Ned Tijdschr Geneeskd, 1992 Oct 10, 136(41), 2025 - 9 {Diagnosis in recurrent bacterial meningitis; a literature study}; Miedema CJ et al.; Recurrent bacterial meningitis can be caused by different mechanisms . In order to make the diagnostics more efficient, we studied literature to find these underlying mechanisms . Two groups could be identified: group I, patients with a congenital or posttraumatic defect in the bones of the skull and group II, patients with a deficiency of a component of complement . The patients in group I were much younger at the time of their first meningitis and suffered more often from otitis, rhinorrhoea and deafness diagnosed before the first meningitis . Streptococcus pneumoniae was most frequently cultured in the cerebrospinal fluid, the group with complement deficiency showed Neisseria meningitidis almost exclusively . Family history revealed more members with infections caused by neisseriae spp . Although it was difficult to diagnose the bony defects, physical examination, radiography and high resolution CT scanning of the skull were helpful . Age, history, physical examination and cerebrospinal fluid culture were the most helpful in diagnostic factors. J Infect Dis, 1992 Oct, 166(4), 919 - 22 Single-dose cefixime versus single-dose ceftriaxone in the treatment of antimicrobial-resistant Neisseria gonorrhoeae infection; Plourde PJ et al.; Sexually transmitted diseases (STDs) have a significant adverse effect on reproductive and child health worldwide . The control of STDs such as gonorrhea is therefore an absolute priority . Cefixime, an oral third-generation cephalosporin with in vitro activity similar to that of ceftriaxone, may be an effective candidate for the treatment of gonorrhea . The efficacy of a single oral 400-mg dose of cefixime was compared with that of a single intramuscular 250-mg dose of ceftriaxone for the treatment of Neisseria gonorrhoeae urethritis in 190 men and cervicitis in 46 women in Nairobi, Kenya . A bacteriologic cure was recorded in 100% of 63 evaluatable patients treated with ceftriaxone and 118 (98%) of 121 evaluatable patients treated with cefixime . Cefixime, as a single oral dose, is an effective alternative for the treatment of uncomplicated gonococcal urethritis in men and cervicitis in women. Pediatr Res, 1992 Oct, 32(4), 376 - 85 Rational design of conjugate vaccines; Dintzis RZ; Whereas bacterial polysaccharides, classified as T-cell-independent antigens, elicit protective antibodies in adults, booster injections fail to produce an augmented response or promote antibody class switching . Because T-cell-dependent antigens, typically proteins, both produce boosted antibody levels and promote antibody class switching, it has been considered highly desirable to attempt to convert the T-cell-independent polysaccharide antigens into T-cell-dependent antigens, particularly for use in high-risk groups . A number of clinical trials now report the efficacy of conjugate vaccines in inducing the production of antibody in response to a number of previously poorly immunogenic--mainly T-cell-independent--antigens . In addition to conjugate vaccines containing bacterial polysaccharides, vaccines containing relevant peptides from a variety of pathogens are also being formulated and investigated . Questions remain, however, regarding their synthesis, use, and efficacy . The best ages for vaccine administration and selection of the optimal protein carrier are still under investigation, as are questions regarding the use of adjuvants, which can greatly affect the vaccine's potency . Spacing and size of epitope and size and composition of the final structure also must be considered; the importance of molecular size and aggregation of antigen in increasing immunogenicity have been well documented . These questions must be addressed for the much-needed development of conjugate vaccines against some common infections worldwide, including malaria, bacterial meningitis, and infections from Pseudomonas aeruginosa and Neisseria gonorrhoeae because of increasing susceptibility to these infections and resistance of the pathogens to chemotherapeutic agents and/or antibiotics. Genitourin Med, 1992 Oct, 68(5), 321 - 4 Antibiotic susceptibilities, serotypes and auxotypes of Neisseria gonorrhoeae isolated in New Zealand; Brett MS et al.; OBJECTIVE--The aim of the study was to determine the distribution of auxotypes and serotypes and the prevalence of antibiotic resistance among New Zealand isolates of Neisseria gonorrhoeae . MATERIALS AND METHODS--A total of 486 gonococci isolated in 1988 were auxotyped, serotyped, and tested for susceptibilities to ten antibiotics . RESULTS--The gonococci were susceptible to all the antibiotics tested except penicillin and tetracycline . Eleven (2.2%) produced beta-lactamase, one (0.2%) showed chromosomal penicillin resistance, and 18 (3.7%) were resistant to a low-level of tetracycline . Most of the gonococci belonged to six auxotypes . The three predominant auxotypes were arginine-requiring (Arg-), non-requiring (NR), and arginine, hypoxanthine, uracil-requiring (AHU-) . The majority of the isolates belonged to serogroup IB and to six serovars . The most prevalent serovars were IB-3 and IB-1 . There was an association between penicillin susceptibility and auxotype or serovar among non-penicillinase producing N . gonorrhoeae (PPNG) isolates . CONCLUSIONS--Antibiotic resistance, including penicillin resistance, remains uncommon among gonococci in New Zealand . Baselines have been established for future epidemiological studies using both auxotyping and serotyping. Clin Infect Dis, 1992 Oct, 15(4), 714 - 5 Management of chronic urethral symptoms in men; Augenbraun MH et al.; We describe 20 men who were referred because of chronic urogenital symptoms . They had been previously seen by zero to six physicians (mean, 1.8 physicians) and had been treated with zero to five courses of antimicrobial agents (mean, 2.4 courses) without relief of their symptoms . Results of physical examinations of all patients were normal . An extensive evaluation failed to reveal any objective evidence of urethral inflammation . Cultures for Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, and Trichomonas vaginalis were uniformly negative . No additional antimicrobial agents were prescribed . Data from follow-up questionnaires filled out by 10 of these men 5-28 months later (mean, 11.8 months) disclosed the disappearance of symptoms in three and the reduction of symptoms in four . Chronic urethral symptoms may occur in the absence of objective evidence of inflammation and infection with known urethral pathogens . Observation without antimicrobial therapy is the treatment of choice for such patients. Infect Immun, 1992 Oct, 60(10), 4439 - 42 Effect of exogenous sialylation of the lipooligosaccharide of Neisseria gonorrhoeae on opsonophagocytosis; Kim JJ et al.; Serum-sensitive Neisseria gonorrhoeae strains become serum resistant when grown in the presence of a sialic acid precursor, cytidine monophospho-N-acetylneuraminic acid . We examined the abilities of human neutrophils to phagocytose sialylated and nonsialylated gonococci and observed a decrease in the complement-dependent phagocytosis of sialylated gonococci compared with that of nonsialylated gonococci (50.7 versus 25.9% survival at 30 min) . This decrease in opsonophagocytosis after sialylation may contribute to the pathogenicity of gonococcal infections. Epidemiol Infect, 1992 Oct, 109(2), 265 - 71 Concordance of auxotype/serovar classes of Neisseria gonorrhoeae between sexual contacts; Ison CA et al.; One hundred and three known sexual-contact pairs of patients with culture-proven gonorrhoea who attended St Mary's Hospital, London between May 1989 and February 1991 were identified . All isolates from these patients were serotyped and auxotyped and compared for type concordance within sexual-contact pairs . Serotype was concordant in 80 (78%) of 103 sexual-contact pairs, auxotype in 88 (85%) and auxotype/serovar (A/S) class in 66 (64%) on the first screening . All pairs of isolates showed concordance in both serotype and auxotype when typing was repeated using a single set of serotyping reagents and of auxotyping media . Seventeen serovars, 9 auxotypes and 36 A/S classes were found in this population . Our results suggest that both serotyping and auxotyping may be used as markers to allow tracing of sexual-contact pairs, but that a single set of reagents should be used to ensure maximum reliability. Eur J Immunol, 1992 Oct, 22(10), 2687 - 95 Alpha 1-acid glycoprotein potentiates lipopolysaccharide-induced secretion of interleukin-1 beta, interleukin-6 and tumor necrosis factor-alpha by human monocytes and alveolar and peritoneal macrophages; Boutten A et al.; Although the physiological role of alpha 1-acid glycoprotein (AGP), an acute-phase protein, is poorly understood, several lines of evidence support a modulatory action on the immune response . In this study, we investigated the effect of AGP on the production of interleukin (IL)-1 beta, IL-6 and tumor necrosis factor (TNF)-alpha by human monocytes, macrophages and the monocytic THP-1 cell line . AGP significantly enhanced (2- to 7-fold) the production of these cytokines in monocytes induced by suboptimal concentrations of lipopolysaccharide {E . coli lipopolysaccharide (LPS): 100 ng/ml} in serum-free conditions, whereas it had little or no effect in the absence of LPS . The potentiating effect of AGP was inhibited by specific antibodies . It was concentration dependent and the greatest enhancement was observed with 250-500 micrograms/ml . Moreover, AGP only potentiated the effect of suboptimal concentrations of LPS . AGP did not alter the time course of LPS-induced IL-1 beta, IL-6 or TNF-alpha secretion . AGP acts as a co-inducer and could also potentiate cytokine secretion triggered by Neisseria meningitidis LPS and muramyl dipeptide . The glycan moiety of AGP did not seem to be involved in its potentiating effect, since both its major glycoforms and asialo-AGP potentiated the effect of LPS to the same extent as native AGP . Possible differences in the effect of AGP according to cell maturation were investigated using isolated human macrophages: AGP potentiated LPS-induced cytokine production by both peritoneal and alveolar macrophages . These data suggest that AGP can modulate monocyte/macrophage functions, thereby contributing to the amplification and regulation of immune and inflammatory responses. Curr Opin Genet Dev, 1992 Oct, 2(5), 805 - 11 Neisserial surface variation: how and why? Swanson J, Belland RJ, Hill SA. Neisseria gonorrhoeae exhibits striking variability in several of its surface components (pili, Opa proteins and lipooligosaccharide) in vivo and in vitro . Such flagrant variation of this mucosal pathogen's surface components contrasts sharply with changes in single surface components of blood-borne trypanosomes and borreliae . Despite these differences, similar molecular events are sometimes involved. Mol Cell Probes, 1992 Oct, 6(5), 367 - 73 A prospective study of the polymerase chain reaction for detection of herpes simplex virus in cerebrospinal fluid submitted to the clinical virology laboratory; Aslanzadeh J et al.; Polymerase chain reaction (PCR) was prospectively performed with cerebrospinal fluid (CSF) from 51 patients whose CSF was available for analysis and was submitted for viral culture and/or herpes simplex virus (HSV) serology and 20 patients whose CSF was submitted exclusively to the Clinical Biochemistry Laboratory . Primers were used that flanked a 92 bp segment of the HSV DNA polymerase gene (35 cycles) . Amplified products were electrophoresed on agarose gel, blotted onto nylon membrane, and probed with a 32P-labelled sequence internal to the primers . For nested PCR, 1 microliter of PCR product was amplified for an additional 35 cycles before electrophoresis and Southern blot analysis . Review of the clinical records revealed that 15 patients had central nervous system (CNS) infections . Specific HSV DNA sequences were detected in CSF specimens of three of the individuals {PCR(2), nested PCR(1)} . Two of these patients had disseminated HSV infection including encephalitis and one patient had aseptic meningitis . The diagnoses of the 12 patients with CNS infection who did not have HSV DNA detected in CSF included encephalitis {varicella-zoster virus (1), cytomegalovirus (1), Mycoplasma pneumoniae (1)}, meningitis {Neisseria meningitidis (1), Coccidioides immitis (1), Enterovirus (1), aseptic meningitis (1)}, varicella-zoster radiculitis (2), human immunodeficiency virus dementia (2), and transverse myelitis due to Epstein-Barr virus (1) . Importantly, HSV DNA was also not detected in the CSF of the 36 patients who did not have CNS infection and 20 samples submitted exclusively to the Clinical Biochemistry Laboratory . Our findings demonstrate the utility of PCR as a rapid, non-invasive method for the routine laboratory diagnosis of CNS infection due to HSV. J Biol Chem, 1992 Sep 25, 267(27), 19266 - 71 Pore formation and mitogenicity in blood cells by the class 2 protein of Neisseria meningitidis; Ulmer JB et al.; The class 2 outer membrane protein (MIEP) of Neisseria meningitidis has recently been shown to be mitogenic for lymphocytes (Liu, M.A., Friedman, A., Tai, J., Martinez, D., Deck, R . R., Hawe, L . A., Shieh, J . T.-C., Jenkins, T . D., Donnelly, J . J., and Oliff, A . I . (1992) Proc . Natl . Acad . Sci . U.S.A . 89, 4633-4637 . In this study, a possible connection between MIEP's mitogenicity and its possible action as a porin was investigated . MIEP, purified from the bacterial outer membrane protein complex under denaturing conditions, caused a modest but specific release of ions (86Rb) from both erythrocytes and lymphocytes, ultimately resulting in cell lysis . The dose-response of MIEP on erythrocyte lysis was qualitatively similar to a known porin (protein I from Neisseria gonorrhoeae) but was much less efficient . Induction or preservation of native structure in MIEP increased pore formation, resulting in levels comparable to that of the protein I porin . These observations suggest that native MIEP, free of the other outer membrane proteins of Neisseria meningitidis, can efficiently form pores in cells, but that denatured MIEP is variably and marginally effective . However, pore formation by MIEP was not related to its mitogenicity in lymphocytes, based on: (i) native MIEP was not mitogenic; (ii) denatured MIEP was highly mitogenic; and (iii) denatured MIEP was mitogenic at concentrations below the threshold level for pore formation . Therefore, mitogenicity is dependent upon MIEP being in a denatured, monomeric state and is masked by native conformation. Am J Obstet Gynecol, 1992 Sep, 167(3), 653 - 60 Microbial etiology of urban emergency department acute salpingitis: treatment with ofloxacin; Soper DE et al.; OBJECTIVES: We attempted to define the microbiologic characteristics of acute salpingitis in women presenting to an urban emergency department with pelvic inflammatory disease and to determine the effectiveness of ofloxacin in treating this disease . STUDY DESIGN: Women with pelvic inflammatory disease underwent laparoscopy to confirm the diagnosis and to culture the fallopian tubes and cul-de-sac . All patients (n = 36) were treated with parenteral ofloxacin and discharged on a regimen of oral ofloxacin to complete a 10- to 14-day course . RESULTS: Neisseria gonorrhoeae was isolated from at least one site in 25 patients (69.4%) including the fallopian tube or cul-de-sac in 12 of them . Chlamydia trachomatis was isolated from the endocervix and/or endometrium in 6 patients (16.7%); concomitant Neisseria gonorrhoeae was present in 4 patients (66.6%) . A polymicrobial infection was identified in only one patient . All patients responded to antibiotic therapy with ofloxacin . CONCLUSIONS: Acute salpingitis in our urban emergency department population is related primarily to upper genital tract infection with Neisseria gonorrhoeae . Ofloxacin is effective therapy for this disease. Am J Obstet Gynecol, 1992 Sep, 167(3), 588 - 91 Detection of cervical Chlamydia trachomatis and Neisseria gonorrhoeae with deoxyribonucleic acid probe assays in obstetric patients; Hosein IK et al.; OBJECTIVE: The Gen-Probe PACE 2 deoxyribonucleic acid probe assays for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae are targeted against the ribosomal ribonucleic acid of each pathogen . Our study compared the performance of the probe assays with culture for Chlamydia trachomatis (246 patients) and Neisseria gonorrhoeae (310 patients) while screening obstetric patients . STUDY DESIGN: Using culture as a gold standard, we assessed the sensitivity, specificity, positive predictive value, and negative predictive value of the chlamydia and gonorrhea probes . RESULTS: The prevalence of chlamydia by culture was 13.4% and gonorrhea 4.8% . Against culture, the chlamydia probe assay performed as follows: sensitivity 93.9%, specificity 99.1%, positive predictive value 93.9%, and negative predictive value 99.1% . Values for the gonorrhea probe assay were 93.3%, 99.0%, 82.4%, and 99.7%, respectively . Additional molecular analysis of probe-positive-culture-negative specimens suggests that the gonorrhea probe-positive predictive value may be even higher . CONCLUSION: The Gen-Probe PACE 2 deoxyribonucleic acid probe assays for chlamydia and gonorrhea appear to be promising as convenient, reliable, and cost-effective alternatives to conventional cultures in screening obstetric patients. South Med J . 1992 Sep;85(9):929. Infective endocarditis due to Neisseria sicca and associated with intravenous drug abuse; Valenzuela GA et al.; Intravenous drug abusers are subject to infective endocarditis from unusual pathogens, including the saprophytic species of Neisseria, sometimes transmitted by needles contaminated with oral secretions . We have recently encountered such a case, in which a 37-year-old man with vegetations on the anterior leaflet of the tricuspid valve had blood cultures positive for N sicca . A history of intravenous drug abuse using needles contaminated with oral secretions should alert clinicians to the possibility of infective endocarditis due to saprophytic Neisseria species. J Clin Invest, 1992 Sep, 90(3), 1000 - 6 Regulation of catalase in Neisseria gonorrhoeae . Effects of oxidant stress and exposure to human neutrophils; Zheng HY et al.; We studied the effects of oxidant stress on the catalase activity and hydrogen peroxide sensitivity of Neisseria gonorrhoeae . N . gonorrhoeae is an obligate pathogen of man that evokes a remarkable but ineffective neutrophil response . Gonococci make no superoxide dismutase but express high catalase activity . Gonococcal catalase activity increased threefold when organisms were subjected to 1.0 mM hydrogen peroxide . This increase in catalase activity was marked by a parallel increase in protein concentration recognized by a rabbit polyclonal antibody raised against the purified gonococcal enzyme . Catalase was primarily localized to the gonococcal cytoplasm in the presence or absence of stress; only a single isoenzyme of catalase could be identified . Exposure of gonococci to neutrophil-derived oxidants was accomplished by stimulating neutrophils with phorbol myristate acetate or by using gonococcal Opa variants that interacted with neutrophils with different degrees of efficiency . Gonococci exposed to neutrophils demonstrated a twofold increase in catalase activity in spite of some reduction in viability . Exposure of gonococci to 1.0 mM hydrogen peroxide made the organisms significantly more resistant to higher concentrations of hydrogen peroxide and to neutrophils than control organisms . These results suggest that catalase is an important defense for N . gonorrhoeae during attack by human neutrophils . The rapid response of this enzyme to hydrogen peroxide should be taken into consideration in studies designed to evaluate the interaction between neutrophils and gonococci. J Bacteriol, 1992 Sep, 174(18), 5978 - 81 Role of pilA, an essential regulatory gene of Neisseria gonorrhoeae, in the stress response; Taha MK et al.; Sequence analysis has shown that PilA, a transcriptional regulator of pilin gene expression in Neisseria gonorrhoeae, has extensive homology with the 54-kDa protein of the signal recognition particle of eukaryotes and its receptor, as well as with two proteins of Escherichia coli, FtsY and Ffh, which have been proposed to be a part of a signal recognition particle-like apparatus . We tested the putative role of PilA in protein export in N . gonorrhoeae and did not find any effect . However, we did observe induction of a heat shock response and a previously described slow-growth phenotype when PilA function was impaired . We also examined the interference of pilA expression in E . coli with the function of the products of ftsY and ffh and observed an accumulation of pre-beta-lactamase . We argue against a direct role for PilA in protein export in gonococci and propose instead that PilA is involved in the modulation of cell growth rate in response to different environmental conditions. Indian J Med Res, 1992 Sep, 95, 227 - 9 Auxotyping of Neisseria gonorrhoeae as an additional epidemiological marker; Agarwal SK et al.; Auxotypes and penicillin sensitivity of 102 strains of N . gonorrhoeae were studied . Ten distinct auxotypes on the basis of growth requirement to seven amino acids were observed . The commonest pattern seen was zero auxotype (33.3%), followed by auxotype requiring proline (18.6%) . MIC of 72 (71.5%) strains ranged from < 0.003 IU/ml to 0.062 IU/ml of benzyl penicillin . MIC of the other 30 (29.5%) strains was found to be > or = 0.125 IU/ml, indicating penicillin resistance . None of the strains were penicillinase producers . A case of reinfection was also detected on the basis of change in auxotype pattern. Eur J Clin Microbiol Infect Dis, 1992 Sep, 11(9), 804 - 9 Use of genomic fingerprinting in the characterization of Neisseria gonorrhoeae isolated in Valencia, Spain; Dasi M et al.; Ninety-five Neisseria gonorrhoeae organisms isolated in Valencia, Spain, were characterized by antibiotic sensitivity testing, auxotyping, serotyping, plasmid analysis and restriction endonuclease fingerprinting (HindIII digestion) . Cluster analysis of the restriction patterns revealed that 31 isolates (32.6%) formed 12 clearly defined clusters . Penicillinase-producing Neisseria gonorrhoeae strains formed four of these groups . Eight groups of gonococcal strains were identified by auxotyping, although 83% of isolates belonged to two auxotypes (Proto, Pro-) . Twenty-three different serovars were identified by serotyping . The serovar pattern IB/rop was found in 38% of isolates . A 60% coincidence was found between gonococcal groupings obtained by combination of auxotyping, serotyping and plasmid analysis and those obtained with the restriction enzyme fingerprinting technique . The specificity of enzyme restriction patterns of Neisseria gonorrhoeae is confirmed to be of practical importance in the epidemiologic study of gonorrhoea. Mol Microbiol, 1992 Sep, 6(18), 2607 - 15 Expression of a functional neisserial fbp gene in Escherichia coli; Berish SA et al.; The ability to acquire iron from a human host is a major determinant in the pathogenesis of Neisseria gonorrhoeae and Neisseria meningitidis . Pathogenic Neisseria spp . do not synthesize siderophores and instead express a receptor-mediated, high-affinity iron acquisition system in the iron-restricted environment of its host . A ferric-iron-binding protein (Fbp) of Neisseria spp . is also iron-regulated and may play a central role in this novel iron-uptake system . To define the physical properties of Fbp further, we used polymerase chain reaction to synthesize DNA fragments containing the fbp structural gene with and without the sequence encoding the Fbp leader peptide . These fragments were ligated into pUC13 to create in-frame fusions with the alpha peptide of lacZ . The expression of Fbp was under the control of the lacZ promoter . Both fusion clones produced Fbp in large amounts, facilitating the purification of quantities of Fbp sufficient for elucidating the biochemical, immunologic, and functional properties of this protein. Kansenshogaku Zasshi, 1992 Sep, 66(9), 1209 - 12 {Detection of Neisseria gonorrhoeae in first-voided urine sediments from male urethritis patients by polymerase chain reaction}; Komeda H et al.; Neisseria gonorrhoeae was detected from first-voided urine sediments of male patients with urethritis by polymerase chain reaction (PCR) . Urine and urinary sediment were treated with proteinase K, and DNA was further purified by phenol extraction . Two oligonucleotides based on sequences within a ribosomal RNA gene from N . gonorrhoeae were used as primers for the PCR . A DNA fragment of 206 bp specific for N . gonorrhoeae was amplified by PCR and detected by agarose gel electrophoresis . In 19 specimens of urine sediments collected from 21 patients in whom N . gonorrhoeae was isolated from urethral swab by culture, 206 bp DNA fragment was amplified by PCR . In all specimens of urine sediments from 24 patients in whom cultures for N . gonorrhoeae were negative, no DNA was amplified by the PCR . The overall coincidence rate between the PCR for detecting N . gonorrhoeae in first-voided urine sediments and culture in urethral swab was 95.6% (43/45) . PCR procedure for detection of pathogens from first-voided urine sediments would be noninvasive and would be applied for the diagnosis of gonococcal urethritis and chlamydial urethritis. Diagn Microbiol Infect Dis, 1992 Sep-Oct, 15(7), 627 - 32 Cefmetazole and trospectomycin in vitro susceptibility testing interpretive criteria and quality control guidelines for Neisseria gonorrheae; Jones RN et al.; Cefmetazole and trospectomycin were tested in a multilaboratory trial to establish Neisseria gonorrhoeae susceptibility testing criteria and quality control (QC) guidelines . Cefmetazole was active against the penicillinase-producing isolates and has an MIC90 of 16 micrograms/ml, the breakpoint MIC previously used for nonfastidious species . However, a single-dose gonorrhea regimen (1 g i.m.) would require a lower less than or equal to 2 micrograms/ml breakpoint with a correlate zone (greater than or equal to 33 mm) consistent with similarly used cephamycins (cefoxitin and cefotetan) . An intermediate category was proposed for MICs greater than 2-4 micrograms/m (28-32 mm) pending more clinical experience with higher and/or prolonged cefmetazole dosing regimens . Trospectomycin was active (MIC90, 8 micrograms/ml) against all spectinomycin-susceptible gonococci . A susceptible breakpoint MIC of less than or equal to 16 micrograms trospectomycin per milliliter was proposed with a correlate zone diameter of greater than or equal to 17 mm . An intermediate category was also suggested for trospectomycin at 32 micrograms/ml (14-16 mm) . QC guidelines were established for 30-micrograms cefmetazole and 30-micrograms trospectomycin disk diffusion tests and the GC agar base MICs using a multilaboratory study design consistent with National Committee for Clinical Laboratory Standards (NCCLS) M23-T guidelines . Both drugs were stable in GC agar plates for 21 days stored at 2 degrees-5 degrees C. Am J Prev Med, 1992 Sep-Oct, 8(5), 298 - 302 Prevalence of Chlamydia trachomatis infection among women in a multiphysician primary care practice; Nelson ME; I screened 312 women, 18-45 years of age, presenting for routine gynecologic examination or prenatal care in a multiphysician primary care practice for Chlamydia trachomatis and Neisseria gonorrhoeae . I evaluated age, pregnancy, payment status, and presence of clinical cervicitis or gonorrhea as possible predictors of risk for chlamydial infection . Compared to culture, the direct immunofluorescent antibody (DFA) test used to screen for C trachomatis had a sensitivity of 70% and a specificity of 97% . By culture, the overall prevalence of chlamydial infection was 3.2% (confidence limits {CL} = 1.1-5.9) with a prevalence of 2.2% in nonpregnant women and 9.3% in pregnant women . Overall prevalence by the DFA test was 5.45% . Pregnancy status and youth were the significant predictors of risk for infection as determined by culture but not by Microtrak . Payment status, clinical cervicitis, and gonorrhea cultures were not useful predictors of increased risk . I discuss the implications of using culture, an imperfect "gold standard," for determining sensitivity, specificity, and prevalence. Am J Perinatol, 1992 Sep-Nov, 9(5-6), 368 - 70 Significance of positive cervical cultures for Chlamydia trachomatis in patients with preterm premature rupture of membranes; Ismail MA et al.; We tested the hypothesis that in patients with preterm premature rupture of membranes the presence of Chlamydia trachomatis in the cervix shortens the latent period (time from rupture of membranes to delivery) and increases the incidence of chorioamnionitis and early endometritis . A total of 178 conservatively managed patients with PROM between 22 and 35 weeks' gestation had cervical cultures for chlamydia, group B Streptococcus (GBS) and Neisseria gonorrhoeae performed at the time of rupture . Patients with GBS and gonorrhea were treated at the time the culture results were available and excluded from analysis . The remaining patients were divided into group 1: 26 patients (14.6%) positive for only chlamydia (and not treated until discharge from the hospital); group 2: 120 patients (67.4%) negative for all three organisms . The two groups did not differ in cesarean rate, duration of conservative management, hospital stay, or birthweight . Furthermore, the rates of chorioamnionitis (30.8% group 1; 38.3% group 2) or early endometritis (11.5% group 1; 20.8% group 2) were similar . We conclude that in patients with preterm premature rupture of membranes, the presence of chlamydia in the cervix appears to neither decrease the latent period nor increase the incidence of chorioamnionitis and early endometritis. Sex Transm Dis, 1992 Sep-Oct, 19(5), 288 - 90 Fulminant endocarditis due to infection with penicillinase-producing Neisseria gonorrhoeae; Weiss PJ et al.; Endocarditis is a rare but potentially lethal manifestation of gonococcal infection . We report the case of a patient with fulminant endocarditis secondary to infection with penicillinase-producing Neisseria gonorrhoeae (PPNG) . The patient had rapid deterioration from extensive destruction of the aortic valve with abscess and fistula formation . Lifesaving emergency surgery was performed . To our knowledge this is the first reported case of gonococcal endocarditis secondary to infection with a penicillinase-producing organism. Sex Transm Dis, 1992 Sep-Oct, 19(5), 284 - 7 Patterns of antibiotic susceptibility of gonococci isolated in Hong Kong, 1987-1990; Kam KM et al.; Among the 14,528 strains of Neisseria gonorrhoeae isolated from the Government Social Hygiene Sexually Transmitted Disease (STD) Clinics in Hong Kong between 1987 and 1990, there has been a trend toward a decrease in the percentage of penicillin resistant strains in both penicillinase-producing and nonpenicillinase producing N . gonorrhoeae (PPNG and non-PPNG) and an increase in moderate resistant strains, whereas the proportion of sensitive strains has remained stable, except for a small increase in 1990 . Presently, PPNG still accounts for 31% of all isolates . In early 1991, 100 consecutive isolates were tested for minimum inhibitory concentrations (MIC) against 6 commonly used antibiotics . Although ofloxacin has been used as the first-line treatment for gonorrhea for the last 5 years, there is still no sign of in vitro resistance . Two isolates with high-level tetracycline resistance (MIC greater than 16 mg/l) were detected that have not been seen before . Sensitivity to spectinomycin, cefuroxime, and ceftriaxone has also been maintained, and these drugs can probably be recommended as alternative treatments in noncompliant cases . Analysis of location of contact shows an increasing proportion of cases of gonorrhea from overseas, particularly from parts of China . Comparison with the limited information published in the region shows that the population sampled can be very heterogeneous . With the continued flux of international travel, one should be extremely careful when trying to get an accurate assessment of epidemiologic dataPIP: Laboratory researchers identified 14,528 strains of Neisseria gonorrhoeae isolated from lower to middle class patients who attended the Government Social Hygiene Sexually Transmitted Disease Clinics in Hong Kong between 1987-90 . They also used 100 strains collected during the 1st part of 1991 as control strains . They wanted to determine patterns of antibiotic susceptibility . The number of positive isolates fall from 5971 to 2039 during the study period . The percentage of strains sensitive to penicillin did not differ greatly (4.5% in 1987 and 1989, 3.4% in 1988, and 6% in 1990) . On the other hand, the percentage of moderately resistant strains rose from 15.2% to 32% . The percentage of penicillinase-producing N . gonorrhoeae (PPNG) and nonpenicillinase-producing N . gonorrhoeae decreased from 38.7% to 31% and 41.1% to 30.9%, respectively . The control strains exhibited considerable sensitivity to ofloxacin, the antibiotic of choice for treating uncomplicated gonorrhea, as well as spectinomycin and ceftriaxone . 2 strains were very resistant to tetracycline which, in the past, did not exhibit this resistance . Most patients from whom samples were taken lived in Hong Kong (79% in 1987 and 61% in 1990), but the percentage of foreign patients grew (21-39%) which was simultaneous with the worldwide growth in international trade and travel . Most of these foreigners came to Hong Kong from Macau (50% in 1987 and 49% in 1990) and China (14% in 1987 and 32% in 1990) . The population served by the clinics apparently acquire the N . gonorrhoeae strains from nearby areas . Future studies should include samples from private clinics which tend to serve the widely traveled groups to obtain an accurate assessment of the real strain population of Hong Kong . Sex Transm Dis, 1992 Sep-Oct, 19(5), 259 - 65 Underdiagnosis of Chlamydia trachomatis infection . Diagnostic limitations in patients with low-level infection; Lin JS et al.; To determine limitations in commonly used methods for detection of Chlamydia trachomatis, 601 genitourinary specimens from patients in a sexually transmitted disease clinic were examined with quantitative cultures and by 2 different direct antigen tests, immunofluorescence (Micro Trak; Syva Company, Palo Alto, CA) and enzyme immunoassay (Chlamydiazyme; Abbott Laboratories, North Chicago, IL) . Genital specimens were held no longer than 5 hours (at 4 degrees C) prior to inoculation for culture; 28% (168/601) were positive . To evaluate the effect of storage on culture efficacy, duplicate specimens were also stored at -70 degrees C and brought out subsequently for culture a second time . Only 32% (8/25) of specimens cultured within 5 hours and having less than 10 inclusions were positive on reculture, compared with 98% (49/50) positive for specimens with greater than or equal to 10 inclusions initially (P less than 0.001) . Sensitivities of the two antigen tests were similar and taken together diminished significantly (P less than 0.001) as the number of organisms (inclusion forming units) in corresponding cultures decreased: 82% (51/62) sensitivity in cultures with greater than 100 inclusions; 50% (22/44) with 10-100 inclusions; and only 11% (6/53) with less than 10 . Lack of urethral discharge in men with C . trachomatis infection (free of Neisseria gonorrhoeae) was associated with low numbers of inclusions (less than 10) and antigen tests failed in 68% (15/22) of these patients. MCN Am J Matern Child Nurs, 1992 Sep-Oct, 17(5), 256 - 60 Condoms as primary prevention in sexually active women; Libbus MK; PIP: The origin of the word condom is the subject of some debate, but the use of a linen sheath as a preventive measure for venereal disease was noted in the writings of Fallopius in 1564 . In recent years condom sales have increased, and in a sample of San Francisco male homosexuals consistent condom use was reported to have increased from 26% to 79% between 1984 and 1987 . Condom sales in drugstores increased by over 20% from 1986 to 1987, with women being responsible for an estimated 40-50% of US purchases . Studies suggest a failure rate of 2-15/100 couples using condoms . Failure rates for 1st-year users average about 12%, but consistent and correct condom use theoretically results in approximately a 2% failure rate . Mean breakage rates ranging from 0% to 13% have been reported . Both epidemiological and laboratory studies have demonstrated that latex condoms are effective mechanical barriers to important viral transmissions including HIV, herpes simplex virus (HSV), hepatitis B virus (HBV), and cytomegalovirus (CMV), as well as bacteria such as Chlamydia trachomatis and Neisseria gonorrhea . Condoms are safe to use, particularly in view of the fact that AIDS is now 1 of the 5 leading causes of death for women ages 15-44 . An important contraindication, however, is the presence of latex allergy, potentially leading to contact urticaria or manifestations of anaphylaxis . The female condom shows promise for placing personal protection increasingly under the control of women . Condom promotion in the US with education at both public and individual levels could emulate developed and developing countries that have promoted condom use with marketing and mass-media techniques, as well conspicuous and aggressive distribution methods . Nursing is involved in program efforts aimed at enhancing condom use and nurses can be effective in encouraging clients to use condoms to protect themselves . J Clin Microbiol, 1992 Sep, 30(9), 2290 - 4 Neisseria spp . and AIDS; Morla N et al.; Neisseria meningitidis from various serogroups and two commensal neisseriae (N . sicca and N . perflava) were isolated from 15 patients at various stages of human immunodeficiency virus infection in this clinical and bacteriological study . The cases were grouped into the following three classes: (i) infections with an N . meningitidis strain of a serogroup known to be pathogenic (A, B, or C) and apparently independent of the human immunodeficiency virus infection, (ii) infections with a N . meningitidis strain of a serogroup which is normally either commensal or poorly pathogenic (serogroups Y, X, Z, and Z,29E), (iii) pulmonary and disseminated infections occurring in the course of the clinical evolutionary stage of AIDS, in two cases of which commensal neisseriae (N . sicca and N . perflava) were isolated from blood cultures. Sex Transm Dis, 1992 Sep-Oct, 19(5), 252 - 8 Seroepidemiologic study of hepatitis C virus in sexually transmitted disease risk groups; Stary A et al.; To identify the importance of heterosexual activity as a possible route for the transmission of the hepatitis C virus (HCV), a screening of antibodies against HCV (anti-HCV) was performed in 200 sexually transmitted disease patients with different risks for incurring genital infections as well as in 100 registered prostitutes . Out of all 300 persons tested, 14 cases of HCV infection were detected . Anti-HCV was present in 3 of the prostitutes and in 11 of the STD patients . Evaluating known risk factors, such as intravenous drug use or blood transfusion, 6 out of the 11 STD patients and all of the prostitutes in whom anti-HCV was present were intravenous drug users and exhibited highly promiscuous behavior . Intravenous drug use was the probable means of acquisition in 9 of the 14 subjects in whom anti-HCV was present, and homosexual promiscuous behavior was assumed to be the means of acquisition in another 2 subjects . In heterosexual patients engaging in high-risk behavior (high number of sexual partners and genital infections), the exclusion of intravenous drug use decreased the prevalence of anti-HCV from 12.1% to 4.1%, demonstrating no significant increase from the prevalence among low-risk persons . Most of the patients were screened for STDs, such as syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, human immunodeficiency virus (HIV), hepatitis B virus (HBV), trichomoniasis, and yeast infections . The highest rate of coinfection with anti-HCV was found in patients with serologic evidence of an HIV infection (50%).(ABSTRACT TRUNCATED AT 250 WORDS) J Bacteriol, 1992 Sep, 174(18), 5888 - 94 FK-506-binding proteins from streptomycetes producing immunosuppressive macrolactones of the FK-506 type; Pahl A et al.; FK-506-binding proteins (FKBPs), which in T cells are supposed to mediate the immunosuppressive effects of the compounds FK-506 and rapamycin, have been isolated from Streptomyces chrysomallus, S . hygroscopicus subsp . ascomyceticus, and S . hygroscopicus . The latter two strains are producers of ascomycin (the ethyl analog of FK-506) and rapamycin, respectively . Like the 12-kDa FKBP in eukaryotic organisms such as humans, bovines, and Saccharomyces cerevisiae, or the FKBPs from gram-positive streptomycetes are peptidyl-prolyl-cis-trans isomerases . Inhibition studies using FK-506, rapamycin, or ascomycin, revealed inhibition of the peptidyl-prolyl cis-trans isomerase activity of the proteins at the nanomolar level, which is in the same range as with eukaryotic FKBPs . The M(r)s of the various FKBPs were 13,500 to 15,000, and they had the same pI of approximately 4.5 . The N-terminal sequences of the three FKBPs were nearly identical in the first 20 amino acids . The amino acid sequence deduced from the gene sequence of S . chrysomallus gave a polypeptide of 124 amino acids . The homologies to FKBPs from humans, S . cerevisiae, and Neurospora crassa were 38, 39, and 50% identity in relevant positions, respectively . Significant homology of 38% was also seen with the C-terminal halves of bacterial protein surface antigens like the Mip protein of Legionella pneumophila and the 27-kDa Mip-like protein of Chlamydia trachomatis . In addition, two more open reading frames in Pseudomonas aeruginosa and Neisseria meningitidis of unknown function show regions of homology to the S . chrysomallus FKBP . In contrast to fungi, streptomycetes are resistant to macrolactones . Ascomycin-producing S . hygroscopicus subsp . ascomyceticus excretes the compound almost quantitatively into medium, which indicates that the organism has an efficient self-protection mechanism against its own secondary metabolite. J Bacteriol, 1992 Sep, 174(17), 5654 - 60 Cloning and linkage analysis of Neisseria gonorrhoeae DNA methyltransferases; Gunn JS et al.; We have cloned DNA methyltransferases (MTases) from various strains of Neisseria gonorrhoeae . Each of these clones represents a single specificity, indicating that the multiple gonococcal MTase specificities are encoded by monospecific MTases . The DNAs of five strains (FA5100, F62, MS11, Pgh3-2, and WR302) were digested with NheI, SpeI, or NheI plus SpeI and subjected to pulsed-field gel electrophoresis . The DNA MTase clones were used to probe Southern blots of these pulsed-field gels to determine whether the MTase genes are linked and whether there are strain-to-strain differences . The results indicate that none of these genes are closely linked, but variable hybridization patterns indicate that there exist restriction fragment length polymorphisms between the strains tested . Most of the chromosomal regions containing these restriction fragment length polymorphisms are clustered in regions containing gonococcal genes known or suspected to antigenically vary via genetic recombination. J Bacteriol, 1992 Sep, 174(18), 5788 - 97 Gonococcal transferrin-binding protein 1 is required for transferrin utilization and is homologous to TonB-dependent outer membrane receptors; Cornelissen CN et al.; The pathogenic Neisseria species are capable of utilizing transferrin as their sole source of iron . A neisserial transferrin receptor has been identified and its characteristics defined; however, the biochemical identities of proteins which are required for transferrin receptor function have not yet been determined . We identified two iron-repressible transferrin-binding proteins in Neisseria gonorrhoeae, TBP1 and TBP2 . Two approaches were taken to clone genes required for gonococcal transferrin receptor function . First, polyclonal antiserum raised against TBP1 was used to identify clones expressing TBP1 epitopes . Second, a wild-type gene copy was cloned that repaired the defect in a transferrin receptor function (trf) mutant . The clones obtained by these two approaches were shown to overlap by DNA sequencing . Transposon mutagenesis of both clones and recombination of mutagenized fragments into the gonococcal chromosome generated mutants that showed reduced binding of transferrin to whole cells and that were incapable of growth on transferrin . No TBP1 was produced in these mutants, but TBP2 expression was normal . The DNA sequence of the gene encoding gonococcal TBP1 (tbpA) predicted a protein sequence homologous to the Escherichia coli and Pseudomonas putida TonB-dependent outer membrane receptors . Thus, both the function and the predicted protein sequence of TBP1 were consistent with this protein serving as a transferrin receptor. Fam Med, 1992 Aug, 24(6), 447 - 52 Inflammation on the cervical Papanicolaou smear: the predictive value for infection in asymptomatic women; Bertolino JG et al.; BACKGROUND: The clinical significance of inflammation on the cervical Papanicolaou (Pap) smear of asymptomatic women is unknown . This study assessed the possible association between inflammation on Pap smears with the presence of cervical/vaginal pathogens . METHODS: A questionnaire was given to 290 asymptomatic women seen for routine gynecologic examination, including Pap smear, in a primary care setting . The women were tested for the presence of Candida species, Trichomonas vaginalis, Gardnerella vaginalis, Neisseria gonnorrhoeae, and Chlamydia trachomatis . RESULTS: Recovery of Chlamydia and Trichomonas was more frequent in women with inflammation on Pap smear than in women without inflammation, but the positive predictive value of inflammation was only 7% for Chlamydia and 14% for Trichomonas . Seventy-one percent of the women with inflammation had no evidence of any of the organisms . After a 6-month follow-up period, women with inflammation on Pap smear were no more likely than their matched counterparts without inflammation to return for a clinic visit with symptoms of vaginitis . CONCLUSIONS: In this study, inflammation on Pap smear had a relatively low predictive value for the presence of vaginal pathogens in asymptomatic women. J Med Microbiol, 1992 Aug, 37(2), 96 - 9 Analysis of genetic variability of penicillinase non-producing Neisseria gonorrhoeae strains with different levels of resistance to penicillin; de la Fuente L et al.; Genetic variability among 41 penicillinase non-producing Neisseria gonorrhoeae strains, isolated in Spain, with different levels of resistance to penicillin was investigated by multilocus enzyme electrophoresis . Based on the results obtained by analysis at seven enzyme loci, the strains were separated into 17 electrophoretic types . The average number of alleles/enzyme locus was 2.85; the mean genetic diversity/locus was 0.49 for individual isolates and 0.516 for electrophoretic types . The results showed that these gonococcal strains were, genetically, a highly variable group of organisms. Clin Infect Dis, 1992 Aug, 15(2), 321 - 4 Endocarditis due to Neisseria mucosa: two case reports and review; Ingram RJ et al.; Two cases of endocarditis caused by Neisseria mucosa are reported, and the literature on N . mucosa endocarditis is reviewed . N . mucosa is a rare but serious cause of endocarditis that is associated with a high rate of embolic complications and high mortality and is not always highly sensitive to benzylpenicillin . Most patients with N . mucosa endocarditis have been treated with combined therapy with penicillin and an aminoglycoside, although the optimal regimen has not been defined. J Clin Microbiol, 1992 Aug, 30(8), 2191 - 4 Proposed interpretive criteria and quality control parameters for testing susceptibility of Neisseria gonorrhoeae to beta-lactam-clavulanate combinations; Fuchs PC et al.; To support future clinical studies, in vitro susceptibility tests were examined to determine whether Neisseria gonorrhoeae could be tested reliably against two beta-lactam-clavulanate combinations . All isolates that were tested appeared to be susceptible to amoxicillin and ticarcillin in combination with clavulanic acid . In the absence of resistant isolates, only a breakpoint for a susceptible category could be defined for agar dilution tests with amoxicillin-clavulanic acid (MIC of less than or equal to 2.0/1.0 micrograms/ml is tentatively proposed) . For disk diffusion tests, a corresponding breakpoint zone diameter of greater than or equal to 28 mm is suggested . The validity of the breakpoints for penicillinase-negative penicillin-resistant strains awaits clinical data . Proposed quality control limits for testing amoxicillin-clavulanic acid by agar dilution and disk diffusion methods are a MIC of 0.25/0.125 to 1.0/0.5 micrograms/ml and zones of 30 to 40 mm in diameter for N . gonorrhoeae ATCC 49226, a MIC of 0.125/0.06 to 0.5/0.25 micrograms/ml for Staphylococcus aureus ATCC 29213, and zones of 30 to 38 mm for S . aureus ATCC 25923 . Ticarcillin-clavulanate is currently tested against other species by preparing doubling dilutions of ticarcillin with a constant 2 micrograms of clavulanate per ml . By that method, all gonococci were susceptible to low concentrations . However, the amount of clavulanic acid that is included (2 micrograms/ml) will, by itself, inhibit many strains of N . gonorrhoeae . Consequently, the role of ticarcillin in the combination cannot be determined, and such tests are not recommended. J Clin Microbiol, 1992 Aug, 30(8), 2181 - 3 Evaluation of a urease-based confirmatory enzyme-linked immunosorbent assay for diagnosis of Neisseria gonorrhoeae; Carballo M et al.; A new urease-based enzyme-linked immunosorbent assay utilizing novel monoclonal antibodies was evaluated for the culture confirmation of Neisseria gonorrhoeae, with 270 isolates of N . gonorrhoeae, 56 isolates of diverse Neisseria spp., and 29 Moraxella isolates . The test was highly specific (100.00%) and sensitive (97.83%) . No cross-reactions were observed with any of the Neisseria or Moraxella isolates tested . Fifty percent (3 of 6) of the false-negative results were obtained with isolates of serovar IA-4, a serovar rarely encountered in North America. Glycoconj J, 1992 Aug, 9(4), 168 - 73 Glycopeptidolipids--a new class of artificial antigens with carbohydrate determinants . Synthesis of artificial antigen with type-specific oligosaccharide hapten from Neisseria meningitidis group B; Dmitriev BA et al.; Synthetic lipopeptide N-palmitoyltyrosyl-seryl-seryl-asparaginyl-alanine, an analogue of B-mitogenic tripalmitoyl-pentapeptide from Escherichia coli lipoprotein, was coupled with an oligosaccharide hapten from Neisseria meningitidis lipooligosaccharide to give a glycopeptidolipid conjugate--the artificial antigen of a new type processing the type-specific microbial determinant. Antimicrob Agents Chemother, 1992 Aug, 36(8), 1764 - 5 Orally administered cefpodoxime proxetil for treatment of uncomplicated gonococcal urethritis in males: a dose-response study; Novak E et al.; An open-label, dose-response study of cefpodoxime proxetil (CPD), an expanded-spectrum cephalosporin, was conducted with 58 males with uncomplicated Neisseria gonorrhoeae infections with single doses of 600, 400, 200, 100, or 50 mg of CPD administered orally by tablet . CPD eradicated N . gonorrhoeae in all 50 evaluable patients (10 per group) at all doses studied . Eight of the isolates eradicated were beta-lactamase-producing organisms . Two patients reported three side effects, nausea, vomiting, and diarrhea, which were mild and resolved without intervention or sequelae . There were no clinically remarkable drug-related changes in vital signs or clinical laboratory assays . Results show that single oral doses of CPD are an effective and well-tolerated treatment for uncomplicated N . gonorrhoeae infection in males at doses as low as 50 mg. Antimicrob Agents Chemother, 1992 Aug, 36(8), 1682 - 7 Antibiotic susceptibility survey of Neisseria gonorrhoeae in Thailand; Clendennen TE et al.; The antibiotic susceptibilities of Neisseria gonorrhoeae isolates obtained from patients attending sexually transmitted disease clinics in Cholburi and Bangkok, Thailand, were determined by agar dilution . Some 28.2% of isolates produced beta-lactamase . A total of 97.9% of beta-lactamase-positive and 51% of beta-lactamase-negative isolates tested were resistant to penicillin (MICs, greater than or equal to 2 micrograms/ml), 70% of isolates tested were resistant to tetracycline (MICs, greater than or equal to 2 micrograms/ml), and 91% of isolates tested were susceptible to spectinomycin (MICs, less than or equal to 64 micrograms/ml) . The MICs for 90% of isolates for the other drugs tested were 2 micrograms/ml for erythromycin, 2 micrograms/ml for cefoxitin, 1 micrograms/ml for cefuroxime, 0.125 micrograms/ml for cefpodoxime, 0.06 micrograms/ml for cefotaxime, 0.25 micrograms/ml for ceftazidime, 0.03 micrograms/ml for ceftizoxime, 0.03 micrograms/ml for ceftriaxone, 0.03 micrograms/ml for cefixime, 0.06 micrograms/ml for aztreonam, 0.008 micrograms/ml for ciprofloxacin, 0.125 micrograms/ml for norfloxacin, and 0.075 micrograms/ml for ofloxacin . Fewer than 1.5% of isolates were resistant to the extended-spectrum cephalosporins tested . Some 0.3% or fewer isolates were resistant to broad-spectrum cephalosporins, fluoroquinolones, or the monobactam aztreonam . Antibiotic resistance among N . gonorrhoeae isolates from Cholburi and Bangkok in May 1990 appeared to be primarily limited to penicillin and tetracycline, which are no longer used to control gonorrhea . Spectinomycin, which has been in general use against gonorrhea in Thailand since 1983, has dwindling utility, with resistance at a level of 8.9%. Kansenshogaku Zasshi, 1992 Aug, 66(8), 1105 - 12 {Quantitative analyses of the normal throat flora of children with upper respiratory tract infections}; Yoshinaga M et al.; Relationship between the normal throat flora and pathogenic bacteria recovered from the throat in 139 children with upper respiratory tract infections in winter were studied using quantitative analyses . Pathogenic bacteria examined include S . pyogenes, H . influenzae, S . aureus, and S . pneumoniae, and the normal floras include alpha-streptococci, gamma-streptococci, Neisseria species, and Micrococci . Children with S . pyogenes in their throats (S . pyogenes group) were examined with anti-streptococcal antibodies such as anti-streptolysin O, anti-streptokinase, and anti-deoxyribonuclease B . Eighty seven pathogenic bacteria were recovered from 72 children (51.8%) out of 139 . S . pyogenes and S . pneumoniae groups showed significantly lower alpha-streptococci and gamma-streptococci in incidence of appearance when compared with children with the no pathogenic bacteria in their throats (no bacteria group) . H . influenzae group showed significantly lower gamma-streptococci and higher Neisseria sp . in incidence of appearance compared with the no bacteria group . Positive cases for anti-streptococcal antibodies showed a significantly lower alpha-streptococci in number compared with negative cases for antibodies and the no bacteria group, and a significantly lower gamma-streptococci in incidence of appearance compared with the no bacteria group . These data suggest that the normal throat flora may have a role in prevention of colonization by the pathogenic bacteria in vivo, as were shown in vitro by many authors, and that the quantitative analysis of the normal flora is useful because this methodology might reveal whether the bacteria recovered from the throat show the pathogenicity. Drugs, 1992 Aug, 44(2), 207 - 15 Effective treatment of urethritis . A practical guide; Bowie WR; Most cases of urethritis can be readily treated using recommended regimens . The most important causes of urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae, and initial treatment is directed at them . Optimal management requires obtaining a thorough sexual history, evaluation for objective clinical and laboratory evidence of infection, antimicrobial therapy directed towards the major aetiologies, and evaluation and treatment of sexual partners . Treatment of gonorrhoea requires a single-dose regimen active against N . gonorrhoeae, plus a regimen active against C . trachomatis and nongonococcal urethritis . The usually recommended treatment for N . gonorrhoeae is a single dose of ceftriaxone 250mg intramuscularly, but there are many alternatives, including oral ones . Only in very restricted geographical areas and under restricted situations are penicillins still reliable against N . gonorrhoeae . Recommended optimal treatment of C . trachomatis or nongonococcal urethritis currently requires 7 days' treatment with a tetracycline . Some guidelines now propose ofloxacin 300 mg orally twice daily for 7 days as an equivalent alternative, and there are very promising data with a single dose therapy with azithromycin, a long-acting macrolide antimicrobial . Using recommended regimens, microbiological failure is infrequent in compliant patients . Recurrent urethritis is, however, frequent . For patients who receive recommended treatment and do well, no follow-up cultures are needed . Patients with persistent or recurrent symptoms require careful re-evaluation of the patient, documentation of urethritis, and retreatment with antimicrobial agents a second time if urethritis is documented by positive cultures or increased numbers of polymorphonuclear leucocytes in urethral secretions.(ABSTRACT TRUNCATED AT 250 WORDS) J Infect Dis, 1992 Aug, 166(2), 316 - 25 Human vaccination with Escherichia coli J5 mutant induces cross-reactive bactericidal antibody against Neisseria gonorrhoeae lipooligosaccharide; Dale PA et al.; The lipopolysaccharides of enteric gram-negative bacteria and the lipooligosaccharides (LOS) of Neisseria gonorrhoeae may share antigenic determinants that are targets of bactericidal antibody . Natural (disseminated) infection with a serum-resistant gonococcal strain and immunization with Escherichia coli J5 stimulated bactericidal IgG anti-LOS antibodies that recognize different serum-resistant gonococcal LOS epitopes . In bactericidal assays, convalescent serum from disseminated infection killed only the homologous strain while post-J5 vaccination serum killed 6 of 9 additional strains . Both convalescent and post-J5 vaccination sera mediated marker (51Cr) release from liposomes sensitized with serum-resistant gonococcal LOS (homologous strain), linking acquired killing activity to cross-reacting anti-LOS antibody . Post-J5 IgG mediated 51Cr release more effectively than did convalescent IgG . Thus, bactericidal antibody elicited by J5 vaccination is more efficacious and broadly cross-reactive against serum-resistant gonococci than is antibody elicited by natural infection . Moreover, multiple LOS epitopes may serve as bactericidal targets on serum-resistant gonococci. Microb Pathog, 1992 Aug, 13(2), 93 - 108 Effect of attachment factors (pili plus Opa) on Neisseria gonorrhoeae invasion of human fallopian tube tissue in vitro: quantitation by computerized image analysis; Gorby GL et al.; Pili (P) and opacity-associated proteins (Opa) facilitate Neisseria gonorrhoeae attachment to human fallopian tube epithelium . Subsequent effects on invasion are unproven . Computerized image analysis was used to study the effects of attachment factors on invasion by comparing a P+Opa+ variant to a P-Opa- variant of strain R10 in the fallopian tube organ culture model . Gonococci in sections of infected fallopian tube tissue were identified with FITC-labelled monoclonal anti-gonococcal antibodies . Nomarski DIC microscopy was used to establish anatomic boundaries that excluded extracellular gonococci from invasion measurements . The area of intracellular fluorescence served as an index of gonococcal invasion . With conservative criteria to exclude extracellular gonococci, the per cent of the intracellular area occupied by fluorescent P+Opa+ gonococci was 18% compared to 4.7% for the P-Opa- variant (P < 0.001) . Data suggest that P+Opa+ organisms invaded deeper than P-Opa- microbes over the same time period (P = 0.029) . Intra-observer variation in invasion measurements was not significant (P > or = 0.85), and inter-observer correlation was high (correlation coefficient = 0.96) . Computerized image analysis is a rapid, reliable means of quantifying gonococcal invasion of fallopian tube epithelium . We conclude that gonococcal attachment factors can facilitate events which enhance gonococcal invasion of fallopian tube epithelium. J Bacteriol, 1992 Aug, 174(15), 4899 - 906 Construction of a Neisseria gonorrhoeae MS11 derivative deficient in NgoMI restriction and modification; Stein DC et al.; We have cloned from Neisseria gonorrhoeae MS11 the gene encoding a methylase that modifies the sequence GCCGGC . The corresponding restriction enzyme was also encoded by this clone . Sequence analysis demonstrated that the methylase shares sequence similarities with other cytosine methylases, but the sequence organization of M.NgoMI is different from that seen for other cytosine methylases . A deletion was introduced into the chromosome of N . gonorrhoeae MS11 to produce strain MUG701, a strain that is inactivated in both the methylase and the restriction genes . Although this strain no longer methylated its DNA at the NgoMI recognition sequence, cells were viable and had no other significant phenotypic changes . Transformation data indicated that MS11 does not produce enough restriction activity to block plasmid transformation in the gonococcus, even though restriction activity could be demonstrated in E . coli containing the cloned gene. J Biosoc Sci, 1992 Jul, 24(3), 355 - 65 Endemic disease, nutrition and fertility in developing countries; Mascie-Taylor CG; PIP: Subfecundity is caused by disease and nutrition as well as by genetic, environmental, and psychological components . Sexually transmitted diseases (STDs) are caused by 21 different pathogens of which syphilis, gonorrhea, and chlamydia are the most important . Syphilis is caused by the bacterium Treponema pallidum with incidence of 10% in Thailand . 20% in Papua New Guinea, and 40% in Ethiopia . Stillbirths in infected mothers range from 66% to 80% . Gonorrhea is caused by the bacterium Neisseria gonorrhoea and its incidence was 18% in female patients in Ugandan clinic . 20% of women in Africa with cervical gonorrhea develop salpingitis . The risk of pelvic inflammatory disease is several times higher in IUD users . The bacterium Chlamydia trachomatis caused infertility in 15.4% of men in a 1991 study . Herpes simplex virus 2 infects 15-30% of sexually active adults, and the chance of fetal transmission is 40% when maternal lesions are present . Diseases other than STDs include tuberculosis (TB) whose development is aided by conditions such as malnutrition, malaria, leprosy, syphilis, and African sleeping sickness . Genital TB causes a 5-50% rate of menstrual disorders including amenorrhea and a 55-85% rate of sterility in women . Malaria is caused by Plasmodium protozoa, and the feverish state included by it can lead to oligospermia . Severe malarial anemia can lead to fetal and maternal mortality . The protozoa Trypanosoma causes African sleeping sickness that produces azoospermia and impairs the pituitary gland and ovaries . Schistosomiasis (bilharzia) and filariasis have less direct effect on fecundity but they negatively impact nutritional status . Maternal nutrition substantially impacts fetal and infant survival . During the Dutch famine of 1944-45 there was a 50% decrease in births 9 months subsequently . A 10-15% weight loss results in amenorrhea . Mol Microbiol, 1992 Jul, 6(13), 1729 - 37 Human neutrophil response to recombinant neisserial Opa proteins; Belland RJ et al.; Interactions of human neutrophils with recombinant Escherichia coli expressing gonococcal outer membrane Opa proteins were examined using chemiluminescent and biological assays . Seven opa loci from Neisseria gonorrhoeae MS11 4.8 were expressed as beta-lactamase-Opa fusion proteins that contained all but the mature N-terminal amino acid of the full-length Opa protein fused to three N-terminal amino acids derived from the mature beta-lactamase . The Opa fusion proteins were exported and assembled in the outer membrane of E . coli in a manner similar to that of Opa in N . gonorrhoeae, as evaluated by antibody binding and in situ proteolytic cleavage . All fusion proteins exhibited the characteristic heat-modifiable migration in SDS-polyacrylamide gel electrophoresis that typifies Opa proteins of neisseriae . Opa fusion proteins conferred on E . coli the ability to stimulate a chemiluminescent response from human neutrophils in the absence of antibody or complement . The nature of the response in terms of chemiluminescence, phagocytosis, and killing was in all cases analogous to that seen using N . gonorrhoeae expressing the equivalent Opa protein . Neither E . coli nor gonococci expressing OpaA elicited a response from neutrophils . Use of E . coli expressing Opa fusions should be useful in defining their biological activities and pathogenic roles. J Med Microbiol, 1992 Jul, 37(1), 51 - 5 An analysis of lectin agglutination as a means of sub-dividing gonococcal serovars; Moyes A et al.; Sixteen lectins were examined for their ability to agglutinate 298 strains of Neisseria gonorrhoeae . Seven lectins failed to agglutinate any of the strains; the remaining nine lectins gave 22 different agglutination patterns . The 298 strains were divided into 14 serovars with a single panel of monoclonal antibody typing reagents; lectin agglutination subdivided these into 57 serovar/lectin patterns . A combination of two monoclonal antibody serotyping panels divided the strains into 32 serovar combinations; lectin agglutination further subdivided these into 79 serovar/lectin patterns . There was no correlation between lectin pattern and serovar . Lectin agglutination is a simple supplementary typing method and could be particularly useful in micro-epidemiological studies. Infect Immun, 1992 Jul, 60(7), 3017 - 20 Further antigenic similarities of Neisseria gonorrhoeae lipooligosaccharides and human glycosphingolipids; Mandrell RE; Anticarbohydrate monoclonal antibodies were tested for their ability to bind to various strains of Neisseria . A monoclonal antibody that binds to the ganglio-series glycosphingolipid, ganglio-N-triaosylceramide, also bound to strains of Neisseria gonorrhoeae but not to other species of Neisseria . An antibody specific for the globo-series glycosphingolipid, globotriaosylceramide, also bound to strains of N . gonorrhoeae, Neisseria meningitidis, Neisseria lactamica, and Branhamella catarrhalis but not to any other strains of nonpathogenic Neisseria. Int J STD AIDS, 1992 Jul-Aug, 3(4), 273 - 7 Strain characteristics and antibiotic susceptibility of isolates of Neisseria gonorrhoeae causing disseminated gonococcal infection in Australia . Members of the Australian Gonococcal Surveillance Programme; Tapsall JW et al.; The auxotype (A) and serovar (S) distribution and antibiotic and serum sensitivity of 22 strains of Neisseria gonorrhoeae isolated from blood and joints were determined . With one exception, these strains from disseminated gonococcal infections (DGI) belonged to one of 4 serovars of the IA serogroup and were resistant to killing by normal human serum . The auxotype distribution of these Australian strains differed significantly from that reported elsewhere in that 17 of the 22 isolates were proline requires, but none were of the AHU auxotype . This lack of the AHU auxotype in the DGI strains in Australia was explained by the virtual absence of AHU requirers in a sample of 1560 mucosal strains isolated in Sydney and Darwin from 1987 to 1990 . The A/S distribution of these mucosal isolates also helped to account for the low (0.12) percentage of DGI strains in isolates examined by the Australian Gonococcal Surveillance Programme (AGSP) from 1981 to 1991, and the differences in the rates of DGI in Sydney (0.08%) and Darwin (0.87%) . There was a relative lack of the IA serogroup strains which are mostly responsible for DGI in the mucosal isolates from Sydney (15% of all strains) but a higher proportion of these serovars (40%) in the Darwin sample . There were 46 cases of DGI in data from the AGSP, 29 of these being women . Seven of the cases diagnosed in Australia were infected with penicillinase-producing gonococci suggesting that antibiotics other than the penicillins should now be used for this condition in this region. Ir J Med Sci, 1992 Jul, 161(7), 460 - 2 Teenage girls attending a Dublin sexually transmitted disease clinic: a socio-sexual and diagnostic profile; Fitzpatrick C et al.; Over a 12 month period, 32 teenage girls attended the sexually transmitted disease clinic in the Mater Misericordiae Hospital, Dublin for the first time, accounting for 17.8% of all first visits . Their mean age was 18.2 years (range 15-19 years) . Twenty-four (75%) were from social class V . Five (15.6%) were abusing drugs . The mean age of first coitus was 16.1 years (range 13-19 years) . The mean number of sexual partners was 1.8 (range 1-5) . Four (12.5%) had been sexually abused in the past . Fourteen (43.8%) had never used contraception . Twenty-three (71.9%) were nulligravidae: 2 were diagnosed as being pregnant in the clinic . Twelve (37.5%) were unaware of cervical cytology screening . Of 29 having intercourse without condoms, none considered themselves to be at risk of contracting HIV from their present partner . A total of 26 diagnoses were made in 23 patients (71.9%) . The most common diagnosis was ano-genital condylomata acuminata (6, 18.8%); Chlamydia trachomatis was located in 2 patients and Neisseria gonorrhoea in one . Mild to moderate dyskaryosis was reported in 4 cervical smears (12.5%) . This data highlights the need for priority targeting of this high risk group. Sex Transm Dis, 1992 Jul-Aug, 19(4), 219 - 24 Evaluation of an enzyme immunoassay and a modified coagglutination assay for typing gonococcal isolates with monoclonal antibodies; Carballo M et al.; In order to resolve methodologic and interpretation problems associated with the serotyping of Neisseria gonorrhoeae isolates with monoclonal antibodies specific for Protein I (PI) by coagglutination (the standard method; CoA1), two methods were compared with CoA1: an enzyme immunoassay (EIA) and a modified coagglutination assay (CoA2), in which methylene blue was added to the monoclonal antibody reagents . When the EIA was compared with the CoA1 method, 92.7% of the WI isolates were typed identically and 89% of the WII/III isolates were typed identically . When the CoA2 was compared with the CoA1 method, 92.7% of WI isolates were typed into similar serovars, in comparison to only 80.5% of the WII/III isolates . With the EIA method, only 21 of 328 isolates (6.4%) were retested because duplicate results were inconsistent, in comparison to 72 isolates (22%) with the CoA1 method and 120 isolates (36.6%) with the CoA2 method . In most cases result inconsistencies between duplicate tests were due to differences in reading weakly positive coagglutination reactions with single reagents (which on duplicate testing might be negative), the most notable being PIA reagent 4A12(b) and PIB reagents 1F5(b) and 2G2(g) . The EIA method was the most reproducible method, and provides some degree of automation when serotyping large numbers of isolates. Sex Transm Dis, 1992 Jul-Aug, 19(4), 213 - 8 Temporal trends in gonococcal antibiotic resistance in Baltimore; Reichart CA et al.; Each month from August 1986 through July 1990, clinical and laboratory data were evaluated for the first 25 urethral isolates of Neisseria gonorrhoeae from men attending a Baltimore sexually transmitted disease (STD) clinic as part of an effort to understand factors that contribute to changes in gonococcal antimicrobial susceptibility . During the 48-month study period, 1193 gonococcal isolates were evaluated; the proportion of penicillinase-producing N . gonorrhoeae (PPNG) isolates steadily increased, the prevalence of tetracycline-resistant N . gonorrhoeae (TRNG) remained relatively stable, and chromosomally mediated penicillin resistance increased steadily during the first 5 6-month intervals, then decreased, only to increase again during the final 2 6-month intervals . Changes in antibiotic treatment regimens for gonorrhea were associated with changes in the prevalence of chromosomally mediated penicillin resistance . In a supplementary study to characterize patterns of antibiotic use among men and women attending the STD clinics, 9% of patients reported antibiotic use in the 2 weeks prior to clinic visit . Antibiotics were taken prior to clinic attendance by 65% of patients reporting antibiotic use, because of concerns regarding possible STD or STD exposure . These patients were significantly less likely to be culture positive for N . gonorrhoeae when compared with patients who did not report antibiotic use . Temporal trends in N . gonorrhoeae antibiotic resistance appear to be influenced by many factors, including treatment regimens and self medication. Sex Transm Dis, 1992 Jul-Aug, 19(4), 206 - 12 The emergence of penicillinase-producing Neisseria gonorrhoeae strains carrying the 4.9 kb (Toronto) plasmid in Denmark and of a novel large plasmid in two nonpenicillinase-producing Neisseria gonorrhoeae strains; Reimann K et al.; This study comprised plasmid analysis and antimicrobial susceptibility testing of 712 out of a total of 730 penicillinase-producing Neisseria gonorrhoeae (PPNG) and 744 random non-PPNG strains isolated in Denmark between 1985 and 1990 . The rate of patients with PPNG infections rose from 1% to 2% during 1985-1987 to 6.9% in 1989, and then decreased to 4.8% in 1990 . A decrease in cases of gonorrhea from 9,798 to 1,990 was seen during the same period . Strains harboring the 4.9 kb (Toronto) plasmid first appeared in 1987; in 1988-1990, 65% to 78% of strains from patients with PPNG infections acquired in Denmark contained this plasmid . The majority of these strains seemed to belong to a single clone . Tetracycline-resistant PPNG strains (MIC greater than 32 mg/L) first appeared in Denmark in 1989, and tetracycline-resistant non-PPNG strains carrying a 40 kb plasmid (tetM?) first appeared in 1990 . A novel 41-42 kb plasmid appeared in one strain in 1987 and another in 1988 . The minimum inhibitory concentration (MIC) of tetracycline for these two strains was 4 mg/l . The significance of this plasmid is yet unknown. J Antimicrob Chemother, 1992 Jul, 30 Suppl A, 53 - 8 A collaborative study of the in-vitro sensitivity to RP 59500 of bacteria isolated in seven hospitals in France; Soussy CJ et al.; The in-vitro activity of RP 59500 was determined against 1051 recent clinical bacterial isolates . The susceptibility to RP 59500 was determined with an agar dilution technique for all the isolates, while MICs and MBCs were determined for 82 selected strains in broth . Isolates of both Staphylococcus aureus and coagulase-negative staphylococci appeared to be potentially susceptible to RP 59500, independent of susceptibility to methicillin or MLS resistance . (S . aureus: methicillin-sensitive, MIC90, 1.0 mg/L; methicillin-resistant, MIC90 1.0 mg/L; coagulase-negative staphylococci: methicillin-sensitive, MIC90 0.5 mg/L) . Lancefield group A, B, C and G streptococci (MIC50 0.5 and MIC90 1.0 mg/L) and Streptococcus pneumoniae (MIC50 0.5 and MIC90 1.0 mg/L) appeared to be susceptible to RP 59500 . Some Streptococcus spp . and enterococci as well as Listeria monocytogenes were inhibited by a higher concentration of RP 59500 (enterococci: MIC90 4 mg/L, range 0.125-16 mg/L) . Comparatively low MICs were seen when Legionella spp., Neisseria gonorrhoeae and Gardnerella vaginalis were tested . Broth dilution MIC/MBC determinations showed no evidence of tolerance, as MIC values were within two dilutions of MBC values . RP 59500 might be a useful compound in the treatment of infections caused by a range of Gram-negative and Gram-positive bacteria, including those resistant to methicillin and/or macrolides. Eur J Clin Microbiol Infect Dis, 1992 Jul, 11(7), 602 - 9 Evaluation of a fluorescent DNA hybridization assay for the detection of Neisseria gonorrhoeae; Cano RJ et al.; This study evaluates a four-hour fluorescent DNA hybridization assay using both known bacterial isolates and clinical specimens . A biotinylated oligonucleotide probe from a sequence of the plasmid-encoded gene cppB was used . Hybrids were detected by addition of a streptavidin-alkaline phosphatase conjugate, followed by incubation for 30 min in a fluorescent substrate for alkaline phosphatase . The level of detection of the fluorescent assay was 0.1 pg of cryptic plasmid DNA or 200 cfu of the plasmid-containing strain NG 34/85 of Neisseria gonorrhoeae . A total of 119 reference strains of Neisseria gonorrhoeae and other related bacteria were tested for reactivity with the probe . All Neisseria gonorrhoeae strains, including eight plasmid-free strains, hybridized with the probe . Fluorescence ratios were 2.67 for plasmid-free strains and 3.85 for plasmid-containing strains . Of the heterologous microorganisms tested, only one of six strains of Neisseria cinerea gave a fluorescence ratio above the 2.0 cut-off value for positivity with the probe at a cell density of 1 x 10(4) cfu . The probe was also evaluated using clinical specimens from 100 patients attending a clinic for sexually transmitted diseases . The sensitivity of the assay was 100% while the specificity was 97.5% . Positive and negative predictive values were 91.2% and 100%, respectively . The fluorescent DNA hybridization assay for the detection of Neisseria gonorrhoeae described here thus appears to be a highly specific and sensitive assay. Biotechnology (N Y), 1992 Jul, 10(7), 799 - 804 Sequence-specific cleavage of protein fusions using a recombinant Neisseria type 2 IgA protease; Pohlner J et al.; Sequence-specific enzymatic cleavage of protein fusions is an important application in recombinant protein technology . We have used the Neisseria type 2 IgA protease (EC 3.4.24.13), produced and secreted by Escherichia coli host cells, for efficiently processing polypeptides at authentic or engineered target sites . In different substrates, the microbial protease specifically cleaves the peptide bond distal to the second Pro residue of the sequence Yaa-Pro-/-Xaa-Pro, where Yaa stands for Pro (or rarely for Pro in combination with Ala, Gly or Thr) and Xaa stands for Thr, Ser or Ala . Highly specific proteolysis has been obtained not only with soluble and purified protein fusions but also with insoluble aggregates derived from cytoplasmic inclusion bodies . The sequence-specificity and simple production of the recombinant IgA protease make it a versatile tool for the in vitro processing of recombinant proteins. Mol Microbiol, 1992 Jul, 6(14), 1887 - 94 PulO, a component of the pullulanase secretion pathway of Klebsiella oxytoca, correctly and efficiently processes gonococcal type IV prepilin in Escherichia coli; Dupuy B et al.; The PulO protein required for extracellular secretion of pullulanase by Klebsiella oxytoca is known to be highly homologous to two type IV prepilin peptidases, namely XcpA(PilD) (Pseudomonas aeruginosa) and TcpJ (Vibrio cholerae) . The predicted prepilin peptidase activity of PulO was confirmed by showing that it could correctly process the product of the cloned pilE.1 type IV pilin structural gene from Neisseria gonorrhoeae in Escherichia coli . The P . aeruginosa prepilin peptidase and another putative prepilin peptidase, ComC from Bacillus subtilis, also processed prePilE . Subcellular fractionation showed that the pilE gene product that had been processed by PulO remained associated with the cytoplasmic membrane, as did the unprocessed precursor . PulO was also shown to process three of the four prePilE-PhoA hybrids tested . Southern hybridization experiments suggest that a pulO homologue is present in the N . gonorrhoeae chromosome. J Infect Dis, 1992 Jul, 166(1), 173 - 7 Genetic diversity of penicillin-resistant Neisseria meningitidis; Campos J et al.; The genetic relatedness of 42 penicillin-resistant Neisseria meningitidis isolates obtained during a 2-year period from a single hospital was studied by multilocus enzyme electrophoresis and by restriction fragment length polymorphism (RFLP) analysis of penicillin-binding protein (PBP) 2 genes . The PBP 2 genes of 7 susceptible strains gave identical RFLP profiles . Sixteen different PBP 2 RFLP profiles were found among the 42 resistant strains, but 4 were found in greater than 1 resistant isolate . Multilocus enzyme electrophoresis revealed a high level of genetic diversity . Four clusters of resistant strains could be distinguished at a genetic distance of 0.75 . Resistant strains with the most common PBP 2 RFLP profile were restricted to one of these clusters and may be derived from a common ancestral strain . However, resistant strains with the 3 other common RFLP profiles were distributed in two or more of the clusters. Int J Gynecol Pathol, 1992 Jul, 11(3), 197 - 203 Prevalence and cytologic manifestations of human papilloma virus (HPV) types 6, 11, 16, 18, 31, 33, 35, 42, 43, 44, 45, 51, 52, and 56 among 500 consecutive women; Kiviat NB et al.; The prevalence and associated cytologic manifestations of cervical infection with human papillomavirus (HPV) types 6, 11, 16, 18, 31, 33, 35, 42, 43, 44, 45, 51, 52, and 56 were studied among 500 consecutive women attending the Harborview Medical Center Sexually Transmitted Diseases (STD) Clinic in Seattle, WA . Using radiolabeled-probes without prior amplification of DNA, HPV DNA was detected in cervical specimens from 120 (24%) of the women and was found to be more prevalent than Chlamydia trachomatis (13%), Neisseria gonorrhoeae (12%), or mucopurulent cervicitis (20%) . High-risk HPV types 16 or 18 were present alone in 5% of the women; intermediate-risk types 31, 33, 35, 45, 51, 52, or 56 in 3%; and low-risk types 6, 11, 42, 43, and 44 in 5% . In an additional 8% HPV DNA was detected but could be characterized only as being type 6, 11, 16, 18, 31, 33, or 35 . Each grouping of HPV types was equally associated with squamous intraepithelial lesions (SILs) of the cervix . In the absence of SIL and koilocytosis, the cytologic changes associated with HPV infection included frequent binucleation and variation in nuclear size and chromatin distribution . Parakeratosis and hyperkeratosis without nuclear atypia were not associated with HPV DNA . The natural history and clinical significance of these HPV-associated lesions remain to be defined. Tidsskr Nor Laegeforen, 1992 Jun 20, 112(16), 2082 - 4 {Chlamydia trachomatis and Neisseria gonorrhoeae among women seeking abortion in Norway . Results from a nationwide study}; Skjeldestad FE et al.; In April and May 1991 all women requesting abortion in Norway were screened for Chlamydia trachomatis and Neisseria gonorrhoeae . During the study period 2,194 abortions were carried out . The study included 2,110 women with representative tests for C trachomatis from the cervix uteri . Only 1,702 women were tested for N gonorrhoeae . The prevalence of N gonorrhoeae was 0.5% (8:1,702), and of C trachomatis 5.4% (113:2,100) . The prevalence of C trachomatis decreased from 9.1% among women less than or equal to 19 years to 2.0% among women greater than or equal to 35 years of age . Prevalence of C trachomatis was significantly lower among subjects resident in health region no . IV (mid-western part of Norway) than among candidates for abortion from the other four health regions . Being less than 25 years of age was the best single parameter for identifying chlamydia-positive cases . The prevalence of N gonorrhoeae among women seeking abortion in Norway is so low that screening is not recommended . However, the prevalence of C trachomatis is still high enough to recommend screening of all women less than 25 years of age who request abortion . Chlamydia-positive cases should be tested for N gonorrhoeaePIP: Between April 2 and May 31, 1991 a total of 2259 women requesting abortion in Norway were screened for Chlamydia trachomatis and Neisseria gonorrhoea . During the study period, 2194 abortions were carried out, but chlamydia tests were not done in 32 cases . The study included 2110 women with representative tests for C . trachomatis from the cervix uteri . Only 1702 women were tested for N . gonorrhoea . Almost 60% of the chlamydia tests were analyzed by means of the enzyme-linked immunosorbent assay (ELISA), and 36% of cases a culture was produced . 5.6% of chlamydia tests analyzed with ELISA were positive, the corresponding result with culture was 5.1% . The prevalence of N . gonorrhea was .5% (8/1702) and of C . trachomatis 5.4% (112/2100) . 5 of the gonorrhea-positive women were also positive for chlamydia . The prevalence of C . trachomatis decreased from 9.1% among women or= 19 years to 2% among women or= 35 years of age . Prevalence of C . trachomatis was significantly lower among patients residing in health region IV (the midwestern part of Norway) than among abortion seekers from the other 4 health regions, which could not be clarified by age or civil status factors . Age under 25 years was the best single parameter for identifying chlamydia-positive cases . The prevalence of N . gonorrhea among women seeking abortion in Norway is so low that screening is not recommended . However, the prevalence of C . trachomatis is still high enough to recommend screening of all women under 25 years of age who seek abortions . Chlamydia-positive cases also should be tested for N . gonorrhea . Tidsskr Nor Laegeforen, 1992 Jun 20, 112(16), 2080 - 1 {Which women should be tested for Chlamydia trachomatis in general practice?}; Halvorsen LE et al.; Specimens to test for Chlamydia trachomatis and Neisseria gonorrhoeae were collected as a routine from female patients undergoing gynecological examinations in general practice . In 3.9% of 517 non-pregnant women the culture for C trachomatis was positive . None were infected with N gonorrhoeae . C trachomatis was detected in ten of 138 (7.2%) women with genital symptoms, compared with ten of 379 (2.6%) without symptoms . The annual incidence rate for C trachomatis in asymptomatic patients was 0.3% for women older than 25 years, and 5.4% for women younger than 25 years . Routine testing for C trachomatis is recommended during gynecological examination in general practice of asymptomatic women younger than 25 years . Tests should be taken at minimum two-year intervals . Routine tests for N gonorrhoeae are not recommended. Proc Natl Acad Sci U S A, 1992 Jun 15, 89(12), 5512 - 6 Escherichia coli expressing a Neisseria gonorrhoeae opacity-associated outer membrane protein invade human cervical and endometrial epithelial cell lines; Simon D et al.; Members of the opacity-associated (Opa) outer membrane protein family of Neisseria gonorrhoeae have been proposed to mediate adherence to and invasion of cultured human epithelial cells . We transformed Escherichia coli with a plasmid containing a gonococcal opa gene fused in-frame to the leader sequence of the beta-lactamase gene as described by Palmer et al . {Palmer, L., Brooks, G . F . & Falkow, S . (1989) Mol . Microbiol . 3, 663-671} . These transformed E . coli {E . coli (opa)} expressed the heat-modifiable opa gene product (the Opa protein) in their outer membrane and adhered to and invaded ME-180 human endocervical epithelial cells . In a 2-h adherence assay, an average of 26.7 E . coli (opa) adhered per ME-180 cell, whereas the control E . coli carrying only the expression vector (pKT279) did not adhere at all (less than 0.15 bacterium per cell) . We investigated the ability of the adherent E . coli (opa) to invade ME-180 epithelial cells by using a gentamicin selection assay . We recovered up to 1 x 10(6) gentamicin-resistant bacteria per monolayer when ME-180 cells were infected with E . coli (opa) compared to less than 10 bacteria when the epithelial cells were infected with the same number of control E . coli (pKT279) . The kinetics and level of invasion by E . coli (opa) were similar to invasion by Opa+ N . gonorrhoeae . Maximum invasion occurred 4 h after infection with 4 x 10(7) bacteria . Transmission electron microscopy studies confirmed that E . coli (opa) invaded ME-180 cells . In comparative studies, the number of E . coli (opa) that invaded HEC-1-B human endometrial epithelial cells was about an order of magnitude less than the number that invaded ME-180 cells, and E . coli (opa) did not invade Chang human conjunctival epithelial cells at all . The observations that early (less than 4 h) invasion by E . coli (opa) was dramatically inhibited, in a dose-responsive manner, by the actin-disrupting reagent cytochalasin D but later invasion (8-24 h) was not suggest that invasion mediated by Opa proteins may occur by two mechanisms, only one of which is dependent upon microfilament function . Transmission electron microscopy also revealed that infected epithelial cells had a dramatically increased amount of cytoplasmic fibrillar material surrounding the nucleus . The function and genesis of this material remain unclear . These studies indicate that at least one gonococcal Opa protein is an invasin. Proc Natl Acad Sci U S A, 1992 Jun 15, 89(12), 5366 - 70 Gene conversion in Neisseria gonorrhoeae: evidence for its role in pilus antigenic variation; Zhang QY et al.; Antigenic variation of gonococcal pili results from the unidirectional transfer of genetic information from variant-encoding partial pilin genes to an active expression locus . Two potential mechanisms that may result in the observed alterations of gene linkage and organization are conversion and transformation . To determine the relative contributions of these two distinct pathways of recombination to pilus variation, gonococcal strains carrying defined frameshift, missense, and nonsense mutations within the pilin expression locus were constructed . Reversion to a piliated state required correction of the lesions and provided a simple means of scoring productive recombination and antigenic variation . Examination of the mutants revealed a lack of correspondence between the frequencies with which they could be transformed (10(-6) per recipient) and the incidence with which they gave rise to revertants (greater than 10(-4) per colony-forming unit per generation) . Further, the rates of reversion demonstrated by these mutants were not altered by growth in the presence of DNase I, conditions that abolished intercellular transfer of chromosomal markers during cultivation . Through the use of a pilin mutant in which a frameshift mutation encompassed the introduction of a restriction endonuclease site, the symmetry of recombination that resulted in reversion could be scored by Southern hybridization . In all cases examined, the DNA alterations responsible for pilin variation were nonreciprocal events . The results favor the model that productive pilin gene rearrangements in gonococci arise by gene conversion. Singapore Med J, 1992 Jun, 33(3), 279 - 81 Changing trends in the epidemiology and management of gonococcal ophthalmia neonatorum; Gururaj AK et al.; Between June 1985 and December 1988, 58 cases of gonococcal ophthalmia neonatorum were admitted to the neonatal unit at the University Hospital (USM) . Of these, 15 (25.9%) cases were due to penicillin-resistant strains of Neisseria gonorrhoea . Of the 58 cases, 56 cases were treated effectively with a single dose of antibiotic given systemically . The mean period of recovery was shorter with spectinomycin in doses of 40 mg/kg than with cefotaxime (100 mg/kg) . There was no permanent sequelae in the treated cases . An increasing incidence of infection with penicillin-resistant strains of N . gonorrhoea has been observed in the area of study. Hautarzt, 1992 Jun, 43(6), 352 - 8 {Local and systemic humoral immune response to protein I of Neisseria gonorrhoeae}; Kohl PK et al.; Knowledge of the immune response to natural infection with Neisseria gonorrhoeae is presupposition for the development of a gonococcal vaccine . Pili and protein I have gained importance for a subunite vaccine . A pilus vaccine proved to be ineffective in a field trial due to extensive pilus variability . According to an alternative strategy protein I may represent an important vaccine candidate for a gonococcal vaccine . To study the local and systemic, humoral immune response to N . gonorrhoeae cervical secretion, vaginal fluid and serum from prostitutes and family planning patients were compared by the use of a protein I ELISA . In local secretions and in serum patients in the study group showed significantly higher anti-protein-I-IgA-levels than patients in the control group . In cervical secretion immune response to an acute gonococcal infection consisted of a short lived, significant increase of anti-protein-I-IgA, while anti-protein-I-IgG showed a lower, but longer lasting significant increase . The course of the immune response in vaginal fluid reflected the immune response of cervical secretion at a lower level . In serum antigenic stimulus of a local gonococcal infection resulted in a significant but short lived protein I specific IgG immune response . In local infection with N . gonorrhoeae protein I represents a target antigen of the local and systemic immune response . Clear differences exist between local and systemic humoral immune response in the protein I reactive immunoglobulin class and in the course of reactivity . In the future it may be possible to define epitopes on protein I which induce protective immunity. J Dent, 1992 Jun, 20(3), 145 - 51 Development of dental plaque on the incisor teeth of monkeys (Macaca fascicularis); Radford JR et al.; Bacterial plaque which had accumulated for 0.5, 1, 2, 4, 7, 14 and 28 days was cultured from the labial surface of one of the central incisor teeth in 15 monkeys (Macaca fascicularis) . Each sampling area was defined by a metal well contained within a custom-made removable acrylic block . The number (log10) of the total colony forming units (c.f.u.) increased significantly from 3.40 to 6.02 between 0.5 and 28 days . Similarly the number of streptococci increased from 2.80 to 4.79 during the same period, although when expressed as a percentage of the total c.f.u., the proportions decreased from 34.9 per cent at 1 day to 6.9 per cent at 7 days and then remained at that level . The number of micro-aerophilic actinomyces increased throughout the period of plaque accumulation and comprised 15.3 per cent of the total c.f.u . at 28 days . Neisseriae were infrequently isolated from 0.5- and 1-day-old plaque and were not recovered at more than 1 per cent of the total c.f.u . during any period of plaque accumulation . The fastest doubling time (median) of the total c.f.u . was 1.9 h (range 1.3-18.5 h) . The rapid development of dental plaque after tooth cleaning emphasizes the importance of regular and meticulous oral hygiene to control the accumulation of potentially periodontopathic and cariogenic bacteria. Genitourin Med, 1992 Jun, 68(3), 170 - 3 Genomic fingerprinting of penicillinase-producing strains of Neisseria gonorrhoeae in Valencia, Spain; Dasi MA et al.; OBJECTIVE--To compare the value of different markers and their combinations with the restriction enzyme technique in the differentiations of penicillinase-producing N . gonorrhoeae (PPNG) strains . MATERIALS AND METHODS--17 PPNG strains isolated from symptomatic, untreated male patients with urethritis were characterised by antibiotic sensitivity testing, auxotyping, serotyping, plasmid profile, and restriction endonuclease fingerprinting (Hind III digestion) . Cluster analysis with the method of unweighted pair-group average (UPGMA) linkage was used to calculate similarity or dissimilarity for PPNG strains . MAIN RESULTS--Either auxotyping or plasmid profile alone differentiated three groups of PPNG strains, whereas the combination auxotyping/serotyping identified 10 . Although the combination auxotyping/serotyping/plasmid profile and the restriction enzyme technique showed a similar discrimination ability (differentiation of 11 PPNG strains), genomic fingerprinting gave highly specific restriction patterns on individual gonococcal isolates . CONCLUSIONS--The combination of different markers gave more epidemiological information than the use of only one . The sequence of discriminating ability for PPNG strains was: auxotyping/serotyping less than auxotyping/serotyping/plasmid profile less than restriction patterns of genomic DNA. Fertil Steril, 1992 Jun, 57(6), 1177 - 9 Earth, motherhood, and the intrauterine device; Eschenbach DA; PIP: Commentary is provided on the relationship between the use of the IUD and infertility from the development of pelvic inflammatory disease (PID), preventive behavior for those using an IUD, and recent reviews of the Dalkon Shield . Among IUD users who have never been pregnant, tubal infertility is increased 2-6 fold (200-600%), and most with tubal infertility will never bear a child . Tubal infertility develops in 11% of patients with PID, but most IUD users do not develop PID . The physicians responsibility is 1) to give formal and extensive recognition to the connection that IUD uses causes PID; 2) to inform patients of the potential risk of PID and sterility; 3) to develop proper patient selection for an IUD; 4) to identify and treat PID, which may appear initially as abnormal uterine bleeding and mild pain; 5) to recognize that the IUD facilitates the development of PID in patients with Neisseria gonorrhoea and Chlamydia trachomatis even though 25-50% of IUD patients have neither infection; 6) to recognize that the risk of PID is increased in the first 4-6 months of insertion and to research alternatives, e.g . the use of available antibiotics to treat selected patients to reduce infections, and 7) to realize that most PID occurs 6 months after insertion and indolent abscess formation is expected to increase among longterm copper IUD users . The reviews referred to in this article are ones claiming unfair removal of the Dalkon Shield in 1974 based on flawed study design and analysis of case control and the understanding that the Dalkon Shield is no worse than other IUDs and not related to PID . The author points out that neither review mentions that primary tubal infertility increased 6-fold among Dalkon Shield users who had used only 1 IUD in their life, and that infertility increased 3-fold among IUD users compared with the non-IUD using population . The case control studies provide enough evidence for the cause and effect relationship . The Kronmal et al . article did not present convincing new evidence even with reanalysis of the original Lee et al . data . In the Memford and Kessel review case controlled studies are excluded from consideration . Most PID goes unrecognized . The rate of PID cannot be determined . The goal is to protect patients and reduce population . The enemy is not physicians with opposing positions on this issue . EMBO J, 1992 Jun, 11(6), 2327 - 35 Selective extracellular release of cholera toxin B subunit by Escherichia coli: dissection of Neisseria Iga beta-mediated outer membrane transport; Klauser T et al.; The C-terminal domain (Iga beta) of the Neisseria IgA protease precursor is involved in the transport of covalently attached proteins across the outer membrane of Gram-negative bacteria . We investigated outer membrane transport in Escherichia coli using fusion proteins consisting of an N-terminal signal sequence for inner membrane transport, the Vibrio cholerae toxin B subunit (CtxB) as a passenger and Iga beta . The process probably involves two distinct steps: (i) integration of Iga beta into the outer membrane and (ii) translocation of the passenger across the membrane . The outer membrane integrated part of Iga beta is the C-terminal 30 kDa core, which serves as a translocator for both the passenger and the linking region situated between the passenger and Iga beta core . The completeness of the translocation is demonstrated by the extracellular release of the passenger protein owing to the action of the E . coli outer membrane OmpT protease . Translocation of the CtxB moiety occurs efficiently under conditions preventing intramolecular disulphide bond formation . In contrast, if disulphide bond formation in the periplasm proceeds, then translocation halts after the export of the linking region . In this situation transmembrane intermediates are generated which give rise to characteristic fragments resulting from rapid proteolytic degradation of the periplasmically trapped portion . Based on the identification of translocation intermediates we propose that the polypeptide chain of the passenger passes in a linear fashion across the bacterial outer membrane. J Pediatr, 1992 Jun, 120(6), 872 - 7 Comparison of the vaginal flora in sexually abused and nonabused girls; Gardner JJ; The presence of sexually transmitted pathogens in the vagina of the sexually abused girl may provide direct evidence of sexual abuse; the presence of other abnormal vaginal organisms may provide indirect evidence of abuse . To identify abnormal vaginal organisms, we prospectively studied the flora of 209 sexually abused girls (cases) and compared it with that in a concurrent control group of 108 girls . Case and control subjects were from the same community, were predominantly white, and 71% of each group were 3 to 10 years of age . The sexually transmitted pathogens (Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, herpes simplex virus) were isolated exclusively from the case group at a low frequency (less than 1%) . The isolation of Mycoplasma species exclusively in the case group (4%), and of Gardnerella vaginalis in 7% of the case group versus 1% of the control group, suggests that both these organisms may be sexually transmitted . Other bacteria also were collectively more frequent in the case group (16% vs 6%) . There may be an association between sexual activity and colonization of the lower genital tract in young girls. Kansenshogaku Zasshi, 1992 Jun, 66(6), 743 - 53 {Epidemiological and bacteriological study on gonococcal infections}; Nishimura M et al.; Epidemiological and bacteriological studies on Neisseria gonorrhoeae isolated in Sapporo, Japan, in 1980 and 1991 performed and the following results were obtained . 1 . The range of age in the patients infected with Neisseria gonorrhoeae tended to be younger than those in the whole country . 2 . Male patients in the early 20s or younger with gonococcal urethritis were often infected by bon-professional females but those in their late 20s or older were often infected from professional females, for example prostitutes and hostesses . 3 . The rate of professional females who were positive to gonococci reached 17.4% and young females in their teens with cervicitis had the highest morbidity rate of gonococci than those in the older females . 4 . The latent period in gonococcal infections tended to become longer gradually . 5 . The isolation rate of penicillinase producing Neisseria gonorrhoeae (PPNG) showed a peak of 23.9% (61/255) in 1985, but gradually declined thereafter and it was 3.7% (1/27) in 1991 . 6 . An investigation on auxotype showed a decline of proto and Pro-strains and an increase of AHU-strains in non-PPNG . And most of the PPNG belonged to proto or Pro-strains . 7 . With the relationship between auxotype and sensitivity to AMPC, AHU-strains were more sensitive than proto or Pro-strains. Zhonghua Liu Xing Bing Xue Za Zhi, 1992 Jun, 13(3), 129 - 33 {Multilocus enzyme electrophoretic types of Neisseria meningitidis serogroup B and their epidemiologic significances}; Li X; In order to expand the epidemiologic relationships between the strains of Neisseria meningitidis serogroup B isolated from patients and carriers, 57 cases and 45 carrier isolates were collected in 11 provinces and 2 municipalities of China since the 1970s and their multilocus enzyme electrophoretic types and clonal population structures were studied by multilocus enzyme electrophoresis . It was primarily found that the above strains could be divided into 69 electrophoretic types (ET) and 13 clones . Among others, the clone I was the most important one, because the clone I represented 63.7% of all strains tested and 77.2% of the case isolates and its district distributions were quite wide since the 1970s . In addition, it was an obvious tendency that more and more of the case isolates gathered up the clone I since 1984 and the predominant ETs also occurred in the complex ET 1 and ET 24 of the clone I . As compared with the case isolates, the above carrier isolates displayed more heterogenetic types . Only 40% of all carrier isolates belonged to the above clone I and predominant ETs. Br J Obstet Gynaecol, 1992 May, 99(5), 434 - 8 A double-blind randomized study of the effect of erythromycin in preventing pelvic inflammatory disease after first trimester abortion; Sorensen JL et al.; OBJECTIVE: To assess the prophylactic use of erythromycin in prevention of post-abortal pelvic inflammation disease (PID) in first trimester abortion . DESIGN: Double-blind, randomized controlled trial . SETTING: Department of Surgery, County Hospital, Denmark . SUBJECTS: Four hundred and thirty two women who were to undergo induced abortion before 12 weeks gestation were randomized to be treated either with prophylactic erythromycin or a placebo . INTERVENTION: The women were randomized to receive a placebo or erythromycin, 500 mg twice a day for 7 1/2 days starting the evening before the abortion . All the women were investigated for Chlamydia trachomatis and Neisseria gonorrhoea before the abortion . MAIN OUTCOME MEASURES: Frequency of cervical C . trachomatis and N . gonorrhoea and frequency of PID after abortion . RESULTS: Fifty four women were excluded after randomization . The frequency of PID was 11% (20/189) in the erythromycin group and 16% (30/189) in the placebo group (P = 0.13, chi 2-test) . The prevalence of C . trachomatis was 19% (15/78) in women less than or equal to 20 years of age, 13% (14/109) in women between 21 and 25 years and 2% (5/241) in women greater than or equal to 26 years of age . In women positive for C . trachomatis erythromycin prophylaxis significantly reduced the frequency of PID to 8% (1/13) compared with 43% (6/14) in the placebo group (P = 0.051, logistic regression analysis) . Erythromycin had no effect on other potential high risk groups (first pregnancy, nulliparous, less than 20 years of age, and women with previous PID) . CONCLUSION: Prophylactic erythromycin is not warranted for all women having an abortion . Cervical C . trachomatis is a risk factor for postabortal PID, and prophylaxis with erythromycin significantly reduces the frequency of PID . However, only a few women with PID had cervical C . trachomatis, and the prevention of post-abortal PID remains a major challenge requiring further studies. Salud Publica Mex, 1992 May-Jun, 34(3), 292 - 300 {Use of molecular biology in the epidemiological characterization of Neisseria gonorrhoeae}; Nader-Garcia E et al.; This paper describes current methods useful to define molecular markers from a collection of Neisseria gonorrhoeae strains . The procedures of auxotyping, serotyping and plasmid profiling led to the obtention of 10 auxotypes, 19 serotypes and five plasmid types (including beta-lactamase plasmids) among 41 gonococci studied . Twelve patterns of antimicrobial resistance were determined as well, through in vitro susceptibility testing by agar dilution . These tools in conjunction, offer the possibility to study gonorrhea in a dynamic fashion from an epidemiologic perspective . Furthermore, they have allowed us to establish a gonococcal reference laboratory in our institution. Klin Padiatr, 1992 May-Jun, 204(3), 163 - 70 {Meningitis in 154 children of a pediatric clinic in Germany: clinical and epidemiologic aspects}; Hensel M et al.; In a retrospective study, the histories of the non-neonates treated for primary meningitis in the Pediatric Department of Mainz University Hospital between 1986 and 1989 were analyzed with regard to etiological, diagnostic, clinical and epidemiological criteria . In the period studied there were 37 cases of infectious meningitis (11 Neisseria meningitidis (29.7%), 7 H . influenzae (18.9%), 3 S . pneumoniae (8.1%), 16 other (43.2%)), and 117 cases of acute aseptic meningitis syndrome (12 mumps virus (10.3%), 3 Borrelia burgdorferi (7.7%), 3 FSME (2.6%), 2 herpes simplex virus, 91 other (77.8%)) . Sixty-six percent of the patients were male . Of the infants with infectious meningitis, 68% were under 5 years old . In contrast, 69% of the children with noninfectious meningitis were aged 5 or older . While 70% of the infectious meningitis cases occurred in fall and winter, 64% of the cases of acute aseptic meningitis syndrome occurred in spring and summer . In differential diagnosis between infectious and acute aseptic meningitis syndrome maximal sensitivity was a CRP value exceeding 0.5 mg/dl, a CSF lactate value of over 3 mmol/l and a CSF cell count of over 2000/3 cells . In none of the cases did a second or third lumbar puncture furnish information additional to that which could have been deduced from physical examination and course of temperature . A second lumbar puncture failed to produce unexpected results, or have consequences for therapy, in any of the 14 cases with noninfectious meningitis . Of 37 infants with infectious disease, one (2.7%) died from the sequelae of pneumococcal meningitis . Recovery was partial in 8 (22.2%) of the 36 surviving infants.(ABSTRACT TRUNCATED AT 250 WORDS) Hinyokika Kiyo, 1992 May, 38(5), 629 - 32 {Bacteriological and clinical studies on levofloxacin in male gonococcal urethritis}; Saito I et al.; We performed basic and clinical studies in male gonococcal urethritis on a new oral antimicrobial agent, levofloxacin (LVFX, DR-3355), a new quinolone derivative . The antibacterial activity of LVFX against clinical strains of Neisseria gonorrhoeae was roughly comparable to that of ofloxacin, and ciprofloxacin . LVFX was administered to 10 males with gonococcal urethritis, 200 mg twice a day (8 cases