, and detection of HPV DNA in the penis of husbands are all surrogate markers of exposure to HPV during marriage . IMPLICATIONS: Men who report multiple sexual partners or who are carriers of HPV DNA may be vectors of high-risk HPV types and may place their wives at high risk of developing cervical cancer . Prostitutes are an important reservoir of high-risk HPVs. Enferm Infecc Microbiol Clin, 1996 Aug-Sep, 14(7), 441 - 3 {Variation of the incidence and antibiotic sensitivity of Neisseria gonorrhoeae in a 7-year period}; Nebreda T et al.; BACKGROUND: The aim of this study was to determine the incidence and antibiotic sensitivity of Neisseria gonorrhoeae versus penicillin, tetracycline, cefoxitin, ceftriaxone and spectinomycin from 1988 to 1994 in the province of Soria (Spain) . METHODS: From January 1988 to December 1994, clinical samples of 57 strains of N . gonorrhoeae were isolated . Auxotype, serotype, and minimum inhibitory concentration (MIC) studies were performed versus 5 antimicrobials and analysis of plasmids in the penicillinase producer strains (PPNG), was carried out in the Bacteriology Department of the Instituto Carlos III in Madrid (Spain) . RESULTS: The rate of incidence of the isolation of N . gonorrhoeae was similar from 1988 to 1990 (11.7 to 19.1 cases per 100,000 inhabitants) and decreased from 1991 to 1994 (6.4 to 0 cases per 100,000 inhabitants) . The strains belonged to 30 different auxotypes/serotypes indicating a great heterogeneity among them . The proportion of penicillinase producing N . gonorrhoeae (PPNG) increased over the study period . The first strains with high resistance to tetracycline (TRNG) were first isolated in the authors' area in 1991 and the proportion increased up to the end of the study . All the strains were sensitive to ceftriaxone, cefoxitin and spectinomycin . CONCLUSIONS: A decrease was observed in the rate of incidence of N . gonorrhoeae since 1991 with an increase in the proportion of NGPP and TRNG strains . Ceftriaxone and spectinomycin present good activity versus all the strains studied with their empiric use as treatment being possible in the province of Soria (Spain). Genitourin Med, 1996 Aug, 72(4), 295 - 7 Mutation in DNA gyrase of norfloxacin-resistant clinical isolates of Neisseria gonorrhoeae; Tanaka M et al.; BACKGROUND AND OBJECTIVES: Recently a rapid decrease in the susceptibility of Neisseria gonorrhoeae isolates to fluoroquinolones has occurred and gonococcal fluoroquinolone resistance is now a significant problem in the treatment of gonorrhoea in Japan . Thus, in order to investigate the quinolone resistance mechanisms in clinical isolates of N gonorrhoeae we studied an alteration in the DNA gyrase subunit A (GyrA) which is well-known as a common mechanism of bacterial quinolone resistance . MATERIALS AND METHODS: Four clinical isolates of N gonorrhoeae resistant to norfloxacin and 5 strains susceptible to norfloxacin, including 2 clinical isolates and 3 WHO reference strains, were tested in this study . To identify mutations in the GyrA genes of gonococcal strains, polymerase chain reaction and direct DNA sequencing were performed . RESULTS: A single base change (serine codon TCC changed to phenylalanine codon TTC), which resulted in an amino acid change in GyrA at position 91, was identified in all 4 norfloxacin-resistant strains for which the MICs of norfloxacin ranged from 1.0 to 8.0 micrograms/ml, while no mutation within GyrA was detected in 5 norfloxacin-susceptible strains for which the MICs of norfloxacin ranged from 0.004 to 0.063 microgram/ml . CONCLUSIONS: The results from this study suggest that the serine-91 to phenylalanine substitution in GyrA is probably an essential mutation in fluoroquinolone resistance in clinical isolates of N gonorrhoeae. Genitourin Med, 1996 Aug, 72(4), 253 - 7 Antimicrobial agents and gonorrhoea: therapeutic choice, resistance and susceptibility testing; Ison CA; INTRODUCTION: Neisseria gonorrhoeae, the causative agent of gonorrhoea is a particularly well adapted pathogen that has continued to evolve mechanisms to evade treatment with antimicrobial agents . THERAPEUTIC CHOICE: The choice of antibiotic for use in the first-line treatment of gonorrhoea should be made with knowledge of the susceptibility of the isolates of N gonorrhoeae to be encountered . RESISTANCE: High-level resistance to penicillin and tetracycline in N gonorrhoeae is plasmid-mediated and a major therapeutic problem . Penicillinase-producing N gonorrhoeae, first described in 1976, have now spread worldwide and tetracycline-resistant N gonorrhoeae, described in 1985, are becoming increasingly prevalent . Chromosomal resistance to penicillin is low-level and affects a range of antibiotics . High-level resistance to spectinomycin has been sporadic and has not limited its use whereas the emergence of resistance to ciprofloxacin will have a significant impact on its use for gonorrhoea . SUSCEPTIBILITY TESTING: A variety of methods are available including disc diffusion, breakpoint agar dilution technique, E-test and determination of the minimum inhibitory concentration (MIC) . The choice of methodology will depend on the number and type of isolates and the facilities available for testing . DISCUSSION: Surveillance programmes to monitor levels of antibiotic resistant isolates are essential to ensure therapeutic success. J Obstet Gynaecol Res, 1996 Aug, 22(4), 331 - 40 The association of Chlamydia trachomatis/gonococcal infection and tubal factor infertility; Swasdio K et al.; OBJECTIVE: To determine the association of past Chlamydia trachomatis and past Neisseria gonorrhoeae infection with tubal factor infertility . METHODS: A cross-sectional study was conducted . Cases consisted of 55 primary infertile women with laparoscopy confirmed tubal damage (group A) and their husbands, consecutively attending the Infertility Unit at Maharaj Nakorn Chiang Mai Hospital between 1990 and 1992; and 58 primary infertile women with laparoscopy confirmed normal tubes (group B) and their husbands, consecutively attending the same hospital over the same period . Controls consisted of 59 postpartum women (group C) and their husbands omitted to the same hospital over the same period as cases . Past chlamydial and gonococcal infections were assessed by measuring serum IgG antibodies by enzyme immunoassay (EIA) . The EIA antigens consisted of purified elementary bodies of C . trachomatis serovar L1, or purified alpha pili of N . gonorrhoeae strain P9 . RESULTS: The prevalence of positive IgG antibody to gonococcal pili in sera from group A was 29.1%, significantly higher than the prevalence of 5.2% in group B or 3.4% in group C (p = 0.000) . The husbands of women in group A had a significantly higher prevalence of IgG antibody to gonococcal pili (36.4%) than the husbands of women in group B (8.6%) or group C (18.6%) (p = 0.002) . There was no significant difference in positive IgA antibody between case and control groups . After controlling for age, group A showed significantly higher prevalences of past gonorrhea (OR = 32.4, 95% CI 4.3, 242.2) and past chlamydial infection (OR = 3.2, 95% CI 1.2, 8.5) than group C . The husbands of women in group A also had higher prevalences of both types of infection than the husbands of women in group C; the odds ratios for past gonorrhea or chlamydial infections were 2.8 (95% CI 1.1, 6.9) and 2.9 (95% CI 1.2, 7.1), respectively . Neither infertile women with normal tubes (group B) nor their husbands showed any difference when compared with controls . CONCLUSION: These results suggest that in this region of northern Thailand there is an association between past gonorrhea and past chlamydial infection and tubal factor infertility. Mol Microbiol, 1996 Aug, 21(3), 433 - 40 Questions about gonococcal pilus phase- and antigenic variation; Seifert HS; Pathogenic organisms inhabit one of several defined locations within a host where temperature, pH, and nutrients are relatively constant . While the microorganism must adapt to different environments within the host, the host immune system is the most formidable predator that can limit the growth of a pathogen . Neisseria gonorrhoeae (the gonococcus, Gc) is the causative agent of gonorrhoea, and has evolved several systems for varying the antigenicity of different surface antigens, presumably to help evade the effects of the human immune system . The On/Off/On phase variation of surface structure expression also alters the antigenic characteristics of the bacterial cell surface . Antigenic variation of the major subunit of the pilus, pilin, occurs by unidirectional, homologous recombination between a silent locus and the expression locus . The silent loci lie from 1 to 900 kb from the expression locus in the chromosome yet all can donate their sequences to the expression locus . The genetic composition of the pilin loci of two Gc strains has been elucidated, and the types of changes that lead to altered forms of the pilus have been extensively characterized . However, little is known about the precise molecular mechanisms used to allow high-frequency, non-reciprocal, chromosomal recombination between pilin loci or about what regulates the process of maintaining chromosome fidelity. Pediatr Infect Dis J, 1996 Aug, 15(8), 662 - 7 Acceptability and usefulness of vaginal washes in premenarcheal girls as a diagnostic procedure for sexually transmitted diseases . The Child Protection Centre at the Winnipeg Children's Hospital; Embree JE et al.; OBJECTIVE: To assess the suitability of vaginal washes as specimens for sexually transmitted disease diagnosis and determine the usefulness of PCR technology for Chlamydia trachomatis diagnosis in prepubertal girls . STUDY DESIGN: Paired sets of vaginal secretions were collected with swabs and by vaginal wash from 138 prepubertal girls for evaluation because of alleged sexual abuse . Detection by culture of Neisseria gonorrhoeae and C . trachomatis was compared between the two sampling techniques . PCR techniques were also used to test 29 vaginal wash specimens for C . trachomatis . RESULTS: In the prepubertal girls N . gonorrhoeae was detected in two wash specimens but in only one swab specimen; C . trachomatis was detected by culture in both paired specimens from two children and by PCR in vaginal washes from both of the two children positive by culture; PCR identified two other infected children . CONCLUSIONS: A vaginal wash technique coupled with newer molecular amplification technology may be useful in the assessment of sexually abused children. J Ethnopharmacol, 1996 Aug, 53(2), 57 - 63 Antineoplastic agents 338 . The cancer cell growth inhibitory . Constituents of Terminalia arjuna (Combretaceae); Pettit GR et al.; By means of bioassay-guided separation methods, the cancer cell growth inhibitory constituents residing in the bark, stem and leaves of the Mauritius medicinal plant Terminalia arjuna (Combretaceae) were examined . The cancer cell line active components were found to be gallic acid, ethyl gallate, and the flavone luteolin . Only gallic acid was previously known to occur in this plant . Luteolin has a well established record of inhibiting various cancer cell lines and may account for most of the rationale underlying the use of T . arjuna in traditional cancer treatments . Luteolin was also found to exhibit specific activity against the pathogenic bacterium Neisseria gonorrhoeae. J Pediatr Adolesc Gynecol, 1996 Aug, 9(3), 129 - 32 The coincident diagnosis of pelvic inflammatory disease and pregnancy: are they compatible? Acquavella AP, Rubin A, D'Angelo LJ. OBJECTIVES: To determine the frequency of coincident diagnoses of pregnancy and pelvic inflammatory disease (PID) in adolescents seeking care at a large urban children's hospital . DESIGN: All inpatient medical records for the period from January 1, 1984 through December 31, 1993 were searched for dual diagnoses of pregnancy and PID (presumed secondary to endometritis, salpingitis, or both) . During this period, there were 1205 patients admitted for PID, 67 of whom were also pregnant . Ten of these 67 admissions were eliminated from this study because of incomplete or missing records, errors in diagnosis, or lack of proper examinations . The charts of the remaining 57 subjects were reviewed for demographics, physical findings, and laboratory studies . OUTCOME MEASURES: For the purposes of this study, a diagnosis of suspected PID was defined as lower abdominal tenderness, cervical motion tenderness, and adnexal tenderness ("major criteria"), as well as either a positive cervical specimen for Neisseria gonorrhoeae or Chlamydia trachomatis or adnexal fullness ("minor criteria") . RESULTS: The mean age of the 57 subjects was 16.8 years, and the mean gestational age was 6.7 weeks . Twenty-four (42.1%) of the subjects met the criteria for a concurrent diagnosis of PID and pregnancy; 13 had physical findings and a positive cervical specimen for either N . gonorrhoeae or C . trachomatis, and 11 subjects had the minor criteria of adnexal fullness . Twenty-six (45.6%) of the 57 subjects were primigravida, 35 (61.4%) had a history of a sexually transmitted disease, and 18 (31.6%) had been previously admitted to a hospital for PID . CONCLUSION: This study found that PID and pregnancy can coexist in adolescents . Therefore, physicians who treat adolescents must consider the possibility of PID in pregnant adolescents presenting with abdominal pain. Am J Obstet Gynecol, 1996 Aug, 175(2), 435 - 41 Role of bacterial vaginosis-associated microorganisms in endometritis; Hillier SL et al.; OBJECTIVE: Our goal was to define the role of bacterial vaginosis and bacterial vaginosis-associated microorganisms in endometritis . STUDY DESIGN: Endometrial biopsies were obtained for histologic and microbiologic study from 178 consecutive women with suspected pelvic inflammatory disease, and 85 of them underwent laparoscopy to diagnose salpingitis . RESULTS: Histologic endometritis was confirmed in 117 (65%) of the women . Among women who underwent laparoscopy, salpingitis was present in 68% of those with and 23% of those without endometritis . Some but not all bacterial vaginosis-associated microorganisms were linked with endometritis . By logistic regression analysis, after adjustment for bacterial vaginosis and isolation of Neisseria gonorrhoeae and Chlamydia trachomatis, endometritis was associated with endometrial N . gonorrhoeae (odds ratio 5.7, 95% confidence interval 1.8 to 17.5), C . trachomatis (odds ratio 4.8, 95% confidence interval 1.3 to 18.2), anaerobic gram-negative rods (odds ratio 2.6, 95% confidence interval 1.1 to 5.7), and nonwhite race (odds ratio 2.3, 95% confidence interval 1.1 to 4.8) . CONCLUSIONS: The association of anaerobic gram-negative rods with endometritis, after adjustment for bacterial vaginosis, N . gonorrhoeae, and C . trachomatis, supports the role of these microorganisms in the etiology of histologic endometritis among women with clinically suspected pelvic inflammatory disease. J Bacteriol, 1996 Aug, 178(16), 5020 - 3 Analysis of Fur binding to operator sequences within the Neisseria gonorrhoeae fbpA promoter; Desai PJ et al.; The gene encoding Neisseria gonorrhoeae periplasmic binding protein FbpA contains two regions whose sequences exhibit homology with the Escherichia coli ferric uptake regulator protein (Fur) consensus binding sequence . In this study, DNase I footprinting experiments were employed to characterize the operator sequences within the fbpA promoter region to which E . coli Fur binds . A 160-bp fragment encompassing the promotor region and the putative iron boxes of the fbpA promoter was incubated with Fur, DNaseI was added, and the products of these reactions were sequenced to identify nucleotide peaks that were protected . At 50 nM Fur, a protected region that spanned 33 bp and extended 19 bp upstream and 8 bp downstream of the -35 region of the fbpA promoter was observed . At higher concentrations of Fur (75 and 100 nM), an extension of this protected region upstream of the -35 region was observed . Introduction of a plasmid carrying an fbpA-cat transcriptional fusion in E . coli H1717 (Fur+) resulted in an 88% induction of chloramphenicol acetyltransferase expression under conditions of iron restriction; however, chloramphenicol acetyltransferase expression was not responsive to iron in E . coli H1745 (Fur-), indicating that transcriptional regulation of fbpA in response to iron occurs via the negative regulator Fur . The extent of the fbpA operator sequence (42 bp), as defined by our footprinting analysis, would suggest the binding