Sex Transm Dis, 1994 Mar-Apr, 21(2), 107 - 11 Multicenter trial of single-dose azithromycin vs . ceftriaxone in the treatment of uncomplicated gonorrhea . Azithromycin Gonorrhea Study Group; Handsfield HH et al.; BACKGROUND AND OBJECTIVES: Azithromycin is a new, long-acting azalide antibiotic that is active against Neisseria gonorrhoeae . A single oral dose of 1.0 g is effective against uncomplicated genital infection with Chlamydia trachomatis . GOAL OF THIS STUDY: To compare the efficacy and tolerance of single-dose treatment of uncomplicated gonorrhea with azithromycin, 2.0 g orally, and ceftriaxone, 250 mg intramuscularly . STUDY DESIGN: Seven hundred twenty-four men and women with presumptive, uncomplicated gonorrhea were treated with azithromycin 2.0 g orally or ceftriaxone 250 mg intramuscularly in a 2:1 ratio in a multicenter, open, randomized control trial in 10 public sexually transmitted disease clinics in the United States . Patients were followed up in 5 to 9 days and, for a subset of patients, 12 to 18 days after treatment . The main outcome measures were the isolation of N . gonorrhoeae and C . trachomatis and patient-reported side effects . RESULTS: Among infected patients who returned for follow-up, N . gonorrhoeae was eradicated from all anatomic sites in 370 of 374 (98.9%; 95% confidence interval {95%CI} 97.9%-100%) treated with azithromycin and 171 of 175 (97.7%; 95%CI 95.5%-99.9%) given ceftriaxone . Treatment with either drug was effective in all 73 patients infected with beta-lactamase-producing N . gonorrhoeae . Chlamydial infection was eradicated in all 17 patients given azithromycin who returned and were recultured at follow-up and in two of seven patients given ceftriaxone (P < 0.001) . Gastrointestinal side effects occurred in 35.3% (95%CI 30.7%-39.8%) of patients given azithromycin; of those with symptoms, these were moderate in 10.1% and severe in 2.9% . CONCLUSIONS: Azithromycin 2.0 g and ceftriaxone 250 mg are equally effective in the treatment of uncomplicated gonorrhea . Azithromycin was associated with a relatively high frequency of gastrointestinal side effects and is expensive, but it has the advantages of oral administration and efficacy against concomitant chlamydial infection. J Clin Microbiol, 1994 Mar, 32(3), 701 - 4 Enzyme electrophoresis, sero- and subtyping, and outer membrane protein characterization of two Neisseria meningitidis strains involved in laboratory-acquired infections; Guibourdenche M et al.; Two cases of laboratory-acquired infections due to Neisseria meningitidis were suspected to have occurred in two French hospitals . The first case occurred shortly, i.e., 3 days, after one strain had been handled by a laboratory technician, and the link between this strain and the strain causing meningitis was easily established . In the second case, infection occurred 3 weeks after 10 strains had been handled by a technician . In this case, it was necessary to use high-resolution markers in order to establish the link between the infecting strain and 1 of the 10 strains handled . The antigenic formulae of the two infecting strains (serogroup:serotype:subtype) were, respectively, C:NT:P1.12 and B:2a:P1.2 . Outer membrane protein profile analysis and multilocus enzyme electrophoresis unequivocally confirmed the identity of the respective strains. J Am Board Fam Pract, 1994 Mar-Apr, 7(2), 110 - 23 Pelvic inflammatory disease: diagnosis and management; Quan M; BACKGROUND: Acute pelvic inflammatory disease (PID) is a major gynecologic health problem in the United States, afflicting more than 1 million women each year and generating annual direct and indirect costs estimated at $4.2 billion . Family physicians can play an important role in the prevention, as well as diagnosis and treatment, of PID . METHODS: A MEDLINE search for articles published from 1985 to the present was made using the key words "pelvic inflammatory disease," "endometritis," "salpingitis," "tubo-ovarian abscess," "adnexitis," "pelvic abscess," "parametritis," and "oophoritis." The bibliographies of these articles and the author's personal files were also sources of information . RESULTS AND CONCLUSIONS: A number of risk factors have been linked to PID, including young age, age at first intercourse, multiple sex partners, the presence of bacterial vaginosis, vaginal douching, the use of an intrauterine contraceptive device, and a history of a sexually transmitted disease . The diagnosis of PID represents a major clinical challenge that requires a careful history and physical examination coupled with selective and knowledgeable use of the diagnostic tests and procedures currently available . Broad-spectrum antibiotics, which represent the cornerstone of therapy, must adequately cover the polymicrobial spectrum of pathogens implicated in this infection, which includes Neisseria gonorrhoeae, Chlamydia trachomatis, and specific cervicovaginal anaerobic and aerobic bacteria . The numerous sequelae associated with PID, which include infertility, ectopic pregnancy, and chronic pelvic pain syndromes, underscore the need for effective measures for preventing pelvic inflammatory disease. J Infect Dis, 1994 Mar, 169(3), 532 - 7 Human experimentation with Neisseria gonorrhoeae: rationale, methods, and implications for the biology of infection and vaccine development; Cohen MS et al.; Neisseria gonorrhoeae infection is limited to the human host . Experimental urethral infection in male volunteers was used to study different aspects of the infection . Urethral installation of a variety of gonococcal variants (10(4)-10(6)) led to infection in 27 subjects, who developed pyuria and shed bacteria in urine before urethritis developed 1-6 days after gonococcal inoculation . The incubation period was affected by the inoculation procedure and size of the inoculum . Subjects were treated with intramuscular ceftriaxone (250 mg) if urethritis developed or at 6 days after inoculation . Urine cultures became negative within several hours of therapy, and symptoms resolved within 1 day of therapy . Infected patients suffered no major complications . Experimental male urethral gonococcal infection provides a unique opportunity to understand the biology and immunology of gonococcal infection and is an efficient method to test gonococcal vaccine candidates. Ann Thorac Surg, 1994 Mar, 57(3), 748 - 50 Neisseria gonorrhoeae mycotic ascending aortic aneurysm; Risher WH et al.; Mycotic aneurysms of the ascending aorta are rare . We report the case of a 38-year-old woman with systemic lupus erythematosus being treated with steroids who presented with a large Neisseria gonorrhoeae ascending aortic aneurysm . She was successfully treated with surgical resection of the aneurysm and prolonged postoperative antibiotic therapy. J Bacteriol, 1994 Mar, 176(6), 1764 - 6 Identification of the iroA gene product of Neisseria meningitidis as a lactoferrin receptor; Pettersson A et al.; The iroA gene product is an iron limitation-inducible outer membrane protein of Neisseria meningitidis . A spontaneous mutant lacking the gene was unable to bind lactoferrin . Furthermore, Escherichia coli strains expressing the IroA protein were capable of binding lactoferrin . Apparently, the IroA protein functions as a lactoferrin receptor. J Exp Med, 1994 Mar 1, 179(3), 911 - 20 Multiple gonococcal opacity proteins are expressed during experimental urethral infection in the male; Jerse AE et al.; The opacity (Opa) proteins of Neisseria gonorrhoeae are a family of outer membrane proteins demonstrating phase and antigenic variation . N . gonorrhoeae strain FA0190 has 11 opa loci that encode at least 8 antigenically distinct Opa proteins . To determine if expression of one Opa protein or a subset of them is favored during gonococcal infection, we inoculated Opa-negative variants of strain FA1090 intraurethrally into male volunteers . The Opa phenotype of gonococci isolated from urine and urethral swab cultures from nine infected subjects was determined . Opa proteins were expressed in a large proportion of the reisolates from the infected subjects . Gonococci cultured from urine or urethral swab samples from six of the subjects were uniformly Opa positive, with the predominant Opa variants differing among subjects . Three different Opa proteins were represented as the predominant type in at least one subject each . In three subjects, there was more heterogeneity in Opa phenotype of the reisolates, including the presence of Opa-negative variants . An increase in the proportion of isolates expressing multiple Opa proteins occurred over time in most subjects . Passage of the inoculum in vitro did not result in similar changes in Opa expression . There was no detectable difference in infectivity of an Opa-negative variant and one expressing an Opa protein (OpaF) that was highly represented in reisolates from the original nine subjects . Reisolates from three infected volunteers inoculated with the OpaF variant showed continued expression of OpaF alone or in conjunction with other Opa proteins . These results demonstrate that there is strong selection for expression of one or more Opa proteins by strain FA1090 in vivo, but that no single protein is preferentially expressed during early infection in the male urethra. Am J Reprod Immunol, 1994 Mar-Apr, 31(2-3), 77 - 83 Antisperm antibodies (ASAs) in infertile males: subclass distribution of IgA antibodies and the effect of an IgA1 protease on sperm-bound antibodies; Kutteh WH et al.; PROBLEM: (1) To determine the IgA subclass distribution of antibodies in the serum and on the sperm of infertile male patients . (2) To determine the effect of an IgA1 protease on the binding of IgA antisperm antibodies (ASA) . METHOD: Fifteen infertile males with ASA in serum (10) or on sperm (5) were recruited for this study . Duration of infertility was at least one year . Monoclonal antibodies to human IgA1 and IgA2 were conjugated to immunobeads . The distribution of IgA1 and IgA2 subclass ASA was determined for positive serum and sperm samples . The effects of an IgA1 protease (isolated from Neisseria meningitidis strain HF13) on sperm-bound antibodies was evaluated by immunobead binding . RESULTS: In serum, the IgA1 subclass ASA was predominate (91%) when compared with IgA2 (9%) subclass . Direct sperm-bound antibodies displayed a distribution more characteristic of the secretory immune system with IgA1 accounting for 63% and IgA2 accounting for 37% of the total IgA ASA . Enzyme treatment dramatically reduced the amount of serum IgA antibodies bound to sperm (P < 0.05) . Similarly, a significant reduction in direct sperm-bound antibodies was observed after enzymatic treatment with no loss in sperm motility . CONCLUSIONS: (1) Although IgA1 direct sperm-bound antibodies were dominant, when compared with serum there was a higher proportion of IgA2 subclass, which suggests a local production of IgA . (2) Specific IgA1 protease treatment is capable of reducing the amount of immunobead-detectable IgA on sperm . Hamster oocyte sperm-penetration assays are ongoing to determine if this treatment might improve sperm penetration rates. Sex Transm Dis, 1994 Mar-Apr, 21(2 Suppl), S81 - 3 Epidemiology of sexually transmitted diseases . What does it tell us? Kohl PK. Incidence numbers of Neisseria gonorrhoeae, Treponema pallidum and Chlamydia trachomatis differ substantially in different countries at different times . In European countries, the incidence of gonorrhea and of primary and secondary syphilis currently is extremely low . In North American countries gonorrhea incidence declined at a very slow annual rate and syphilis incidence increased . Chlamydial infections show a profile that seems to be delayed by two decades from infections with Neisseria gonorrhoeae . Our efforts in the future should be directed to prevent the resurgence of gonorrhea and syphilis and to achieve the same success with chlamydial infections . Poor populations in developed and developing countries, which have similar demographic, social and economic characteristics, represent one important target group for control programs . Education of young and poor people represent the challenge of the future for sexually transmitted diseases control strategies . Combined strategies also will have an effect on incurable viral STD. J Pak Med Assoc, 1994 Mar, 44(3), 70 - 1 Beta-lactamase producing Neisseria gonorrhea strains in Karachi; Khanani R et al.; Urethral or cervical swab of 255 patients attending Skin and Social Hygiene Centre and found positive for gram negative intracellular diplococci on direct microscopy were inoculated on Modified New York City (MNYC) medium and chocolate (heated blood) agar for isolation of neisseria gonorrhea . Growth of N . gonorrhea was obtained in 134 (52.5%) cases . These strains were tested for penicillin susceptibility by disc diffusion method and for the production of beta-lactamase by rapid penicillinase paper strip test and rapid chromogenic cephalosporin method . Penicillin resistance was found in 31 (23%) strains, of which twelve (9%) were beta-lactamase producers (PPNG), the remaining 19 (14%) strains were penicillin resistant beta-lactamase negative (Pen RB Neg) . We conclude that PPNG as well as other penicillin resistant strains (Pen RB Neg) of neisseria gonorrhea are prevalent in our country and appropriate changes in the conventional therapeutic regime are desirable. Diagn Microbiol Infect Dis, 1994 Mar, 18(3), 175 - 80 Evaluation of interpretive criteria of agar dilution and disk diffusion susceptibility tests for Neisseria gonorrhoeae; Altaie SS et al.; Using strains of Neisseria gonorrhoeae from Western New York, the National Committee for Clinical Laboratory Standards' (NCCLS) interpretive criteria for disk diffusion susceptibility testing was evaluated on chocolate-Mueller-Hinton agar (CMH) and GC agar . The reference method for comparison was the NCCLS agar dilution minimum inhibitory concentration (MIC) method . Even though the zone sizes were significantly smaller on the CMH agar, the interpretations were not significantly different on either GC or CMH agars except for tetracycline . On the CMH agar, the number of tetracycline-resistant strains was greater than on GC agar: 3% of the strains failed to grow on CMH agar and 4% did not produce interpretable zone sizes for ceftriaxone . Therefore, the use of CMH is not recommended . There was a significant difference between the interpretative criteria of the MIC and the disk diffusion method only for tetracycline . Therefore, the NCCLS zone-diameter interpretation criteria for tetracycline does not seem applicable for N . gonorrhoeae isolates in the Buffalo, New York, area. Bratisl Lek Listy, 1994 Mar, 95(3), 122 - 4 {Quantification of Neisseria gonorrhoeae from the cervicovaginal area in nonpregnant women infected with gonorrhoea}; Pec J et al.; The authors studied quantification of Neisseria gonorrhoeae from the cervicovaginal area of 53 nonpregnant women with gonorrhoea . The variability of the amount of gonococci in cervicovaginal secretion was rather high from 1.0.10(1) to 1.1.10(8) cfu N . gonorrhoeae in 1 ml . Maximum values of N . gonorrhoeae have been found intra menses (from 1.0.10(2) to 3.0.10(8) cfu N . gonorrhoeae in 1 ml) . These findings allow the authors to make some, already more or less known, conclusions usable in clinical practice. J Bacteriol, 1994 Mar, 176(5), 1323 - 31 Type IV prepilin peptidase gene of Neisseria gonorrhoeae MS11: presence of a related gene in other piliated and nonpiliated Neisseria strains; Dupuy B et al.; The assembly of type IV pili in Neisseria gonorrhoeae is a complex process likely to require the products of many genes . One of these is the enzyme prepilin peptidase, which cleaves and then N methylates the precursor pilin subunits prior to their assembly into pili . We have used a PCR amplification strategy to clone the N . gonorrhoeae prepilin peptidase gene, pilDNg . A single copy of the gene is shown to be present in the chromosome . Its product promotes correct cleavage of the gonococcal prepillin in Escherichia coli cells carrying both the prepilin peptidase gene and the pilin structural gene . PilDNg also cleaves prePulG, a type IV pilin-like protein of Klebsiella oxytoca . Moreover, PilDNg complements a mutation in the gene coding for the prepilin peptidase-like protein of K . oxytoca, pulO, partially restoring PulG-PulO-dependent extracellular secretion of the enzyme pullulanase . Finally, we show that genes homologous to pilDNg are present and expressed in a variety of species in the genus Neisseria, including some commensal strains. J Histochem Cytochem, 1994 Mar, 42(3), 297 - 306 Digital confocal microscopy allows measurement and three-dimensional multiple spectral reconstruction of Neisseria gonorrhoeae/epithelial cell interactions in the human fallopian tube organ culture model; Gorby GL; A strategy for measuring Neisseria gonorrhoeae attachment and invasion in the human Fallopian tube organ culture (FTOC) model via computerized image analysis (CIA) combined with "digital" confocal microscopy (DCM) was tested . DCM on serial image stacks of fluorescent latex beads reduced out-of-focus light propagation in the Z-axis (p < 0.005) and improved the shape factor of lateral three-dimensional reconstructions of the beads (p < 0.001) . Sections of tissue infected for 44 hr with piliated, Opa+ gonococci were stained with fluorescein-labeled monoclonal anti-gonococcal antibodies, rhodamine-labeled phalloidin, and Hoechst 33342 . Serial images collected at identical focal planes for each fluorochrome were subjected to DCM . Epithelial cytoplasmic regions of interest defined by rhodamine-stained actin were superimposed on the corresponding fluorescein-stained and Hoechst-stained images . Fluorescent objects defined by gray-scale threshold were measured by computerized image analysis using different border treatments to differentiate attached from intracellular gonococci or count cell nuclei . Compared with raw images, measurement of DCM images was less dependent on threshold choice (p < 0.05) . DCM augments conventional microscopy in removing out-of-focus light from fluorescent images, in reconstructing three-dimensional images, and in quantitatively differentiating extracellular from intracellular gonococci in a natural target tissue. Int J Cancer, 1994 Feb 1, 56(3), 358 - 63 Sexually transmitted agents and cervical neoplasia in Colombia and Spain; de Sanjose S et al.; Case-control studies of cervical intra-epithelial neoplasia grade III (CIN III) and of invasive cervical cancer were carried out in Spain and Colombia to assess the relationship between cervical cancer and 6 common sexually transmitted agents (STAs) . The CIN-III studies included 525 cases and 512 controls matched for age and for the place of recruitment; the invasive-cancer studies included 373 histologically confirmed cases of squamous-cell carcinoma and 387 age-stratified controls selected randomly from the populations that generated the cases . Antibodies to Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, herpes simplex virus type II (HSV-2) and cytomegalovirus (CMV) were tested in 88% of the women . Cervical scrapes were examined for HPV DNA in 63% of the women using a polymerase-chain-reaction assay (PCR) . Among controls, the highest antibody prevalence was to CMV (96.5%), followed by HSV-2 (31.4%) and C . trachomatis (23.3%) . For all STAs, the sero-prevalence was markedly higher in Colombia than in Spain both for cases and for controls . After adjustment for the presence of HPV DNA, C . trachomatis was the only STA associated with CIN III in both countries; Spain and Colombia . In both countries, the risk of CIN III increased with increasing of C . trachomatis antibody titers . Among Spanish women, an increase in risk of invasive carcinoma was found for those with antibodies to N . gonorrhoeae; those with antibodies to HSV-2 and those with antibodies to C . trachomatis . These associations were present only in HPV-DNA-negative women . Among HPV-DNA-positive women, none of the STAs considered were associated with cervical neoplasia . Our findings could be interpreted as indicating that past infections with HSV-2, N . gonorrhoeae and C . trachomatis are surrogate markers of HPV, but because HPV DNA may have escaped detection, we cannot exclude that these STAs are also of separate etiological significance. Genitourin Med, 1994 Feb, 70(1), 3 - 6 Leukocyte esterase urine strips for the screening of men with urethritis--use in developing countries; Tyndall MW et al.; BACKGROUND AND OBJECTIVES--The leukocyte esterase (LE) strip is a useful tool for the screening of men with urethritis . In developing countries, where laboratory facilities are limited, and sexually transmitted diseases endemic, simple and inexpensive diagnostic tests which perform well, would be of great value . METHODS--Men presenting with urethritis to a referral clinic for sexually transmitted diseases in Nairobi, Kenya participated in this cohort analytical study . First-void urine was collected for LE dipstick testing as part of the diagnostic work-up . The results of the dipstick measurement were compared with the laboratory detection of Chlamydia trachomatis and Neisseria gonorrhoeae . RESULTS--Of 200 men with symptoms of urethritis, 33 (17%) had a pathogen detected from the urethra or the urine . Chlamydia was detected in urine by PCR in 22 (11%), and gonorrhoea was cultured from the urethra in 11 (6%) . Esterase activity (trace or greater) had a sensitivity of 76%, a specificity of 80%, a positive predictive value of 42% and a negative predictive value of 94% for the presence of chlamydia or gonorrhoea . CONCLUSIONS--The use of the LE dipstick for the screening of men with symptomatic urethritis can improve diagnostic accuracy and reduce the amount of empiric antimicrobial therapy . The low detection rate of chlamydia in these men with a clinical diagnosis of nongonococcal urethritis needs further study. Obstet Gynecol, 1994 Feb, 83(2), 280 - 6 Piperacillin and tazobactam versus clindamycin and gentamicin in the treatment of hospitalized women with pelvic infection . The Piperacillin/tazobactam Study Group; Sweet RL et al.; OBJECTIVE: To compare the efficacy and safety of a combination of piperacillin and tazobactam with that of clindamycin and gentamicin in the treatment of hospitalized women with infections of the upper genital tract . METHODS: This was a randomized open-label trial in hospitalized women with infections of the upper genital tract . Patients were recruited at 12 hospitals in the United States and two hospitals in Canada and were randomly assigned to one of two regimens in a 2:1 ratio . One group received piperacillin, 3 g every 6 hours, and tazobactam, 375 mg every 6 hours; the other group received clindamycin, 900 mg every 8 hours, and gentamicin, 2.5-5.0 mg/kg/day in three divided doses . Therapy with the assigned regimen was to be administered for a minimum of 3 days . Cultures for aerobic and anaerobic bacteria were obtained from the site of infection before initiation of therapy . Cultures for Chlamydia trachomatis were also obtained from patients with endometritis or pelvic inflammatory disease . Subjects were evaluated for clinical and bacteriologic response at 24-72 hours and 2-4 weeks after completing therapy . RESULTS: Two hundred ninety-nine patients were enrolled; 196 were in the piperacillin-tazobactam group and 103 were in the clindamycin-gentamicin group . The most common diagnoses were endometritis (146) and pelvic inflammatory disease (115) . The most common microorganisms recovered included: Peptostreptococcus sp (99), Prevotella sp (87), black pigmented Bacteroides (29), B fragilis (11), enterococci (64), group B streptococcus (26), Escherichia coli (31), Neisseria gonorrhoeae (49), and C trachomatis (19) . A favorable clinical response occurred in 84.7% (166 of 196) of piperacillin-tazobactam patients and 87.3% (90 of 103) of clindamycin-gentamicin patients . Among those evaluable for bacteriologic response, 78% (67 of 86) and 82% (23 of 28), respectively, had a favorable response . Diarrhea occurred significantly more frequently in the piperacillin-tazobactam group (9.7 versus 2.9%; P = .04), but the majority of episodes were mild to moderate . None of the adverse experiences in either treatment group were considered life-threatening and drug-related . CONCLUSION: The combination of piperacillin and tazobactam is an effective and well-tolerated antibiotic regimen for the treatment of infections of the upper genital tract in women. Nihon Kyobu Shikkan Gakkai Zasshi, 1994 Feb, 32(2), 146 - 51 {Bacterial flora of the respiratory tract in patients with long term tracheostomy--colonization of the lower respiratory tract by Pseudomonas aeruginosa}; Tano Y et al.; Throat secretions (TS) and bronchial secretions aspirated from tracheostomy sites (TSTA) from six subjects with long term tracheostomy were simultaneously collected and then cultured every two weeks from January, 1990, to December, 1992 . Isolated bacteria were mainly alpha-streptococci (96.2%) and Neisseria (69.6%) in TS, and Pseudomonas aeruginosa (75.7%) in TSTA . In all cases, P . aeruginosa was isolated from and colonization of the lower respiratory tract by this organism was apparent 24.4 months, on average, after tracheostomy . There were ten episodes of respiratory infection in five cases, eight of which occurred after colonization . P . aeruginosa was the causative organism in seven of these episodes . Findings in patients with long term tracheostomy indicated separate colonization of the upper and lower respiratory tracts and that P . aeruginosa colonized the lower respiratory tract . The colonization of the lower respiratory tract by P . aeruginosa would thus appear to be an important factor inducing respiratory infection. Mol Chem Neuropathol, 1994 Feb-Apr, 21(2-3), 299 - 309 Ganglioside conjugate vaccines . Immunotherapy against tumors of neuroectodermal origin; Helling F et al.; Gangliosides are known to be suitable targets for immune attack against cancer but they are poorly immunogenic . Active immunization with ganglioside/BCG or liposome vaccines results in moderate titer IgM antibody responses of short duration . Covalent attachment of poorly immunogenic antigens to immunogenic proteins is a potent method for inducing an IgG antibody response . GD3, a dominant ganglioside on malignant melanoma, was modified by ozone cleavage of the double bond in the ceramide backbone, an aldehyde group introduced and used for coupling via reductive amination to epsilon-amino-lysyl groups of proteins . Utilizing this method, GD3 conjugates were constructed with: 1 . Synthetic multiple antigenic peptide (MAP) constructs expressing 4 repeats of a malaria T-cell epitope; 2 . Outer membrane proteins (OMP) of Neisseria meningitidis; 3 . Cationized bovine serum albumin; 4 . Keyhole limpet hemocyanin (KLH); and 5 . Polylysine . In addition, conjugates containing only the GD3 oligosaccharide were synthesized . All constructs were tested for antigenicity using anti-GD3 antibody R24, and for immunogenicity in mice . Serum antibody levels were analyzed by ELISA and immune thin-layer chromatography . Results in the mouse show a significant improvement in the IgM antibody response and a consistent IgG response against GD3 using GD3-KLH conjugates . Other carrier proteins and the use of GD3 oligosaccharide were significantly less effective . If improved immunogenicity and clinical benefit with conjugate vaccines can be demonstrated in patients with melanoma, this approach may be applicable to patients with other tumors of neuroectodermal origin, including gliomas, glioblastomas, astrocytomas, and neuroblastomas. Mol Cell Probes, 1994 Feb, 8(1), 55 - 61 Design and characterization of PCR primers for detection of pathogenic Neisseriae; Muralidhar B et al.; Oligonucleotide polymerase chain reaction (PCR) primers directed at a group of closely related Neisserial species were designed from 16S rDNA sequences even though only a single such sequence from the targeted group was known . The amplifiable group included all Neisserial species considered pathogenic for man, including Neisseria gonorrhoea and Neisseria meningitidis . None of 43 other bacterial DNA specimens were amplified, including five non-Neisserial Neisseriaceae and three non-pathogenic Neisseriae . Another non-pathogenic Neisserial species gave a signal only at high DNA concentrations . DNA specimens from the pathogenic Neisseriae were detectable in amounts as low as 0.01 pg per PCR reaction, the approximate equivalent of a single organism, with equal sensitivity in buffer or in simple extracts of human inflammatory synovial fluids to which Neisserial DNA had been added . Simultaneously studied control specimens lacking added DNA were negative . The approach used to design these group-directed primers using only a single rDNA sequence from the targeted group by exploiting known patterns of sequence conservation among the 16S rDNA genes may prove useful for designing other similar group-directed primers . Polymerase chain reaction primers prepared in this way should prove of value in a number of areas, both investigational and clinical. J Clin Microbiol, 1994 Feb, 32(2), 464 - 8 Nonrepresentative PCR amplification of variable gene sequences in clinical specimens containing dilute, complex mixtures of microorganisms; Wright CJ et al.; PCR amplification and DNA sequencing of the expression locus from Neisseria gonorrhoeae contained in urine sediments collected from experimentally infected human subjects produced two observations . First, different pilin sequences were obtained when separate aliquots of the same sample were amplified and sequenced . In contrast, the same pilin sequence was obtained when repeated amplifications were performed on individual colonies grown from the clinical samples . Second, mixed sequences (i.e., more than one nucleotide at variable positions in the pilin gene sequence) were observed in both the direct clinical isolates and individual cultures grown from the isolates . These results suggest that when clinical samples are directly examined by PCR amplification and sequencing, multiple amplifications may be required to detect sequence variants in the sample and minority variant sequences will not always be detected. Gene, 1994 Jan 28, 138(1-2), 43 - 50 Cloning and constitutive expression of structural genes encoding gonococcal porin protein in Escherichia coli and attenuated Salmonella typhimurium vaccine strains; Elkins C et al.; Previous reports {Gotschlich et al., Proc . Natl . Acad . Sci . USA 84 (1987) 8135-8139; Carbonetti and Sparling, Proc . Natl . Acad . Sci . USA 84 (1987) 9084-9088; Carbonetti et al., Proc . Natl . Acad . Sci . USA 85 (1988) 6841-6845} concluded that synthesis of the porin protein (Por) from Neisseria gonorrhoeae in Escherichia coli was toxic to that organism, which limited studies of the biology of Por in foreign hosts . We assembled intact por genes from the gonococcal strains, FA19 (serogroup PIA) and FA6434 (a hybrid Por containing epitopes from serogroups PIA and PIB), and observed stable expression in E . coli without evident toxicity . Expression of por from strain MS11 (serogroup PIB) in E . coli was difficult, but por from MS11 was expressed without toxicity when the -35 region of the por promoter was removed . Encouraged by this, we moved por from E . coli into attenuated Salmonella typhimurium strains and expressed por either in single copy from the chromosome or in multiple copy from plasmids . Expression levels of por in S . typhimurium were higher from plasmids than from the chromosome, probably due to a gene dosage effect . This work will enable study of the immune response to Por in mice vaccinated orally with live S . typhimurium. J Mol Biol, 1994 Jan 21, 235(3), 1154 - 5 Crystallization and preliminary X-ray investigation of a recombinant outer membrane protein from Neisseria meningitidis; de la Sierra IL et al.; A protein constituent of the outer membrane from Neisseria meningitidis (hereafter called P64K) has been crystallized using the hanging drop technique . Crystals are tetragonal with unit cell dimensions a = b = 136.84 A and c = 78.44 A, compatible with a single monomer of 64 kDa in the asymmetric unit . When exposed to high intensity synchrotron radiation, these crystals diffract X-rays to at least 2.9 A resolution, indicating that a high resolution structure analysis is feasible. Schweiz Rundsch Med Prax, 1994 Jan 11, 83(2), 46 - 8 {Gonorrheal arthritis}; Weber M et al.; A 43-year-old female patient presented with migratory arthralgias, generalized exanthema and arthritis of the left elbow . She had a history of fever and chills three days earlier . Beside to a maculopapular and pustular rash and a joint involvement we found a swelling of the dorsal surface of her right hand without wrist effusion or synovitis . The clinical presentation was typical for the diagnosis of disseminated gonococcal infection (arthritis-dermatitis syndrome) . Arthrocentesis was performed, and the cultures of the synovial fluid on chocolate agar were positive for Neisseria gonorrhoeae . The serologic examination for gonococcus was negative, it became positive some weeks later . The therapy with intravenous penicillin G 6 x 10(6) units/day for ten days was successful; unfortunately, we could not treat the partner . The present case report is illustrated with colour prints and describes the typical clinical picture of a diagnosis which is nowadays rare or even forgotten. Cancer Res, 1994 Jan 1, 54(1), 197 - 203 GD3 vaccines for melanoma: superior immunogenicity of keyhole limpet hemocyanin conjugate vaccines; Helling F et al.; Cell surface gangliosides show altered patterns of expression as a consequence of malignant transformation and have therefore been of interest as potential targets for immunotherapy, including vaccine construction . One obstacle has been that some of the gangliosides that are overexpressed in human cancers are poorly immunogenic in humans . A case in point is GD3, a prominent ganglioside of human malignant melanoma . Using an approach that has been effective in the construction of bacterial carbohydrate vaccines, we have succeeded in increasing the immunogenicity of GD3 in the mouse by conjugating the ganglioside with immunogenic carriers . Several conjugation methods were used . The optimal procedure involved ozone cleavage of the double bond of GD3 in the ceramide backbone, introducing an aldehyde group, and coupling to aminolysyl groups of proteins by reductive amination . Conjugates were constructed with a synthetic multiple antigenic peptide expressing repeats of a malarial T-cell epitope, outer membrane proteins of Neisseria meningitidis, cationized bovine serum albumin, keyhole limpet hemocyanin, and polylysine . Mice immunized with these conjugates showed a stronger antibody response to GD3 than mice immunized with unconjugated GD3 . The strongest response was observed in mice immunized with the keyhole limpet hemocyanin conjugate of the GD3 aldehyde derivative and the adjuvant QS-21 . These mice showed not only a long-lasting high-titer IgM response but also a consistent high-titer IgG response (predominantly IgG1), indicating recruitment of T-cell help, although the titers of IgM and IgG antibodies following booster immunizations were not as high as they are in the response to classical T-cell-dependent antigens . This method is applicable to other gangliosides, and it may be useful in the construction of immunogenic ganglioside vaccines for the immunotherapy of human cancers expressing gangliosides on their cell surface. Antimicrob Agents Chemother, 1994 Jan, 38(1), 155 - 8 Antimicrobial susceptibilities of Neisseria gonorrhoeae strains representing five distinct resistance phenotypes; Rice RJ et al.; The susceptibilities of 109 strains of Neisseria gonorrhoeae to penicillin G, tetracycline, amoxicillin-clavulanic acid, cefotetan, cefoxitin, ceftriaxone, ciprofloxacin, and fleroxacin were determined . The activities of cefmetazole, cefuroxime, cefixime, and ofloxacin were also determined against 62 of these strains . Strains represented penicillin-susceptible (Pen(s)) N . gonorrhoeae; penicillinase-producing N . gonorrhoeae (PPNG) possessing 2.9-, 3.05-, 3.2-, or 4.4-MDa beta-lactamase plasmids; strains with high-level, plasmid-mediated tetracycline resistance (TRNG); strains with plasmid-mediated resistance to penicillin and tetracycline; and strains with chromosomally mediated resistance to penicillin and tetracycline (CMRNG) . Ceftriaxone, cefixime, and ciprofloxacin were the most active agents tested against all strains . Pen(s), TRNG, and PPNG strains possessing a 3.2-MDa beta-lactamase plasmid were more susceptible to amoxicillin-clavulanic acid, extended- and broad-spectrum cephalosporins, and quinolones than were either PPNG strains possessing a 2.9-, a 3.05-, or a 4.4-MDa beta-lactamase plasmid or CMRNG strains. Sex Transm Dis, 1994 Jan-Feb, 21(1), 43 - 6 Single dose azithromycin treatment of gonorrhea and infections caused by C . trachomatis and U . urealyticum in men; Steingrimsson O et al.; BACKGROUND AND OBJECTIVES: Single dose regimens have advantages in the treatment of STD . Azithromycin has unique pharmacokinetics that may make single dose regimens feasible . Treatment with a single 1 g dose of azithromycin was compared to 100 mg doxycycline twice daily for seven days . STUDY DESIGN: This was a randomized third-party blinded study on 183 male patients, 176 of whom could be evaluated for efficacy . RESULTS: Chlamydia trachomatis was cultured from 148 patients, 79 receiving azithromycin and 69 receiving doxycycline . Six patients receiving azithromycin had positive cultures on follow-up, four were known to have had sexual intercourse with infected partners . Fifty-one patients had gonorrhea; 28 were treated with azithromycin and 23 with doxycycline . Neisseria gonorrhoeae was eradicated from all patients except one receiving azithromycin . He denied sexual exposure during follow-up . Sixty patients were infected with Ureaplasma urealyticum, 35 were treated with azithromycin and 25 with doxycycline . Five patients in each group had positive cultures on follow up . Three patients receiving azithromycin and two receiving doxycycline were known to have had sexual exposure during follow-up . CONCLUSION: A single dose of azithromycin showed similar effectiveness as a 7-day regimen of doxycycline. FEMS Microbiol Lett, 1994 Jan 1, 115(1), 39 - 44 Neisseria gonorrhoeae possesses two nicotinamide adenine dinucleotide-independent lactate dehydrogenases; Fischer RS et al.; An important metabolic capability of Neisseria gonorrhoeae is the utilization of host-derived lactate . Two isoenzymes of the membrane-associated, pyridine dinucleotide-independent type of lactate dehydrogenase (iLDH) participate in lactate assimilation, but exhibit distinctive properties . Isoenzyme iLDH-I utilized lactate exclusively as substrate, exhibiting a preference for the D-isomer . In contrast, isoenzyme iLDH-II exhibited broad substrate specificity (lactate, phenyllactate, and 4-hydroxyphenyllactate), but was stereospecific for the L-isomers . These results explain the difficulty in isolating mutants unable to utilize lactate. Rev Med Chil, 1994 Jan, 122(1), 42 - 7 {Detection of anti-gonococcal antibodies using a dot immunobinding assay in a high risk female population}; Soto L et al.; The bacteriological diagnosis of gonorrhea in women has a low efficiency . A dot immunobinding assay, using whole piliated Neisseria gonorrhoeae cells, was used to detect antigonococcal antibodies in 300 prostitutes in whom a parallel Thayer-Martin culture of endocervical secretion was performed . Twenty sera from men with bacteriologically confirmed gonorrhoea were used as positive controls and 20 sera from children without history of gonococcal infections, as negative controls . Antibodies were detected in 49.7% of women and culture was positive in only one . All men with gonorrhea has positive titers and all sera from children were negative, except one that had a cross-reaction . Test sensitivity in the female population was 1 and specificity 0.5 . There were no false negative reactions . Although the test detected antibodies in high risk women, there were cross-reactions . Therefore, the technique should be improved, using a more specific antigen. Arch Med Res, 1994 Winter, 25(4), 455 - 61 Evaluation of the efficacy of human antimeningococcal immunoglobulin G in infant rats experimentally infected with Neisseria meningitidis group B; Infante JF et al.; Infants rats, a well known model for the experimental reproduction of bacterial meningitis, were used by us to test the protective potential of antibodies developed in humans who had been vaccinated with the Cuban antimeningitis vaccine (VA-MENGOCBC) . Newborn rats were inoculated by the intraperitoneal and intranasal routes with suspensions of Neisseria meningitidis group B bacteria . Bacteremia kinetics were evaluated from blood and brain-spinal fluid cultures . Samples of the central nervous system were taken and smears of backbone fluids prepared for histopathologic evaluations . Characterization of bacteremia evolution, as well as the mean lethal dose of germs and histopathologic features, were determined . After standardization of the model, therapeutic schemes were applied using passive immunization pre- and post-infection with N . meningitidis . A significant level of protection was obtained in relation to control animals that received the same challenge doses. Scand J Infect Dis, 1994, 26(5), 605 - 9 Bacteremia in patients without known underlying disorders; Amit M et al.; Of 2030 consecutive patients with bacteremia, only 102 were free from underlying disorders . 43 were males, and the median age was 66 years . The sources of infection were the urinary tract (in 48%), lower respiratory tract (13%), endocarditis (7%), biliary tract (6%) and the meninges (5%) . The most common pathogens were Escherichia coli (in 45% of patients), Streptococcus pneumoniae (21%), Staphylococcus aureus (9%) and hemolytic streptococci (9%) . Overall mortality rate was 13%, 4% in patients with urinary tract infection and 19% in patients with other sources . Half of the deaths occurred within 2 days of hospitalization, and 75% of them within 4 days . All patients with septic shock and all patients with meningitis died . Other factors related to mortality were residence in a nursing home, low functional capacity, advanced age, high blood urea nitrogen and creatinine and low albumin, and infections caused by Staphylococcus aureus, Neisseria meningitidis and polymicrobial infections . A protective effect of appropriate antimicrobial antibiotic therapy could not be demonstrated . In conclusion, bacteremic patients with no known underlying disorder and source of their infection other than the urinary tract should be given maximum supportive treatment and should be closely watched. Bull Soc Pathol Exot, 1994, 87(3), 148 - 51 {Rhinopharyngeal carriage of Neisseria meningitidis serogroup C in the collectivity around the patients of Mali . Apropos of 1,033 subjects sampled}; Koumare B et al.; This study showed that the carriage rate is nul or low in collectivity not in close contact, but high in collectivity in close contact (schools, particularly coranic schools) . In this later case, the duration of the carriage may reach several weeks (2 to 6 in our study) at variable rates (3.7 to 9.6%; 12.5 to 62.5%; 14.3 to 42.9% according to the coranic school visited) . For the strains of N . meningitidis serogroup C isolated, the rate of resistance to sulfamides and cotrimoxazole is 86.8% . These results explain why during epidemics, it is necessary to close schools and avoid to use for the chemoprophylaxis, sulfamids and their associations because of resistance. Pediatr Neurosurg, 1994, 21(3), 189 - 91 Cerebrospinal fluid shunt infection by Neisseria sicca; Hornyik G et al.; Neisseria sicca is considered to be a nonpathogenic oral saprophyte . Presented here is an unusual case of cerebrospinal fluid (CSF) shunt infection by N . sicca . Although medical management of the common community-acquired meningitides, including infection by Neisseria meningitidis, is often successful in patients with CSF shunts, removal and replacement of the infected shunt was necessary in this case. Acta Microbiol Immunol Hung, 1994, 41(3), 291 - 3 A comparative study for detection of Chlamydia trachomatis and Neisseria gonorrhoeae with DNA probe (a note); Szell A et al.; A newly developed DNA probe assay (Gen-Probe Pace 2 San Diego, USA) was compared with Chlamydia trachomatis direct immunofluorescence and Neisseria gonorrhoeae culture . Detection of C . trachomatis in cervical specimens from women and urethral specimens from men showed 23% positivity out of 313 cases . Out of the 69 positive cases 40 were positive with both examinations, in 29 cases only with DNA probe . Examinations of N . gonorrhoeae in 254 patients gave 98% positivity . Sensitivity of DNA probe assay was 100%, specificity was 97.8% . On the basis of preliminary data Gen-Probe is suitable for the detection of both causative agents. Acta Microbiol Pol, 1994, 43(1), 103 - 5 Identification of a new restriction endonuclease R.NciII, from Neisseria cinerea; Piekarowicz A; Site-specific restriction endonuclease R . Nci II has been purified from Neisseria cinerea strain 32615 . The enzyme recognizes the sequence 5' GATC 3' and its activity is inhibited by the presence of methylated adenine residue within the recognition sequence. Trop Geogr Med, 1994, 46(1), 44 - 5 Diagnosis of Trichomonas vaginalis in male urethritis; Pillay DG et al.; Trichomonas vaginalis was diagnosed in 42 (19%) of 227 adult males with urethral discharge . In 27 men (15%) T . vaginalis was isolated together with Neisseria gonorrhoeae . Non-gonococcal urethritis was diagnosed in 15 patients and T . vaginalis was isolated from 47% of such patients . Stained smear preparations, i.e . RapiDiff and acridine orange of modified Diamond's media, were superior to wet smear microscopy for the identification of T . vaginalis . RapiDiff stain was the most sensitive and identified 41 of 42 (98%) positive cultures . It is recommended that all turbid culture media should be stained for the optimal diagnosis of trichomoniasis. Gene, 1993 Dec 31, 137(2), 233 - 6 Transcriptional control of gonococcal pilE expression: involvement of an alternate sigma factor; Boyle-Vavra S et al.; The pilE gene encoding Neisseria gonorrhoeae (Gc) pilin contains two putative promoter sequences 5' to the transcription start point (tsp), a Pribnow box and an RpoN-binding consensus sequence . Sequence analysis shows that the nucleotide (nt) sequence of the pilE promoter region is completely conserved among eight different Gc isolates . Using a pilE::lacZ transcriptional fusion, we demonstrate that the RpoN sigma factor can function in Escherichia coli to increase pilE transcription when the NifA activator from Klebsiella is present in trans . In addition, over-production of the native pilin protein using RpoN and NifA is lethal to E . coli . Finally, we show that the RpoN sigma factor decreases the basal expression of pilE when an activator is not present . These results suggest that, in Gc, pilE transcription may be regulated by RpoN in conjunction with an activator and that sigma 70 can also act to direct transcription of pilE. Gene, 1993 Dec 31, 137(2), 153 - 62 A rapid and sensitive PCR strategy employed for amplification and sequencing of porA from a single colony-forming unit of Neisseria meningitidis; Saunders NB et al.; The predicted amino acid sequence was determined for the class-1 outer membrane protein, PorA, from a B:15:P1.7,3 strain of Neisseria meningitidis that is currently causing an epidemic of meningitis in Northern Chile . The P1.7,3 PorA showed a unique sequence in the exposed loop 4 of the putative porin structure that is different from all the reported PorA sequences . Based on the nucleotide (nt) sequence of the P1.7,3 porA, we designed two sets of PCR (polymerase chain reaction) primers that specifically amplified porA from any N . meningitidis strain, and a third set of primers that amplified porA only from the P1.7,3 strain . Using these primers, we developed a sensitive double hot-start nested PCR (HNPCR) strategy that could amplify porA and generate nt sequence from as low as a single colony-forming unit . This strategy consisted of three phases of PCR . The first two phases were designed to generate amplified target DNA that could be directly visualized by ethidium bromide staining starting from one to two molecules of Neisseria genome . The third phase was designed to generate a sequence of several hundred nt directly from the amplified DNA . A number of culture-negative cerebrospinal fluid samples from individuals suspected of meningitis during a vaccine trial were analyzed by this strategy to obtain more accurate information on the actual number of cases that occurred in the study and the non-study populations . The basic HNPCR strategy described here could be applied to amplify and sequence target DNAs from any low-copy-number biological sample. Genitourin Med, 1993 Dec, 69(6), 434 - 8 Sexually transmitted diseases reported by STD services in The Netherlands, 1984-1990; Treurniet HF et al.; OBJECTIVE--To present general trends in sexually transmitted disease (STD) in the Netherlands during the period 1984-1990 and to describe characteristics of the patients in order to get insight into possible factors underlying these trends . METHODS--Since 1984 patients diagnosed with STD visiting STD clinics and local public health services in the Netherlands are reported by the nursing staffs . In addition to diagnosis and gender of the patient epidemiological background information is registered . The reported annual cases of gonorrhoea, syphilis and Chlamydia trachomatis infections are presented . Further, the epidemiological features of over 25,000 patients with infections due to Chlamydia trachomatis, gonorrhoea or syphilis infections were compared . RESULTS--During the period 1984-1990 an overall decrease in the total number of gonorrhoea infections was reported; among homosexual males; however, an increase in gonorrhoea rates and an increasing number of sexual partners after 1989 was reported . Furthermore, the percentage of gonorrhoea infections caused by penicillinase-producing Neisseria gonorrhoeae was found to be on the increase in various subgroups but not in homosexual males . Syphilis rates among females declined from 1984 to 1987 after which an increase was reported reaching a peak in 1989; syphilis rates among males peaked during 1989 . After 1988 Chlamydia trachomatis infections increased which, however, is largely due to the introduction of screening among all visitors of the Amsterdam STD service resulting in improved case-detection . Finally, it appeared that STDs are not randomly distributed over the population but are associated with certain patient characteristics . CONCLUSION--The data provided by STD services reveal an epidemiological pattern for STDs in the Netherlands . The increase in the reported number of gonorrhoea infections among homosexuals together with the increasing number of sexual partners among homosexual males suggest that a group of highly sexually active individuals switch or return to higher risk behaviours . Further research is needed to determine the causes of the described trends and behavioural changes in order to undertake preventive activities. Genitourin Med, 1993 Dec, 69(6), 427 - 30 High prevalence of sexually transmitted diseases in a rural area in Mozambique; Vuylsteke B et al.; OBJECTIVE--To assess the extent of the sexually transmitted diseases (STDs) problem in a rural area of Mozambique . METHODS--A cross sectional study among pregnant women and patients presenting with genital complaints . Laboratory confirmation was done for gonorrhoea, chlamydial infection, active syphilis, trichomoniasis and HIV infection . SETTING--A primary health care setting in Vilanculos, Inhambane province, Mozambique . RESULTS--Evidence of one or more of the above STDs was found in 51% of 201 pregnant women, 56% of 85 women and 62% of 77 men with genital complaints . Neisseria gonorrhoea or Chlamydia trachomatis were found in 16% of pregnant women, 23% of female patients and 28% of male patients; genital ulcer disease was present in 6%, 28% and 36%, of respectively pregnant women, female and male patients . The prevalence of active syphilis was about the same in the three groups of study subjects, that is 15% . HIV infection was found in 4% of the male patients; no HIV infection could be detected in the female groups . CONCLUSION--STDs were a major health problem in this rural area in Mozambique . Though HIV infection was still low, the high prevalence of STDs indicates that the potential is there for an explosive spread of the HIV/AIDS epidemic. J Bacteriol, 1993 Dec, 175(24), 8030 - 7 Characterization of the rho genes of Neisseria gonorrhoeae and Salmonella typhimurium; Miloso M et al.; We have cloned and sequenced the genomic regions encompassing the rho genes of Neisseria gonorrhoeae and Salmonella typhimurium . Rho factor of S . typhimurium has only three amino acid differences with respect to the Escherichia coli homolog . Northern (RNA) blots and primer extension experiments were used to characterize the N . gonorrhoeae rho transcript and to identify the transcription initiation and termination elements of this cistron . The function of the Rho factor of N . gonorrhoeae was investigated by complementation assays of rho mutants of E . coli and S . typhimurium and by in vivo transcription assays in polar mutants of S . typhimurium. Pediatrics, 1993 Dec, 92(6), 755 - 60 Randomized trial of silver nitrate, erythromycin, and no eye prophylaxis for the prevention of conjunctivitis among newborns not at risk for gonococcal ophthalmitis . Eye Prophylaxis Study Group; Bell TA et al.; OBJECTIVE . To compare the efficacy of commonly used forms of eye prophylaxis for newborns with no prophylaxis in the prevention of nongonococcal conjunctivitis . DESIGN . Randomized doubly masked clinical trial . SETTING . University of Washington Hospital and affiliated clinics, Seattle, between 1985 and 1990 . SUBJECTS . The medical records of 8499 women were evaluated for possible participation; 2577 were eligible . Of the 758 enrolled, the infants of 630 were evaluable . INTERVENTION . Comparison of silver nitrate, erythromycin, and no eye prophylaxis given at birth for the prevention of conjunctivitis . MAIN OUTCOME MEASURES . Conjunctivitis during the first 60 days of life and nasolacrimal duct patency in the first 2 days of life . RESULTS . The frequency of impatent tear ducts at the 30- to 48-hour examination did not differ significantly by prophylaxis group . Among the 630 infants randomized and observed, 109 (17%) developed mild conjunctivitis . Sixty-nine (63%) of the cases appeared during the first 2 weeks of life . After 2 months of observation, infants allocated to silver nitrate eye prophylaxis at birth had a 39% lower rate of conjunctivitis (hazard ratio = 0.61, 95% confidence interval = 0.39 to 0.97), and those allocated to erythromycin had a 31% lower rate of conjunctivitis (hazard ratio = 0.69, 95% confidence interval = 0.44 to 1.07), than did those allocated to no prophylaxis . CONCLUSION . Silver nitrate eye prophylaxis caused no sustained deleterious effects and even provided some benefit to infants born to women without Neisseria gonorrhoeae . However, the effect was modest and against microorganisms of low virulence . The results suggest that parental choice of a prophylaxis agent including no prophylaxis is reasonable for women receiving prenatal care and who are screened for sexually transmitted diseases during pregnancy. Br J Biomed Sci, 1993 Dec, 50(4), 301 - 4 Neisseria gonorrhoeae penicillin susceptibility: a comparison of three testing methods; Hitchcock PA; The 3-disc sensitivity method and the PDM Epsilometer (E-Test) were compared against the agar plate dilution reference method for the testing of N . gonorrhoeae penicillin susceptibility . Forty-six clinical isolates and five reference strains were examined . Both methods showed a high level of correlation in the detection of both high and moderate levels of resistance and both should be considered suitable for routine use . The E-Test had the advantage of producing a precise breakdown of the level of moderate resistance and may have a role to play in the diagnostic laboratory for this type of work. Br J Biomed Sci, 1993 Dec, 50(4), 295 - 300 Typing of Neisseria gonorrhoeae by auxotype, serovar and lectin agglutination; Moyes A et al.; A total of 267 strains of Neisseria gonorrhoeae, comprising 129 serogroup IA and 138 serogroup IB, isolated in Edinburgh over a two-year period were analysed to assess the discrimination given by three typing methods: auxotyping; serotyping using the Genetic Systems (GS) and Pharmacia (PH) monoclonal antibody panels; and lectin agglutination . Each typing system was assessed individually and in combination . Serotyping subdivided the strains into 14 GS and 18PH serovars . Auxotyping (Aux) yielded 11 separate auxotypes while lectin agglutination yielded 22 different reaction patterns (LP) . The standard auxotype/GS serovar (A/S) classification system yielded 37 classes . Lectin agglutination allowed further subdivision of the main A/S classes . AHU/IA-2 strains,which accounted for 70% of IA strains, yielded nine different lectin patterns (A/S/LP classes) . Likewise, lectin agglutination allowed subdivision of the main IB A/S classes . NR/IB-1, NR/IB-2 and NR/IB-3, which accounted for 28%, 38% and 20% respectively of the IB strains, yielded 7, 7 and 6 A/S/LP classes respectively . It was concluded that lectin agglutination is a useful adjunct to the standard A/S classification system for studying the micro-epidemiology of gonococcal infection. Ann Soc Belg Med Trop, 1993 Dec, 73(4), 267 - 78 {Management of sexually transmissible diseases in an urban environment in Cameroon in 1992}; Louis JP et al.; During the progress, in 1989, of a programme of social marketing of condoms in Cameroon, it was obvious that this approach should be supplemented by a similar programme for the management of STD's . Nine surveys were carried out in 1992 in Yaounde and Douala in the sexually most active male population (in the general community, at the workplace and in the leisure environment) in order to collect the basic data necessary for its implementation . Treatment essentially consists of mono-chemotherapy with drugs which are generally inefficient against the two principal etiologies of urethritis: Neisseria gonorrhoeae and Chlamydia trachomatis . The cost of treatment is considered excessive and leads to poor follow-up of the complete prescription . Simultaneous treatment of partners should be developed . All these data have been taken into account for the elaboration of a pilot programme which should be implemented in 1993. Acta Virol, 1993 Dec, 37(6), 449 - 58 The complex formation of influenza virus envelope glycoproteins with outer membrane proteins of Neisseria meningitidis or Borrelia burgdorferi; Slavik I et al.; The isolation of influenza virus envelope glycoproteins was achieved by one-step procedure consisting of treatment of purified virus with zwitterionic detergent and separation of viral constituents by sucrose density gradient centrifugation . Viral glycoproteins and proteins of outer membrane of N . meningitidis or B . burgdorferi formed complexes after removal of the detergent by dialysis . Complexing of viral glycoproteins and bacterial proteins was monitored by gel chromatography on Sepharose 6B, polyacrylamide gel electrophoresis and electron microscopy . It was demonstrated by immunoblot analysis, that virus-spirochete complexes elicited formation of antibodies in mice directed against osp A and osp B of spirochete, as well as against viral glycoproteins, respectively. Microb Pathog, 1993 Dec, 15(6), 433 - 45 The interaction between human transferrin and transferrin binding protein 2 from Moraxella (Branhamella) catarrhalis differs from that of other human pathogens; Yu RH et al.; The interaction between human transferrin and the transferrin binding proteins of Moraxella catarrhalis was studied by binding and affinity isolation experiments with transferrin and its derivatives . Competition binding experiments demonstrated that, compared to transferrin binding proteins in Neisseria meningitidis, the receptors in M . catarrhalis were more effectively blocked by iron-saturated transferrin than by the apo form of the protein . A combination of direct binding experiments and affinity isolation experiments demonstrated that this was due to a strong preference for binding of iron-saturated transferrin by transferrin binding protein 2 (Tbp2) . Binding and affinity isolation studies also demonstrated that the C-lobe of human transferrin was fully capable of binding to M . catarrhalis transferrin binding protein 1 (Tbp1) but not to Tbp2 . Neither the N-lobe nor a proteolytic derivative of human transferrin lacking only a portion of the C-terminus were capable of effectively binding to M . catarrhalis Tbp2, possibly implicating the involvement of several regions in the binding interaction. Trends Biotechnol, 1993 Dec, 11(12), 506 - 10 Phase and antigenic variation--the impact on strategies for bacterial vaccine design; Maskell D et al.; Many pathogens have the ability to vary the antigenic composition of surface-associated antigens . Often, this variation is mediated by the regulation of gene expression . By varying its antigenicity, the pathogen is able to avoid host immune responses more efficiently; however, this makes the design of vaccines against pathogens that exhibit antigenic variation difficult . In this review, we use the pathogenic Neisseria as an example of antigenically variable bacteria and discuss some attempts to overcome the problems of vaccine design posed by such organisms. Infect Immun, 1993 Nov, 61(11), 4662 - 8 Increased sensitivity of gonococcal pilA mutants to bactericidal activity of normal human serum; Taha MK; PilA is a pleiotropic transcriptional regulator in Neisseria gonorrhoeae, encoded by an essential gene, pilA . It regulates pilin gene expression and stress response and it is implicated in gonococcal adaptation to external signals . All these phenomena may participate in gonococcal virulence . In this report, I tested the role of PilA in another aspect of gonococcal virulence, resistance to the bactericidal effect of normal human serum . Gonococcal mutants with impaired PilA function were more susceptible to the bactericidal effect of normal human serum than the isogenic wild-type strain . However, the major outer membrane protein and the lipooligosaccharide, targets for complement-mediated killing by the serum, were unchanged in the mutants . I discuss the role of PilA in modulating gonococcal sensitivity and resistance to normal human serum. Infect Immun, 1993 Nov, 61(11), 4599 - 606 Identification and cloning of a fur homolog from Neisseria gonorrhoeae; Berish SA et al.; The promoter region of the major iron-regulated protein of Neisseria gonorrhoeae, Fbp, has two regions that exhibit homology with the Escherichia coli consensus Fur-binding sequences . Gel retardation assays suggested that purified E . coli Fur bound to two sites within the Fbp promoter . The presence of a gonococcal Fur homolog was suggested by Southern hybridization under conditions of low stringency, which revealed a DNA locus that exhibited homology to the E . coli fur gene . Oligonucleotides derived from the conserved regions of fur genes of extremely diverse bacteria were used to amplify a 140-bp fragment of a putative gonococcal fur gene . This fragment was used to identify clones containing the entire gonococcal fur gene . After sequencing the gonococcal fur gene and its promoter region, we found that gonococcal Fur exhibited 50% identity with E . coli Fur at the amino acid level; however, it complemented two E . coli Fur- mutants . The presence of a Fur homolog in N . gonorrhoeae suggests that Fur-regulated genes are widely distributed among extremely diverse bacteria. Int J STD AIDS, 1993 Nov-Dec, 4(6), 330 - 2 PPNG at St Thomas' Hospital--a changing provenance; Sherrard J et al.; Between 1986 and 1992, 15% of all cases of penicillinase-producing Neisseria gonorrhoeae (PPNG) notified in the UK were seen at our central London clinic . During this time the geographical provenance of PPNG has changed . Africa and SE Asia have been supplanted by the Caribbean as the predominant source, with 21.4% of all cases being directly imported from there in 1992 . If all gonococcal infections acquired outside the UK had been assumed to be PPNG, together with those occurring in patients with family origins in Africa or SE Asia, some 60% of cases of PPNG could have been predicted before laboratory confirmation of resistance . There is little evidence that PPNG has become endemic in the United Kingdom. Int J Biochem, 1993 Nov, 25(11), 1517 - 27 Polysialic acids; Reglero A et al.; 1 . Polysialic acids are linear homopolymers of N-acetylneuraminic acid (Neu5Ac), N-glycolylneuraminic acid (Neu5Gc) and deaminated neuraminic acid (KDN) residues joined by alpha 2,8, alpha 2-9 or alpha 2,8/alpha 2,9 ketosidic linkages . 2 . They occur in glycoproteins of embryonic neural membranes (playing a role of neural cell adhesion molecules), in non-neural tissues (postnatal kidney), tumours, (neuroectodermal tumours), fish eggs and in the capsule of certain bacteria such as Neisseria meningitidis group B . 3 . These polymers are synthesized through reactions which involve (a) the synthesis of sialic acid; (b) its activation to a cytidine monophosphate sugar nucleotide and (c) the polymerization of the different residues by a polysialyl-transferase complex . 4 . Polysialic acids are involved in organogenesis and in cell growth . In several tissues they act as oncodevelopmental antigens, and in bacteria are also virulent determinants. J Gen Microbiol, 1993 Nov, 139 ( Pt 11), 2603 - 11 Genetic structure of Neisseria gonorrhoeae populations: a non-clonal pathogen; O'Rourke M et al.; Reproduction by binary fission generates a clonal genetic structure in bacterial populations in the absence of a high rate of recombination . The extent of recombination in natural populations of Neisseria gonorrhoeae was determined from an analysis of electrophoretically demonstrable allelic variation at structural genes encoding nine enzyme loci in 227 worldwide isolates . No significant linkage disequilibrium was evident in the population, indicating that recombination must be frequent, relative to binary fission . The genetic structure of N . gonorrhoeae was compared with that of Bacillus subtilis from an earlier study . Linkage disequilibrium was less extreme in the N . gonorrhoeae population than in the local population of B . subtilis, in which only modest clonal structure was evident . Thus, N . gonorrhoeae, unlike pathogens so far examined, has a non-clonal population structure . As expected in a freely recombining population, no correlation was found between electrophoretic genotype and serovar or auxotype. J Clin Microbiol, 1993 Nov, 31(11), 3053 - 5 Evaluation of Etest for testing antimicrobial susceptibilities of Neisseria gonorrhoeae isolates with different growth media; Yeung KH et al.; The MICs for 101 isolates of Neisseria gonorrhoeae obtained by Etest (AB-Biodisk, Solna, Sweden) and the agar dilution method on GC medium base supplemented with 1% Kellog's defined supplement (GCMB) were compared . The overall percent agreement (within 1 log2 dilution) between methods was greater than 97.9 . The Pearson's correlation coefficients for penicillin, tetracycline, erythromycin, and ceftriaxone for the two methods were 0.98, 0.97, 0.93, and 0.93 (P = 0.001), respectively, for comparisons on GCMB . The overall percent agreement was lower when hemoglobin-supplemented GCMB was used . Etest is an attractive alternative to the agar dilution method for gonococcal antimicrobial susceptibility testing and should be further analyzed in multicenter studies. J Antimicrob Chemother, 1993 Nov, 32(5), 677 - 84 Penicillin-binding protein 2 genes of chromosomally-mediated penicillin-resistant Neisseria gonorrhoeae from Greece: screening for codon Asp-345A; Tirodimos I et al.; Low affinity of penicillin for altered penicillin-binding protein 2 (PBP 2) of Neisseria gonorrhoeae that are chromosomally resistant to penicillin (CMRNG) has been attributed, at least partly to the insertion of an additional aspartic acid (Asp-35A) codon in the penA gene . Oligonucleotide probes were used to detect the presence or absence of this extra amino-acid residue in 34 non-penicillinase producing N . gonorrhoeae with decreased susceptibility to penicillin (MICs 0.25-2 mg/L) and 11 strains sensitive to penicillin (MIC < or = 0.06 mg/L) isolated in Greece and previously characterized by auxotype and serovar . The Asp-345A codon was found in all CMRNG strains as well as in strains with intermediate resistance to penicillin, but was absent from all strains exhibiting an MIC of penicillin of < or = 0.03 mg/L . No association of the Asp-345A insertion to any particular auxotype or serovar was found . These results expand the previously reported correlation between the presence of the Asp-345A codon and reduced sensitivity to penicillin, and shows that this particular mutation is common among epidemiologically distinct CMRNG strains. J Antimicrob Chemother, 1993 Nov, 32(5), 667 - 76 Nucleotide sequences of the tet(M) genes from the American and Dutch type tetracycline resistance plasmids of Neisseria gonorrhoeae; Gascoyne-Binzi DM et al.; High-level tetracycline-resistant Neisseria gonorrhoeae (TRNG) has been associated with the presence of a plasmid approximately 25.2 MDa in size which carries a Tet M tetracycline resistance determinant . Two different plasmid types, American and Dutch, have previously been described, based on the restriction endonuclease digestion pattern . In this study, the tet(M) genes from the two plasmid types have been amplified by the polymerase chain reaction (PCR) and then sequenced . The gene sequences from the two plasmids shared 96.8% identity, and showed similarities with different segments of the tet(M) gene sequences from Tn1545, Tn916 and Ureaplasma urealyticum . The data suggest that it is highly likely that the Tet M determinant found in the American type plasmid has a different origin from that present in the Dutch plasmid. Sex Transm Dis, 1993 Nov-Dec, 20(6), 338 - 43 The epidemiology of Neisseria gonorrhoeae isolates in Greenland 1979-1990: the emergence, spread and disappearance of non-PPNG strains carrying the conjugative 38.9 kb plasmid; Reimann K et al.; BACKGROUND: In 1990, Greenland was one of the few areas in the world in which endemic occurrence of PPNG had not been reported . However, between 1982 and 1988 an increase in the prevalence of strains with chromosomally mediated resistance to penicillin had been noticed . The standard treatment regimen was changed early in 1983 . OBJECTIVE: To determine the prevalence of the 38.9 kb plasmid in gonococcal strains isolated in Greenland 1979-1990 . DESIGN: Retrospective (1979-1984) and prospective (1985-1990) studies of antimicrobial susceptibility and plasmid profile of consecutive N . gonorrhoeae isolates from patients attending the STD clinic in Nuuk, Greenland; selected strains from 1982-1984 were subjected to serotyping and auxotyping . RESULTS: Before 1982, N . gonorrhoeae strains harboring the 38.9 kb conjugative plasmid were rare; in 1982, a sudden increase in the prevalence of these strains was strongly associated with the emergence of streptomycin-resistant strains with high-level chromosomally mediated resistance to penicillin, 70% of which carried the 38.9 kb plasmid . Determination of antimicrobial susceptibility pattern, auxotype and serovar supported the assumption of an epidemic spread of a single clone . The predominance of this clone was transient, but the 38.9 kb plasmid spread to penicillin-susceptible as well as to other clones of penicillin-resistant strains . CONCLUSION: The emergence of the 38.9 kb plasmid in 1982 was linked to a single clone of strains, but the subsequent spread of the plasmid was independent of the presence of other plasmids, and its disappearance was not associated with a change in standard treatment regimen. Sex Transm Dis, 1993 Nov-Dec, 20(6), 329 - 33 Detection of the tetM determinant in Neisseria gonorrhoeae; Ison CA et al.; BACKGROUND AND OBJECTIVES: Plasmid-mediated high level resistance to tetracycline in Neisseria gonorrhoeae has become a therapeutic problem in many parts of the world . Simple, fast and accurate screening tests are required to enable rapid detection . GOAL OF THE STUDY: To evaluate screening tests for high-level tetracycline resistance for their ability to predict the presence of the tetM determinant in Neisseria gonorrhoeae . STUDY DESIGN: Strains considered to exhibit plasmid-mediated (90) and chromosomal resistance (19) to tetracycline were used to compare the screening tests, growth on tetracycline agar, disc testing, MIC and plasmid content, with confirmation by hybridization to the tetM probe . A polymerase chain reaction to amplify tetM in N . gonorrhoeae was also evaluated . RESULTS: All strains defined as presumptive TRNG by the screening tests hybridized with the tetM probe . None of the low-level resistant strains were positive in the screening tests or hybridized with the probe . In addition, the polymerase chain reaction (PCR) on whole bacterial cells detected tetM in all TRNG tested . Restriction enzyme digests of the PCR product gave three patterns suggesting genetic diversity within the tetM determinant of N . gonorrhoeae . CONCLUSION: Simple screening tests were found to be reliable predictors of TRNG . tetM was detected by PCR in all strains tested and exhibited some genetic variation that may be of use for epidemiological typing. Sex Transm Dis, 1993 Nov-Dec, 20(6), 314 - 20 Characterization of multiresistant strains of Neisseria gonorrhoeae isolated in Nicaragua; Castro I et al.; The extensive use of antibiotics in Nicaragua raises concerns about the resulting levels of susceptibility of pathogenic bacteria . This is the first study that characterizes 18 strains of N . gonorrhoeae isolated in Nicaragua (1989), for their antibiotic susceptibility . Strains were predominantly of the auxotype/serotype Proto/PIB . There was no difference in lipopolysaccharides profiles obtained after SDS-PAGE for all strains . Variable expression of the PII outer membrane protein was not associated to antimicrobial resistance . All strains were susceptible to ceftriaxone, spectinomycin, rifampin and cefoxitin . The strains were classified in five groups based on plasmid profiles . A total of 78% of the isolates were penicillinase-producing (PPNG) and 22% were tetracycline-resistant N . gonorrhoeae (TRNG) . One PPNG strain showed a concomitant decreased of penicillin binding to penicillin-binding protein 2 . These randomly chosen isolates of N . gonorrhoeae from Nicaragua possess high levels of resistance to multiple families of drugsPIP: In Nicaragua, in 1989, health workers obtained urethral or cervical samples from 18 people with gonorrhea attending public health clinics in Managua and sent them to the National Laboratory of Public Health in Managua for characterization of their antibiotic susceptibility . Of the 18 strains, 15 (83.3%) were of the auxotype/serotype Proto/PIB . Electrophoresis of lipopolysaccharides on SDS-polyacrylamide gels (15%) with 4 M urea revealed no difference in lipopolysaccharide profiles for all strains . The variable expression of the 31-kDa opacity outer membrane protein was not related to antimicrobial resistance . All isolates exhibited susceptibility to ceftriaxone, spectinomycin, cefazolin, cefoxitin, and rifampin . 78% of the strains produced beta-lactamase . 89% of the strains were resistant to penicillin and ampicillin, 44% were resistant to tetracycline, 28% were resistant to cefamandol, 22% were resistant to chloramphenicol, and 11% were resistant to erythromycin . There were 5 distinct groups of Neisseria gonorrhoeae isolated according to their plasmid profiles . The largest was plasmid profile group 1 (55.6%), defined as carrying the 24.5, 3.2, and 2.6 MDa plasmids . It produced beta-lactamase . Penicillinase-producing N . gonorrhoeae (PPNG) comprised 78% of the isolates, 22% of whom were tetracycline-resistant N . gonorrhoea . One PPNG strain exhibited a parallel decrease of penicillin binding to penicillin-binding protein 2 . These findings confirmed the presence of multiresistant N . gonorrhoeae strains in Managua, Nicaragua . Based on these findings, the researchers recommended that penicillin and tetracycline not be used to treat gonorrhea in Nicaragua; they recommended ceftriaxone and spectinomycin . Mol Microbiol, 1993 Nov, 10(3), 567 - 74 Isolation of the periplasm of Neisseria gonorrhoeae; Judd RC et al.; The periplasm of Neisseria gonorrhoeae should be similar to other Gram-negative bacteria, but no published reports confirm this assumption . We used a periplasmic isolation procedure developed in Escherichia coli to release the periplasmic contents of N . gonorrhoeae . The resultant periplasmic extract lacked lipopolysaccharide, protein markers of inner or outer membranes, surface-radiolabelled protein components, or ribosomal proteins . The periplasmic extract contained a single haem protein believed to be a c-type cytochrome known to exist in the periplasm of other Gram-negative species, and retained significant alkaline phosphatase activity . The dominant protein species released in the periplasmic extract was the gonococcal homologue of elongation factor Tu, a major component released in similar periplasmic extracts of E . coli . These data showed that the extraction procedure selectively released periplasmic components and that the gonococcal periplasm was comparable to that of E . coli . Further analysis of the gonococcal periplasm may provide important insights into the physiology of this pathogen of humans. Mol Microbiol, 1993 Nov, 10(4), 699 - 712 A novel determinant (comA) essential for natural transformation competence in Neisseria gonorrhoeae and the effect of a comA defect on pilin variation; Facius D et al.; A novel genetic determinant (comA) has been identified and found to be required for the transformation of piliated Neisseria gonorrhoeae . Mutants in comA of strain MS11 grow normally and are DNA-uptake proficient but blocked in the translocation of DNA into the cytoplasm . Here we show by site-specific mutagenesis and genetic complementation that only one of two open reading frames identified in comA is essential for competence: it encodes a protein (ComA) with a predicted size of 74 kDa . The comA gene maps upstream of the iga locus and is transcribed in the opposite orientation, probably under the control of a putative sigma 54-type promoter . While DNA probes specific for the N . gonorrhoeae iga locus reveal only a little cross-reactivity with commensal Neisseria species, the neighbouring comA gene appears to be present in most of them . ComA fusion proteins were obtained by in vitro translation . The synthesized gene products migrated atypically in SDS gels indicating its strong hydrophobicity . Several transmembrane alpha-helices were predicted from the amino acid sequence of ComA which, in the context of an observed sequence similarity with other inner membrane proteins, suggests a location for the protein in the inner membrane . Using piliated and non-piliated comA mutants the consequences of transformation deficiency on pilin phase variation were assessed . We show that the comA defect affects some but not all types of DNA rearrangements associated with pilE variation . The results are in agreement with previous observations supporting the notion that multiple recombination pathways contribute to the variability of pilE. EMBO J, 1993 Nov, 12(11), 4043 - 51 Phase variation of lipopolysaccharide directs interconversion of invasive and immuno-resistant phenotypes of Neisseria gonorrhoeae; van Putten JP; Phase variation of Neisseria gonorrhoeae lipopolysaccharide (LPS) controls both bacterial entry into human mucosal cells, and bacterial susceptibility to killing by antibodies and complement . The basis for this function is a differential sialylation of the variable oligosaccharide moiety of the LPS . LPS variants that incorporate low amounts of sialic acid enter human mucosal epithelial cells very efficiently, but are susceptible to complement-mediated killing . Phase transition to a highly sialylated LPS phenotype results in equally adhesive but entry deficient bacteria which, however, resist killing by antibodies and complement because of dysfunctional complement activation . Phase variation of N . gonorrhoeae LPS thus functions as an adaptive mechanism enabling bacterial translocation across the mucosal barrier, and, at a later stage of infection, escape from the host immune defence. Mol Microbiol, 1993 Nov, 10(3), 445 - 56 Immunophilins: structure-function relationship and possible role in microbial pathogenicity; Hacker J et al.; Immunophilins are housekeeping proteins present in a wide variety of organisms . Members of two protein superfamilies, cyclophilins (Cyps) and FK506-binding proteins (FKBPs) belong to this class of immunophilins . Despite the fact that the amino acid sequences of Cyp and FKBPs do not exhibit noticeable homology to each other, proteins of both classes are able to ligate immunosuppressive peptide derivatives . Cyps form complexes with the cyclic undercapeptide cyclosporin A and FKBPs are able to bind FK506 as well as rapamycin, both of which have a pipecolyl bond within their structure . In a ligand-bound form, immunophilins interfere with signal transduction in T cells . In addition, immunophilins have peptidyl prolyl cis-trans isomerase (PPlase) activity and are able to accelerate the rate of conformational events in proline-containing polypeptides . Microorganisms produce proteins that exhibit extensive sequence homologies to cyclophilins and FKBPs of higher organisms and which have considerable PPlase catalytic activity . While cyclophilins seem to be present in most if not all microbial species investigated, FKBPs are produced by yeasts as well as by a number of pathogenic bacteria, such as Legionella pneumophila, Chlamydia trachomatis and Neisseria meningitidis . The Mip protein of L . pneumophila is a virulence factor that plays an essential role in the ability of the bacteria to survive and multiply in phagocytic cells . Some results are summarized on the structure and putative functions of immunophilins and place special emphasis on the contribution of these polypeptides to the virulence of pathogenic microorganisms. J Gen Microbiol, 1993 Nov, 139 ( Pt 11), 2613 - 20 Structural comparison and epitope analysis of outer-membrane protein PIA from strains of Neisseria gonorrhoeae with differing serovar specificities; Mee BJ et al.; The sequences of the por genes, encoding outer-membrane protein PI, have been obtained from a number of strains of Neisseria gonorrhoeae that express PIA molecules with differing serovar specificities . The inferred amino acid sequences of the mature proteins each comprise 308 residues and show considerable homology, with the degree of sequence variation between PIA molecules being considerably less than seen previously with PIB, but more evenly distributed throughout the molecule . The positions of sequence variation are largely confined to the regions predicted to form one of eight surface-exposed loops, suggesting a more widespread distribution of potential antigenic diversity . The deduced amino acid sequences were used to synthesize peptides for epitope mapping experiments . Some epitopes responsible for serovar specificity or recognized by bactericidal monoclonal antibodies could be identified on the basis of their reactivity with simple linear peptides, whilst others recognized conformational epitopes . By comparison of sequence differences with mAb reactivity it was possible to identify regions that appear to contribute to such determinants, including separated regions of the molecule which together were required for the formation of the conformational epitopes . All the epitopes identified lie at or close to the apices of the predicted surface-exposed loops 1, 3, 6, or 8, focusing attention on these regions as accessible targets for immune attack. J Infect Dis, 1993 Oct, 168(4), 969 - 78 Pelvic inflammatory disease: metaanalysis of antimicrobial regimen efficacy; Walker CK et al.; An extensive body of literature has investigated the efficacy of antimicrobial regimens used to treat pelvic inflammatory disease (PID), leaving many clinicians confused about how to choose among them . This study provides a formal appraisal of these reports . Thirty-four treatment studies published between 1966 and 1992 were identified, using Medline and bibliographies, and evaluated qualitatively and quantitatively in a metaanalysis . Twenty-one studies met the criteria for inclusion in this evaluation: appropriate system for making the diagnosis of PID, standardized assessment of clinical outcome, and entry and follow-up evaluation for lower genital tract infection with Neisseria gonorrhoeae and Chlamydia trachomatis . This metaanalysis identifies a considerable range of quality in study methods and research design and underscores the limitations inherent in comparing such data . Despite this, a number of antimicrobial regimens appear to have very good short-term clinical and microbiologic efficacy . Pooled clinical cure rates range from 75% to 94% and pooled microbiologic cure rates range from 71% to 100% . A cost comparison is provided, and future research priorities are suggested. Clin Pediatr (Phila), 1993 Oct, 32(10), 609 - 12 Early detection and treatment of sexually transmitted disease in pregnant adolescents of low socioeconomic status; Matson SC et al.; This study evaluated the prevalence of sexually transmitted disease (STD) in adolescents presenting to a primary pediatric care clinic (PPCC) for the diagnosis of pregnancy and our ability to eradicate identified infections . We followed 168 pregnant adolescents of low socioeconomic status from their original pregnancy diagnosis until their first prenatal clinic visit . We collected screening cervical cultures for Neisseria gonorrhoeae and Chlamydia trachomatis by completing a pelvic examination on 91 patients at our PPCC . At the PPCC visit, 29% were positive for gonorrhea, chlamydia, or both . Screening tests for these infections were collected on all patients at the initial prenatal clinic visit . The risk for presenting to the prenatal clinic with a STD was significantly greater in patients not screened and treated for STD at the PPCC . Average delay from diagnosis to first prenatal clinic visit was 35.7 days . Thus, in this adolescent population, primary care providers are missing an important therapeutic opportunity by failing to identify and treat STD at initial diagnosis of pregnancyPIP: Maternal sexually transmitted disease (STD) is an important and preventable cause of infant morbidity and mortality . The early identification and treatment of STDs could, however, reduce the number of premature deliveries, low-birthweight infants, and neonatal deaths . Sexually active adolescents of low socioeconomic status (SES) are at increased risk for perinatal morbidity and mortality due to their substantially higher STD rates compared to adult women . Despite these facts, many primary care providers simply diagnose pregnancies with urine tests, then refer adolescents to a prenatal program for a thorough evaluation, including a screen for STDs . This practice means that young women infected with STDs at the diagnosis of pregnancy will most likely remain infected until they return to begin prenatal care and are subsequently diagnosed and treated for the problem . This study followed a group of pregnant adolescents from the initial diagnosis of pregnancy at a primary pediatric care clinic (PPCC) until the initial prenatal clinic visit . The study was undertaken to document the frequency of STD in adolescents presenting at such a PPCC for pregnancy diagnosis and to evaluate the ability to treat the infections once they are identified . 235 pregnancies were identified at the PPCC serving urban adolescents of low SES in Milwaukee, Wisconsin, over the period August 1, 1988, to January 31, 1992 . 44 of these patients were seen at other prenatal programs, nine had miscarriages and nine had induced abortions before starting prenatal care, and five met the exclusion criteria, so the study findings pertain to only 168 subjects . 91 subjects were screened at the initial visit to the PPCC for gonorrhea and chlamydia with a pelvic exam and 77 were not . The screened group was of mean age 16.4 years compared to the unscreened group at 15.9 years, while the former also reported more STD-related symptoms than the unscreened group at the time of the initial PPCC visit . 29% of the 91 were positive for gonorrhea, chlamydia, or both . The average delay from pregnancy diagnosis to first prenatal clinic visit was 35.7 days . 53 of the 168 women presenting for prenatal care (32%) had STDs . Patients originally screened at the PPCC for STD, however, had a significantly lower prevalence of infection than the previously unscreened group . 22 of the group screened at the initial PPCC were infected, 12 of whom had been previously negative . The authors stress that primary care providers are missing an important therapeutic opportunity in this adolescent population by failing to identify and treat STDs at the initial diagnosis of pregnancy . The initial diagnosis of pregnancy in adolescents should always include screening for STD, with suspected infections treated immediately rather than waiting for definitive test results . Patients should also be given information on how to protect themselves from acquiring new STDs during pregnancy . Antimicrob Agents Chemother, 1993 Oct, 37(10), 2244 - 6 Antibacterial activities of OPC-17116, ofloxacin, and ciprofloxacin against 200 isolates of Neisseria gonorrhoeae; Zenilman JM et al.; OPC-17116 is a new fluoroquinolone with potent activity against aerobic and anaerobic organisms . We evaluated the susceptibilities of 200 clinical gonococcal isolates including organisms with plasmid and chromosomally mediated resistance to beta-lactams and tetracycline . The antibiotics studied included OPC-17116, ofloxacin, ciprofloxacin, penicillin, tetracycline, erythromycin, azithromycin, and ceftriaxone . All isolates tested were susceptible to the quinolone class of antibiotics . The MICs of ciprofloxacin, ofloxacin, and OPC-17116 for 90% of isolates tested were 0.004, 0.03, and 0.004 micrograms/ml, respectively . For organisms with chromosomally mediated resistance to penicillin and tetracycline, geometric mean MICs of all antibiotics including the quinolones were increased. J Clin Microbiol, 1993 Oct, 31(10), 2831 - 3 Discriminatory power of typing schemes based on Simpson's index of diversity for Neisseria gonorrhoeae; Dillon JA et al.; Simpson's index of diversity was used to produce a single numerical value to compare the abilities of single or combined typing schemes to discriminate between unrelated isolates . This calculation was used to compare the discriminating power of auxotype and serovar determination and plasmid content analysis, either singly or in combination, for Neisseria gonorrhoeae isolates having different antimicrobial susceptibilities (i.e., antibiotic-susceptible isolates and those that produce penicillinase, carry plasmid-mediated resistance to tetracycline, have chromosomally mediated penicillin resistance, or both produce penicillinase and carry plasmid-mediated resistance to tetracycline) . Plasmid content analysis and auxotype determination produced the lowest level of discrimination, while a combination of auxotype and serovar typing schemes generally provided higher levels of discrimination . Addition of plasmid content analysis to auxotype and serovar typing provided additional discrimination only with penicillinase-producing isolates . For isolates that carried plasmid-mediated resistance to tetracycline, isolates that were tetracycline resistant, isolates that both produced penicillinase and carried plasmid-mediated resistance to tetracycline, or isolates that had chromosomally mediated penicillin resistance, none of the typing methods produced high discriminatory indices, indicating that these isolates are probably derived from relatively few clones. J Clin Microbiol, 1993 Oct, 31(10), 2783 - 5 Direct DNA probe assay for Neisseria gonorrhoeae in pharyngeal and rectal specimens; Lewis JS et al.; The direct detection of gonococcal DNA in rectal and pharyngeal specimens was evaluated by using a DNA probe-based assay (Gen-Probe, Inc., San Diego, Calif.) . Rectal (234) and pharyngeal (608) swab specimens were obtained from 249 men and 372 women attending sexually transmitted disease clinics in Las Vegas and Reno, Nevada . The prevalence of gonococcal infection by culture at the pharyngeal and rectal sites was 2.9% (16 of 548 specimens) in women and 2.7% (8 of 294 specimens) in men . No false-positive reactions were observed among the 234 rectal specimens tested . Two probe-positive, culture-negative specimens were detected among the 361 pharyngeal specimens obtained from women . Both of these samples were confirmed as Neisseria gonorrhoeae by a probe competition assay . The overall correlation of the DNA probe test with pharyngeal and rectal cultures was 99.4% (837 of 842 cultures), with a sensitivity of 87.5% (21 of 24 cultures) and specificity of 99.7% (816 of 818 cultures) . The positive and negative predictive values of the DNA assay were 91.3 and 99.8%, respectively . The direct DNA probe assay provides an alternative to culture screening for rectal and/or pharyngeal gonococcal infections. Genitourin Med, 1993 Oct, 69(5), 361 - 3 Microbiology of acute epididymitis in a developing community; Hoosen AA et al.; OBJECTIVE--To investigate the aetiology of acute epididymitis in a developing community with a view of determining appropriate antimicrobial therapy . SETTING--City Health Sexually Transmitted Diseases Clinic, King Edward VIII Hospital, Durban, South Africa . PARTICIPANTS--144 adult men with clinically diagnosed acute epididymitis . METHOD--Endourethral swab and midstream urine (MSU) specimens were processed to detect sexually transmitted pathogens and urinary tract infections . RESULTS--The majority of patients (93%) were less than 35 years of age . Neisseria gonorrhoeae and/or Chlamydia trachomatis were detected in 78% of patients: N gonorrhoeae in 57%, C trachomatis in 34% and both in 13% . Escherichia coli was cultured more frequently from MSU specimens of older patients, 30% versus 3% . In 53% of patients urethritis was diagnosed by the presence of inflammatory cells in endourethral smears in the absence of a visible urethral discharge . CONCLUSION--In our setting of a busy clinic with limited facilities, we recommend the performance of a Gram stain on endourethral specimens from patients with acute epididymitis . If inflammatory cells and Gram negative diplococci are detected, treatment with antimicrobial agents to cover both penicillinase-producing N gonorrhoeae strains and C trachomatis is recommended . If Gram negative diplococci are not detected in the presence of microscopic evidence of urethritis, treatment for chlamydial infection alone is recommended. Genitourin Med, 1993 Oct, 69(5), 357 - 60 The association between sexually transmitted pathogens and cervical intra-epithelial neoplasia in a developing community; Kharsany AB et al.; OBJECTIVE--To determine the association of sexually transmitted pathogens in women with cervical intra-epithelial neoplasia (CIN) . SETTING--An urban tertiary referral hospital serving a large indigent developing community . PARTICIPANTS--48 women attending a colposcopy clinic and 49 women attending a family planning clinic . METHODS--Vaginal, endocervical, rectal swab specimens and sera were collected for the detection of sexually transmitted pathogens . Cervical cytology was performed on all patients . Women attending the colposcopy clinic had confirmation of abnormal cervical cytology by colposcopic directed biopsy . RESULTS--The mean age of women with CIN (33 years) was significantly greater than that of the women without CIN (28 years) and that of the family planning group (26 years) . There was a high prevalence of sexually transmitted pathogens in all women . A significantly higher prevalence of bacterial vaginosis was found in women with CIN compared to those without (50% vs 20%; p = 0.034) . The human papilloma virus (HPV) was detected in 46% of women with CIN and 65% of those without CIN . Chlamydia trachomatis (21%) and Trichomonas vaginalis (39%) were detected frequently in women with CIN . C . trachomatis (14%-21%) was detected more frequently than Neisseria gonorrhoeae (3-5%) in all asymptomatic women studied . CONCLUSION--This study demonstrates a high prevalence of sexually transmitted pathogens in women with and without CIN as well as family planning clinic attenders . Bacterial vaginosis was a significant finding in women with CIN . C . trachomatis was detected in a high proportion of all women studied and found more commonly than N . gonorrhoeae . We therefore recommend that all women attending gynaecological services in a developing community be investigated and treated for sexually transmitted diseases. Int J Syst Bacteriol, 1993 Oct, 43(4), 687 - 93 Neisseria weaveri sp . nov . (formerly CDC group M-5), from dog bite wounds of humans; Holmes B et al.; The taxonomic relationships of strains belonging to Centers for Disease Control group M-5 were examined . Previous studies of rRNA cistron similarities placed this organism on the Neisseriaceae rRNA branch of rRNA superfamily III; the closest neighbors included the genus Neisseria and groups EF-4a and EF-4b . The group M-5 strains were characterized by a range of phenotypic tests, and their G + C contents and DNA-DNA relatedness levels were determined . In addition, a numerical taxonomic analysis of the whole-cell protein patterns (obtained by sodium dodecyl sulfate-polyacrylamide gel electrophoresis) of group M-5 and related taxa was performed . The strains studied included 45 group M-5 strains, the type strains of six Neisseria species or subspecies, three group EF-4a reference strains, and three group EF-4b reference strains plus the type strain of the phenotypically similar organism Oligella urethralis . Our results showed that the group M-5 strains were members of a homogeneous taxon distinct from phylogenetically closely related taxa . The genomic divergence as revealed by levels of rRNA cistron similarity and phenotypic characteristics indicate that group M-5 can be considered a new species of the genus Neisseria . We therefore propose the new species Neisseria weaveri, with NCTC 12742 (= CCUG 4007 = ISL775/91 = LMG 5135) as the type strain . N . weaveri strains are strictly aerobic, gram-negative, nonmotile, rod-shaped organisms which are catalase and oxidase positive, nonsaccharolytic, and able to grow on MacConkey agar and do not reduce nitrate but generally reduce nitrite.(ABSTRACT TRUNCATED AT 250 WORDS) Am J Obstet Gynecol, 1993 Oct, 169(4), 976 - 81 Randomized trial of prophylactic antibiotic therapy after preterm amnion rupture; Owen J et al.; OBJECTIVE: Our purpose was to determine whether maternal administration of prophylactic ampicillin or erythromycin after preterm amnion rupture is associated with maternal or neonatal benefits . STUDY DESIGN: Women with singleton pregnancies between 24 and 33 weeks 6 days of gestation were eligible if they had no immediate indication for delivery . After giving informed consent, patients were randomized either to receive ampicillin (erythromycin if penicillin allergic) until delivery or to enter a control group . Women whose cervical cultures were positive for either group B streptococci or Neisseria gonorrhoeae received treatment . Tocolytics and corticosteroids were not used . RESULTS: From January 1990 to February 1992 117 patients (antibiotics 59, control 58) were recruited and analyzed . Prophylactic antibiotics were associated with a longer latent phase (mean 12 vs 7.0 days, p = 0.004) and fewer maternal infectious complications (29% vs 60%, p = 0.001) . A higher incidence of neonatal necrotizing enterocolitis was observed in the treatment group (14% vs 3.5%, p = 0.05) . Other neonatal complications, including death, were lower in the treatment group, but none attained statistical significance (p = 0.09 to 0.33) . CONCLUSION: The use of prophylactic antibiotics in selected patients after preterm amnion rupture appears to have a demonstrable maternal benefit . Large, multicenter trials may demonstrate a significant neonatal benefit or confirm any adverse outcomes. Am J Obstet Gynecol, 1993 Oct, 169(4), 1031 - 5 The risk of sexually transmitted diseases in human immunodeficiency virus-infected parturients; Lindsay MK et al.; OBJECTIVE: We assessed the prevalence of and defined the relationship between other sexually transmitted diseases and human immunodeficiency virus infection . STUDY DESIGN: We performed a case-control study among 121 human immunodeficiency virus-infected and 222 randomly selected seronegative parturient women . These women were identified from a prenatal population undergoing routine voluntary antibody screening in a large urban hospital in the southeastern United States . RESULTS: During the 24-month study period, 16,868 women consented to human immunodeficiency virus antibody screening; 121 (7.2/1000) were infected with human immunodeficiency virus . Cases were significantly more likely than controls to be infected with at least one sexually transmitted disease during pregnancy (48% vs 21%; odds ratio 3.4, 95% confidence interval 2.1 to 5.7) . The prevalence of Chlamydia trachomatis and hepatitis B infection did not differ significantly among the groups . Cases were significantly more likely than controls to be infected with Treponema pallidum (29% vs 4%; odds ratio 9.6, 95% confidence interval 4.2 to 22.4) . This relationship persisted after we controlled for confounding risk factors (odds ratio 9.2, 95% confidence interval 2.1 to 13.3) . In addition, cases were significantly more likely than controls to be infected with Neisseria gonorrhoeae (17.2% vs 4%; odds ratio 5.2, 95% confidence interval 2.1 to 13.3) . This relationship also persisted after we controlled for confounders (odds ratio 3.7, 95% confidence interval 1.4 to 10.0) . CONCLUSION: Human immunodeficiency virus-infected parturient women in our center are at substantial risk of having other sexually transmitted diseases. Diagn Microbiol Infect Dis, 1993 Oct, 17(3), 243 - 5 Interpretive criteria for cefodizime in vitro susceptibility tests with Neisseria gonorrhoeae; Barrett MS et al.; Cefodizime was tested against 100 strains of Neisseria gonorrhoeae with varying susceptibility patterns to penicillin . Agar-dilution minimum inhibitory concentrations (MIC) and disk diffusion susceptibility testing were performed in triplicate for each strain according to National Committee for Clinical Laboratory Standards (NCCLS) guidelines to establish susceptibility interpretive criteria for this beta-lactamase-stable cephalosporin . Cefodizime was very active against these strains of N . gonorrhoeae, with a MIC50 of only 0.008 microgram/ml . Because no resistant strains were documented, a single susceptible criterion of < or = 0.05 microgram/ml (> or = 31 mm) was proposed to predict clinical success after a single intramuscular (i.m.) dose. Diagn Microbiol Infect Dis, 1993 Oct, 17(3), 193 - 6 Assessment of gelatin supplementation of PEDS Plus BACTEC blood culture medium; McDonald JC et al.; Gelatin supplementation of blood culture media has been shown to neutralize the effects of sodium polyanetholesulfonate and enhance detection of Neisseria species . We evaluated the effect of 1.2% gelatin supplementation of nonradiometric Peds Plus Bactec blood culture medium on the rate and speed of recovery of pathogens from pediatric patients . From June 1991 to June 1992, a total of 6451 paired comparisons of blood cultures in Peds Plus medium and gelatin-supplemented Peds Plus medium were done: 465 organisms were isolated, of which 338 were significant . There were no significant differences in recovery of organisms or the speed of detection of microbial growth between the two media . In particular, the recovery of Neisseria meningitidis (eight isolates) was not improved with gelatin supplementation . In conclusion, gelatin supplementation of Peds Plus Bactec medium does not offer any advantage over the regular Peds Plus Bactec medium. Mol Microbiol, 1993 Oct, 10(2), 311 - 8 The ferric iron-binding protein of pathogenic Neisseria spp . functions as a periplasmic transport protein in iron acquisition from human transferrin; Chen CY et al.; The ferric iron-binding protein (Fbp) expressed by pathogenic Neisseria spp . has been proposed to play a central role in the high-affinity acquisition of iron from human transferrin . The results of this investigation provide evidence that Fbp participates in this process as a functional analogue of a Gram-negative periplasmic-binding protein component, which operates as a part of a general active transport process for the receptor-mediated, high-affinity transport of iron from human transferrin . Known properties of Fbp are correlated with those of other well-characterized periplasmic-binding proteins, including structural features and the reversible binding of ligand . Predictive of a periplasmic-binding protein, which functions in the high-affinity acquisition of iron, is that Fbp is a transient participant in the process of iron acquisition from human transferrin . Evidence for this is demonstrated by results of pulse-chase experiments . Taken together, the data described here and elsewhere suggest that pathogenic Neisseria spp . use a periplasmic-binding protein-mediated active transport mechanism for the acquisition of iron from human transferrin. Gene, 1993 Sep 30, 132(1), 15 - 20 Natural variation of the NgoII restriction-modification system of Neisseria gonorrhoeae; Gunn JS et al.; The NgoII restriction-modification (R-M) system of Neisseria gonorrhoeae recognizes the sequence 5'-GGCC-3' . This system is encoded by two separate genes, dcmB for the methyltransferase (MTase) and dcrB for the restriction endonuclease (ENase) . Three strains that vary in their NgoII phenotype were examined . Strain Pgh3-2 produced detectable levels of both enzymes, strain F62 lacked detectable levels of the dcrB gene product, and strain WR302 failed to produce either gene product . Strains that lacked either enzyme activity still possessed the genes that encode them . Transcriptional fusions of dcrB in strains F62 and Pgh3-2 indicate that this gene is transcribed at nearly identical levels in each strain . The DNA encoding the NgoII R-M system was cloned from the three strains, and the nucleotide sequence was determined . The dcrB genes of WR302 and F62 possess the same frameshift mutation (base position 1435) which would result in a truncated protein . The WR302 dcmB was found to have a point mutation that changed Arg288 (a residue that is conserved in all prokaryotic and phage cytosine MTases sequenced to date) to Trp. FEMS Microbiol Lett, 1993 Sep 15, 112(3), 243 - 50 Population genetics of a transformable bacterium: the influence of horizontal genetic exchange on the biology of Neisseria meningitidis; Maiden MC; Information of the biochemistry and genetics of bacterial species, usually obtained by the study of single isolates, is enhanced by studies of populations of bacteria . Recent advances in molecular technology, particularly polymerase chain reaction-based nucleotide sequence analysis, provide powerful tools for the study of population genetics . Data obtained by such techniques indicate that, while some bacterial species have a clonal population structure, others are non-clonal or panmictic . Clonal populations are a consequence of asexual reproduction by binary fission; panmictic population structures result from 'horizontal' exchange of genetic material between clones . A consequence of horizontal genetic exchange is mosaic gene structures, recognisable by comparisons of nucleotide sequences . In transformable bacteria, for example the human pathogen Neisseria meningitidis, several different genes, including the gene encoding the class 1 outer membrane protein, a major surface antigen, are mosaics . This genetic process has implications both for vaccine design and in the interpretation of epidemiological data. J Clin Microbiol, 1993 Sep, 31(9), 2535 - 7 Incidence of Neisseria gonorrhoeae isolates negative by Syva direct fluorescent-antibody test but positive by Gen-Probe accuprobe test in a sexually transmitted disease clinic population; Beebe JL et al.; To determine the accuracy of the Syva (Palo Alto, Calif.) direct fluorescent-antibody (DFA) test in comparison with the Gen-Probe (San Diego, Calif.) Accuprobe culture confirmation test, we tested 395 isolates of Neisseria gonorrhoeae from cultures obtained from patients attending a sexually transmitted disease clinic from 1 July 1991 through 30 June 1992 . All isolates were tested for DFA reactivity with a polyclonal reagent (Difco Laboratories, Detroit, Mich.) and a monoclonal reagent (Syva, Inc., direct specimen test) and for specific molecular probe reactivity by the Gen-Probe Accuprobe culture confirmation test for N . gonorrhoeae . The 395 isolates gave positive results for the Gen-Probe culture confirmation test and the Difco polyclonal direct specimen test . However, 18 (4.6%) of the isolates were negative for N . gonorrhoeae by the Syva DFA test . With the exception of six beta-lactamase-positive isolates, all isolates that were negative by Syva DFA were sensitive to penicillin, tetracycline, spectinomycin, and ceftriaxone by disk-diffusion susceptibility testing . Auxotyping and serotyping studies indicated that strains negative by Syva DFA consisted of several variants . The frequency of N . gonorrhoeae isolates showing negative results by Syva DFA in this patient population ranged from 0 to 11.5%/month . Laboratories using only the Syva DFA test for confirmation of N . gonorrhoeae may incur a significant risk of misidentification. J Clin Microbiol, 1993 Sep, 31(9), 2531 - 2 Ceftizoxime interpretive criteria for in vitro susceptibility tests with Neisseria gonorrhoeae; Barrett MS et al.; Ceftizoxime was tested in triplicate against 100 clinical strains of Neisseria gonorrhoeae in accordance with National Committee for Clinical Laboratory Standards guid