Neisseria

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) or 100 mg twice a day for 3 days (2 cases) . Clinical evaluation was made according to the criteria of the Japanese UTI Committee . Overall efficacy rate was 100% (10/10) . In the complication of chlamydia trachomatis (2 cases), efficacy rate was 100% (2/2) . No subjective or objective adverse reactions occurred.

J Clin Pathol, 1992 May, 45(5), 439 - 42
Polymerase chain reaction for the detection of Neisseria gonorrhoeae in clinical samples; Ho BS et al.; AIMS: To evaluate the use of a cppB gene derived polymerase chain reaction (PCR) assay for direct detection of Neisseria gonorrhoeae in clinical samples . METHODS: A PCR assay was performed on 33 N gonorrhoeae strains and 12 other Neisseria species and other normal genital flora to evaluate the specificity of the chosen cppB primers . The assay was subsequently evaluated with 52 clinical swab samples collected from China . RESULTS: An amplified product of 390 base pairs (bp) was observed with all the N gonorrhoeae strains, each of these products on digestion with the restriction enzyme MspI produced two bands of 250 bp and 140 bp respectively . This set of primers did not produce any amplified product of the expected length with the other non-gonococcal strains tested . For the 52 clinical swabs, 34 were culture positive and PCR successfully detected all these positives . In addition the PCR was positive for two swabs which were culture negative but positive for N gonorrhoeae antigens when tested with the ELISA method (Gonozyme) . CONCLUSIONS: This PCR assay is a promising diagnostic tool for detection of gonococci directly from clinical swab samples . Further evaluation is necessary.

J Clin Microbiol, 1992 May, 30(5), 1205 - 9
Detection of bacterial growth by gas absorption; Waters JR; When 24 different aerobic organisms were grown in a shaken culture, all were found to first absorb gas from the headspace . In a rudimentary medium, such as tryptic soy broth, 16 of the 24 organisms did not produce gas following the initial gas absorption . We have developed a simple, noninvasive method for detecting both gas absorption and production in multiple culture vials . The time to positivity was compared with that obtained by the BACTEC 460 blood culture system . For nearly all of these organisms, there was no difference . For some of those organisms that did not produce gas, e.g . Staphylococcus epidermidis, Moraxella osloensis, and Neisseria meningitidis, detection by gas absorption was a few hours faster . Gas absorption appears to be a promising technique for a new automated blood culture system because of its simplicity and because medium without special additives can be used to detect organisms that do not produce gas.

J Clin Microbiol, 1992 May, 30(5), 1162 - 6
Evaluation of culture and the Gen-Probe PACE 2 assay for detection of Neisseria gonorrhoeae and Chlamydia trachomatis in endocervical specimens transported to a state health laboratory; Limberger RJ et al.; The Gen-Probe PACE 2 assay (Gen-Probe Inc., San Diego, Calif.) was compared with culture for the detection of Neisseria gonorrhoeae in endocervical specimens that were mailed to the laboratory . During mail transport, the specimens were exposed to extremes of hot and cold weather for several days before arriving in the laboratory . Specimens on culture plates deteriorated during transport, as evidenced by many dead gonococcus-like colonies . The manufacturer's recommendation for reporting PACE 2 assay-positive results was modified to create a suspicious category for samples with relative light units near the positive cutoff value . Of a total of 4,869 specimens tested, 30 were positive by both methods and 102 were positive only by the PACE 2 assay . These additional 102 positive specimens were likely to be true positives, as indicated by several lines of indirect evidence, including detailed probe competition analysis, patient history, and the lack of false-positive results in hand-delivered specimens . Although Gen-Probe Inc . indicates that specimens are stable for up to 7 days, N . gonorrhoeae was easily detectable by the PACE 2 assay after 1 month of incubation at room temperature in the PACE 2 transport buffer . We also compared the Gen-Probe PACE 2 assay for Chlamydia trachomatis with culture on endocervical specimens delivered by same-day courier . Of 398 endocervical specimens tested, the PACE 2 assay detected 19 of 20 culture-positive samples . Although the assay failed to detect one culture-positive sample, it was able to detect two very weak culture-suspicious samples . Finally, PACE 2 assays for N . gonorrhoeae and C . trachomatis performed on the same samples indicated that the coinfection rate was 40% for women attending five family planning clinics . We concluded that the Gen-Probe PACE 2 assay system should be considered for use in testing those specimens that are transported to the laboratory through the mail.

Am J Public Health, 1992 May, 82(5), 669 - 74
Barrier contraceptives and sexually transmitted diseases in women: a comparison of female-dependent methods and condoms; Rosenberg MJ et al.; INTRODUCTION . Most efforts at sexually transmitted disease (STD) protection center on condom use, but little is known about how condoms compare with other barrier methods, particularly those controlled by women . METHODS . To evaluate the effect of different barrier contraceptives on the prevalence of STDs and other vaginal infections, we retrospectively studied 5681 visits by women to an urban STD clinic . RESULTS . As compared with women using no contraceptive or with tubal ligations, women using the contraceptive sponge or diaphragm had at least 65% lower rates of infection with Neisseria gonorrhoeae and Trichomonas vaginalis, while condom users had 34% and 30% lower rates, respectively . For Chlamydia trachomatis, the reduction was 13% among sponge users, 72% among diaphragm users, and 3% among condom users, although these differences were not significant . When compared with women using condoms, women using female-dependent methods (sponge or diaphragm) had significantly lower rates of both gonorrhea and trichomoniasis . Vaginal candidiasis was more common among women using diaphragms but not other barrier methods, while rates of bacterial vaginosis were similar among all groups . CONCLUSIONS . Women using the contraceptive sponge or diaphragm experience protection from STDs to a greater extent than those relying on condoms . Female-dependent barrier contraceptives should receive more attention in STD risk-reduction programs.

J Reprod Med, 1992 May, 37(5), 473 - 5
Neisseria sicca endocarditis complicating pregnancy . A case report; Deger R et al.; Neisseria sicca, a commensal organism of the oropharynx, has rarely been implicated as a pathogen responsible for causing bacterial endocarditis . A pregnant woman developed N sicca endocarditis at 32 weeks' gestation . Although there was an initial delay in diagnosis and therapy, the maternal and fetal outcomes were excellent.

Kansenshogaku Zasshi, 1992 May, 66(5), 592 - 8
{Relation of bacterial flora between upper and lower respiratory tracts in patients with long-term tracheostomy}; Tano Y et al.; Throat secretions (TS) and bronchial secretions aspirated from tracheostomy (TSTA) were cultured at the same time in 9 subjects with long term tracheostomy every two weeks from January, 1990 to December, 1990 . Total number of each examination in TS and TSTA were 200 times . Mean number of bacteria isolated by single culture were 2.9 strains in TS and 1.8 strains in TSTA . Isolated bacteria were mainly alpha-Streptococcus (84.8%) and Neisseria (69%) in TS, and Pseudomonas aeruginosa (53.5%) and Serratia marcescens (30%) in TSTA . Only 20% of P . aeruginosa or S . marcescens in TSTA were isolated from TS . In 8 cases of 9, P . aeruginosa in TSTA were isolated with every time or long term . There were 14 episodes of respiratory infections in 6 cases . P . aeruginosa were causative organisms in 7 episodes . It suggests that P . aeruginosa tended to colonize in lower respiratory tracts of the patients with long term tracheostomy and to become causative organisms in respiratory infections.

Kansenshogaku Zasshi, 1992 May, 66(5), 555 - 60
{Detection of Neisseria gonorrhoeae from male patients with urethritis by polymerase chain reaction}; Deguchi T et al.; A polymerase chain reaction (PCR) procedure was developed for detection of Neisseria gonorrhoeae . Two oligonucleotides based on sequences within a 16S ribosomal RNA gene from N . gonorrhoeae were used as extension primers for the PCR . A single DNA fragment of 206 bp was amplified, when N . gonorrhoeae DNA was template for the PCR . No amplified product was detected in Chlamydia trachomatis DNA, Ureaplasma urealyticum DNA or other bacterial DNAs . The DNA fragment of 206 bp was detected on agarose gel electrophoresis, when DNA of greater than or equal to 6.5 N . gonorrhoeae per PCR was used as template DNA for the PCR . The culture and the PCR were carried out for detection of N . gonorrhoeae in 67 urethral swabs obtained from male patients with urethritis . In 27 of 28 specimens in which N . gonorrhoeae was isolated and identified by the culture, 206 bp DNA fragment was amplified by the PCR, but in one specimen no DNA fragment was detected . In 2 of 39 culture-negative specimens, 206 pb DNA fragment was detected and in the remaining specimens, PCR was negative for N . gonorrhoeae . The overall detection coincidence rate between the culture and the PCR was 95.5% (64/67) . Thus, the PCR procedure developed in this study was sensitive and specific for detection of N . gonorrhoeae and could be applied for diagnosis of gonococcal urethritis.

Mol Microbiol, 1992 May, 6(10), 1271 - 9
Variations in the expression of pili: the effect on adherence of Neisseria meningitidis to human epithelial and endothelial cells; Virji M et al.; The effect of variations in Neisseria meningitidis pili on bacterial interactions with three epithelial cell lines as well as human umbilical vein endothelial cells was studied using a panel of seven strains expressing Class I or Class II pili . Comparison of adherence of piliated and pilus-deficient variants of each strain to epithelial cells suggested that Class I pili may mediate bacterial adherence with all three epithelial cell lines . In contrast, Class II pili of the strains used did not increase bacterial adherence to Hep-2 larynx carcinoma cells, although an increase in adherence to Chang conjunctival and A549 lung carcinoma epithelial cells was observed in the Class II pili-expressing strains . In addition to these interclass functional variations, differences in adherence to epithelial cells were also observed among Class I and Class II strains . Functionally different pilin variants of one Class I strain, MC58, were obtained by single colony isolation . One piliated variant was identified which had concurrently lost the ability to adhere to both Chang and Hep-2 cells ('non-adherent' phenotype; adherence of less than 2 bacteria per cell) . In addition, several adherent pilin variants were isolated from non-adherent Pil- and Pil+ bacteria by selection on Chang cells (adherence of 10-25 bacteria per cell) . In contrast to epithelial cells, all variant pili, whether of Class I or Class II, adhered to endothelial cells in substantially larger numbers (greater than 50 bacteria per cell) and therefore implied the existence of distinct mechanisms in pilus-facilitated interactions of N . meningitidis with endothelial and epithelial cells.

Antimicrob Agents Chemother, 1992 May, 36(5), 1131 - 2
In vitro activity of temafloxacin compared with those of other agents against 100 clinical isolates of Neisseria gonorrhoeae; Glatt AE et al.; The activity of temafloxacin hydrochloride was evaluated by agar dilution against 100 clinical isolates of Neisseria gonorrhoeae and compared with the activities of penicillin, tetracycline, ceftriaxone, ciprofloxacin, and ofloxacin . Temafloxacin inhibited 100% of study isolates at a concentration of 0.015 microgram/ml or less and was highly active against penicillin- and tetracycline-resistant strains . The in vitro activity of temafloxacin was nearly identical to that of ceftriaxone and was slightly less than that observed with ciprofloxacin and ofloxacin . Temafloxacin represents a promising alternative agent for investigation in the treatment of infection due to N . gonorrhoeae.

J Clin Microbiol, 1992 May, 30(5), 1317 - 9
MIC and disk diffusion quality control guidelines for Neisseria gonorrhoeae susceptibility tests of cefdinir, cefetamet, CI-960, fleroxacin, lomefloxacin, and temafloxacin; Erwin ME et al.; Cefdinir (FK482), cefetamet (Ro 15-8074), CI-960, fleroxacin, lomefloxacin, and temafloxacin have potent activities against Neisseria gonorrhoeae . They were tested in a multilaboratory study to establish quality control guidelines . Quality control ranges for N . gonorrhoeae ATCC 49226 were determined by using multiple GC agar lots, three disk lots, and a number of test replicates consistent with the M23-T guidelines of the National Committee for Clinical Laboratory Standards . The MIC ranges included 2 to 4 log2 dilution steps . The recommended inhibition zone diameter ranges were generally 7 to 8 mm and included greater than or equal to 91.3% of all recorded study results.

J Clin Microbiol, 1992 May, 30(5), 1170 - 3
Interpretive criteria for susceptibility testing of CI-960 (PD127391, AM-1091), fleroxacin, lomefloxacin, and temafloxacin against Neisseria gonorrhoeae, including drug stability in GC agar medium; Erwin ME et al.; CI-960, fleroxacin, lomefloxacin, and temafloxacin were tested against over 100 strains of Neisseria gonorrhoeae . Each organism was tested in triplicate by using agar dilution and disk diffusion methods recommended by the National Committee for Clinical Laboratory Standards . CI-960 was the most potent compound, with a MIC against 90% of the strains tested of 0.008 microgram/ml, and the least active was fleroxacin (MIC against 90% of strains, 0.12 microgram/ml) . Only the susceptible interpretive category was recommended for the CI-960 tests as follows: 5-micrograms disk, greater than or equal to 39 mm (MIC correlate, less than or equal to 0.12 microgram/ml) . Three interpretive categories were proposed for the other fluoroquinolones as follows: fleroxacin, 5-micrograms disk susceptible at greater than or equal to 33 mm (MIC correlate, less than or equal to 0.25 microgram/ml), intermediate at 28 to 32 mm (MIC correlate, 0.5 microgram/ml), and resistant at less than or equal to 27 mm (MIC correlate, greater than 0.5 microgram/ml); lomefloxacin, 10-micrograms disk susceptible at greater than or equal to 35 mm (MIC correlate, less than or equal to 0.12 microgram/ml), intermediate at 28 to 34 mm (MIC correlates, 0.25 to 0.5 microgram/ml), and resistant at less than or equal to 27 mm (MIC correlate, greater than 0.5 microgram/ml); and temafloxacin, 5-micrograms disk susceptible at greater than or equal to 36 mm (MIC correlate, less than or equal to 0.06 microgram/ml), intermediate at 28 to 35 mm (MIC correlates 0.12 to 0.25 microgram/ml), and resistant at less than or equal to 27 mm (greater than 0.25 microgram/ml) . Interpretive agreement between disk diffusion results and the MICs was 100% for each agent, with the exception of lomefloxacin, which had a 0.9% minor error . All drugs were stable in GC agar medium for at least 21 days when stored at 2 to 5 degrees C.

Proc Natl Acad Sci U S A, 1992 Apr 15, 89(8), 3204 - 8
Neisseria gonorrhoeae PilC expression provides a selective mechanism for structural diversity of pili; Jonsson AB et al.; Pili of Neisseria gonorrhoeae undergo both phase and structural variation . Phase variation of gonococcal pili can be caused by a RecA-independent on/off switch in PilC, a protein involved in pilus biogenesis . We show here that spontaneous nonpiliated PilC- derivatives as well as PilC- insertional mutants have also acquired sequence alterations in pilE relative to the pilE gene of the piliated MS11mk(P+)-u parent, so that the pilin produced is processed to soluble S-pilin and can be released into the medium . It is proposed that pilin alterations are selected for in PilC- bacteria if the parental nonassembled pilin is toxic to the cells--i.e., is not degradable to S-pilin at rates sufficient to allow viability of the cells . Toxicity is indicated by the extreme instability of certain unassembled pilin sequences and by the low frequency of nonpiliated, pilin+, PilC- variants that emerge from piliated recA- cells . The presence of a point mutation changing leucine-39 to phenylalanine at the cleavage site for S-pilin in one nonpiliated, PilC-, recA- variant relative to its piliated parent is a further argument for a selective mechanism of structural diversity of the gonococcal pilin.

Zentralbl Bakteriol, 1992 Apr, 276(4), 548 - 55
Coincidence of hepatitis B-virus markers and other sexually transmitted diseases in different STD-risk groups; Stary A et al.; To evaluate the prevalence of hepatitis-B-virus (HBV)-markers in STD patients and the significance of promiscuous heterosexual activity as a risk factor for the transmission of HBV, a serological screening was performed in 499 patients, in addition to the routine STD diagnostic programme . Two groups of patients were evaluated: group 1 (120 patients) was drawn from the STD clinic of the Public Health Office (PHO), group 2 (379 patients) from a private STD outpatient clinic . Promiscuous activity was reported significantly more often by persons of group 1 than by those attending the private clinic (59.3% vs . 5.1%) . The infection rate of gonorrhea, syphilis and Chlamydia trachomatis was high in patients of the PHO (46.7%, 35.3%, 27.5%) whereas most of the STDs were seldom ascertained in patients of the private clinic (1.1%, 0%, 5.6%) . Similar to other STDs, the prevalence of HBV markers differed significantly between patients of the PHO and those of the private clinic (33.3% vs . 6.3%; p = .0000) . Comparison of HBV and other STDs showed the highest coincidence of HBV markers in patients with serological evidence of syphilis (44.2%), and in one third of patients with Neisseria gonorrhoeae as well as HIV infection . The data obtained in the present study demonstrate that also in Austria, in addition to homosexual preference and drug abuse, promiscuous heterosexual activity must be considered a substantial risk factor for the transmission of HBV.

Enferm Infecc Microbiol Clin, 1992 Apr, 10(4), 200 - 4
{Membrane proteins electrophoretic profiles study applied to Neisseria gonorrhoeae epidemiology}; Camarena JJ et al.; The analysis of electrophoretic profiles of membrane proteins is one of the epidemiological methods of bacterial typing . The profiles of membrane proteins of 95 isolates were studied for valuing their usefulness in the epidemiology of N . gonorrhoeae . The results were compared with the obtained using other characterization methods (auxotyping, serotyping and antimicrobial sensibility) . The proteins I and II (PI and PII) showed clear differences between isolates . Only protein-I (PI) with constant molecular weight for each isolate was valid to discriminate between strains . It was observed correlation between serovariety IA and molecular weight of PI 33.6-36 kD, and the serovariety IB with molecular weight 35.5-37 kD . Though it wasn't possible discriminated between the different serovarieties . It was proved a sensibility decrease to penicillin, tetracycline and cloramfenicol in those strains with molecular weight of PI greater than 35.5 kD (serogroup WII/WIII) . In the 80% of the isolates considered multiple antibiotic-resistant it was observed a significant increase of the membrane protein dough of 52 kD . All the strains with this protein increased were multiple antibiotic-resistant.

Genitourin Med, 1992 Apr, 68(2), 111 - 6
Antimicrobial susceptibility of Neisseria gonorrhoeae in Zaire: high level plasmid-mediated tetracycline resistance in central Africa; Van Dyck E et al.; OBJECTIVE--To determine the in vitro antimicrobial susceptibility of gonococcal strains isolated in 1988 among female prostitutes in Kinshasa, Zaire and to characterise strains with high level tetracycline resistance . METHODS--Minimal inhibitory concentrations of 8 antimicrobials were measured by agar dilution technique . Plasmid-profiles and serovars were determined . RESULTS--Two hundred and thirteen strains of Neisseria gonorrhoeae were tested of which 59% were beta-lactamase producers and an additional 21% showed intermediate or chromosomal resistance to penicillin (MIC = 0.5-8 mg/l) . Eleven percent of the strains were resistant to the combination sulfamethoxazole-trimethoprim (MIC greater than 8 mg/l) and 57% of the isolates showed decreased susceptibility to thiamphenicol (MIC = 1-4 mg/l) . All strains were sensitive to spectinomycin, norfloxacin and ceftriaxone and moderately sensitive to kanamycin . Chromosomal resistance to tetracycline was observed in 45% of strains (MIC = 2-8 mg/l) . Ten percent were highly resistant to tetracycline (TRNG, MIC = 16-128 mg/l) and were shown to carry a plasmid borne Tet M determinant; such strains were not found in Kinshasa in 1985 . TRNG belonged to 4 different serovars, which were also the dominant serovars in non-TRNG . CONCLUSION--These findings illustrate the high frequency of multiresistant gonococci in Zaire and suggest that high level tetracycline resistant strains of N . gonorrhoeae have become endemic in Central Africa.

J Clin Microbiol, 1992 Apr, 30(4), 974 - 80
Evaluation of the standardized disk diffusion and agar dilution antibiotic susceptibility test methods by using strains of Neisseria gonorrhoeae from the United States and Southeast Asia; Putnam SD et al.; Presently, most Neisseria gonorrhoeae testing is based on beta-lactamase tests and agar dilution with common therapeutic agents . The National Committee for Clinical Laboratory Standards (NCCLS) recently described a disk diffusion test that produced results similar to the reference agar dilution method for the antibiotic susceptibility of N . gonorrhoeae . We obtained 71 gonococcal isolates from active-duty males aboard a United States Navy vessel while deployed in the Western Pacific during 1989 . In addition, 47 isolates of N . gonorrhoeae were obtained from sexually transmitted disease clinics within the branch clinic operations of the Naval Hospital, San Diego (SD), and tested . Antibiotic susceptibility tests by using the NCCLS agar dilution and disk diffusion techniques were compared . Among the Southeast Asia (SEA) isolates, 47% were beta-lactamase producers compared with 10.5% of the SD isolates . The mean MICs (SEA/SD) in micrograms per milliliter for both groups were as follows: penicillin, 88/15; tetracycline, 2.2/0.95; erythromycin, 1.2/0.49; ceftriaxone, 0.016/0.012; cefotaxime, 0.034/0.03; cefuroxime, 0.44/0.17; cefoxitin, 1.3/0.97; spectinomycin, 150/131; ciprofloxacin, 0.07/0.034; norfloxacin, 0.77/0.29; lomefloxacin, 0.15/0.0.056; and ofloxacin, 0.07/0.036 . The established NCCLS interpretive criteria for both susceptibility methods appear applicable to domestic gonococcal strains . However, modifications may be necessary for the more antimicrobial agent-resistant SEA isolates on the basis of the clinical success and cure rates following the indicated single-dose regimens for the geographic region.

J Clin Microbiol, 1992 Apr, 30(4), 813 - 6
Interpretive criteria and quality control limits for testing susceptibility of Neisseria gonorrhoeae to enoxacin; Barry AL et al.; For testing the susceptibility of Neisseria gonorrhoeae to enoxacin, a proposed susceptibility category includes strains for which MICs are less than or equal to 0.5 micrograms/ml and zones of inhibition are greater than or equal to 32 mm in diameter . Because of the sparcity of resistant gonococci, a resistance category was not defined, but laboratory-selected resistant mutants were appropriately categorized by the proposed criteria . A review of clinical data confirmed the utility of a single 400-mg oral dose of enoxacin for treating gonorrhea caused by strains judged to be susceptible by the proposed criteria . For quality control purposes, for N . gonorrhoeae ATCC 49226 MICs should be 0.016 to 0.06 micrograms/ml and zones of inhibition should be 43 to 51 mm in diameter.

J Clin Microbiol, 1992 Apr, 30(4), 1024 - 6
Proposed interpretive criteria and quality control parameters for ofloxacin susceptibility testing of Neisseria gonorrhoeae; Fuchs PC et al.; A multilaboratory study designed to determine the in vitro susceptibility criteria and quality control parameters for ofloxacin against Neisseria gonorrhoeae was conducted according to the guidelines of the National Committee for Clinical Laboratory Standards . Proposed susceptibility breakpoints are MICs of less than or equal to 0.25 microgram/ml for the agar dilution test and greater than or equal to 31 mm for the disk diffusion test . A category for resistance could not be defined . Proposed acceptable quality control MICs for N . gonorrhoeae ATCC 49226 and Staphylococcus aureus ATCC 29213 range from 0.004 to 0.03 microgram/ml and 0.25 to 1.0 microgram/ml, respectively . With 5-micrograms ofloxacin disks, acceptable inhibitory zone diameters for S . aureus ATCC 25923 and the N . gonorrhoeae control strains range from 22 to 27 mm and 43 to 51 mm, respectively.

Genitourin Med, 1992 Apr, 68(2), 106 - 10
Molecular typing of Neisseria gonorrhoeae by restriction fragment length polymorphisms; Poh CL et al.; OBJECTIVE--To characterise Neisseria gonorrhoeae isolates by restriction fragment length polymorphisms (RFLPs) in ribosomal RNA genes . DESIGN--Generation of RFLP patterns by HincII restriction of rRNA genes followed by hybridisation with a non-radioactive labelled broad spectrum 16 + 23S rRNA gene probe . This typing method was developed and compared with MAb based serotyping . SPECIMENS--Forty three randomly collected isolates from Bangkok (27 isolates) and Singapore (16 isolates) were studied . RESULTS--The RFLP patterns generated were reproducible and highly discriminatory between strains . Analysis of RFLPs produced by HincII restriction of rRNA genes established 9 patterns amongst the 43 isolates examined . Strains present within a common serovar could be further subdivided by RFLP typing . Identical RFLP patterns were found in some strains that belonged to various serovars . CONCLUSION--RFLP typing based on heterogeneities of rRNA gene restriction patterns could be advantageously used to complement monoclonal antibody based serotyping for further subdivision of serovars . Higher sensitivity of this combined approach would enable better differentiation of strains in epidemiological studies.

J Bacteriol, 1992 Apr, 174(8), 2694 - 701
Sequence analysis and complementation studies of the argJ gene encoding ornithine acetyltransferase from Neisseria gonorrhoeae; Martin PR et al.; Clinical isolates of Neisseria gonorrhoeae frequently are deficient in arginine biosynthesis . These auxotrophs often have defects in the fifth step of the arginine biosynthetic pathway, the conversion of acetylornithine to ornithine . This reaction is catalyzed by the enzyme ornithine acetyltransferase, which is a product of the argJ gene . We have cloned and sequenced the gonococcal argJ gene and found that it contains an open reading frame of 1,218 nucleotides and encodes a peptide with a deduced Mr of 42,879 . This predicted size was supported by minicell analysis . This gene was capable of complementing both Escherichia coli argE and argA mutations and of transforming an ArgJ- strain of N . gonorrhoeae to Arg+ . Southern blots were able to detect bands that specifically hybridized to the gonococcal argJ gene in genomic DNA from Pseudomonas aeruginosa but not E . coli, a result that reflects the divergent nature of the arginine biosynthetic pathway in these organisms.

Sex Transm Dis, 1992 Mar-Apr, 19(2), 99 - 104
Evaluation of field follow-up in a sexually transmitted disease clinic for patients at risk for infection with Neisseria gonorrhoeae and Chlamydia trachomatis; Katz BP et al.; Field follow-up to locate and treat partners of patients with syphilis and gonorrhea is standard procedure in the United States . The present study utilized 12,732 heterosexual index patients with gonococcal infection, chlamydial infection, and related syndromes to evaluate the effectiveness of field follow-up over a 6-year period . Field follow-up located 82% of the 13,845 partners identified by the index patients . Of those partners who were located, 36% had a documented infection with either chlamydia or gonorrhea . An average of only 1.09 partners per index patient was named, however, indicating that all partners may not have been reported . The largest number of infected partners was located for all index patients with gonorrhea and for men with chlamydia . Contact tracing was also effective for women with chlamydia, although less so . Field follow-up, as conducted in this study, is effective in locating the partners who are reported by the index patients.

Sex Transm Dis, 1992 Mar-Apr, 19(2), 92 - 3
Cefixime in the treatment of uncomplicated gonorrhea; Dunnett DM et al.; One hundred consecutive patients with uncomplicated gonorrhea were treated with 800 mg of cefixime . Follow-up evaluation was obtained for 73 patients, and at that time 71 of the 73 had negative culture results for Neisseria gonorrhoeae . Minimal adverse side effects were reported . Cefixime 800 mg appears to be an excellent treatment for uncomplicated gonorrhea.

Sex Transm Dis, 1992 Mar-Apr, 19(2), 88 - 91
Disease prevalence among women attending a sexually transmitted disease clinic varies with reason for visit; Pabst KM et al.; Prevalence of sexually transmitted diseases (STD) and selected behavioral and demographic variables were evaluated in 279 women attending a Baltimore STD clinic, using a standardized questionnaire and cultures for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis . Stratified by reason for clinic visit, 102 (37%) of 279 women attending the clinic stated that they were recent contacts to men with STDs with the majority (59 out of 102, or 58%) reporting gonorrhea contact as their reason for visit . Another 124 women (44%) came to the clinic for symptom evaluation, and 53 (19%) for other reasons . Prevalence of STDs was higher among those attending as contacts than among noncontacts: 35% versus 15% for N . gonorrhoeae; 26% versus 16% for C . trachomatis; and 27% versus 15% for T . vaginalis (P less than 0.05 for each) . Furthermore, multiple infections were found in 23% of those attending as contacts but only in 10% of noncontacts (P less than 0.001) . In general, patients reporting contact with an infected person were also less likely to report symptoms (43% versus 34%, P less than 0.001), despite increased disease prevalence . These data suggest that multiple STDs are often present in women attending STD clinics, irrespective of reason for visit . Merely treating women for reported exposure without further evaluation will fail to identify a substantial number of women coinfected with other organisms.

Mol Microbiol, 1992 Mar, 6(6), 729 - 34
The interaction of naturally elaborated blebs from serum-susceptible and serum-resistant strains of Neisseria gonorrhoeae with normal human serum; Pettit RK et al.; We studied the interaction of normal human serum immunoglobulins with outer-membrane bleb antigens of Neisseria gonorrhoeae . Gonococcal 68,000 Dalton and Lip (H.8 antigen) outer-membrane proteins were recognized by normal human serum immunoglobulins in blebs from serum-resistant strains, but not in blebs from serum-susceptible strains . The addition of blebs from a serum-resistant strain to bactericidal assays resulted in significantly greater inhibition of serum killing than the addition of blebs from a serum-susceptible strain . Our results indicate that blebs from two serum-resistant gonococcal strains have an enhanced ability to bind and remove cell-targeted bactericidal factors, and that outer-membrane blebbing may contribute to serum resistance.

Mol Microbiol, 1992 Mar, 6(6), 723 - 8
Characterization of naturally elaborated blebs from serum-susceptible and serum-resistant strains of Neisseria gonorrhoeae; Pettit RK et al.; Outer-membrane blebs from two serum-susceptible and two serum-resistant strains of Neisseria gonorrhoeae were characterized . In general, bleb surfaces resembled cell surfaces, but there were qualitative and quantitative protein differences in blebs released by serum-susceptible and serum-resistant strains . Relative to blebs from serum-resistant strains, blebs from serum-susceptible strains expressed reduced amounts of major outer-membrane proteins I and III, and little if any 68,000 Dalton outer-membrane protein.

Int J STD AIDS, 1992 Mar-Apr, 3(2), 111 - 6
Treatment of acute gonococcal infections in Bangkok with a dose range of the new cephalosporin, cefodizime; Chitwarakorn A et al.; In this randomized dose range study conducted in Bangkok, 326 patients with presumed acute uncomplicated gonorrhoea were treated with a single intramuscular dose of either 0.25 g, 0.5 g, or 1.0 g of a new aminothiazole cephalosporin, cefodizime . One hundred and eighty men and 110 women were evaluable for efficacy . Pathogens were eliminated in all but 4 of these patients resulting in a cure rate of 99%, irrespective of dose, sex, or multiplicity of infected sites . A high percentage of the 290 strains of Neisseria gonorrhoeae isolated from the evaluable patients showed resistance to penicillin, and 40% were penicillinase producing (PPNG) . The minimum inhibitory concentration of cefodizime for 90% of the PPNG strains was less than 0.04 mg/l . No clinically relevant adverse drug reactions were reported . This study demonstrates that a single 0.25 g dose of cefodizime is effective against both PPNG and non-PPNG strains in a geographic region characterized by high endemic antibiotic resistance.

CMAJ, 1992 Mar 1, 146(5), 715 - 21
Management of Chlamydia trachomatis genital infections: reported practices of primary care physicians; McDougall L et al.; OBJECTIVE: To determine the knowledge of primary care physicians about Chlamydia trachomatis genital infection and its management . DESIGN: Self-administered questionnaire comprising direct questions and hypothetical cases . PARTICIPANTS: All 108 general and family practitioners on the north shore of Vancouver were sent the questionnaire; 79 (73%) responded . RESULTS: There was a reasonable level of knowledge in many areas, particularly among the physicians who had graduated more recently than the others . Virtually all stated that they have access to chlamydial diagnostic testing, and most indicated that they test for chlamydial infection at least occasionally . However, many of the respondents failed to consider that youths in their practice may be sexually active, and only 28% knew that women 15 to 19 years of age have the highest reported rates of chlamydial infection . Many of the physicians were confused about syndromes that are or are not associated with C . trachomatis infection; this indicated the possibility of inappropriate testing and treatment decisions . If they had to test for C . trachomatis in a prepubescent girl 34% reported that they would obtain a specimen from the endocervix, a technique that is inappropriately invasive . When presented with a positive test result many of the respondents failed to consider the possibility of a false-positive result . Fortunately all of the physicians were well informed about correct treatment regimens for C . trachomatis infection, although many did not realize how effective they really are . In the case of a young man with suspected or proven gonorrhea or a young female outpatient with pelvic inflammatory disease, only 19% and 20% respectively stated that they would prescribe a regimen appropriate for both penicillinase-producing Neisseria gonorrhoeae and C . trachomatis . Many of the respondents had not heard of management guidelines, and fewer still reported that they consult them . CONCLUSIONS: Despite the availability of several sets of guidelines there appear to be important gaps in the knowledge and practice of many primary care physicians with respect to genital infections . Since the preparation of guidelines is time-consuming and expensive, further work should be done to evaluate their impact and to address their limitations.

J Clin Microbiol, 1992 Mar, 30(3), 719 - 20
Association of an important Neisseria species, Neisseria elongata subsp . nitroreducens, with bacteremia, endocarditis, and osteomyelitis; Wong JD et al.; We retrospectively analyzed epidemiologic information associated with 22 cultures of Neisseria elongata subsp . nitroreducens (formerly CDC group M-6) submitted to the Microbial Diseases Laboratory, California Department of Health Services, Berkeley, over a 16-year period . The most common illnesses noted with this bacterium were endocarditis, bacteremia, and osteomyelitis . Risk factors associated with N . elongata subsp . nitroreducens infection included dental manipulations and/or a previous history of endocarditis, valve damage, or rheumatic heart disease.

Am J Obstet Gynecol, 1992 Mar, 166(3), 945 - 9
Preterm premature rupture of membranes: results of expectant management in patients with cervical cultures positive for group B streptococcus or Neisseria gonorrhoeae; Maxwell GL et al.; OBJECTIVE: The antepartum course and short-term neonatal outcome for patients with premature rupture of membranes between 26 and 33 weeks' gestation with positive cervical cultures for group B streptococcus or Neisseria gonorrhoeae were reviewed . STUDY DESIGN: A retrospective analysis of 182 patients managed expectantly over a 3-year period was done . Thirty-four patients had cervical cultures positive for group B streptococcus, 11 had positive cultures for Neisseria gonorrhoeae, and 137 had negative cultures . Prophylactic antibiotics were routinely given, and antibiotic therapy was continued in patients with positive cultures . RESULTS: There was no difference between groups in latent phase or maternal morbidity . The incidence of neonatal pneumonia was increased in those with positive cervical cultures (p = 0.009, odds ratio 6.9, 90% confidence interval 2.1 to 22.8), but there was no difference in neonatal sepsis, respiratory distress, or neonatal mortality . CONCLUSION: These data support the conservative or expectant management of premature rupture of membranes between 26 and 33 weeks in patients with positive cervical cultures who are given prophylactic antibiotic therapy.

Am J Clin Pathol, 1992 Mar, 97(3), 309 - 12
Cross-reaction of clinical isolates of bacteria and yeasts with the chlamydiazyme test for chlamydial antigen, before and after use of a blocking reagent; Kellogg JA et al.; More than 1,000 clinical isolates of bacteria and yeasts were identified, subcultured, and tested at 10(8) colony-forming units per milliliter with the Chlamydiazyme assay to determine the variety of microorganisms which could cause false-positive results for Chlamydial antigen . False-positive Chlamydiazyme results were obtained from 27 of 465 (5.8%) gram-negative, aerobic, or facultatively anaerobic bacterial isolates (including 8 of 39 {20.5%} Neisseria gonorrhoeae and 8 of 149 {5.4%} Escherichia coli isolates) and also from 2 of 46 (4.3%) Bacteroides species isolates . No false-positive results were obtained either from 373 gram-positive bacterial isolates or from 153 yeasts . Results from 21 of 29 (72.4%) isolates that cross-reacted with Chlamydiazyme antibodies were repeatedly positive, but all 21 were confirmed as false-positive results using a blocking antibody . When an initial Chlamydiazyme result is positive, repeating the test, with and without use of the blocking antibody, appears to be effective in identifying those results (more likely from poorly collected endocervical specimens) that are falsely positive, even in the presence of high concentrations of cross-reacting bacteria . Microscopic determination of endocervical specimen adequacy also may help to minimize false-positive (and false-negative) Chlamydiazyme results.

Infect Immun, 1992 Mar, 60(3), 989 - 97
Growth of Neisseria gonorrhoeae in CMP-N-acetylneuraminic acid inhibits nonopsonic (opacity-associated outer membrane protein-mediated) interactions with human neutrophils; Rest RF et al.; Gonococci possessing certain opacity-associated (Opa) outer membrane proteins adhere to and are phagocytosed by human neutrophils in the absence of serum . Recently, it has been shown that serum-sensitive strains of Neisseria gonorrhoeae possessing the appropriate lipooligosaccharide phenotype become serum resistant when grown in the presence of CMP-N-acetylneuraminic acid (CMP-NANA) because of sialylation of their lipooligosaccharide . We investigated whether such sialylation affects nonopsonic (antibody- and complement-independent) interactions of gonococci with human neutrophils in vitro . We grew Opa+ gonococci in the presence of up to 50 micrograms of CMP-NANA per ml, incubated them with neutrophils in vitro, and measured their abilities to adhere to neutrophils, stimulate neutrophil luminol-dependent chemiluminescence (LDCL), and be phagocytically killed by neutrophils . Growth in CMP-NANA dramatically inhibited (in a dose-dependent manner) the ability of Opa+ gonococci to adhere to neutrophils and stimulate neutrophil LDCL . Growth of Opa+ gonococci in 50 micrograms of CMP-NANA per ml appeared to delay, but did not inhibit, their killing by neutrophils . Sialidase treatment of sialylated Opa+ gonococci, i.e., gonococci grown with CMP-NANA, totally restored their abilities to adhere to neutrophils and stimulate neutrophil LDCL . Opa- gonococci grown in the presence of 50 micrograms of CMP-NANA per ml and opsonized with fresh human serum bound to neutrophils only about 30% less efficiently than did Opa- gonococci grown without CMP-NANA and opsonized . The results of our studies show that sialylated Opa+ gonococci have dramatically reduced nonopsonic interactions with neutrophils . Some gonococcal strains may resist killing by human neutrophils in vivo by such a mechanism.

Infect Immun, 1992 Mar, 60(3), 1232 - 6
Characterization of a cryptic gene pair from Neisseria gonorrhoeae that is common to pathogenic Neisseria species; Seifert HS et al.; A pair of genes, each of which produces in Escherichia coli a 20-kDa, periplasmically localized protein that cross-reacts with anti-rpoN monoclonal antibody, was isolated from Neisseria gonorrhoeae . Homologs of the two genes were detected in pathogenic Neisseria species but not in commensal species . These genes are designated cnp1 and cnp2 (cryptic neisserial protein).

J Infect Dis, 1992 Mar, 165(3), 573 - 6
Urinary leukocyte esterase test: a screening method for the detection of asymptomatic chlamydial and gonococcal infections in men; McNagny SE et al.; The ability of a urinary dipstick leukocyte esterase test (LET) to predict culture-verified asymptomatic urethral infections of Chlamydia trachomatis and Neisseria gonorrhoeae was determined in 1095 men (aged 18-39) who presented to an urban hospital for acute general medical care . Prevalence of chlamydial and gonococcal infections were 4% and 2.5% respectively; LET sensitivity was 41% and specificity was 91% . In the youngest one-third, the prevalence of infection and LET sensitivity and specificity increased to 9%, 58%, and 93%, respectively . Higher inclusion count in chlamydia culture was also significantly correlated with younger age . This is the first study to assess LET performance as a screening test for asymptomatic disease in adult men and suggests that LET has promising accuracy in young men but is less likely to be a useful screening test in men greater than 25 years old.

Sex Transm Dis, 1992 Mar-Apr, 19(2), 94 - 8
Oral cefixime versus intramuscular ceftriaxone in patients with uncomplicated gonococcal infections; Portilla I et al.; A randomized trial was conducted to compare cefixime (400 mg or 800 mg single oral dose) with ceftriaxone (250 mg single intramuscular dose) in terms of efficacy and safety for the treatment of uncomplicated Neisseria gonorrhoeae urethritis or cervicitis . Of 75 men and 150 women screened, 187 had positive culture results for N . gonorrhoeae . The course of treatment was evaluable in 155 cases (59 men, 96 women) . Bacteriologic eradication was evident in 97% (105 out of 108) of the patients treated with cefixime and in 100% (47 out of 47) of the patients treated with ceftriaxone . N . gonorrhoeae was eliminated at 98% (143 out of 146) and 100% (72 out of 72) of the infection sites in the respective treatment groups . Of the 187 isolates, 8 were penicillinase-producing (PPNG) and 20 had high-level tetracycline resistance (TRNG) . The cefixime and ceftriaxone MIC90 for all 187 study isolates was 0.008 micrograms/ml . The adverse clinical experiences reported by the patients treated with cefixime (10%) were self-limiting; no adverse experiences occurred in the patients treated with ceftriaxone . Cefixime was as well tolerated and efficacious as ceftriaxone in the treatment of the patients with uncomplicated N . gonorrhoeae urethritis or cervicitis reported here.

Res Microbiol, 1992 Mar-Apr, 143(3), 295 - 305
Cloning and characterization of a Neisseria gene homologous to hisJ and argT of Escherichia coli and Salmonella typhimurium; Lavitola A et al.; We have isolated from a genomic library of the pathogenic Neisseriae gonorrhoeae T2 strain, a gene encoding a putative protein of 268 amino acids which exhibited significant similarity to the hisJ and argT gene products of Salmonella typhimurium and Escherichia coli, periplasmic proteins deputed to amino acid transport within the cell . The gene is transcribed as a monocistronic mRNA species of about 960 nucleotides flanked by regulatory elements for initiation and termination of transcription that are efficiently recognized in an E . coli host.

Int J Gynaecol Obstet, 1992 Mar, 37(3), 185 - 91
Vaginal microbial flora as a cofactor in the pathogenesis of uterine cervical intraepithelial neoplasia; Guijon F et al.; The vaginal microbial flora of 106 women with histopathologically confirmed cervical intraepithelial neoplasia and 79 women without disease, was evaluated for Gardnerella vaginalis, Trichomonas vaginalis, Candida albicans and other yeasts . Flora morphology was assessed by gram staining of secretions . Cervical cultures were examined for Herpes Simplex virus, Cytomegalovirus and Neisseria gonorrhoeae . Chlamydia trachomatis antigens in cervical secretions were detected by enzyme immunoassay . Human Papillomavirus was identified by koilocytosis in cytologic or histopathologic specimens . Human Papillomavirus infection (P less than 0.00001), vaginal infection with Mycoplasma hominis (P = 0.012) and abnormal vaginal flora (P = 0.006) were significantly associated with CIN, suggesting that CIN may be promoted by vaginal microorganisms in conjunction with human papillomavirus cervical infection.

Infect Immun, 1992 Mar, 60(3), 970 - 5
Molecular characterization of the argJ mutation in Neisseria gonorrhoeae strains with requirements for arginine, hypoxanthine, and uracil; Martin PR et al.; Arginine auxotrophs are commonly encountered among clinical isolates of Neisseria gonorrhoeae . Arginine auxotrophs which also require hypoxanthine and uracil (AHU strains) compose a unique set of strains that are highly homogeneous and are believed to be clonally derived . The Arg- phenotype of these strains is due to a lesion in the argJ gene encoding ornithine acetyltransferase . We have cloned the mutant argJ gene from an AHU strain and compared the sequence of this gene to the wild-type argJ gene . The mutant gene contained a 3-bp deletion within a repetitive region of the argJ gene . This mutation was restored to the wild-type sequence in a naturally occurring Arg+ revertant of the AHU strain . This deletion was detected in a wide variety of other AHU strains but not in other ArgJ- strains or in ArgJ+ strains, supporting the theory that AHU strains are clonally derived.

Tidsskr Nor Laegeforen . 1992 Feb 28;112(6):743.
{Contraception, abortion and sexually transmitted diseases}; Nesheim BI; PIP: Contraceptives that protect against pregnancy tend to offer the least protection against sexually transmitted diseases (STDs), particularly needed by young people who change partners frequently . Oral contraceptive (OCs) protect best against pregnancy and salpingitis, but they do not protect against infections of the cervix; thus, there is a higher incidence of Chlamydia trachomatis and Neisseria gonorrhea among OC users . The IUD is also very effective, but there is an elevated risk of infections during the first 20 days after fitting, as bacteria may move up to the uterus from the cervical canal during insertion . The effectiveness of the condom depends on the users, and studies show that when used consistently it provides significant protection against STDs . The diaphragm also protects against STDs, but it is insignificant from a quantitative point of view . In Norway, in 1977, 30% of 18-19 year old women used OCs, and 21% used IUDs . In contrast, in 1988, 65% of 20-year old women used OCs and 5% used IUDs . Condom use remains unchanged . The rate of abortion has not changed since 1977; it is highest among women aged 18-29 (about 30/1000 women per year), although safe contraception use has increased from 50% to 70% among women aged 18-19 . Free-service health clinics with evening hours have met a clear need for counseling in the past 20 years . In the 1970s the demand was high for induced abortion, safe contraceptives, and IUD insertion . Later, OCs had lower hormone content and fewer site effects, and their dispensation became more widespread among general practitioners . Nowadays a large proportion of women seek advice on STDs, and 65% of them attend because the consultation is free . It is an important task of these clinics to provide guidance, examination, and treatment to high-risk people to help them avoid STDs and unwanted pregnancy .

Proc Natl Acad Sci U S A, 1992 Feb 15, 89(4), 1164 - 8
Neisseria meningitidis encodes an FK506-inhibitable rotamase; Sampson BA et al.; Eukaryotic peptidyl-prolyl cis-trans isomerases (rotamases) fall into two classes, the cyclophilins inhibited by cyclosporin A and the FK506-binding proteins inhibited by the macrolide antibiotic FK506 . In prokaryotes homologs of cyclophilins have been identified and found to have rotamase activity . Sequence similarities have been noted between FK506-binding proteins and gene products in a number of bacterial species, but whether these bacterial proteins have rotamase activity is not known . Using the polymerase chain reaction, we have cloned and sequenced a homolog of an FK506-binding protein from Neisseria meningitidis and expressed the gene product as a fusion protein with maltose-binding protein . The fusion protein was purified by affinity chromatography . By measuring the rate of chymotrypsin cleavage of the substrate succinyl-Ala-Ala-Pro-Phe p-nitroanilide, we found that the fusion protein had rotamase activity comparable to that of human FK506-binding protein . This rotamase activity was inhibited by FK506.

MMWR Morb Mortal Wkly Rep, 1992 Feb 14, 41(6), 94 - 5, 101
Street outreach for STD/HIV prevention--Colorado Springs, Colorado, 1987-1991; Lack of circumcision increases the risk of urinary tract infection in young men; Division of Infectious Diseases, University of Washington Medical Center, SeattleOBJECTIVE--To determine whether lack of circumcision increases the risk of urinary tract infection (UTI) in adult men . DESIGN AND SETTING--Retrospective case-control study (1987-1990) at a sexually transmitted disease clinic in Seattle, Wash . PATIENTS--Twenty-six men (median age, 30 years) who had microbiologically confirmed symptomatic UTIs (cases) compared with 52 men (median age, 32 years) who had urinary symptoms but negative urine cultures (controls) . MAIN OUTCOME MEASURE--Circumcision status among bacteriuric and nonbacteriuric men . RESULTS--The bacteriuric and nonbacteriuric groups were similar in age, race, sexual activity, and sexual preference . Eight (31%) of the 26 bacteriuric men were uncircumcised compared with 6 (12%) of the 52 nonbacteriuric men (P = .037; odds ratio, 3.4; 95% confidence interval, 1.0 to 11.2) . Among 19 patients infected with gram-negative bacilli, 8 (42%) of 19 were uncircumcised vs 6 (12%) of 52 nonbacteriuric men (P = .004; odds ratio, 5.6; 95% confidence interval, 1.6 to 19.4) . Escherichia coli was the most common urinary isolate (15 of 26 isolates), and the majority of E coli strains possessed urovirulence determinants, including mannose-resistant hemagglutination (10 of 14 isolates), F fimbriae (11 of 14 isolates), P fimbriae (6 of 14 isolates), hemolysin (10 of 14 isolates), and aerobactin (8 of 14 isolates) . Although all 26 bacteriuric men had urethral cultures negative for Chlamydia trachomatis and Neisseria gonorrhoeae, Gram-stained urethral smears showed evidence of urethritis in 17 (68%) of 25 men . CONCLUSIONS--(1) Lack of circumcision increases the risk of UTI in young adult men . (2) The majority of these infections result from urovirulent strains of E coli . (3) Clinically, these infections often produce urethritis as well as UTI.

S Afr Med J, 1992 Feb 1, 81(3), 156 - 7
The prevalence of potential pathogenic micro-organisms in the endocervix of pregnant women at Tygerberg Hospital; van Rensburg HJ et al.; The prevalence of potential pathogenic organisms cultured from the endocervix in 206 pregnant patients was: Ureaplasma urealyticum 63%, Mycoplasma hominis 39%, Candida albicans 20%, Chlamydia trachomatis 11%, Neisseria gonorrhoeae 7%, group B beta-haemolytic streptococcus 6% and Listeria monocytogenes 1% . The most common complications of pregnancy found were: preterm labour 14%, urinary tract infection 8% and premature rupture of membranes 4% . Significantly more patients in whom C . trachomatis or C . albicans were found delivered prematurely . Other organisms were not associated with preterm labour.

Antimicrob Agents Chemother, 1992 Feb, 36(2), 277 - 82
In vitro antibiotic susceptibilities of Neisseria gonorrhoeae isolates in the Philippines; Clendennen TE 3rd et al.; Antibiotic susceptibility surveillance testing was performed on clinical isolates of Neisseria gonorrhoeae collected in September 1989 in the Philippines . beta-Lactamase was produced by 77 (55%) of 140 isolates . In vitro MIC testing revealed significant resistance to penicillin (MIC for 90% of isolates {MIC90}, greater than 64 micrograms/ml), tetracycline (MIC90, 4 micrograms/ml), and cefmetazole (MIC90, 8 micrograms/ml) . Spectinomycin resistance was rare (10 of 117), but the MIC90 was 32 micrograms/ml . Isolates were susceptible to fluoroquinolones and cephalosporins at the time of this survey, as evidenced by the MIC90s of ciprofloxacin (0.25 microgram/ml), norfloxacin (2.0 micrograms/ml), ofloxacin (0.625 microgram/ml), cefpodoxime (2.0 micrograms/ml), cefotaxime (1.0 microgram/ml), ceftazidime (0.25 microgram/ml), ceftizoxime (0.25 microgram/ml), and ceftriaxone (0.06 microgram/ml) . To date, ceftriaxone resistance has not emerged, despite the widespread use of this antibiotic in the Philippines.

Diagn Microbiol Infect Dis, 1992 Feb, 15(2), 165 - 7
Neisseria sicca endocarditis with embolic phenomena; Vernaleo JR et al.; Two patients with poor oral hygiene developed Neisseria sicca endocarditis, one after probable intravenous drug abuse and Staphylococcus aureus endocarditis and the other after a periodontal surgical procedure . Both experienced significant embolic phenomena and both required 6 or more weeks of intravenous antibiotic therapy . The diagnosis of N . sicca endocarditis must be considered when this organism is isolated from blood cultures in patients with emboli.

J Mol Evol, 1992 Feb, 34(2), 115 - 25
Role of interspecies transfer of chromosomal genes in the evolution of penicillin resistance in pathogenic and commensal Neisseria species; Spratt BG et al.; The two pathogenic species of Neisseria, N . meningitidis and N . gonorrhoeae, have evolved resistance to penicillin by alterations in chromosomal genes encoding the high molecular weight penicillin-binding proteins, or PBPs . The PBP 2 gene (penA) has been sequenced from over 20 Neisseria isolates, including susceptible and resistant strains of the two pathogenic species, and five human commensal species . The genes from penicillin-susceptible strains of N . meningitidis and N . gonorrhoeae are very uniform, whereas those from penicillin-resistant strains consist of a mosaic of regions resembling those in susceptible strains of the same species, interspersed with regions resembling those in one, or in some cases, two of the commensal species . The mosaic structure is interpreted as having arisen from the horizontal transfer, by genetic transformation, of blocks of DNA, usually of a few hundred base pairs . The commensal species identified as donors in these interspecies recombinational events (N . flavescens and N . cinerea) are intrinsically more resistant to penicillin than typical isolates of the pathogenic species . Transformation has apparently provided N . meningitidis and N . gonorrhoeae with a mechanism by which they can obtain increased resistance to penicillin by replacing their penA genes (or the relevant parts of them) with the penA genes of related species that fortuitously produce forms of PBP 2 that are less susceptible to inhibition by the antibiotic . The ends of the diverged blocks of DNA in the penA genes of different penicillin-resistant strains are located at the same position more often than would be the case if they represent independent crossovers at random points along the gene . Some of these common crossover points may represent common ancestry, but reasons are given for thinking that some may represent independent events occurring at recombinational hotspots.

Clin Infect Dis, 1992 Feb, 14(2), 450 - 7
Epidemiology of penicillin-resistant Neisseria gonorrhoeae isolated in Taiwan, 1960-1990; Chu ML et al.; The epidemiology of penicillin-susceptible Neisseria gonorrhoeae isolated in Taiwan from 1960 to 1990 is summarized . The isolation of N . gonorrhoeae less sensitive to penicillin (i.e., with intrinsic resistance) was first reported in 1960 . The rate at which organisms less sensitive to penicillin (MIC, greater than or equal to 0.5 microgram/mL) were isolated increased to 17%, 50%, 80.1%, and 88.8% in 1967, 1975, 1984, and 1990, respectively . Penicillinase-producing N . gonorrhoeae (PPNG) first appeared in Taiwan in late 1976, and the first six strains of PPNG isolated were from United States military servicemen who had relocated from Southeast Asia . The percentage of PPNG strains rose to 37.82% in 1982, and has remained high (50%-62%) since 1983 . In the present study, resistance of N . gonorrhoeae to spectinomycin (MIC, greater than 32 micrograms/mL), third-generation cephalosporins (MIC, greater than 4 micrograms/mL), or quinolones (MIC, greater than 4 micrograms/mL) has not been found . Strains requiring arginine, hypoxanthine, and uracil for growth, which frequently cause disseminated gonococcal infections, were not isolated . PPNG strains tended to be of the prototrophic auxotype (55%); non-PPNG strains were mostly of the proline-requiring auxotype (48.8%) . Two kinds of R plasmids were isolated in the PPNG strains: the 4.4-MD Asian type (82%-95%) and the 3.05-MD Toronto type (5%-18%) . All of the PPNG strains possessing Toronto R plasmid were of the same auxotype/serotype (prototrophic/IB) . Evidence suggests that the Asian-type R plasmid was imported into Taiwan in 1976, while the Toronto-type R plasmid may have first emerged in Taiwan in 1983.(ABSTRACT TRUNCATED AT 250 WORDS)

Genitourin Med, 1992 Feb, 68(1), 16 - 9
A serovar analysis of heterosexual gonorrhoea in Edinburgh 1986-90; Young H et al.; OBJECTIVE--To analyse the frequency of different gonococcal serovars within Edinburgh, Scotland and to describe changes that occurred in the frequency of such serovars over time . METHODS--All heterosexual patients with a diagnosis of gonorrhoea confirmed on culture between January 1986 and December 1990 had their gonococcal strain serotyped . Temporal changes in the prevalence of gonorrhoea and the serovar of the isolates were analysed . RESULTS--Isolates of Neisseria gonorrhoeae from 1356 episodes of gonorrhoea were serotyped . Three serovars, Bajk (IB-3/IB-6), Bacejk (IB-1/IB-2) and Aedgkih (IA-1/IA-2), dominated, occurring in two-thirds of all infections . Over the study period Bajk (IB-3/IB-6) and Aedgkih (IA-1/IA-2) isolates declined in frequency in parallel with an overall fall in the prevalence of gonorrhoea but Bacejk (IB-1/IB-2) persisted at a lower but fairly constant level . Despite a fall in the number of gonococcal infections the variety of new serovars being isolated fluctuated . CONCLUSIONS--The ability of some serovars to persist while others decline in incidence may be partially related to antibiotic sensitivities but other factors such as an ability to evade the immune response and transfer of serovars from one population group to another may also be important.

Epidemiol Infect, 1992 Feb, 108(1), 31 - 8
Genetic relationships among Neisseria gonorrhoeae serovars analysed by multilocus enzyme electrophoresis; Poh CL et al.; Multilocus enzyme electrophoretic analysis was employed to assess the genetic relatedness of Neisseria gonorrhoeae . Based on the diversity of electromorphs at 9 enzyme loci, 16 electrophoretic types (ETs) were established amongst the 65 isolates . The average number of alleles per enzyme locus was 1.7 and the mean genetic diversity per locus was 0.212 . The majority of isolates belonged to either ET1 (32.3%) or ET2 (16.9%) . No specific correlation of ETs was seen with serovars as the major types, ETs 1 and 2, were found distributed amongst the various serovars . Major serovars such as Bacjk (IB-1/2) and Bajk (IB-3/6) were each represented by 6 or 8 ETs respectively . Analysis of the genetic relationships of ETs to each other showed some clustering of subgroups that were more closely related than others.

J Med Microbiol, 1992 Feb, 36(2), 121 - 7
Isolation of haemin-binding proteins of Neisseria gonorrhoeae; Lee BC; Although Neisseria gonorrhoeae can use haem as the sole exogenous iron source for growth in vitro, the mechanism of haem-iron uptake in the gonococcus is unknown . Two haemin-binding proteins (HmBPs) of 97 and 44 Kda were isolated by batch ligand affinity-chromatography from whole cells or total membranes of gonococci grown under iron-limited conditions but not from those grown under iron-sufficient conditions . Competition binding experiments indicated that the haemin-protein interaction was specific; only haemin or haem-containing proteins, such as human haemoglobin or equine cytochrome c111, but not protoporphyrin IX, iron loaded human transferrin or lactoferrin, could abrogate binding . Identical HmBPs were isolated from three other clinical gonococcal strains, suggesting that these may be interstrain structural and functional homogeneity amongst these polypeptides.

Acta Obstet Gynecol Scand, 1992 Feb, 71(2), 129 - 34
Comparative evaluation of clindamycin/gentamicin and cefoxitin/doxycycline for treatment of pelvic inflammatory disease: a multi-center trial . The European Study Group; Bacteraemia in children in the south-western Cape . A hospital-based survey; Department of Paediatrics, University of StellenboschDuring 1989, of the 8,524 children admitted to the paediatric wards of Tygerberg Hospital, 165 (1.96%) had bacteraemia . The incidence of community-acquired bacteraemias was 1.6% and that of nosocomial bacteraemias 0.5% . The most important community-acquired isolates were Streptococcus pneumoniae, Staphylococcus aureus and Neisseria meningitidis . The most important nosocomial isolates were Klebsiella and Salmonella spp . Both bacteraemia (relative risk (RR) = 2.08) and severe malnutrition (RR = 3.01) were more common in black patients . Overall, severe malnutrition was more common than mild malnutrition or a normal nutritional status in bacteraemic patients (odds radio (OR) = 3.17) . Nineteen patients with bacteraemia died, there was a significantly higher case-fatality rate in patients with extreme malnutrition (P = 0.03; OR = 3.7) . Gram-negative bacilli were found more commonly in patients with extreme malnutrition (OR = 5.4) and patients with nosocomial bacteraemia (OR = 4.6) . Three of 39 patients (7.6%) with nosocomial bacteraemia had suppurative thrombophlebitis.

J Biol Chem, 1992 Jan 15, 267(2), 922 - 5
Structure of the L2 lipopolysaccharide core oligosaccharides of Neisseria meningitidis; Gamian A et al.; Three different oligosaccharides were identified following mild acid hydrolysis of the lipopolysaccharide obtained from Neisseria meningitidis serotype 2 and their structures elucidated by combined chemical and physical techniques . The use of 500 MHz 1H nmr in both one- and two-dimensional modes as well as nuclear Overhauser effect experiments were employed . To assist in the structural assignments the oligosaccharides were also degraded by chemical and enzymatic procedures to smaller fragments . The oligosaccharides were all triantennary nonasaccharides in which the longest antenna terminates in lacto-N-neotetraose . Two of the nonasaccharides (major components), not separable by column chromatography, were distinguishable only by their different patterns of phosphorylethanolamine substitution and the third minor component by the absence of this substituent.

J Clin Microbiol, 1992 Jan, 30(1), 132 - 7
Characterization of Neisseria meningitidis serogroup C by multilocus enzyme electrophoresis and ribosomal DNA restriction profiles (ribotyping); Woods TC et al.; We compared multilocus enzyme electrophoresis (MEE) and ribosomal DNA fingerprinting (ribotyping) for subtyping 44 strains of Neisseria meningitidis serogroup C that were isolated in Los Angeles County, California, between December 1985 and July 1986 . The isolates were divided into six enzyme types (ETs) by MEE, but 36 of the isolates were clustered in one ET, 3 . The same isolates were divided into 17 ribotypes by use of restriction endonucleases ClaI, EcoRI, and XhoI . Twenty of the 36 ET 3 isolates were divided into 17 ribotypes by use of restriction endonucleases ClaI, EcoRI, and XhoI . Twenty of the 36 ET 3 isolates were grouped in a single ribotype, J . The rate of infection with ribotype J strains was higher in the southern part of the study area than in the northern part . Isolates from each of eight pairs (each isolate pair was cultured from the same patient from the same or different sites) were found identical by MEE, but ribotyping revealed a difference in one pair . In this study, ribotyping showed a greater discriminating capacity than MEE for subtyping N . meningitidis serogroup C, but the epidemiologic relevance of this increased sensitivity needs further assessment.

Am Fam Physician, 1992 Jan, 45(1), 209 - 14
Disseminated gonococcal infection; Kerle KK et al.; The most frequent systemic complication of acute, untreated gonorrhea is disseminated infection, which develops in 0.5 to 3 percent of the more than 700,000 Americans infected with Neisseria gonorrhoeae each year . The classic triad of features consists of dermatitis, tenosynovitis and migratory polyarthritis . Disseminated gonococcal infection is most common in young women but may develop in sexually active persons of any age . The diagnosis often is not suspected because the initial mucosal infection is frequently asymptomatic, providing no clue to an infectious etiology . Prompt identification and treatment are essential to prevent complications such as endocarditis, meningitis, perihepatitis and permanent joint damage.

Acta Microbiol Hung, 1992, 39(1), 21 - 30
Morphological changes of Neisseria gonorrhoeae in amniotic fluid of pregnant women in their midtrimester; Pec J et al.; Ten selected samples of amniotic fluid obtained through transabdominal amniocentesis from 10 pregnant women in their 17th-19th weeks of pregnancy were investigated for the survival of Neisseria gonorrhoeae in amniotic fluid . In 8 cases an antibacterial effect was observed with morphological changes comparable to the effect of benzylpenicillin . When N . gonorrhoeae was inoculated in amniotic fluid at 10(5)-10(7) cells/ml, it survived as an average 2 h longer than after inoculation of 10(2)-10(4) cells/ml . Electron microscopic pictures of gonococci taken after 2.6 and 24 h incubation in amniotic fluid correlated with the growth curves . Electron microscopically there were marked morphologic changes of N . gonorrhoeae, viz . vacuolar degeneration of their cytoplasm with a damage to the bacterial wall up to its complete destruction and lysis of the cell.

J Hyg Epidemiol Microbiol Immunol, 1992, 36(1), 111 - 8
Microbial causative agents of male urethritis; Stefanik M et al.; The incidence of Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Neisseria gonorrhoeae and Trichomonas vaginalis was studied in men with urethritis . Out of 150 examined men 48.7% had the positive isolation of U . urealyticum, 26.0% C . trachomatis, 22.7% N . gonorrhoeae, 18.7% M . hominis and in one (0.7%) patient T . vaginalis was found . None of the above mentioned microorganisms was detected in 24.7% of examined men . In 43.3% cases only one agent was isolated . In 23.3% of the men the combination of two agents, in 8.0% the combination of three and in 0.7% even the combination of four studied microorganisms was observed . C . trachomatis was most frequently observed in combination with N . gonorrhoeae (15 cases) and U . urealyticum (14 cases) . M . hominis and U . urealyticum occurred simultaneously in 22 examined men.N.gonorrhoeae was most frequently found together with U . urealyticum (16 cases) . Concerning the occurrence of other bacteria and yeasts, no significant difference was found between the groups positive and negative for the above mentioned microorganisms.

Probl Tuberk, 1992, (1-2), 53 - 5
{Effects of low-intensity garnet laser irradiation on microorganisms and wounds}; Kaliuk AN et al.; The influence of low-intensity garnet laser radiation a wavelength of 0.53 microns (green spectrum) on Mycobacterium tuberculosis (MT), nonspecific microflora and regeneration of aseptic and purulent wounds has been studied experimentally for the first time . Irradiation of MT and nonspecific microflora inoculations has shown that this type of laser radiation fails to stimulate growth of MT and nonspecific microflora and has an inhibiting action on MT manifested by delayed MT growth, a lower number of dimensions of the growth colonies as compared to those of the control inoculations and has a bacteriostatic action on micrococci and Neisseria organisms . Influence of this type of laser on the aseptic and purulent wounds in 50 guinea pigs has revealed a more rapid regeneration of aseptic wounds (by 3-4 days) as compared to the control.

Int J STD AIDS, 1992 Jan-Feb, 3(1), 52 - 3
An epidemic of Neisseria gonorrhoeae in a Somali orphanage; Ahmed HJ et al.; Neisseria gonorrhoeae was isolated from 53 young females (6-14 years old) in a Somali orphanage . A male guardian was found to be the effective transmitter having sexually abused the children . All the bacterial isolates were of the same serogroup WI and the same serovar Aedih . This presents an unusual example of a tight geographic cluster of infected people which is often characteristic of gonorrhoea epidemicsPIP: The physician of an orphanage in Afgoye, 30 km from Mogadishu, Somalia, noticed vaginal discharge in 95 of the 500 girls at the orphanage in September 1987 . A Somali-Italian investigative team took vaginal specimens from the 95 girls . Laboratory personnel isolated Neisseria gonorrhoea in 56% of the 95 6-14 year old females (53) who all lived in 2 adjacent dormitories . They found that all the bacterial isolates were of the N . gonorrhoea WI serogroup and Aedih serovar . The physician prescribed penicillin treatment for all the girls . Contact tracing revealed that a male guardian was the source of gonorrhea . Some children had already accused him of sexually abusing them . Orphanage officials had transferred him 1 week before the arrival of the investigative team . His room had been very near to the 2 dormitories for only a few weeks before the investigative team arrived . In this short time, his sexual abuse effected this cluster of infections . This supports the present theory of gonorrhea epidemiology that a core group of infectious people are most likely responsible for most, if not all, of the continuing endemicity of gonorrhea . The infection rate was in range of the estimated probability of transmission (50-70%) during sexual intercourse from an infectious male to a female . The results showed that high resolution typing of gonococci has in addition to its scientific value a more practical value; forensic medicine and illustration that gonorrhea consists of smaller microepidemics .

Int J STD AIDS, 1992 Jan-Feb, 3(1), 49 - 51
Single-dose therapy of anogenital and pharyngeal gonorrhoea with ciprofloxacin; Balachandran T et al.; A single dose of ciprofloxacin, 250 mg by mouth, was used in an open study to treat pharyngeal or rectal gonorrhoea or both in 64 patients (32 men and 32 women) . The study also included 151 men with urethral gonorrhoea and 53 women with cervical or urethral gonorrhoea . Ciprofloxacin cured 63 (98%) patients with pharyngeal or rectal gonorrhoea (including 5 patients with penicillinase-producing Neisseria gonorrhoeae; PPNG), 147 (97%) men with urethral gonorrhoea (including 8 with PPNG) and 52 (98%) women with cervical or urethral gonorrhoea . All the isolates of N . gonorrhoeae were sensitive to 0.03 mg/l of ciprofloxacin . Five of the 6 patients with treatment failure were subsequently cured by a single oral dose of ciprofloxacin 250 mg . None of the patients reported an adverse reaction . Ciprofloxacin 250 mg as a single oral dose is effective and safe in treating patients with pharyngeal or rectal gonorrhoea, including those with PPNG strains.

Bol Asoc Med P R, 1992 Jan, 84(1), 21 - 5
The new macrolides: expanding the ways in antibiotic treatment; Aviles Santa ML et al.; After almost forty years of its introduction, erythromycin will not be the exclusive member of the macrolide group of antibiotic agents, but a new generation of its derivatives which surpass it in pharmacological properties and clinical efficacy will also be available . Clarithromycin, a 14-membered derivative, has shown acid stability, longer half-life, lower protein binding and higher lung tissue penetration . Its exceedingly high activity against erythromycin-susceptible gram-positive cocci, Mycoplasma pneumoniae, and Legionella pneumophila makes it and important alternative choice in the therapy of respiratory tract infections . Also, it has shown high activity against Chlamydia trachomatis, and high urinary clearance of this unmetabolized molecule, important properties which would render it a special role in the treatment of genitourinary tract infections . Azithromycin, a 15-membered derivative has shown enhanced basicity (due to the nitrogen atom in its lactone ring), longer half-life and lower protein bindings . Its exceptional activity against Hemophilus influenzae, Branhamella catarrhalis, Neisseria gonorrhoeae, Ureaplasma urealyticum and gram-negative bacteria, and its high concentration in tonsillar, pulmonary, prostatic and female reproductive tract tissues, assigns it an honorific place among the macrolides in the therapy against respiratory tract and genitourinary tract infections . Its role against T . gondii deserves further study, but points out this agent as a promise against this parasite.

Mol Microbiol, 1992 Jan, 6(2), 197 - 208
Silent pilin genes of Neisseria gonorrhoeae MS11 and the occurrence of related hypervariant sequences among other gonococcal isolates; Haas R et al.; Pilin variation in Neisseria gonorrhoeae depends on a family of variant genes that undergo homologous, intragenic recombination . This work focuses on the repertoire of silent variant pilin genes in strain MS11, which contribute to the extensive variation of the expressed gene copy . A total of 17 silent copies were identified, which are, to varying degrees, truncated at their 5' coding region and grouped in seven distinct pil loci . Most silent copies belong to loci pilS1, pilS2 and pilS6, which contain six, two and three silent copies, respectively, tandemly arranged . The pilS5 and pilS7 loci each contain only a single copy . In addition, two silent copies are associated with each of the two pilE loci . By comparison with sequences present in the expressed gene of other variants of the same strain, it is suggested that each silent locus is capable of donating variant sequences into the expression locus and, thus, each silent copy can contribute to the variability of pilin expression . Often, concomitant with changes in the expressed copy, the silent copies of the pilE1 locus undergo recombinations as well . Analyses of unrelated clinical isolates of N . gonorrhoeae reveal homologies of hypervariant pilin sequences with those present in strain MS11, suggesting a limited diversity of such sequences within the gonococcal population and the existence of substantial functional constraints on the variability of pilin and pili . The data further indicate that hypervariant pilin sequences are subject to horizontal exchange and interstrain recombination.

J Investig Allergol Clin Immunol, 1992 Jan-Feb, 2(1), 33 - 5
IgE antibodies against Neisseria flavescens; Alonso A et al.; Bacterial allergy is still a matter of controversy . We sustain that this name should be employed only in the presence of a specific IgE against antigens from bacteria . In 100 atopic patients and 100 healthy controls with Neisseria flavescens in their pharyngeal exudates, we performed type I immediate skin tests with Neisseria flavescens and IgE-RAST throughout 1 year . Positive wheal and flare reactions were elicited in 8 of 100 atopic patients as well as in 3 of 100 nonatopic subjects . IgE-RAST/anti-Neisseria flavescens was found in 6 of the former group and in 1 of the latter . Neither late-phase nor Arthus-like reactions were recorded . Neisseria flavescens is a non-pathogenic commensal of the oropharynx with scarce antigenic properties and seems not to play an important role in these conditions (rhinitis/asthma) . Bacterial immunotherapy should be considered only in the presence of specific IgE antibodies with careful selection of the bacteria or their antigens.

Rev Chil Obstet Ginecol, 1992, 57(4), 279 - 82
{Cervical and abdominal microbiology in infertile patients}; Lopez X et al.; The microbiology of twenty-nine asymptomatic infertile women was evaluated prospectively . Samples were taken from the cervix and the endosalpinx during laparoscopy . Cultures for aerobes, anaerobes, Neisseria gonorrhoeae, Mycoplasma, Ureaplasma urealyticum and Chlamydia trachomatis were performed . No association was found between the presence of germs in the abdomen or cervix and tubal abnormalities . History of previous IUD use was associated with tubal disease.

Chemotherapy, 1992, 38(5), 303 - 7
In vitro activity of sparfloxacin and other antimicrobial agents against genital pathogens; Lefevre JC et al.; The in vitro activity of sparfloxacin was determined for 60 strains of Neisseria gonorrhoeae, 15 strains of Chlamydia trachomatis and 40 strains each of Gardnerella vaginalis, Mycoplasma hominis, and Ureaplasma urealyticum and compared with those of ampicillin, azithromycin, clarithromycin, erythromycin, ofloxacin, temafloxacin and tetracycline . Sparfloxacin was active against all the strains studied and appeared to be the most potent quinolone tested . Sparfloxacin had the lowest MICs against N . gonorrhoeae (MICs 0.002-0.06 micrograms/ml) . Its MICs against C . trachomatis (0.03-0.06 micrograms/ml) were higher than those of clarithromycin but lower than those of the other antimicrobial agents . Sparfloxacin was particularly active against tetracycline-susceptible as well as resistant strains of M . hominis (MICs, 0.06 micrograms/ml) and U . urealyticum (MICs 0.125-1 micrograms/ml) . Because of this in vitro activity and its tissue distribution, sparfloxacin might be a valuable therapeutic agent for treating major bacterial sexually transmitted diseases.

Bull Soc Pathol Exot, 1992, 85(3), 209 - 11
{Prevalence of Chlamydia trachomatis in genital samples from Abidjan}; Sanon PS et al.; A study of direct genital swabs achieved in Abidjan, on 116 men and 131 women consulting for urogenital complaints, has revealed that the men show a prevalence of 28.4% Chlamydia trachomatis, and of 18.1% Neisseria gonorrhoeae . Concerning the women the prevalence of the same germs are 13.7% for Chlamydia trachomatis, and 4.6% for Neisseria gonorrhoeae . These results show the importance of Chlamydia trachomatis as a sexually transmitted disease in Abidjan (Cote-d'Ivoire) . No differences were observed according to age in the two groups.

Clin Neurol Neurosurg, 1992, 94(2), 173 - 5
Kingella kingae, a rare cause of bacterial meningitis; Van Erps J et al.; A male adolescent with a history of pharyngitis developed meningitis due to Kingella kingae . This is a Gram-negative coccobacillus belonging to the family of Neisseriaceae . It is a rarely reported human pathogen, from which only 2 cases of meningitis have been described up to the present day . Our patient developed ophthalmoplegia, suggestive of basal meningitis . He was treated with penicillin G and recovered completely.

Pathology, 1992 Jan, 24(1), 27 - 31
Characteristics of Neisseria gonorrhoeae isolated in Australia showing decreased sensitivity to quinolone antibiotics; Tapsall JW et al.; Forty three strains of Neisseria gonorrhoeae with decreased sensitivity to quinolone antibiotics were detected amongst 2141 Australian isolates of gonococci examined in the years 1984 to 1990 . The strains examined belonged to 23 different auxotype/serovar classes, were generally more resistant to other antibiotics and, in the majority of cases, were isolated from travellers entering or returning to Australia from SE Asia . Quinolone-sensitive wild-type gonococci became less sensitive to these agents in vitro at a relatively high frequency when grown in the presence of quinolone concentrations at or around the MIC (Mean Inhibitory Concentration) of the antibiotic . Further increments in the levels of quinolone resistance of the already less-sensitive gonococci were also produced by this means, but high-level resistance to these agents was not observed . This suggests that mechanisms other than alterations in the DNA-gyrase of the organisms were responsible for the changes seen . Although spread of quinolone resistance in gonococci in Australia is unlikely to be rapid, if these antibiotics are used in therapy, treatment regimens with higher rather than lower dosages of quinolone antibiotics should be employed.

Arch Microbiol, 1992, 157(2), 131 - 4
Structure of the sugar-phosphate moiety of lipid A from lipooligosaccharide of Neisseria meningitidis group B, strain BC5S No . 125 . Hydrolytic stability of phosphate and pyrophosphate substituents; L'vov VL et al.; On the basis of chemical and NMR data the partial structure of lipid A from lipooligosaccharide (LOS) of Neisseria meningitidis group B, strain BC5S No 125 was established . Lipid A consisted of disaccharide 2-deoxy-6-O-{2-deoxy-2-(3-hydroxytetradecanoylamino)- beta-gluco-pyranosyl}-2-(3-hydroxytetradecanoylamino)- alpha-glucopyranose carrying the beta-(2-aminoethyl)pyrophosphate residue at 0-4' and the pyrophosphate or phosphate residue at 0-1 . On hydrolysis of the acidic form of LOS with 1% acetic acid the substituent at 0-1 was practically completely removed whereas that at 0-4' was stable . The analogous hydrolysis of the Mg-salt of LOS was accompanied by splitting off the pyrophosphate linkage in the substituent at 0-4' . Hydrolysis of LOS at pH 4.5 in the presence of SDS led mainly to a lipid A preparation retaining both pyrophosphate residues.

J Hyg Epidemiol Microbiol Immunol, 1992, 36(4), 412 - 8
Penicillinase-producing Neisseria gonorrhoeae conjunctivitis on some Nigerian children; Ebong EO et al.; During 21 month study of bacterial conjunctivitis among 121 children in two health care centres in Calabar, Nigeria, a total of 90 (74.4%) cases were culturally confirmed . Neonates had the highest age-specific attack rates with 48 (53.3%) cases . Neisseria gonorrhoeae, the predominant pathogen, was recovered from 32 (35.6%) infections; 21 (65.6%) of them from neonates . Cultures of genital swabs of consenting parents of infected neonates as well as those of three female children aged 2-12 years with concurrent vulvo-vaginitis yielded N . gonorrhoeae . Younger women, mostly primi-gravidae were more frequently found to have benefited from peri-natal health care services than older multi-gravidae . Nevertheless, such access to health care services did not appear to influence the frequency of gonococcal conjunctivitis in neonates from the two maternal groups (P < 0.01) . Sexual abuse and contaminated fomites were the possible modes of gonococcal infection transmission to older children . Overall, 22 (68.8%) strains of gonococci were resistant to penicillin; 19 (59.4%) were penicillinase-producing Neisseria gonorrhoeae (PPNG), while 5 (15.6%) had chromosomally-mediated resistance . All isolates were sensitive to erythromycin . This study recommends a review of gonorrhoea surveillance in pregnancy to include routine examination of cervical swabs just before delivery.

Am J Med, 1991 Dec 30, 91(6A), 140S - 144S
Recent developments in the treatment of sexually transmitted diseases; Mogabgab WJ; Recent changes in the treatment of sexually transmitted diseases include recognition of penicillin-resistant Neisseria gonorrhoeae, identification of Chlamydia trachomatis as the leading cause of bacterial genital infection in the United States, and the realization that the urethritis syndrome is often associated with multiple pathogens . There is currently no monotherapy that eradicates all STD pathogens . The role of fluoroquinolones in the treatment of STDs is still evolving . The investigational agent, temafloxacin, has good activity against gonococci, nongonococcal organisms, and, unlike other quinolones, against Bacteroides fragilis and other anaerobes . Norfloxacin, ciprofloxacin, enoxacin, ofloxacin, and temafloxacin single-dose therapy have demonstrated clinical efficacy for gonococcal infections in non-comparative and comparative trials, including bacterial eradication of isolates resistant to other agents.

Am J Med, 1991 Dec 30, 91(6A), 24S - 26S
In vitro activity of temafloxacin against pathogens causing sexually transmitted diseases; Segreti J; The fluoroquinolones represent a new therapeutic alternative for the treatment of many sexually transmitted diseases, especially those caused by Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, and Urea-plasma urealyticum . In vitro studies have demonstrated the 90% minimal inhibitory concentrations (MIC90s) of temafloxacin for these pathogens to be less than 0.03 micrograms/mL for N . gonorrhoeae; 0.25 micrograms/mL for C . trachomatis; 0.125-2 micrograms/mL for M . hominis; and 4 micrograms/mL for U . urealyticum . These concentrations are equal to or less than those achievable in plasma following a 400-mg temafloxacin oral dose given twice daily . Based on temafloxacin's antimicrobial activity and pharmacokinetic profile, it appears to be an excellent agent for the treatment of patients with gonococcal or nongonococcal urethritis and/or cervicitis.

Am J Med, 1991 Dec 30, 91(6A), 145S - 149S
Single-dose oral temafloxacin versus parenteral ceftriaxone in the treatment of gonococcal urethritis/cervicitis; Mogabgab WJ; Temafloxacin is an oral fluoroquinolone with potent in vitro activity against Neisseria gonorrhoeae . The efficacy and safety of a single dose of temafloxacin were compared with ceftriaxone, the current treatment of choice for gonorrhea, in a randomized, multicenter study . A total of 421 patients with uncomplicated gonococcal urethritis or cervicitis were randomly assigned to receive a single oral dose of temafloxacin 200 mg (n = 63) or 400 mg (n = 175), or a single intramuscular injection of ceftriaxone 250 mg (n = 183) . In evaluable patients, bacteriologic cure rates were greater than 99% for both temafloxacin and ceftriaxone recipients . Corresponding clinical cure rates were 93.6% and 94.6%, respectively . Both regimens were well tolerated . A single oral dose of temafloxacin appears to be as safe and effective as injectable ceftriaxone in the treatment of uncomplicated gonococcal urethritis or cervicitis.

FEMS Microbiol Lett, 1991 Dec 15, 69(1), 69 - 72
Structural heterogeneity of the lipopolysaccharides of the Neisseriaceae; Sandlin R et al.; Lipopolysaccharides from 5 different genera of the Neisseriaceae were analyzed on sodium dodecylsulfate-polyacrylamide gel electrophoresis, and visualized by silver staining . Significant heterogeneity in the banding patterns was observed with some of the strains producing only low molecular mass molecules and others producing O-repeating units . All genera examined except Branhamella contained strains that were able to produce an O-repeating side chain on their lipopolysaccharides . The ability to produce the repeating subunit did not correlate with the presence of plasmids.

J Bacteriol, 1991 Dec, 173(23), 7589 - 98
Neisseria gonorrhoeae prepilin export studied in Escherichia coli; Dupuy B et al.; The pilE gene of Neisseria gonorrhoeae MS11 and a series of pilE-phoA gene fusions were expressed in Escherichia coli . The PhoA hybrid proteins were shown to be located in the membrane fraction of the cells, and the prepilin product of the pilE gene was shown to be located exclusively in the cytoplasmic membrane . Analysis of the prepilin-PhoA hybrids showed that the first 20 residues of prepilin can function as an efficient export (signal) sequence . This segment of prepilin includes an unbroken sequence of 8 hydrophobic or neutral residues that form the N-terminal half of a 16-residue hydrophobic region of prepilin . Neither prepilin nor the prepilin-PhoA hybrids were processed by E . coli leader peptidase despite the presence of two consensus cleavage sites for this enzyme just after this hydrophobic region . Comparisons of the specific molecular activities of the four prepilin-PhoA hybrids and analysis of their susceptibility to proteolysis by trypsin and proteinase K in spheroplasts allow us to propose two models for the topology of prepilin in the E . coli cytoplasmic membrane . The bulk of the evidence supports the simplest of the two models, in which prepilin is anchored in the membrane solely by the N-terminal hydrophobic domain, with the extreme N terminus facing the cytoplasm and the longer C terminus facing the periplasm.

Enferm Infecc Microbiol Clin, 1991 Dec, 9(10), 619 - 23
{Antimicrobial sensitivity of 402 strains of Neisseria gonorrhoeae isolated in 7 Spanish cities}; Perea EJ et al.; To study N . gonorrhoeae resistance in Spain . We evaluate 402 strains consecutively isolated in 7 Spanish cities (Barcelona, Bilbao, Madrid, Murcia, Seville, Valencia and Valladolid) . The MIC to 9 antimicrobial agents was determined by agar-dilution (DST) method . We found a high incidence (15.7%) of penicillinase producer strains (NGPP) . Most (53.3%) of all non-NGPP strains showed reduced sensitivity to penicillin and 1.5% of the strains had chromosomally mediated resistance . All NGPP strains and 90% of non-NGPP strains showed reduced sensitivity to tetracycline (MIC greater than 0.23 mg/l) . We did not found any strain with high-level tetracycline resistance . MIC90 for the other drugs tested were: erythromycin, 0.125 mg/l; spectinomycin, 16 mg/l; cefoxitin, 2 mg/l; cefuroxime 0.06 mg/l; ceftriaxone 0.0037 mg/l; ofloxacin 0.06 mg/l and ciprofloxacin, 0.0018 mg/l . NGPP are very prevalent in Spain . Most of these strains had chromosomally mediated resistance to penicillin and tetracycline . We did not found resistance to other antimicrobial agents.

Mol Microbiol, 1991 Dec, 5(12), 3063 - 72
Prevalence of gene sequences coding for hypervariable regions of Opa (protein II) in Neisseria gonorrhoeae; Brooks GF et al.; Opas (protein IIs) are a family of surface-exposed proteins of Neisseria gonorrhoeae . Each strain of N . gonorrhoeae has multiple (10-11) genes encoding for Opas . Identifiable elements in opa genes include the coding repeat within the signal sequence, conserve 5' and 3' regions, and hypervariable regions (HV1 and HV2) located within the structural gene . N . gonorrhoeae strains appear to have many biological properties in common that are either HV-region-mediated or associated with the presence of specific HV regions, suggesting that HV regions could be found in many clinical isolates . Oligonucleotides from three source strains representing three conserved regions of opa, 12 HV1 regions, and 14 HV2 regions were used by dot blot analysis to probe 120 clinical isolates of N . gonorrhoeae . The probe for the coding repeat hybridized to all 120 strains, the 3' conserved-region probe reacted with 98% of the strains, and the 5' conserved-region probe with 90% of the strains . Nine HV1 probes hybridized to 3.3-39.2% of the strains, and 13 of the HV2 probes hybridized to 1.7-25% of the isolates . Analysis of the number of probes that hybridized to each of the isolates showed that 19% did not hybridize with any of the HV1 probes and 25% did not hybridize with any of the HV2 probes . Approximately three-quarters of the isolates hybridized with one, two or three of the HV1 probes or one, two or three of the HV2 probes; 89% of the isolates hybridized to least one HV1 or one HV2 probe . The data indicate that some genes encoding HV regions of N . gonorrhoeae Opa proteins are widely distributed in nature.

J Rheumatol, 1991 Dec, 18(12), 1932 - 3
Gonococcal septic arthritis of the hip; Lee AH et al.; We describe a patient with a Neisseria gonorrhoeae monoarthritis of the hip . Treatment with intravenous ceftriaxone, oral doxycycline, and repeated fluoroscopic needle aspirations resulted in a complete recovery of function without residual deficit . Gonococcal monoarthritis of the hip is rare . Gonococcal hip infections appear to respond well to antibiotics and drainage by arthrocentesis . This differs from hip infections caused by other bacteria where joint damage is common and where the recommended initial treatment is open surgical drainage.

Kansenshogaku Zasshi, 1991 Dec, 65(12), 1569 - 77
{Bacteriological studies on pharyngeal and tracheal colonization in patients of operations and patients in ICU}; Yoshitomi Y et al.; Bacterial colonization of the pharynx before and one week after operation, and contamination of the trachea during intubation in 7 patients who underwent operations were investigated . And bacterial colonization of pharynx, tracheas, and mechanical-ventilators in 7 ICU patients was investigated . Flora of palms of 10 ICU personnel was also examined: 1) Oral bacteria began to be found in the trachea several hours after intubation . 2) In oropharyngeal flora, one week after operation, Neisseria and anaerobes which belong to normal flora decreased because of antibiotics, but no new resistant bacteria appeared . 3) Although isolates from pharynx of preoperative patients were normal flora, those of ICU patients were Staphylococcus epidermidis, Enterococcus spp., gram-negative rods such as Pseudomonas aeruginosa, and yeast liked organisms etc, which were resistant to antibiotics . 4) From the trachea of intubated patients in ICU, oral bacteria were isolated . 5) Pseudomonas pickettii was isolated from the expiratory side of ventilator circuits in one patient, but it was not isolated from the patient . 6) From hands of ICU personnel, gram-positive bacteria such as coagulase negative staphylococci, Coryne bacterium spp . and Bacillus spp . were isolated . 7) One patient in ICU, who developed pneumonia due to resistant Bacteroides fragilis following oropharyngeal colonization, was reported . These studies suggested the importance of environmental control, careful selection of antibiotics, and attention to change of flora.

Br J Obstet Gynaecol, 1991 Dec, 98(12), 1260 - 6
The role of Chlamydia trachomatis and Neisseria gonorrhoeae in the aetiology of ectopic pregnancy in Gabon; Ville Y et al.; OBJECTIVE--To study the association between ectopic pregnancy and Chlamydia trachomatis and Neisseria gonorrhoeae . DESIGN--A prospective observational study with two comparison groups . SETTING--A general hospital in Franceville, Gabon . SUBJECTS--Forty-five women with ectopic pregnancies and two comparison groups each of 45 women, one at 5 to 12 and the other at 32 to 41 weeks gestation . MAIN OUTCOME MEASURES--Serum levels of IgG and IgA antibodies to C . trachomatis (L1 and rMOMP) and N . gonorrhoeae (pili) in all the women . In the women with ectopic pregnancy peritoneal adhesions were scored and in 40 women samples of tube were cultured for organisms being studied . RESULTS--IgG and IgA antibodies to C . trachomatis (L1) were detected in 84% of the ectopic group and 53 and 39% of the comparison groups (P less than 0.0001) . IgG and IgA antibodies to N . gonorrhoeae occurred in 49, 28 and 18% and 49, 28 and 26% of the groups but the differences were not statistically significant . Adhesions were positively associated with the antibodies . C . trachomatis was cultured from the tubes of 71% of the women with ectopic pregnancy . CONCLUSIONS--Infection with chlamydia, and probably with N . gonorrhoeae, is an important factor in the causation of ectopic pregnancy in GabonPIP: A general hospital in Franceville, Gabon was the site for this prospective, observational study with 2 comparison groups which studied the association between ectopic pregnancy and Chlamydia trachomatous and Neisseria gonorrhoea . 45 women with ectopic pregnancies and 2 comparison groups, each with 45 women, were part of the study, 1 group from 5-12 weeks and the other at 32-41 weeks gestation . Serum levels of IgG and IgA antibodies to C . trachomatous (L1 and rMOMP) and gonorrhoea (pili) in all of the women were measured . In women with ectopic pregnancy, peritoneal adhesions were scored and in 40 women, samples of tube were cultured for organisms under study . IgG and IgA antibodies to C . trachomatous (L1) were detected in 84% of the ectopic group and 53% and 39% of the comparison groups (p0.001) . IgG and IgA antibodies to N . gonorrhoea occurred in 49, 28, and 18%, and 49, 28, and 26% for the groups but the differences were not statistically significant . Adhesions were positively associated with the antibodies . C . trachomatous was cultured from the tubes of 71% of the women with ectopic pregnancies . It was concluded that infection with chlamydia, and probably with N . gonorrhoea, is an important factor in the causation of ectopic pregnancy in Gabon .

APMIS, 1991 Dec, 99(12), 1120 - 8
Normal human serum depleted of C1q, factor D and properdin: its use in studies of complement activation; Sjoholm AG et al.; Normal human sera were depleted of C1q, factor D (D) and properdin (P) by a simple and reproducible procedure providing reagents for analysis of complement-dependent functions . Classical pathway activity was restored with purified C1q, and alternative pathway activity with purified D and P . Since both activation pathways were abolished, antibodies and other components could be removed without loss of complement activity during immunoabsorption procedures . Synergism between the two pathways during haemolysis of rabbit erythrocytes was clearly demonstrated, and was also found on analysis of C3 cleavage in serum incubated with other alternative pathway activators such as zymosan and inulin . Experiments with a Neisseria meningitidis serogroup W-135 strain isolated from a patient with inherited P deficiency showed that both pathways were capable of supporting antibody-dependent killing of the bacteria in serum . The alternative pathway was possibly more efficient than the classical pathway in the assay system . In C1q,D,P-depleted serum with high concentrations of anticapsular IgG antibodies, the addition of D alone resulted in efficient alternative pathway-mediated killing . The alternative pathway was equally efficient in a C1q,D,P-depleted serum with low concentrations of anticapsular antibody, but in this case the reaction required both D and P.

J Exp Med, 1991 Dec 1, 174(6), 1601 - 5
Expression of paragloboside-like lipooligosaccharides may be a necessary component of gonococcal pathogenesis in men; Schneider H et al.; To learn how lipooligosaccharide (LOS) phase variations affect pathogenesis, we studied two male volunteers who were challenged intraurethrally with Neisseria gonorrhoeae that make a single LOS of 3,600 daltons and sequentially followed LOS expression by gonococci as urethritis developed . LOS variation occurred in vivo . Signs and symptoms of gonorrhea began with the appearance of variants making 4,700-dalton LOS that are immunochemically similar to glycosphingolipids of human hematopoietic cells (Mandrell, R.E., J.M . Griffiss, and B.A . Macher . 1989 . J . Exp . Med . 168:107) and that have acceptors for sialic acid . A variant that appeared at the onset of leukorrhoea was shed by 34/36 men with naturally acquired gonorrhea at the time they sought medical attention; the other two shed the variant associated with dysuria . None shed the challenge variant . These data show that in vivo phase shifts to higher molecular mass LOS that mimic human cell membrane glycolipids are associated with the development of gonococcal leukorrhea.

J Bacteriol, 1991 Dec, 173(24), 7896 - 902
Analysis of the lsi region involved in lipooligosaccharide biosynthesis in Neisseria gonorrhoeae; Petricoin EF 3rd et al.; The genetic locus (lsi-1) responsible for the transformation of the lipooligosaccharide (LOS)-defective Neisseria gonorrhoeae mutant FA5100 to LOS expression was studied by deletion mutagenesis and sequence analysis . An open reading frame that was preceded by a leader sequence containing regions with the potential to form hairpin loops was identified . A perfect sigma 70 promoter consensus sequence was found upstream from this open reading frame . Promoter function was screened for functionality by using lac fusion cassettes and in vitro transcription-translation analysis . A frameshift mutation in the lsi-1 gene was constructed by site-directed mutagenesis and introduced into the chromosome of FA19, the LOS-expressing isogenic parent strain of FA5100 . The mutant was characterized by Southern blotting, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and Western blotting (immunoblotting) and found to be phenotypically identical to FA5100.

Infect Immun, 1991 Dec, 59(12), 4628 - 35
Interactions of Neisseria gonorrhoeae with human neutrophils: studies with purified PII (Opa) outer membrane proteins and synthetic Opa peptides; Naids FL et al.; We investigated the role of gonococcal outer membrane protein PII (also called Opa protein) in nonopsonic adherence to human neutrophils . Gonococcal outer membranes, purified Opa in detergent (Opa), purified Opa in liposomes (Opa+ lips), and peptides composing the second hypervariable (HV2) region of OpaB (strain FA1090) in liposomes (pepHV2 lips) were tested for their abilities to inhibit subsequent gonococcal adherence to human neutrophils . Outer membranes from gonococci possessing adherent Opa, liposomes containing adherent Opa, purified adherent Opa, and two of three liposome preparations (pepHV2 lips) containing peptides from the HV2 region of an adherent Opa inhibited subsequent adherence to neutrophils of homologous Opa+ gonococci . On the other hand, outer membranes from Opa- gonococci, outer membranes containing a nonadherent Opa (OpaA from strain FA1090), purified OpaA, and OpaA lips had little or no inhibitory effect . Outer membranes containing adherent Opas, purified adherent Opas, and liposomes containing such Opas all bound to neutrophils, whereas preparations containing OpaA or no Opa protein did not . The results indicate that (i) Opa proteins can bind to neutrophils in a partially purified or purified form and (ii) the HV2 region of Opa appears to at least partially mediate Opa's biological role.

J Electron Microsc Tech, 1991 Dec, 19(4), 461 - 7
Scanning electron microscopy of piliated Neisseria gonorrhoeae processed with hexamethyldisilazane; Dekker NP et al.; Piliated Neisseria gonorrhoeae are virulent and attach readily to some human mucosal cells . The study of interactions between piliated Neisseria gonorrhoeae and surface structures of eukaryotic cells in tissue culture requires consistent high resolution imaging in scanning electron microscopy (SEM) . The combination of the fixatives glutaraldehyde, osmium, tannic acid, and uranyl acetate improves preservation of pili and other delicate structures . Following the critical point drying (CPD) process, pili bundles remained intact, but charging produced image distortion in most of the specimens . The use of hexamethyldisilazane (HMDS) with air drying substantially reduced charging and image distortion . Less contrast and greater resolution of pili bundles and surface structures of bacteria or tissue culture cells were obtained at magnifications of 10,000 or higher . As an alternative to CPD, HMDS processing of cell culture monolayers was simple and was more efficient when a large number of samples was processed.

Infect Immun, 1991 Dec, 59(12), 4674 - 6
Shared antigenicity and immunogenicity of type 4 pilins expressed by Pseudomonas aeruginosa, Moraxella bovis, Neisseria gonorrhoaea, Dichelobacter nodosus, and Vibrio cholerae; Patel P et al.; Immunoblotting with polyclonal rabbit antibodies raised against pilins expressed by Pseudomonas aeruginosa, Moraxella bovis, Neisseria gonorrhoeae, Dichelobacter nodosus, and Vibrio cholerae was used to demonstrate that these polypeptides display conserved antigenic and, in most cases, immunogenic determinants . These determinants appear to be localized to the highly homologous amino-terminal domains (residues 1 to 25).

Infect Immun, 1991 Dec, 59(12), 4383 - 90
Stimulation of human neutrophil oxidative metabolism by nonopsonized Neisseria gonorrhoeae; Naids FL et al.; Nonopsonized gonococci possessing opacity-associated (Opa; previously PII) outer membrane proteins stimulate neutrophils to undergo a vigorous oxidative response when measured by luminol-dependent chemiluminescence (LDCL) . In these studies, we characterized the mechanism of this stimulation . No gonococci that we tested induced measurable release of neutrophil superoxide anion (O2-) or hydrogen peroxide (H2O2) as measured by reduction of cytochrome c or the oxidation of scopoletin, respectively . Neutrophils pretreated with gonococci and then exposed to phorbol myristate acetate, the chemotactic peptide formylmethionylleucylphenylalanine, or opsonized zymosan released levels of neutrophil O2- and H2O2 comparable to controls, indicating that gonococci were not preventing or inhibiting neutrophil O2- or H2O2 release . To ascertain a possible explanation for these seemingly contradictory observations (i.e., induction of LDCL, but no release of O2- or H2O2), we further characterized the ability of Opa+ gonococci to stimulate LDCL . By using 1 mM azide and 4 U of horseradish peroxidase to monitor extracellular LDCL selectively and 2,000 U of catalase to monitor intracellular LDCL selectively, we determined that greater than 80% of total gonococcus-induced neutrophil LDCL occurred intracellularly . In addition, neutrophils stimulated with Opa+ gonococci showed a marked increase in O2 uptake and hexose monophosphate shunt activity . We conclude that Neisseria gonorrhoeae induces neutrophil oxidative metabolism without causing release of detectable amounts of reactive oxygen intermediates into the surrounding milieu . The gonococcus apparently directs oxidase assembly and activity to the phagolysosomal membrane . This could be a mechanism by which extracellular gonococci persist for extended periods in vivo in the presence of high concentrations of neutrophils.

J Immunol Methods, 1991 Nov 22, 144(2), 215 - 21
Studies on the gonococcal IgA1 protease II . Improved methods of enzyme purification and production of monoclonal antibodies to the enzyme; Blake MS et al.; Two types of extremely active proteases that cleave human IgA1 are produced by pathogenic Neisseria in minute concentrations . To study the antigenicity of these enzymes, a simplified method is described to purify these enzymes from large batch cultures to obtain a sufficient quantity of these IgA1 proteases to study these characteristics . In addition, we describe the production of both rabbit polyclonal and mouse monoclonal antibodies to one of these enzymes . One such monoclonal antibody seemed directed toward the active site of the IgA1 protease and inhibited its enzymatic activity.

Proc R Soc Lond B Biol Sci, 1991 Nov 22, 246(1316), 173 - 7
Gonococcal infection and human fertility in sub-Saharan Africa; Brunham RC et al.; An analysis is presented of the influence of Neisseria gonorrhoeae on human population growth in regions of sub-Saharan Africa where gonococcal infections are prevalent in sexually active adults . Combining epidemiological and demographic data within the framework of a mathematical model, we show that gonorrhoea has a major impact on fertility and, concomitantly, on net population growth in areas with a high prevalence of untreated infections . Specifically, a 20% prevalence in sexually active adults is predicted to induce a 50% reduction in net population growth . Model predictions are in good agreement with observed data from Uganda, and the sensitivity of the prediction to various complications, such as heterogeneity in sexual behaviour, is assessed . The analysis suggests that the predicted increase in fertility arising from expanded sexually transmitted disease (STD) control programmes in Africa to help combat the spread of human immunodeficiency viruses (HIV-1 and HIV-2) will help to offset the predicted demographic impact of AIDS in the worst afflicted areas . In other areas the rise in fertility associated with effective STD control will need to be countered by the linkage of STD control programmes with family planning initiatives.

N Engl J Med, 1991 Nov 7, 325(19), 1337 - 41
A comparison of single-dose cefixime with ceftriaxone as treatment for uncomplicated gonorrhea . The Gonorrhea Treatment Study Group; Handsfield HH et al.; BACKGROUND . Because of the widespread existence of Neisseria gonorrhoeae resistant to penicillin or tetracycline, ceftriaxone is now recommended for the treatment of gonorrhea . There is, however, a need for effective antibiotics that can be administered orally as an alternative to ceftriaxone, which requires intramuscular administration . Cefixime is an orally absorbed cephalosporin that is active against resistant gonococci and has pharmacokinetic activity suitable for single-dose administration . METHODS AND RESULTS . In a randomized, unblinded multicenter study of 209 men and 124 women with uncomplicated gonorrhea, we compared three single-dose treatment regimens: 400 mg or 800 mg of cefixime, administered orally, and 250 mg of ceftriaxone administered intramuscularly . The overall cure rates were 96 percent for the 400-mg dose of cefixime (89 of 93 patients) (95 percent confidence interval, 93.5 percent to 97.8 percent); 98 percent for the 800-mg dose of cefixime (86 of 88 patients) (95 percent confidence interval, 94.6 percent to 100 percent); and 98 percent for ceftriaxone (92 of 94 patients) (95 percent confidence interval, 94.9 to 100 percent) . The cure rates were similar in men and women, and pharyngeal infection was eradicated in 20 of 22 patients (91 percent) . Thirty-nine percent of 303 pretreatment gonococcal isolates had one or more types of antimicrobial resistance; the efficacy of all three regimens was independent of the resistance pattern . Chlamydia trachomatis infection persisted in at least half the patients infected in each treatment group . All three regimens were well tolerated . CONCLUSIONS . In the treatment of uncomplicated gonorrhea, a single dose of cefixime (400 or 800 mg) given orally appears to be as effective as the currently recommended regimen of ceftriaxone (250 mg given intramuscularly).

JAMA, 1991 Nov 13, 266(18), 2587 - 93
Pathogenesis of pelvic inflammatory disease . What are the questions?
Rice PA, Schachter J.
Pelvic inflammatory disease is usually caused by Chlamydia trachomatis or Neisseria gonorrhoeae . Chlamydiae and gonococci are primary pathogens of the cervix and often ascend . Resultant damage to the cervix may permit organisms to move upward, but this mechanism of action is not well understood . Puberty and hormones, particularly oral contraceptives, may enhance chlamydial infection, but the mechanisms and likelihood of spread to the upper tract are ill defined . Upper tract infection with C trachomatis involves an acute phase, characterized by an influx of polymorphonuclear leukocytes and a chronic or persistent phase characterized by the presence of mononuclear cells (delayed hypersensitivity) . Gonococci invade nonciliated epithelial cells, but are toxic to ciliated cells, due to elaborated lipooligosaccharides and peptidoglycan . Certain gonococci stimulate chemotaxis of polymorphonuclear leukocytes whose release of toxic metabolites may damage tissue . The immunologic mechanisms that permit specific host responses to these two organisms are now being elucidated and should receive more attention by researchers.

Infect Immun, 1991 Nov, 59(11), 4034 - 41
Subgingival microbiota in squirrel monkeys with naturally occurring periodontal diseases; Beem JE et al.; The squirrel monkey (Saimiri sciureus) has been proposed as an in vivo model for the study of subgingival colonization by suspected periodontopathogens, such as black-pigmented porphyromonads and prevotellas (BP/P) . However, the indigenous microbiota of the squirrel monkey has not been well described . Therefore, in order to more fully characterize the oral microbiota of these animals, we studied two groups of squirrel monkeys from widely different sources . Group I consisted of 50 breeding colony monkeys ranging in age from 9 months to over 6 years which had been raised in captivity; group II consisted of 16 young sexually mature monkeys recently captured in the wild in Guyana . Group I animals in captivity had developed moderate to severe gingivitis, with a mean gingival index (GI) of 2.6; 52% of the sites bled, 26% had detectable calculus, and 83% had detectable BP/P . A group I subset (six animals), for which predominant cultivable microbiota was described, had a mean GI of 2.4 . Colony morphology enumeration revealed that five of the six subset animals were detectably colonized with BP/P (range, 0 to 16.9%) and Actinobacillus actinomycetemcomitans (range, 0 to 3.9%); all subset animals were colonized with Fusobacterium species (range, 0.8 to 3.6%), Actinomyces species (range, 2.3 to 11%), and gram-positive cocci (range, 1.4 to 21.4%) . Predominant cultivable microbiota results revealed the presence of many bacterial species commonly found in the human gingival sulcus . At baseline, group II animals were clinically healthy and had a mean GI of 1.4; 67% of the sites bled and 2.1% had calculus, and none of the animals had detectable BP/P . Neisseriae were very common in noninflamed sites . Subsequently, when inflamed sites were compared with noninflamed sites in group II animals after they had been maintained in captivity for 6 months, inflamed sites exhibited a more complex microbiota and increased proportions of gram-negative rods and asaccharolytic bacteria.

East Afr Med J, 1991 Nov, 68(11), 853 - 9
Prevalence of resistance of N . gonorrhoeae to penicillin and three other antibiotics in a rural area in Kenya; van Hall MA et al.; Of 90 isolates of Neisseria gonorrhoeae in a rural area in Kenya, 44 (48.9%) produced beta-lactamase (penicillinase) . Testing for susceptibility of 35 penicillinase producing N . gonorrhoeae (PPNG) strains to four antibiotics yielded the following results: 16 (45.7%) showed a decreased susceptibility to tetracycline; six (17.1%) showed resistance, probably plasmid mediated; 10 (28.6%) had intermediate susceptibility to gentamicin; one (2.9%) was resistant; and two (5.7%) isolates were resistant to cefotaxime . 16 (57.1%) of 28 non PPNG strains showed a decreased susceptibility to penicillin; 10 (35.7%) were resistant . Nine (32.1%) of 28 non-PPNG isolates showed intermediate susceptibility to tetracycline; one (3.6%) was resistant . Eight of non PPNG isolates (28.6%) showed decreased susceptibility to gentamicin . These results imply that penicillin and tetracycline should be abandoned as primary therapy . For the time being, thiamphenicol and spectinomycin seem to be good alternatives . The observation of cefotaxime resistance in N . gonorrhoeae in a rural area implies a warning concerning future possibilities for use of third generation cephalosporins.

East Afr Med J, 1991 Nov, 68(11), 860 - 4
Dysuria in infancy and childhood: an analysis of 42 children presenting in the paediatrics outpatients department; Babaoye FA et al.; Urinary tract infection (UTI) was the only pathology found among 42 children presenting at the paediatric outpatient department with pain or straining on micturition . 18 (42.9%) had cystourethritis proven bacteriologically . 3 of these had gonococcal urethritis and were all males aged less than 3 years . Four had vasical schistosomiasis . No definite diagnosis could be made in 24 (57.1%) cases . Only secondary symptoms of gross haematuria, urethral discharge and cloudy urine were of diagnostic value, others were not . Children without these specific secondary symptoms predominate and may or may not have urinary tract pathology . Urinary leucocyte count on native urine is a useful screening test to identify those to be further investigatedPIP: Physicians followed 42 1-120 month old children who had visited the outpatient clinic at the Ahmadu Bello University Teaching Hospital in Zaria, Nigeria complaining of pain or who had to strain while urinating until they determined the cause of the urinary condition . They conducted this study to examine the clinical profile of children complaining of pain or strain while urinating . 38 presented with pain and 4 with strain . Physicians could not make a definite diagnosis for 24 children . They were able to diagnose urinary tract infection (UTI) in 42.8% (18), however . The causes of the urinary condition included bacterial (nongonococcal) UTI (26.2%), gonococcal urethritis (7.1%), and schistosomiasis (9.5%) . Physicians found ova of Schistosoma haematobium in the 4 children, with much blood in their urine . Of the remaining 14 children, 13 children complained of pain . 3 boys 3 years old had urethral discharge caused by Neisseria gonorrhoeae infection . The urine of 12 children in the UTI group and 2 of the 24 no definite diagnosis group had significant leucocyturia (+or= 10 white blood cells/ml) . Based on the results of this study, physicians should consider any child complaining of persistent pain as having a pathology in the urinary tract since pain was present in 13 of the 14 UTI cases . As for those patients who experience discomfort during micturition, physicians should further examine those with significant leucocyturia .

Jpn J Antibiot, 1991 Nov, 44(11), 1206 - 10
{Treatment of gonococcal urethritis}; Osato K et al.; Results of the treatment of 5 cases of males with uncomplicated gonoccocal urethritis using levofloxacin (LVFX, DR-3355), the L-type optical isomer of ofloxacin (OFLX), were compared with those treated with OFLX itself . Three hundred mg/day of LVFX or 600 mg/day of OFLX was given to each patient for 5 days . Both drugs showed excellent clinical results in all the patients . When MICs of the 2 drugs were compared against 57 isolated strains of Neisseria gonorrhoeae including 3 penicillinase-producing N . gonorrhoeae, it was found that MICs of LVFX were approximately one half of those of OFLX.

Eur J Epidemiol, 1991 Nov, 7(6), 699 - 701
Urethritis caused by neisseria meningitidis: a case report; Quarto M et al.; Isolation of N . meningitidis from the male urethra has become more common in recent years and this has been attributed to sexual activities and changes in social attitudes . We describe a further case of acute urethritis caused by transmission of N . meningitidis occurring after a single sexual contact (fellatio) in a heterosexual man . The urethritis was initially diagnosed as being caused by N . gonorrhoeae on a presumptive basis, then attributed to N . meningitidis serogroup Y . This case shows the need of accurate diagnostic procedures in all cases resembling gonococcal urethritis.

J Clin Microbiol, 1991 Nov, 29(11), 2434 - 7
Variability in growth of Neisseria polysaccharea on colistin-containing selective media for Neisseria spp; Anand CM et al.; In a prospective survey of 773 healthy schoolchildren in southern Alberta, Canada, Neisseria polysaccharea was isolated from the pharynxes of only 4 (0.5%) subjects, whereas Neisseria lactamica and Neisseria meningitidis were isolated from 110 (14%) and 15 (2%) children, respectively . These strains of N . polysaccharea, together with three other sporadic isolates from Alberta, Canada, were compared with the type strain from France and strains from Spain and Germany . All strains were phenotypically identical, except that the Canadian and German strains, for which the colistin MICs were 1 mg/liter, failed to grow on Thayer-Martin medium (TMM), whereas the type strain and the Spanish strains, for which the colistin MICs were greater than 7.5 mg/liter, were not inhibited . Multilocus enzyme electrophoresis indicated that six distinct electrophoretic types were present among the seven Canadian strains . Our results show that growth on gonococcal selective media which contain colistin is a variable feature of this taxon.

J Appl Bacteriol, 1991 Nov, 71(5), 398 - 401
Microbiological exploitation of cardiac glycosides and alkaloids from Garcinia kola, Borreria ocymoides, Kola nitida and Citrus aurantifolia; Ebana RU et al.; The four medicinal plants, Garcinia kola (roots), Borreria ocymoides (leaves), Kola nitida (bark) and Citrus aurantifolia (roots) were screened for phytochemical components . They were found to contain tannins, phlobatannins, polyphenols, hydroxymethyl anthraquinones, glucides, saponins, alkaloids, cardiac glycosides, flavanoids and reducing compounds . The aqueous and alcoholic extracts as well as alkaloids and cardiac glycosides of the medicinal plants were tested on various pathogenic bacteria . They were found to inhibit such organisms as Staphylococcus aureus, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, beta-haemolytic streptococci, Escherichia coli and Neisseria gonorrhoeae . The usefulness of the phytochemical bases of these plants as potential sources of pharmaceutical drug preparation is discussed.

J R Soc Med, 1991 Nov, 84(11), 657 - 9
Rape and sexually transmitted diseases: patterns of referral and incidence in a department of genitourinary medicine; Ross JD et al.; A retrospective study was carried out of all women attending a Department of Genitourinary Medicine over a 3-year period . Note was taken of referring source, presenting symptoms, infection detected at STD screening and follow-up attendance . Comparison was also made between the number of women referred by the police surgeon and the number who actually attended . We observed an overall incidence of STD of 35% and noted that many infections had a similar prevalence to that of our normal clinic population over the same time period . Only 13% of the women referred by the police attended although after the initial visit attendance was similar regardless of referral source . A number of asymptomatic women were noted to have infection with Neisseria gonorrhoeae and Chlamydia trachomatis . Although, the risk of significant STD following sexual assault is low greater efforts should be made to encourage women to attend for screening whether or not they are symptomatic.

Res Microbiol, 1991 Nov-Dec, 142(9), 985 - 93
Fate of the major outer membrane protein P.IA in early and late events of gonococcal infection of epithelial cells; Weel JF et al.; We investigated the fate of the major outer membrane protein of Neisseria gonorrhoeae, P.IA, during gonococcal infection of Chang conjunctiva epithelial cells by using immunoelectron microscopy . Probing of P.IA epitopes with mono- and polyclonal antibodies revealed variable, fixation-dependent P.IA epitope exposure in the gonococci used as an inoculum in the infection experiments . Detection of invariable exposed P.IA epitopes in cryosections of infected epithelial cells with a polyclonal antiserum revealed unaltered P.IA exposure on the bacterial membranes during early attachment of the bacteria to the eukaryotic cells . Upon entry of the bacteria into the host cells, however, labelling was extended to membraneous structures that intercalated between the bacteria and the host cell surface, and, occasionally, to the host cell plasma membrane . The latter observation is consistent with the suggested active role of P.I . in the uptake process (as shown in 1985 by E.C . Gotschlich) . Once inside the epithelial cells, both morphologically intact and disintegrating bacteria could be distinguished . The disintegration of the bacteria was accompanied by a loss of P.IA immunoreactivity.

Immunology, 1991 Nov, 74(3), 490 - 6
Specificity of the immune response to the group B polysaccharide of Neisseria meningitidis; Lifely MR et al.; A panel of monoclonal antibodies (mAb) and polyclonal sera of murine, human and equine origin, of IgM isotype and with specificity for Neisseria meningitidis group B polysaccharide, an alpha(2----8)-linked homopolymer of sialic acid, were examined for their antigenic and biological specificities . The nature of the antigenic determinants on B polysaccharide was investigated using a series of N-acyl derivatives of B polysaccharide, two sialic acid polymers containing alpha(2----9)-linkages and a series of polynucleotides . The panel of antibodies recognized an array of unrelated antigenic determinants on the B polysaccharide, despite its structural simplicity, and all but one were highly effective in an in vitro bactericidal assay and/or in an in vivo murine passive protection model . There was no evidence that B polysaccharide induced antibody capable of blocking biological activity (blocking antibody).

Mol Immunol, 1991 Nov, 28(11), 1233 - 42
Epitope expression and partial structural characterization of F62 lipooligosaccharide (LOS) of Neisseria gonorrhoeae: IgM monoclonal antibodies (3F11 and 1-1-M) recognize non-reducing termini of the LOS components; Yamasaki R et al.; F62 LOS of Neisseria gonorrhoeae consists of two components . The higher molecular weight (MW) component is recognized by monoclonal antibody (MAb) 1-1-M and the smaller MW component by MAb 3F11 . Epitope expression of the two LOS components and their partial structures were investigated by treating the F62 LOS with several glycosidases and then monitoring their antigenicity with the two mouse IgM MAbs . The 1-1-M-defined LOS component was cleaved with both beta-N-acetylhexosaminidase and endo-beta-galactosidase, and each cleavage resulted in the loss of expression of the 1-1-M-defined epitope . The N-acetylhexosamine (HexNAc) released by the hexosaminidase was found to be GalNAc, and the smaller oligosaccharide released by the endo enzyme was identified to be a dimer GalNAc beta----Gal . In contrast, the MAb 3F11-defined LOS component was not digested by the endo galactosidase, but it was cleaved with alpha and beta-galactosidase, and expression of the MAb 3F11-defined LOS epitope expression of the MAb 3F11-defined LOS was abolished by the treatment with each of two exo enzymes . MAb 3F11 bound to the 1-1-M-defined LOS component resulting from the removal of the beta-GalNAc residue, and the resulting LOS was further cleaved with beta-galactosidase, but not with alpha-galactosidase . From these results, we conclude the following: (1) MAbs 1-1-M and 3F11 both recognize the non-reducing termini of the LOS components; (2) the 1-1-M-defined LOS component has the GalNAc beta----Gal beta 1----4-Glc (or GlcNAc) structure, and the GalNAc beta----Gal residue is involved in the MAb 1-1-M-defined epitope; (3) the MAb 3F11-defined LOS component may not have a Gal beta 1----4GlcNAc beta 1----4Gal beta 1----4Glc structure within the molecule . However, it has beta-Gal residue at its non-reducing terminus, and this residue is involved in the MAb 3F11-defined epitope; (4) the two LOS components share a similar antigenic structure, and the 3F11-defined epitope structure is present in the MAb 1-1-M-defined LOS component . Expression of this epitope within the 1-1-M-defined LOS molecule is blocked by the beta-GalNAc residue; however, the beta-GalNAc residue at the non-reducing end may be not the only structural difference between the two components.

Biochemistry, 1991 Oct 29, 30(43), 10566 - 75
Structural determination of oligosaccharides derived from lipooligosaccharide of Neisseria gonorrhoeae F62 by chemical, enzymatic, and two-dimensional NMR methods; Yamasaki R et al.; F62 LOS of Neisseria gonorrhoeae consists of two major LOS components; the higher and smaller molecular weight (MW) components were recognized by MAbs 1-1-M and 3F11 respectively . Base-line separation of the two major oligosaccharide (OS) components from F62 LOS was achieved by Bio-Gel P-4 chromatography after dephosphorylation of the OS mixture . The structures of the two major OSs were studied by chemical, enzymatic, and 2D NMR methods {double quantum filtered COSY (DQF-COSY), delayed COSY (D-COSY), homonuclear Hartmann-Hahn spectroscopy (HOHAHA), pure-absorption 2D NOE NMR} as well as methylation followed by GC/MS analysis . The OS component derived from the MAb 1-1-M defined LOS component was determined to have a V3-(beta-N-acetylgalactosaminyl)neolactotetraose structure (GalNAc is beta 1----3-linked to a neolactotetraose) at one of its nonreducing termini as shown below . The above pentaose is linked to a branched diheptose-KDO core in which a GlcNAc is alpha-linked . The OS component derived from the MAb 3F11 defined LOS component did not have a GalNAc residue . The rest of its structure was identical to that of the OS-1, and a neolactotetraose is exposed at its nonreducing terminus . {formula: see text}

J Biol Chem, 1991 Oct 15, 266(29), 19303 - 11
The structural basis for pyocin resistance in Neisseria gonorrhoeae lipooligosaccharides; John CM et al.; Pyocin resistance in a strain of Neisseria gonorrhoeae has been found to be associated with structural differences in the oligosaccharide moieties of the gonococcal outer membrane lipooligosaccharides (LOS) . N . gonorrhoeae strain 1291 had been treated with several pyocins, usually lethal bacteriocins produced by Pseudomonas aeruginosa, and a series of surviving mutants were selected . The LOS of these pyocin-resistant mutants had altered electrophoretic mobilities in sodium dodecyl sulfate-polyacrylamide gels (Dudas, K . C., and Apicella, M . A . (1988) Infect . Immun . 56, 499-504) . Structural analyses of the oligosaccharide portions of the wild-type (1291 wt) and five pyocin-resistant strains (1291a-e) by liquid secondary ion mass spectrometry, tandem mass spectrometry, and methylation analysis revealed that four of the mutant strains make oligosaccharides that differ from the wild-type LOS by successive saccharide deletions (1291a,c-e) and, in the oligosaccharide of 1291b, by the addition of a terminal Gal to the 1291c structure . The composition, sequence, and linkages of the terminal tetrasaccharide of the wild-type LOS are the same as the lacto-N-neotetraose terminus of the human paragloboside (Gal beta 1----4GlcNAc beta 1----3Gal beta 1----4Glc-ceramide), and both glycolipids bound the same monoclonal antibodies O6B4/3F11 that recognize this terminal epitope . None of the pyocin-resistant mutants bound this antibody . The 1291b LOS bound a monoclonal antibody that is specific for Gal alpha 1----4Gal beta 1----4Glc-ceramide (Pk glycosphingolipid) and shared a common composition, sequence, and linkages with this latter glycosphingolipid . Organisms that bound the anti-Pk monoclone occurred at the rate of approximately 1/750 among the wild-type parent strain . This structural information supports the conclusion that treatment with pyocin selects for mutants with truncated LOS structures and suggests that the oligosaccharides contained in the LOS of the wild-type strain and 1291b mimic those of human glycosphingolipids.

FEMS Microbiol Lett, 1991 Oct 15, 67(3), 123 - 36
Analysis of the molecular mass heterogeneity of the transferrin receptor in Neisseria meningitidis and commensal Neisseria; Ferreiros CM et al.; Peroxidase-conjugated transferrin was used to detect transferrin receptors both in intact outer membrane vesicles (OMVs) from Neisseria species in a dot blot assay, and in SDS-PAGE-separated OMV proteins after transferring to nitrocellulose membranes . All N . meningitidis strains produced transferrin receptors after culturing in either iron sufficiency or iron restriction although expression was higher in the latter case, whereas only six N . lactamica and two N . sicca (among 20 commensal species) were able to bind transferrin . Molecular mass (MM) of the receptors were mainly between 78 kDa and 85 kDa (87.5% of strains), 12.5% had receptors with MM close to 70 kDa, and 5% showed receptors with MM over 85 kDa . Our results confirm the molecular mass heterogeneity of the transferrin receptors in N . meningitidis, completely disagree with the 'universal' 98 kDa receptor proposed by some authors, and show a low expression of the receptor in commensal Neisseria.

J Reprod Med, 1991 Oct, 36(10), 711 - 6
Complications of cervical cryotherapy in adolescents; Hillard PA et al.; Cervical dysplasia and human papillomavirus (HPV) infections in sexually active adolescents appear to be increasing . Cervical cryotherapy offers the advantages of inexpensive outpatient therapy that is well tolerated without anesthesia . Previous series have focused on women beyond adolescence and have concluded that the risks and complications are rare . Sixty-seven adolescents underwent cervical cryotherapy for cervical intraepithelial neoplasia (CIN) or HPV infection . Pelvic inflammatory disease developed in 9% within one month of treatment . Two patients developed cervical stenosis and hematometra . Cervical cultures performed prior to cryotherapy were documented to be negative, but the interval from negative cultures to treatment exceeded four weeks in 54% of the patients because of problems with patient compliance with appointments . The risk of infectious complication in our adolescent population prompted a recommendation for aggressive preventive measures, including documentation of recent negative cultures for Neisseria gonorrhoeae and Chlamydia . The use of prophylactic antibiotics should be investigated for adolescents undergoing cervical cryotherapy.

J Clin Microbiol, 1991 Oct, 29(10), 2111 - 4
Proposed interpretive criteria and quality control parameters for testing in vitro susceptibility of Neisseria gonorrhoeae to ciprofloxacin; Fuchs PC et al.; Ciprofloxacin was subjected to a multilaboratory study designed to determine its in vitro susceptibility criteria for Neisseria gonorrhoeae and its quality control parameters for both agar dilution and disk diffusion susceptibility testing for this species . All clinical isolates were susceptible, i.e., MICs were less than or equal to 0.06 microgram/ml and zones of inhibition were greater than or equal to 36 mm . A resistant category could not be defined, but in vitro-selected mutants gave zones of less than or equal to 35 mm, and MICs for these strains were greater than or equal to 0.12 microgram/ml . For quality control of ciprofloxacin agar dilution tests on supplemented GC agar, MICs for Staphylococcus aureus ATCC 29213 ranged from 0.12 to 0.5 microgram/ml . For quality control of 5-micrograms ciprofloxacin disk tests, N . gonorrhoeae ATCC 49226 and S . aureus ATCC 25923 produced acceptable zone diameter ranges of 48 to 58 mm and 22 to 26 mm, respectively.

Infect Immun, 1991 Oct, 59(10), 3604 - 9
Eight lipooligosaccharides of Neisseria meningitidis react with a monoclonal antibody which binds lacto-N-neotetraose (Gal beta 1-4GlcNAc beta 1-3Gal beta 1-4Glc); Tsai CM et al.; Eight of 12 serologically different lipooligosaccharides (LOS) of Neisseria meningitidis bound a mouse monoclonal antibody (anti-My-28) that recognizes lacto-N-neotetraose (LNnT) (Gal beta 1-4GlcNAc beta 1-3Gal beta 1-4Glc) . Among the 12 LOS immunotypes, types 2, 3, 4, 7, 8, and 9 exhibited strong binding; types 5 and 10 were moderate; and types 1, 6, 11, and 12 were negative as measured by enzyme-linked immunosorbent assays, immunodot assays, and immunoblot assays . If an LOS showed multiple components by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis, the antibody-reactive epitope was expressed on the larger major component, of which the molecular weight was estimated to be 4,000 for most types . The expression of the reactive epitope on the LOS was influenced by the growth medium, and the epitope could be masked by sialylation when N . meningitidis was grown in tryptic soy broth . N-Acetyllactosamine inhibited the binding of the antibody to all eight reactive LOS . The antibody binding to a representative LOS was best inhibited by LNnT and next by N-acetyllactosamine but was not inhibited by lacto-N-tetraose (Gal beta 1-3GlcNAc beta 1-3Gal beta 1-4Glc) . These results suggest that the LNnT sequence is present in 8 of 12 immunotype LOS . The presence of the LNnT sequence, a structure expressed by a variety of human cells, in the LOS may play a role in the virulence of N . meningitidis by enabling the organism to evade host immune defenses.

Infect Immun, 1991 Oct, 59(10), 3504 - 10
Effect of carrier priming on immunogenicity of saccharide-protein conjugate vaccines; Peeters CC et al.; Previous studies with saccharide-protein conjugates have demonstrated that antibody responses to the saccharide can be improved by the preexistence of carrier immunity . Here we report that prior exposure to the carrier protein can either enhance or suppress antibody response to polysaccharides administered in saccharide-protein conjugates . A dose-dependent role for carrier priming in the antisaccharide antibody response to three saccharide-protein conjugate vaccines, i.e., a Streptococcus pneumoniae type 4 polysaccharide-tetanus toxoid (TT) conjugate (PS4TT), a Neisseria meningitidis group C polysaccharide-TT conjugate (MenCTT), and a N . meningitidis group C oligosaccharide-diphtheria mutant toxin conjugate (MenCCRM), was investigated . The results showed that an increase in the antipolysaccharide antibody response could be obtained for both PS4TT and MenCTT but not for MenCCRM with low-dose carrier priming (0.025 to 0.25 microgram) . However, suppression of the antipolysaccharide antibody response was observed with the PS4TT and MenCTT vaccines with high-dose (25-micrograms) carrier priming . There was no suppression effect with MenCCRM . The increase in the antipolysaccharide antibody response was shown to be restricted to the immunoglobulin G1 (IgG1) subclass, whereas suppression with high-dose carrier priming affected all antipolysaccharide subclass antibodies induced by PS4TT (IgG1, IgG2b, and IgG3) and only two of the four subclass antibodies induced by MenCTT (IgG2a and IgG2b) . The increase in the antipolysaccharide antibody response was also present at the antipolysaccharide IgM antibody level but was not observed at the anti-carrier IgG antibody level.

Protein Expr Purif, 1991 Oct-Dec, 2(5-6), 339 - 49
Expression and purification of a soluble form of penicillin-binding protein 2 from both penicillin-susceptible and penicillin-resistant Neisseria gonorrhoeae; Schultz DE et al.; Resistance to penicillin in non-beta-lactamase-producing strains of Neisseria gonorrhoeae (CMRNG strains) is mediated in part by the production of altered forms of penicillin-binding protein 2 (PBP 2) that have a decreased affinity for penicillin . The reduction in the affinity of PBP 2 is largely due to the insertion of an aspartic acid residue (Asp-345a) into the amino acid sequence of PBP 2 . Truncated forms of N . gonorrhoeae PBP 2, which differed only by the insertion of Asp-345a, were constructed by placing the region of the penA genes encoding the periplasmic domain of PBP 2 (amino acids 42-581) into an ATG expression vector . When the recombinant PBP 2 molecules were overexpressed in Escherichia coli, insoluble PBP 2 inclusion bodies, which could be isolated by low-speed centrifugation of cell lysates, were formed . These insoluble aggregates were solubilized and the truncated PBP 2 polypeptides were partially purified by cation-exchange chromatography and gel filtration in the presence of denaturant prior to the refolding of the enzyme in vitro . After renaturation, gel filtration was used to separate monomeric soluble PBP 2 from improperly folded protein aggregates and other protein contaminants . A 4-liter culture of induced E . coli cells yielded 1.4 mg of soluble PBP 2 or PBP 2' (PBP 2 containing the Asp-345a insertion), both of which were estimated to be 99% pure . The affinity of soluble PBP 2' for {3H}penicillin G was decreased fourfold relative to that of soluble PBP 2, and their affinities were found to be identical to the affinities of the full-length PBP 2 enzymes that were previously determined in N . gonorrhoeae membranes . Furthermore, soluble PBP 2 displayed a rank order of affinity for several other beta-lactam antibiotics that was consistent with the rank order of affinities previously reported for the native molecules . On the basis of these results, both of these soluble PBPs should be suitable for crystallization and X-ray crystallographic analysis.

Mol Cell Probes, 1991 Oct, 5(5), 327 - 35
A DNA sequence for the discrimination of Neisseria gonorrhoeae from other Neisseria species; Miyada CG et al.; A 350 base pair Neisseria gonorrhoeae DNA restriction fragment was cloned after subtractive hybridization to Neisseria meningitidis DNA . This restriction fragment hybridized to 105 out of 106 N . gonorrhoeae strains tested . While three N . meningitidis strains did not hybridize to this probe, Neisseria mucosa DNA exhibited cross-hybridization . This particular clone was used to screen a N . gonorrhoeae genomic DNA library . A positive 2.4 kilobase pair clone was shown by DNA sequencing to contain two long open reading frames . One open reading frame did not hybridize to N . mucosa and other Neisseria species, while it retained specificity for the original 105 N gonorrhoeae strains . This open reading frame also showed significant homology to cytosine DNA methyltransferases.

Mol Microbiol, 1991 Oct, 5(10), 2529 - 39
Physical and genetic map of the Neisseria gonorrhoeae strain MS11-N198 chromosome; Bihimaier A et al.; A macro-restriction map of the Neisseria gonorrhoeae chromosome was constructed using the enzymes Nhel and Spel . Combinations of one- and two-dimensional electrophoresis of completely or partially digested chromosomal DNA were performed to align the restriction fragments . The chromosome is circular, with an estimated size of 2.33 Mb +/- 35 kb . A genetic map was derived from the physical map; positions of over 60 defined loci were determined by Southern hybridization.

Mol Microbiol, 1991 Oct, 5(10), 2351 - 60
H-DNA formation by the coding repeat elements of neisserial opa genes; Belland RJ; The coding repeat region of opa genes from Neisseria gonorrhoeae and Neisseria meningitidis determines the expression state of their respective genes through high-frequency addition of deletion of pentanucleotide coding repeat units (CRs; CTTCT) . In vitro analyses of cloned opa gene CR regions using single-strand specific nucleases, oligonucleotide protection experiments, and modifications of non-B-DNA residues indicate that the regions form structures resembling H-DNA under acidic conditions in the presence of negative supercoiling . The purine/pyrimidine strand bias and H-palindromic nature of the repeat region are consistent with sequence requirements for H-DNA formation . Sequences flanking the repeat elements are required to form the H-DNA structure in vitro as judged by the pattern of exposed non-B-DNA residues in CR sequences synthesized as oligonucleotides to form beta-galactosidase::CR translational fusions . The fusions phase vary by addition and deletion of CR elements and the rate of phase variation increases upon induction of the fusion genes . The opa gene CR region is the first reported bacterial H-DNA structure and is unique in that it lies within the coding sequence for the gene.

Microbiologica, 1991 Oct, 14(4), 343 - 9
Evaluation of vaginal microflora in patients infected with HIV; Mascellino MT et al.; HIV infection is thought to exacerbate the virulence of normal saprophytic vaginal microflora . We studied the vaginal ecosystem of HIV patients to detect the quantitative and qualitative variation of vaginal microorganisms . 15 patients (5 with AIDS and 10 with ARC) were investigated . Vaginal candidiasis was more frequent in this group than in the control groups . Gardnerella was present in 60% of patients generally in association with anaerobic bacteria and Mycoplasma . Among anaerobia, Bacteroides sp and other Gram-negative rods were the most common bacteria . Neisseria gonorrhoeae was absent in all patients tested . Chlamydia trachomatis was recovered in two out of the 15 HIV-positive patients . Aerobic Gram-negative flora was 100-fold that of the control group and anaerobic Gram-negative flora 10-fold.

Sex Transm Dis, 1991 Oct-Dec, 18(4), 238 - 44
Neisseria gonorrhoeae in Athens, Greece . Epidemiologic classification and antimicrobial susceptibility patterns of strains isolated between 1986 and 1989; Tzelepi E et al.; The incidence of gonorrhoea cases diagnosed in a major venereal hospital of Athens, Greece, was markedly reduced between 1986 and 1989 . All 182 gonococcal isolates found during this period were epidemiologically classified into Sero-/Auxo-/Plasmid content (S/A/Pc) types . Susceptibility to six antimicrobials was also determined . Penicillinase-producing Neisseria gonorrhoeae (PPNG) strains were isolated in an increased frequency of 7.7% and a striking shift in their distribution into S/A/Pc types was noted from previous years . The isolates exhibited wide heterogeneity of type: none of the 14 PPNG strains was identical, while the 168 non-PPNG strains were distributed into 64 S/A/Pc types . Fifty-seven percent (57%) of the PPNG and 86% of the non-PPNG isolates were of the WII/III serogroup . Chromosomally mediated resistance to penicillin, ampicillin, or both was exhibited by 14% of the non-PPNG isolates . Greater frequency of reduced susceptibility to cefotaxime, tetracycline, and chloramphenicol was also found among PPNG and non-PPNG strains, mostly of the WII/III serogroup . Twelve percent (12%) of the non-PPNG and 57% of the PPNG strains had multiple patterns of resistance, involving 2 to 4 antimicrobials of different class lines.

Sex Transm Dis, 1991 Oct-Dec, 18(4), 201 - 4
Distribution of the 3.05-Mdal "Toronto" beta-lactamase plasmid among penicillinase-producing isolates of Neisseria gonorrhoeae in the Far East; Sarafian SK et al.; One hundred and fifty-two beta-lactamase-producing Neisseria gonorrhoeae isolates from Japan (n = 25; 1983, 1985, 1986), Taiwan (n = 14; 1983, 1984), and the Republics of Singapore (n = 58; 1986, 1987) and the Philippines (n = 55; 1989) isolated from 1983 through 1989 were characterized by auxotype, serovar, and plasmid content to determine the distribution and diversity of penicillinase-producing N . gonorrhoeae (PPNG) strains possessing the 3.05-Mdal "Toronto" beta-lactamase plasmid . PPNG isolates possessing a 3.05-Mdal beta-lactamase plasmid were isolated in Japan (1/25: 4%), Taiwan (4/14: 29%), and the Republic of the Philippines (3/55: 5%); no PPNG isolates with the 3.05-Mdal plasmid were isolated in the Republic of Singapore . All isolates possessing the 3.05-Mdal plasmid also possessed a 24.5-Mdal conjugative plasmid and belonged to the auxotype/serovar class, Proto/IB-1 . Studies with five isolates possessing the 3.05-Mdal plasmid, and representing isolates from each country in which they were found, confirmed that the beta-lactamase plasmid in these strains could not be transferred to another gonococcal isolate by conjugation . PPNG isolates possessing the "Toronto" plasmid are widespread in the Far East; spread of these isolates may, however, be limited to the physical spread of a single strain.

J Gen Microbiol, 1991 Oct, 137 ( Pt 10), 2483 - 90
The type 4 pilin of Moraxella nonliquefaciens exhibits unique similarities with the pilins of Neisseria gonorrhoeae and Dichelobacter (Bacteroides) nodosus; Tonjum T et al.; Moraxella nonliquefaciens is a bacterium which is part of the normal flora of the human upper respiratory tract and is an occasional cause of disease . Using a previously cloned type 4 pilin gene (tfpQ) from Moraxella bovis as a hybridization probe, we have cloned an 826 bp Sau3 AI fragment which contains an M . nonliquefaciens type 4 pilin gene (tfpA) from strain NCTC 7784 . The pilin gene is expressed in Escherichia coli . We have examined NCTC 7784 and nine other M . nonliquefaciens strains by genomic Southern hybridization using tfpA as a probe, and they all appeared to have more than one pilin gene . While the predicted amino acid sequence of the M . nonliquefaciens tfpA pilin has conserved regions as compared to pilins of M . bovis and M . lacunata, it also shows similarities to both the type 4 pilin of Neisseria gonorrhoeae and the type 4 pilin of Dichelobacter nodosus (formerly Bacteroides nodosus).

Genitourin Med, 1991 Oct, 67(5), 389 - 93
Characterisation of PPNG and non-PPNG Neisseria gonorrhoeae isolates from Singapore; Poh CL et al.; OBJECTIVE--To characterise Neisseria gonorrhoeae isolates from Singapore . DESIGN--Characterisation of Neisseria gonorrhoeae isolates by auxotyping, serological analysis and plasmid profile analysis . SPECIMENS--Sixty randomly collected isolates from 41 symptomatic, untreated males and 19 female prostitutes were studied . RESULTS--Auxotyping of 25 PPNG and 35 non-PPNG strains showed that the Pro-auxotype was prevalent among both PPNG (56%) and non-PPNG (42.5%) strains . Prototrophic strains comprised 28% of PPNG and 32.5% of non-PPNG strains respectively . Serovar analysis showed that with the exception of seven serogroup WI strains, the majority belonged to serogroup WII/III . Serovar Aedih was predominant among both serogroup WI PPNG (80%) and non-PPNG (100%) strains . Serogroup WII/III PPNG strains were represented by nine serovars with the predominant serovars being Bacjk (28%) and Bcgjk (16%) . Eleven serovars were identified in the WII/III non-PPNG strains and the major serovars were Bajk (20%), Bacjk (17%), Back (11.4%) and Beghjk (11.4%) . Analysis of the 25 PPNG strains showed that 16 of them carried the 4.4 MDa (Asian type) resistance plasmid and nine strains harboured the 4.4 MDa plasmid in conjunction with the 24.5 MDa transfer plasmid . The cryptic plasmid of 2.6 MDa was present in 27 of the 35 non-PPNG strains . Five of the non-PPNG strains harbouring the cryptic plasmid also contained the 24.5 MDa transfer plasmid . The plasmid combination of 2.6 + 7.8 + 24.5 MDa was detected in three non-PPNG strains . CONCLUSION--The combination of epidemiological methods used in this study indicated the heterogeneity of N gonorrhoeae strains in Singapore . A total of 16 different combinations of auxotype, plasmid profile and serovar were seen in the 25 PPNG strains compared with 24 such combinations in the 35 non-PPNG strains . Such sensitive differentiation would otherwise not be possible using either auxotype-serovar (A/S) or auxotype-plasmid analysis.

Epidemiol Infect, 1991 Oct, 107(2), 253 - 62
Characterization of Neisseria meningitidis isolated by ribosomal RNA gene restriction patterns and restriction endonuclease digestion of chromosomal DNA; Jordens JZ et al.; The use of ribosomal RNA (rRNA) gene restriction patterns to study the molecular epidemiology of Neisseria meningitidis was investigated . Ninety-four isolates of Neisseria meningitidis were characterized by their rRNA gene restriction patterns with 16 + 23 S rRNA from Escherichia coli as a probe . Thirteen rRNA gene restriction patterns were recognized; each of these patterns represented between 1 and 30 isolates . Isolated with the outbreak-associated phenotype B15P1.16 (sulphonamide resistant) all gave a single rRNA gene restriction pattern but this pattern also contained isolates with other phenotypes . Further discrimination between isolates was achieved by comparison of banding patterns resulting from restriction endonuclease digestion of chromosomal DNA with Bgl II . This gave a banding pattern consisting of about ten bands which was simple to interpret . Using this technique 94 isolates were classified in 54 patterns containing between 1 and 14 isolates . Restriction endonuclease analysis with Bgl II characterized outbreak-associated isolates with the phenotype B15P1.16 and enabled strains not typable by conventional methods to be identified as probable outbreak-associated isolates . The techniques should prove useful for epidemiological studies.

Clin Ther, 1991 Sep-Oct, 13(5), 550 - 6
Randomized comparison of cefotaxime and ceftriaxone in patients with uncomplicated gonorrhea; Jones RB et al.; Cefotaxime is a third-generation cephalosporin with excellent in vitro antimicrobial activity against Neisseria gonorrhoeae, including beta-lactamase-producing strains . A single, 1-gm, intramuscular dose has previously been shown to be effective in the treatment of uncomplicated gonorrhea . A randomized, multicenter study was conducted to evaluate the efficacy and safety of a lower, 500-mg dose of cefotaxime in comparison with ceftriaxone 250 mg, the standard treatment for uncomplicated gonorrhea . One hundred forty-two patients were enrolled and 115 were evaluable . Bacteriologic eradication rates were 95% in the cefotaxime group and 100% in the ceftriaxone group (P = 0.119) . Adverse events that were possibly related to the study drug occurred in 3% and 8% of patients in the cefotaxime and ceftriaxone groups, respectively . Cefotaxime 500 mg appears to be a safe and cost-effective alternative to ceftriaxone 250 mg for the treatment of uncomplicated gonorrhea.

Rev Infect Dis, 1991 Sep-Oct, 13(5), 837 - 41
Meningitis due to Neisseria mucosa: case report and review; Stotka JL et al.; Neisseria mucosa is a species of gram-negative cocci that has a characteristic mucoid, adherent colonial morphology and includes pigmented and nonpigmented morphotypes . The ability of N . mucosa to reduce nitrates distinguishes it from other Neisseria species . N . mucosa is part of the normal human nasopharyngeal flora and infrequently causes human infections, including meningitis . We report a unique case of a patient with a cerebrospinal fluid shunt infection due to N . mucosa and review five other reports of cases of meningitis caused by this organism . Seven additional previously reported cases of presumed N . mucosa meningitis have been excluded from this review on the basis of the current criteria for identification of the organism . In the reports of established cases, female infants and children who often had predisposing conditions predominate . Although the outcome for such patients has been favorable, no clinical or laboratory findings are helpful in distinguishing meningitis due to N . mucosa from that due to other bacteria.

J Bacteriol, 1991 Sep, 173(18), 5921 - 3
Factors influencing the specific interaction of Neisseria gonorrhoeae with transforming DNA; Goodman SD et al.; The specific interaction of transformable Neisseria gonorrhoeae with DNA depends on the recognition of specific 10-residue target sequences . The relative affinity for DNA between 3 and 17 kb in size appears to be linearly related to the frequency of targets on the segment and is unaffected by absolute size . The average frequency of targets in chromosomal DNA of N . gonorrhoeae appears to be approximately one per 1,000 bp.

J Exp Med, 1991 Sep 1, 174(3), 705 - 15
Bacterial entry and intracellular processing of Neisseria gonorrhoeae in epithelial cells: immunomorphological evidence for alterations in the major outer membrane protein P.IB; Weel JF et al.; The fate of the major outer membrane protein of the gonococcus, P.IB, during the adherence, entry, and intracellular processing of the bacteria in infected epithelial cells was investigated using post-embedding immunoelectron microscopy . Various domains of the P.IB molecule were probed at different stages in the infection . These studies revealed that P.IB epitope exposure remained unaltered during the initial attachment of the bacteria to the host cells . In contrast, upon secondary attachment of the bacteria to the eukaryotic cells, apparent zones of adhesion were formed between the gonococci and the host cell membrane, which were characterized by loss of a defined P.IB epitope . These zones of adhesion with the altered P.IB immunoreactivity continued to exist and increased in number during cellular penetration, suggesting that they were essential to bacterial invasion into the eukaryotic cells . After bacterial entry, two classes of gonococci could be recognized; morphologically intact, P.IB-positive bacteria and disintegrated organisms that showed a change in, and, in a later stage, a complete loss of P.IB immunoreactivity . The intracellular alterations in the P.IB antigen could be prevented by treatment of the host cells with the lysosomotropic agent chloroquine . These observations point to a mechanism by which a subpopulation of intracellular gonococci can escape the epithelial cell defense by preventing or resisting exposure to host cell proteolytic activity.

Glycobiology, 1991 Sep, 1(4), 357 - 65
Complete nucleotide and deduced protein sequence of CMP-NeuAc: poly-alpha-2,8 sialosyl sialyltransferase of Escherichia coli K1; Weisgerber C et al.; Poly-alpha-2,8 N-acetylneuraminic acid (polySia) is an important virulence factor in infections caused by Escherichia coli K1 and Neisseria meningitidis B . In E . coli K1 a membranous CMP-NeuAc: poly-alpha-2,8 sialosyl sialyltransferase (polysialyltransferase) complex catalyses the synthesis of linear polySia chains . The complex also elongates sialyl oligomers that serve as exogenous acceptors . The gene encoding a polysialyltransferase of E . coli has been identified by subcloning and DNA sequence analysis . The subcloned DNA fragment codes for a polypeptide with a molecular mass of 47 kDa catalysing the in vitro synthesis of polySia by elongation of exogenous acceptors.

Microb Pathog, 1991 Sep, 11(3), 159 - 70
Alterations of the LPS determine virulence of Neisseria gonorrhoeae in guinea-pig subcutaneous chambers; Demarco de Hormaeche R et al.; The virulence of lipopolysaccharide (LPS) variants of Neisseria gonorrhoeae strain Gc40 was studied in vivo using the guinea-pig subcutaneous chamber model . Survival of variants D1, D2, D4 and D5 was assessed by viable counts made on chamber fluid at various times after inoculation . Chemotactic effect was measured by counts of white cells in the chambers . Differential cell counts and assessments of the location of the gonococci were made on Giemsa-stained smears of chamber fluid . Sensitivity of the variants to normal guinea-pig serum was determined by in vitro bactericidal assays . D1 and D5 had relatively high Mr LPS which was shed in the medium, were serum resistant, produced intense infections and were mainly extracellular . Large number of damaged white cells were present . D2 and D4, had low Mr LPS which was poorly shed in the medium, were serum sensitive and produced low grade infections . D2 was the least infective and was seen mainly inside neutrophils . Collectively the data indicates that the type of LPS on the gonococcal surface and possibly the amount of shed LPS strongly influence the fate of gonococci in vivo, in an environment in which antibodies, complement and phagocytic cells are freely available . This may be decisive at some stages of the human infection.

Infection, 1991 Sep-Oct, 19(5), 305 - 8
Induced abortion: microbiological screening and medical complications; Stray-Pedersen B et al.; Preoperative cervical screening of 1,193 women undergoing first-trimester induced abortions yielded Chlamydia trachomatis in 11.7%, Neisseria gonorrhoeae in 0.8%, Mycoplasma hominis in 22.1%, Ureaplasma urealyticum in 10.1%, herpes simplex virus in 0.9% and Group B streptococci (GBS) in 2.9% . C . trachomatis and N . gonorrhoeae were especially frequent among teenagers . A total of 2.2% (26 women) developed postoperative pelvic inflammatory disease (PID) and 0.9% (13 women) endometritis . PID developed significantly more often in untreated chlamydia-positive (22.7%), M . hominis-positive (8.1%) and GBS-positive (6.1%) women than in women without these microbes (0.5%) (p less than 0.05) . Prompt treatment of the chlamydia infection before or in connection with the abortion procedure significantly decreased the likelihood of developing chlamydial PID from 22.7% to 2.1% (p less than 0.001) . The study confirms the importance of preoperative screening for chlamydia and suggests screening for M . hominis and GBS as well . The results of screening should be available before the abortion, allowing patients to be treated pre- or peroperativelyPIP: Preoperative cervical screening of 1193 women undergoing 1st trimester induced abortions yielded Chlamydia trachomatis in 11.7%, Neisseria gonorrhoeae in 0.8%, Mycoplasma hominis in 22.1%, Ureaplasma urealyticum in 10.1%, herpes simplex virus in 0.9%, and group B streptococci (GBS) in 2.9%, C . trachomatis and N . gonorrhoeae were especially frequent among teens . A total of 2.2% (26 women) developed postoperative pelvic inflammatory disease (PID) and 0.9% (13 women) developed endometritis . PID was seen significantly more often in untreated chlamydia-positive (22.7%), M . hominis-positive (8.1%), and GBS-positive (6.1%) women than in women without these microbes (0.5%; p0.05) . Prompt treatment of the chlamydia infection before or in connection with the abortion procedure significantly decreased the likelihood of developing chlamydial PID from 22.7% to 2.1% (p0.001) . The study confirms the importance of preoperative screening for chlamydia and suggests screening for M . hominis and GBS as well . Results of the screening should be available before the abortion in order to allow patients to be treated pre- or postoperatively . (author's modified)

Diagn Microbiol Infect Dis, 1991 Sep-Oct, 14(5), 383 - 8
Development of Neisseria gonorrhoeae in vitro susceptibility test methods for cefixime including quality control guidelines; Jones RN et al.; Cefixime was tested in a multilaboratory study to establish susceptibility testing interpretive criteria and quality control (QC) guidelines for Neisseria gonorrhoeae . Interpretive criteria were established by using triplicate testing of 102 representative gonococcal strains . Only a susceptible category was proposed for cefixime (greater than or equal to 31 mm and less than or equal to 0.25 micrograms/ml) because of very rare, resistant isolates . QC ranges {N . gonorrhoeae American Type Culture Collection (ATCC) 49226} were established using multiple GC agar lots, three disk lots, and a number of test replicates consistent with the National Committee for Clinical Laboratory Standards (NCCLS) M23-T guidelines . Cefixime was stable in GC agar medium for at least 21 days when stored at 2 degrees-5 degrees C . Oral third-generation cephalosporins, such as cefixime, appear to represent potentially useful clinical alternatives to parenteral drugs of the same class for single-dose therapy of gonorrhea.

J Reprod Med, 1991 Sep, 36(9), 683 - 4
Gonococcal peritonitis after tubal ligation . A case report; Weeks AG et al.; Gonococcal peritonitis occurred after a tubal ligation . Falk's postulated benefit of cornual resection as a preventive measure for recurrent infection does not extend to isthmic interruption . Pelvic inflammatory disease should be considered when a sterilized woman presents with an acute abdomenPIP: Presented is the first case report of intraperitoneal Neisseria gonorrhoea infection after tubal ligation . The patient, a 34-year-old women who underwent bilateral tubal ligation 10 years prior to presentation, complained of right lower quadrant pain, fever, chills, anorexia, and constipation . Prior to sterilization, she had been treated at least 3 times for pelvic inflammatory disease (PID) . Laparotomy revealed 200 mL of free pus in the abdominal cavity, induration of the proximal stump of the right fallopian tube, and a tuboperitoneal fistula . the intraperitoneal culture was positive for N gonorrhoea and pathology demonstrated acute salpingitis . Treatment with ampicillin, gentamicin, and clindamycin eliminated the infection, although uterine and adnexal tenderness persisted at the 6-week follow-up . Falk's postulate that cornual resection prevents reinfection with PID of the upper genital tract apparently cannot be extended to isthmic interruption of the lower and upper tracts . Since this case demonstrates that there can be ascending gonococcal infection in women with prior tubal sterilization, PID should be part of the differential diagnosis of all sterilized women who present with acute pelvic pain .

Pathol Biol (Paris), 1991 Sep, 39(7), 697 - 9
{Characteristics of the first penicillinase-producing strains of Neisseria gonorrhoeae isolated in Tunisia}; Kechrid A et al.; The first penicillinase-producing strain of Neisseria gonorrhoeae was recently isolated in Tunisia (1989) . Betalactamase production was detected by the iodometric agar test . Minimal inhibitory concentrations (MICs) in agar medium were 128 micrograms/ml for penicillin, ampicillin and amoxycillin . With the amoxycillin-clavulanic acid combination, MIC fell to 0.25 microgram/ml . An Asian-type plasmid pattern was evidenced in this strain, with presence of the 2.6 Mdal cryptic plasmid and of a 4.5 Mdal plasmid.

J Bacteriol, 1991 Sep, 173(17), 5476 - 86
Physical map of the chromosome of Neisseria gonorrhoeae FA1090 with locations of genetic markers, including opa and pil genes; Dempsey JA et al.; A physical map of the chromosome of Neisseria gonorrhoeae FA1090 has been constructed . Digestion of strain FA1090 DNA with NheI, SpeI, BglII, or PacI resulted in a limited number of fragments that were resolved by contour-clamped homogeneous electric field electrophoresis . The estimated genome size was 2,219 kb . To construct the map, probes corresponding to single-copy chromosomal sequences were used in Southern blots of digested DNA separated on pulsed-field gels, to determine how the fragments from different digests overlapped . Some of the probes represented identified gonococcal genes, whereas others were anonymous cloned fragments of strain FA1090 DNA . By using this approach, a macrorestriction map of the strain FA1090 chromosome was assembled, and the locations of various genetic markers on the map were determined . Once the map was completed, the repeated gene families encoding Opa and pilin proteins were mapped . The 11 opa loci of strain FA1090 were distributed over approximately 60% of the chromosome . The pil loci were more clustered and were located in two regions separated by approximately one-fourth of the chromosome.

Mol Microbiol, 1991 Sep, 5(9), 2153 - 64
The bacterial porin superfamily: sequence alignment and structure prediction; Jeanteur D et al.; The porins of Gram-negative bacteria are responsible for the 'molecular sieve' properties of the outer membrane . They form large water-filled channels which allow the diffusion of hydrophilic molecules into the periplasmic space . Owing to the strong hydrophilicity of their amino acid sequence and the nature of their secondary structure (beta strands), conventional hydropathy methods for predicting membrane topology are useless for this class of protein . The large number of available porin amino acid sequences was exploited to improve the accuracy of the prediction in combination with tools detecting amphipathicity of secondary structure . Using the constraints of beta-sheet structure these porins are predicted to contain 16 membrane-spanning strands, 14 of which are common to the two (enteric and the neisserial) porin subfamilies.

J Bacteriol, 1991 Sep, 173(18), 5793 - 9
High-frequency mobilization of broad-host-range plasmids into Neisseria gonorrhoeae requires methylation in the donor; Butler CA et al.; Antibiotic resistance in Neisseria gonorrhoeae has been associated with the acquisition of R plasmids from heterologous organisms . The broad-host-range plasmids of incompatibility groups P (IncP) and Q (IncQ) have played a role in this genetic exchange in nature . We have utilized derivatives of RSF1010 (IncQ) and RP1 (IncP) to demonstrate that the plethora of restriction barriers associated with the gonococci markedly reduces mobilization of plasmids from Escherichia coli into strains F62 and PGH 3-2 . Partially purified restriction endonucleases from these gonococcal strains can digest RSF1010 in vitro . Protection of RSF1010-km from digestion by gonococcal enzymes purified from strain F62 is observed when the plasmid is isolated from E . coli containing a coresident plasmid, pCAL7 . Plasmid pCAL7 produces a 5'-MECG-3' cytosine methylase (M.SssI) . The M.SssI methylase only partially protects RSF1010-km from digestion by restriction enzymes from strain PGH 3-2 . Total protection of RSF1010-km from PGH 3-2 restriction requires both pCAL7 and a second coresident plasmid, pFnuDI, which produces a 5'-GGMECC-3' cytosine methylase . When both F62 and PGH 3-2 are utilized as recipients in heterospecific matings with E . coli, mobilization of RSF1010 from strains containing the appropriate methylases into the gonococci occurs at frequencies 4 orders of magnitude higher than from strains without the methylases . Thus, protection of RSF1010 from gonococcal restriction enzymes in vitro correlates with an increase in the conjugal frequency . These data indicate that restriction is a major barrier against efficient conjugal transfer between N . gonorrhoeae and heterologous hosts.

Gene, 1991 Aug 30, 105(1), 125 - 8
Class-3 porin protein of Neisseria meningitidis: cloning and structure of the gene; Butcher S et al.; The gene coding for the class-3 protein of Neisseria meningitidis was cloned and sequenced . The deduced amino acid (aa) sequence was highly homologous (50-78%) to those of other neisserial porin proteins . Alignment of the aa sequence of five neisserial porin proteins pinpointed several regions of identity or near identity . These are assumed to be membrane-spanning beta-strands . A comparison of the homologies between these neisserial porins showed that the class-3 protein is most closely related to the Neisseria gonorrhoeae P1A protein.

Ned Tijdschr Geneeskd, 1991 Aug 24, 135(34), 1542 - 7
{Sexually transmissible disorders in allochtonous population groups; a pilot study}; van de Laar MJ et al.; In the registration of sexually transmitted diseases (STD) carried out by the nursing staff in the STD clinics the share of the immigrant populations of Turkish, Moroccan, Surinam and Antilles origin was investigated for the period 1986-89 . In the total population of STD patients the immigrants appear to be overrepresented . Their share has increased from one-eight to one-fifth of the total number of STD cases . The STD rates (number of cases per 1000) for the Turkish and Moroccan populations are high, even after adjusting for population size and age . High STD rates are most apparent among males, especially among Turkish males . In comparison with the Dutch population more gonorrhoea is found among immigrants, in particular penicillinase producing Neisseria gonorrhoeae (PPNG) . Turkish males (and prostitutes) contributed much to this relatively high prevalence . Further research is to be initiated in order to obtain better insight into the occurrence of STD among immigrant populations in The Netherlands, especially in connection with a potentially increased risk of infection with Human Immunodeficiency Virus (HIV).

Curr Opin Rheumatol, 1991 Aug, 3(4), 603 - 9
Bacterial arthritis; Ho G Jr; In this review of the 1990 septic arthritis literature, we revisit synovial fluid leukocytosis, examine the utility of synovial fluid glucose and protein measurements, and look at the levels of two cytokines, tumor necrosis factor and interleukin-1, in infected joint fluids . We see the many faces of gonococcal arthritis and the ravages of septic arthritis when the host has rheumatoid arthritis . Should we recommend antibiotic prophylaxis for the rheumatoid patient with a prosthetic joint who is undergoing a procedure that leads to transient bacteremia? What are some of the salient features of septic arthritis when it involves the sternoclavicular or sacroiliac joints? We also look at some unusual microorganisms, eg, group C Streptococcus, Streptococcus viridans, Listeria monocytogenes, Pseudomonas cepacia, Pseudomonas maltophilia, and Neisseria sicca . In patients with acquired immunodeficiency syndrome, we encounter reports of septic arthritis, osteomyelitis, and spinal epidural abscess caused by opportunistic microorganisms . Two unusual sites of infection include the C1-2 lateral facet joint and subacromial bursa without involvement of the glenohumeral joint . Finally, we examine how to drain a septic knee: the orthopedic point of view.

J Natl Med Assoc, 1991 Aug, 83(8), 710 - 2
Penicillinase-producing Neisseria gonorrhoeae in a subset of nonemergent patients: I . A trend in the Washington, DC area; Watkins RC et al.; A significant increase in penicillinase-producing isolates of Neisseria gonorrhoeae has been detected and documented in the District of Columbia . Currently, the prevalence of beta-lactamase isolates is approaching 50%, with the greatest number of cases being detected in the 18- to 23-year-old age group, in both males and females . Indicators suggest that this trend, which was first noted in 1987, will become more pronounced in the future . Ceftriaxone is now the first-line drug of choice in treating suspected gonococcal infections.

Genitourin Med, 1991 Aug, 67(4), 335 - 8
Sexually transmitted diseases in homosexual males in Seville, Spain; Rodriguez-Pichardo A et al.; BACKGROUND AND METHODS--The absence of any official statistics on the prevalence of STD in homosexual men in Spain induced us to carry out a prospective study of new homosexual patients who consulted the STD Clinic of the School of Medicine in Seville, between January 1988 and December 1989 . The aim of the study was to determine the prevalence of symptomatic and asymptomatic infections in this group of patients . RESULTS--1805 patients were seen during the study period; 318 patients were homosexual of whom 309 agreed to participate in the study . Of the 309 homosexual men, 108 (35%) had symptoms and the remaining 201 (65%) were asymptomatic . In the symptomatic group the diagnoses were: syphilis 28 (25.9%); urethritis 40 (37%) (of these 40, 11 had Neisseria gonorrhoeae, five had Chlamydia trachomatis, five had Ureaplasma urealyticum, one had Herpes simplex virus and in 18 no pathogen was detected); genital herpes seven (6.4%) . Eleven (10%) had concomitant infections . The following infections were found in the asymptomatic group: syphilis 23 (11.4%), N gonorrhoeae six (3%), C trachomatis two (1%), Herpes simplex virus one (0.5%) . Antibodies against HIV were detected in 30 (9.6%) of the total group . CONCLUSIONS--Sexually transmitted diseases are common amongst homosexual men in Seville and many of these are asymptomatic.

Genitourin Med, 1991 Aug, 67(4), 307 - 11
Epidemiology of penicillin resistant Neisseria gonorrhoeae; Ison CA et al.; OBJECTIVE--To study the epidemiology of Neisseria gonorrhoeae that exhibit both chromosomal and plasmid-mediated resistance to penicillin . MATERIALS AND METHODS--A total of 1589 strains of N gonorrhoeae isolated from patients attending St Mary's Hospital, London were tested for both their susceptibility to penicillin and for their auxotype and serotype . RESULTS--Of the 940 non-penicillinase producing N gonorrhoeae, 840 were considered penicillin sensitive (MIC less than or equal to 0.5 mg/l) and 100 were chromosomally-mediated resistant N gonorrhoeae (CMRNG), (MIC greater than or equal to 1.0 mg/l) . Of the 649 penicillinase producing N gonorrhoeae (PPNG), 429 carried the 4.4 megadalton (MDa) penicillinase encoding plasmid and 220 carried the 3.2 MDa plasmid . CMRNG were predominantly serogroup IB (90%) . PPNG with 3.2 MDa plasmid were the only group more often serogroup IA (58%) than IB (42%) . Serovar IA-1/2 and requirement for arginine, hypoxanthine and uracil (AHU) were associated with increased susceptibility to penicillin whereas serovar IB-5/7 was associated with decreased susceptibility in nonPPNG . There was a significant difference in the distribution of the IA and IB serovars between PPNG carrying either the 4.4 MDa or 3.2 MDa plasmid . AHU and PAOU requiring strains were not found among PPNG and were uncommon among CMRNG . CONCLUSION--Some clear associations have been found but the pattern among PPNG appears more complex and in most instances could be related to clusters of a single strain over a short time span.

J Cell Biol, 1991 Aug, 114(3), 433 - 42
Effects of protein I of Neisseria gonorrhoeae on neutrophil activation: generation of diacylglycerol from phosphatidylcholine via a specific phospholipase C is associated with exocytosis; Haines KA et al.; Upon engagement of chemoattractant receptors, neutrophils generate inositol trisphosphate and diacylglycerol (DG) by means of a phosphatidylinositol-specific phospholipase C (PI-PLC) which is regulated by a GTP-binding protein(s) . We have previously reported (Reibman, J., H . M . Korchak, L . B . Vosshall, K . A . Haines, A . M . Rich, and G . Weissmann . 1988 . J . Biol . Chem . 263:6322-6328) a biphasic rise in DG after exposure of neutrophils to the chemoattractant FMLP: a rapid (less than or equal to 15 s) phase ("triggering") and a slow (greater than or equal to 30 s) phase ("activation") . These derive from distinct intracellular lipid pools . To study the source of rapid and slow DG, we have used a unique probe, protein I, a porin that is the major outer membrane protein of Neisseria gonorrhoeae . Treatment of neutrophils with protein I inhibits exocytosis and homotypic cell adhesion provoked by FMLP without inhibiting assembly of the NADPH oxidase responsible for O2- . generation . DG turnover in PMN labeled with {3H}arachidonate and {14C}glycerol was profoundly altered by protein I . Whereas the rapid peak of DG was only modestly diminished (FMLP vs . FMLP plus protein I = DG labeled with {3H}arachidonic acid (3H-a.a.-DG): 142 +/- 14% SEM vs . 125 +/- 22%; DG labeled with the glycerol backbone with {14C}glycerol (D-14C-G): 125 +/- 10% SEM vs . 107 +/- 8.5% SEM), the slow rise in both 3H-a.a.-DG and D-14C-G was essentially abolished . Moreover, treatment of neutrophils with 4-4'-diisothiocyanatostilbene-2,2'-disulfonic acid (DIDS), which, like protein I, inhibits exocytosis without affecting O2- . generation also inhibited slow DG . However, protein phosphorylation and dephosphorylation (47phox, 66phox) were unaffected in the absence of slow DG . To determine the source of the slow DG, we have analyzed radiolabeled phospholipid (PL) turnover after FMLP +/- protein I (P.I.) . Treatment of PMN with FMLP (0.1 microM) resulted in breakdown of phosphatidylcholine (PC), beginning at 30 s, and reaching a nadir at 60 s (3H-PC = 59 +/- 10.2% SEM of resting, 14C-PC = 57 +/- 6.4%) . Protein I (0.25 microM) significantly inhibited PC turnover after FMLP ({3H}PC = 95 +/- 5.6% and {14C}PC = 86 +/- 8.4% of resting at 60 s), but failed to alter the metabolism of 3H- or 14C-phosphatidylinositol after FMLP (91 +/- 19.6 and 88 +/- 16.5% vs . 92 +/- 9.2 and 91 +/- 16% at 60 s).(ABSTRACT TRUNCATED AT 400 WORDS)

J Clin Microbiol, 1991 Aug, 29(8), 1604 - 9
Disk diffusion method for susceptibility testing of Neisseria gonorrhoeae; Ringertz S et al.; The standard medium for disk diffusion and MIC testing of Neisseria gonorrhoeae (that of the National Committee for Clinical Laboratory Standards) was tested to establish zone correlations for the MIC breakpoints currently used in Sweden . Eight gonococcal control strains representing both susceptible and resistant strains and 50 clinical isolates were tested . The standard medium did not support the growth of two control strains and three clinical isolates when the standardized inoculum was used in the disk diffusion test . The same medium with the addition of hemoglobin was introduced . This medium supported the growth of all strains . The correlations between the MICs and the zones of inhibition were calculated for penicillin, ampicillin, cefuroxime, erythromycin, tetracycline, doxycycline, ciprofloxacin, and spectinomycin . The range of MICs for the clinical isolates were broad, without bimodal distribution, for all antibiotics, except ciprofloxacin and spectinomycin . With the susceptibility distribution of MICs and zones near the current susceptible and intermediate or intermediate and resistant limits, a low reproducibility of tests and a high frequency of minor interpretive errors can be expected . A revision of MIC breakpoints seems warranted but can only be done after renewed clinical evaluation of different treatment regimens.

Mol Microbiol, 1991 Aug, 5(8), 1889 - 901
The opacity proteins of Neisseria gonorrhoeae strain MS11 are encoded by a family of 11 complete genes; Bhat KS et al.; Variants of Neisseria gonorrhoeae MS11 show distinct colony morphologies because of the expression of a class of surface components called opacity (Opa, PII) proteins . Southern analyses combined with molecular cloning of genomic DNA from a single variant of MS11 has identified 11 opa genes contained in separate loci . These opa genes code for distinct opacity proteins which are distinguishable at their variable domains . The opa gene analyses were also extended to divergent variants of MS11 . These studies have shown that, during in vitro and in vivo culture, 10 of the 11 opa genes did not undergo significant change in their primary sequence . However, in these variants, one gene (opaE) underwent non-reciprocal inter-opa recombinations to generate newer Opa variants . Phylogenic analysis of the opa gene sequences suggests that the opa gene family have evolved by a combination of gene duplication, gene replacement and partial inter-opa recombination events.

J Antimicrob Chemother, 1991 Aug, 28(2), 173 - 83
Molecular evolution of tetracycline-resistance plasmids carrying TetM found in Neisseria gonorrhoeae from different countries; Gascoyne DM et al.; High level tetracycline resistant strains of Neisseria gonorrhoeae (TRNG) have been shown to carry a 40.6 kb (25.2 MDa) conjugative plasmid with a Class M tetracycline resistance determinant . Restriction endonuclease analysis mapping showed that there were at least two different TRNG plasmid types which were found in geographically distinct locations . The physical maps of these two plasmids were compared to a gonococcal conjugative plasmid which did not encode tetracycline resistance . The plasmid type which is endemic in the Netherlands was found to be closely related to the gonococcal conjugative plasmid, which supports the established hypothesis that the 40.6 kb plasmid has evolved by transposition of the TetM determinant into the conjugative plasmid . The plasmid found in the United States has either evolved by substantial divergent evolution or it results from a different transposition event . In the UK there have been isolations of TRNGs carrying either of the two plasmid types reflecting a flow of people both across the Atlantic and in Europe . It is possible that further TetM-containing plasmids will be found in N . gonorrhoeae paralleling the family of TEM beta-lactamase encoding plasmids already described.

Anal Biochem, 1991 Aug 1, 196(2), 311 - 8
Purification of rough-type lipopolysaccharides of Neisseria meningitidis from cells and outer membrane vesicles in spent media; Gu XX et al.; A procedure for the purification of Neisseria meningitidis lipopolysaccharide (LPS) from outer membrane vesicles (OMV) in spent growth media was developed . Five different LPS strains of group A N . meningitidis were grown in tryptic soy broth with vigorous aeration for 36-48 h, and centrifuged to collect both cells and supernatants . The amount of LPS in the OMV in the supernatants was higher or at least equal to that in the cells . The OMV in each supernatant were concentrated, pelleted by ultracentrifugation, and treated with 2% sodium deoxycholate to dissociate LPS from OMV . The LPS was then separated from capsular polysaccharides, proteins and phospholipids by gel filtration on Sephacryl S-300 column in 1% sodium deoxycholate, and precipitated from the column fractions in 70% ethanol . In addition, LPS was also extracted from cells with hot phenol-water, ultracentrifuged once after treatment with ribonuclease, and purified on Sephacryl S-300 . When compared with an improved phenol-water extraction method, the LPS obtained from either OMV or cells by the above methods gave a 40-180% increase in yield . The LPS also had much higher activities in limulus amebocyte lysate assay, rabbit pyrogenic test, and enzyme-linked immunosorbent assay . The LPS purified from cells and from OMV were indistinguishable by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis.

Infect Immun, 1991 Aug, 59(8), 2535 - 41
Proteolysis of bacterial membrane proteins by Neisseria gonorrhoeae type 2 immunoglobulin A1 protease; Shoberg RJ et al.; The immunoglobulin A1 (IgA1) proteases of Neisseria gonorrhoeae have been defined as having human IgA1 as their single permissive substrate . However, in recent years there have been reports of other proteins which are susceptible to the proteolytic activity of these enzymes . To examine the possibility that gonococcal membrane proteins are potential substrates for these enzymes, isolated outer and cytoplasmic membranes of N . gonorrhoeae were treated in vitro with exogenous pure IgA1 protease . Analysis of silver-stained sodium dodecyl sulfate-polyacrylamide gels of outer membranes indicated that there were two outer membrane proteins of 78 and 68 kDa which were cleaved by IgA1 protease in vitro in GCM 740 (a wild-type strain) and in two isogenic IgA1 protease-negative variants . Similar results were observed with a second gonococcal strain, F62, and its isogenic IgA1 protease-negative derivative . When GCM 740 cytoplasmic membranes were treated with protease, three minor proteins of 24.5, 23.5, and 21.5 kDa were cleaved . In addition, when outer membranes of Escherichia coli DH1 were treated with IgA1 protease, several proteins were hydrolyzed . While the identities of all of these proteolyzed proteins are unknown, the data presented indicate that there are several proteins found in the isolated membranes of gram-negative bacteria which are permissive in vitro substrates for gonococcal IgA1 protease.

Genitourin Med, 1991 Aug, 67(4), 327 - 30
Genital ulcer disease in men in Durban, South Africa; O'Farrell N et al.; OBJECTIVE--To study the microbial aetiology of genital ulcer disease (GUD) in men . DESIGN--Microbiological and clinical assessment of genital ulcers in men . SETTING--City Health sexually transmitted diseases clinic, King Edward VIII Hospital, Durban, South Africa . PARTICIPANTS--100 Zulu men with genital ulcers who had not received antibiotics in the previous four weeks . RESULTS--Syphilis was diagnosed in 42%, chancroid in 22%, donovanosis (granuloma inguinale) in 11%, genital herpes in 10% and lymphogranuloma venereum (LGV) in 6% . No pathogens were identified in 24% . Mixed infections were detected in 14 men, in whom 13 had syphilis . Five men had HIV-1 antibodies . Neisseria gonorrhoeae was isolated from the ulcers and urethra in seven men and from the urethra alone in five . Scabies was diagnosed clinically in eight . CONCLUSIONS--All the major causes of GUD are prevalent in Zulu men in Durban . Primary syphilis was the commonest and was invariably present in mixed infections . Donovanosis was under-reported and was associated with a long delay before presentation . In this population, genital ulcers other than superficial lesions should be treated with anti-syphilitic therapy and oral antibiotics effective against chancroid and donovanosis.

Genitourin Med, 1991 Aug, 67(4), 322 - 6
Genital ulcer disease in women in Durban, South Africa; O'Farrell N et al.; OBJECTIVE--To study the microbial aetiology of genital ulcer disease (GUD) in women . DESIGN--Microbial and clinical assessment of genital ulcers in women . SETTING--City Health sexually transmitted diseases clinic, King Edward VIII Hospital, Durban, South Africa . PARTICIPANTS--100 Zulu women with genital ulceration who had not received antibiotics in the previous two weeks . RESULTS--Syphilis was diagnosed in 40%, genital herpes in 18%, donovanosis (granuloma inguinale) in 16%, chancroid in 14%, lymphogranuloma venereum in 7% and scabies in 2% . No recognised cause was detected in 18% . Secondary syphilis was diagnosed in 21%, primary syphilis in 16% and mixed primary and secondary syphilis in 3% . Multiple infections were detected in 13 women, of whom 12 had syphilis . Bleeding was observed from the ulcers of 59 during swab collection . Three women had HIV-1 antibodies . Neisseria gonorrhoeae was isolated from the ulcers and endocervix of two women and from the endocervix alone in nine . Generalised scabies was diagnosed in 14 . CONCLUSIONS--All the major causes of GUD are prevalent in Zulu women in Durban: secondary syphilis was the commonest diagnosis . Donovanosis, which often presents late with large ulcers, and genital herpes are now significant problems . Mixed infections with coexisting syphilis are common . All women in this population with GUD should be treated for syphilis and receive oral antibiotics effective for chancroid and donovanosis.

Eur J Biochem, 1991 Aug 1, 199(3), 587 - 94
Primary structure of porin from Rhodobacter capsulatus; Schiltz E et al.; The primary structure of the integral membrane protein porin from the purple bacterium Rhodobacter capsulatus was determined . The protein was cleaved with trypsin, CNBr and Asp-N protease . The peptides were isolated, sequenced and aligned to a total length of 301 residues with an Mr of 31,536 . The low isoelectric point of 3.9 is confirmed by the high excess of 34 Asp and 17 Glu (16.9%) over 10 Lys, 7 Arg and 2 His (6.3%) . Overall sequence similarity to other porins is not evident when using sequence alignment programs . However, a partial relationship to Neisseria porins seems to exist . The established sequence has been used as the basis for a three-dimensional structure determination by X-ray diffraction at 0.18-nm resolution . The arrangement of the sequence in the 16-stranded beta-barrel of porin is given . Some sequence-structure correlations are discussed.

Sex Transm Dis, 1991 Jul-Sep, 18(3), 192 - 4
Treatment of gonorrhea with sulbactam/ampicillin; Ngeow YF et al.; Between January and August, 1989, 36 men and 28 women with uncomplicated lower genital tract infections by Neisseria gonorrhoeae were given single intramuscular injections of sulbactam (500 mg)/ampicillin (1000 mg) together with 1 g oral probenecid . Cure rates that were obtained were 100% for women, 97.2% for men, 100% for patients with penicillinase-producing Neisseria gonorrhoeae (PPNG), and 98.4% for patients with non-PPNG . No serious side effects were encountered, and patient acceptance of the drug was good . A high proportion of patients had concurrent chlamydial infection . Sulbactam/ampicillin was found to be effective against gonococcal urethritis and cervicitis by both PPNG and non-PPNG but have little effect on concomitant chlamydial infections, especially in women.

Sex Transm Dis, 1991 Jul-Sep, 18(3), 180 - 2
Comparison of single-dose ceftizoxime or ceftriaxone in the treatment of uncomplicated urethral gonorrhea; Goldstein AM et al.; Penicillinase-producing strains of Neisseria gonorrhoeae account for an increasing percentage of cases of gonorrhea in the United States . Although many strains of N . gonorrhoeae are still sensitive to penicillin, the CDC currently recommends one dose of ceftriaxone 250 mg IM for treatment of uncomplicated urethral gonorrhea . Ceftizoxime like ceftriaxone is a third generation cephalosporin that demonstrates excellent MICs against beta-lactamase positive and negative strains of N . gonorrhoeae . The clinical efficacy of a single-dose of ceftizoxime 250 mg IM was compared with ceftriaxone 250 mg IM in patients with uncomplicated urethral gonorrhea . In addition, the cost of each regimen was evaluated to determine the most cost-effective agent . A total of 106 and 98 patients were treated with ceftizoxime and ceftriaxone, respectively, with all cases cured . PPNG strains were observed in 25.5% of patients . No adverse events were observed or reported . The cost of ceftizoxime was approximately one-third that of ceftriaxone ($2.37 to $2.56 and $7.15 to $8.70 per dose, respectively) . The data from this study suggest that ceftizoxime 250 mg IM is a safe, cost-effective alternative to the use of ceftriaxone 250 mg IM in the treatment of patients with PPNG-positive and -negative gonorrhea.

Sex Transm Dis, 1991 Jul-Sep, 18(3), 159 - 65
Medical health care for Viennese prostitutes; Stary A et al.; In Vienna, legalized prostitution is tightly controlled by the advisory board of the Viennese Public Health Service . Registered prostitutes are routinely screened for all important STDs, such as syphilis, HIV, gonorrhea, chlamydial- and yeast-infections, and Trichomonas vaginalis . Furthermore, cytological smears are obtained from the cervix and chest X-rays are performed at least once a year . In all pathological findings, an appropriate therapy is implemented . Presenting data of 1989, out of the 713 weekly controlled registered prostitutes, Neisseria gonorrhoeae was detected in 0.3% of all examinations (110/35,368) . In non-registered prostitutes, the infection rate of N . gonorrhoeae was 6.9% (27/354), and so far, 20 times higher than in registered ones . The infection rate of Chlamydia trachomatis, which has been routinely diagnosed in registered prostitutes for several years, has decreased from 20.4% in 1980 to 2.2% in 1989 compared with 31.4% and 10.9% in non-registered prostitutes . In registered prostitutes, the prevalence of genital infections, such as C . trachomatis, T . vaginalis, and yeasts was shown to be 4.9% . The corresponding data in non-registered prostitutes were much higher (18.8%) . Due to examinations for cervical malignancy the incidence of Papanicolaou stain IV and V has decreased from 3.1% in 1988 to 1.6% in 1989 . There was no serologic evidence for syphilis and HIV infection in both special risk groups . The data demonstrate, that due to a good health surveillance of STD-risk groups, a good information service, and free treatment, the prevalence of STDs can be reduced in prostitutes.

Sex Transm Dis, 1991 Jul-Sep, 18(3), 153 - 8
Chromosomal resistance to antibiotics in gonococci from Bahrain; Bindayna KM et al.; Ninety-one isolates of non-penicillinase-producing Neisseria gonorrhoeae from patients in Bahrain were tested for serotype, auxotype, and antibiotic susceptibility . Ten serovars and three auxotypes were found . Of the 91 isolates, 49 (54%) were serovar IB-5/7, 59 (65%) had a penicillin MIC greater than or equal to 1 mg/l, 39 (45%) had a cefuroxime MIC greater than or equal to 0.5 mg/l, and 63 (69%) had a tetracycline MIC of greater than or equal to 4 mg/l . No spectinomycin or high-level tetracycline resistance was seen . Seventy of the 91 isolates were tested against ciprofloxacin and ceftriaxone, and 40 (57%) and 26 (37%) had MICs greater than or equal to 0.03 mg/l, respectively . DNA from two penicillin-resistant isolates was capable of transforming recipient strain FA19 to donor level of penicillin and cephalosporin resistance in four steps . The first three steps were indicative of the acquisition of known resistance mutations . The existence of the fourth level transformants, with the ability of donor DNA to transform strain FA140 to higher levels of resistance, suggest the presence of another resistance mutation.

Sex Transm Dis, 1991 Jul-Sep, 18(3), 150 - 2
Multilocus enzyme analysis of African type penicillinase-producing Neisseria gonorrhoeae (PPNG) strains isolated in Spain; De la Fuente L et al.; Variability among 38 penicillinase-producing and non-producing Neisseria gonorrhoeae (PPNG and non-PPNG) strains that were isolated in Spain was investigated by multilocus enzyme electrophoresis . Based on the results of the analysis at six enzymes loci, the strains were separated into three closely related electrophoretic types (ETs) . The average number of alleles by enzyme locus was 1.33, and the mean genetic diversity by locus was 0.235 . This group of gonococcal was genetically uniform.

Sex Transm Dis, 1991 Jul-Sep, 18(3), 146 - 9
Susceptibility of upper-genital tract isolates from women with pelvic inflammatory disease to ampicillin, cefpodoxime, metronidazole, and doxycycline; Hasselquist MB et al.; The antibiotics that are recommended for treatment of pelvic inflammatory disease (PID) in the outpatient setting are efficacious against Neisseria gonorrhoeae and Chlamydia trachomatis . The susceptibility of non-sexually transmitted pathogens to these agents has not been well studied . The mean inhibitory concentrations of ampicillin, cefpodoxime, metronidazole, and doxycycline were determined for 137 upper-genital tract isolates from 84 women with confirmed PID . Antibiotic resistance was noted in 16%, 9%, 93%, and 72% of the facultative and 0%, 11%, 10%, and 56% of the anaerobic bacteria when tested against ampicillin, cefpodoxime, metronidazole, and doxycycline, respectively . The authors conclude that doxycycline is limited to coverage of Chlamydia and that a single dose of another antibiotic may not be adequate to eradicate the non-sexually transmitted disease pathogens from the upper-genital tract . Additional clinical and microbiologic studies are needed to determine whether the current outpatient antibiotic regimens provide optimal coverage for the non-sexually transmitted pathogens that are associated with PID.

Sex Transm Dis, 1991 Jul-Sep, 18(3), 138 - 42
Prevalence of Trichomonas vaginalis in men at high risk for sexually transmitted diseases; Saxena SB et al.; This study determined the prevalence of Trichomonas vaginalis in young men who were at high risk for sexually transmitted diseases; compared different diagnostic tests for trichomonads; and compared sexual behavior of men with positive and negative trichomonas test results . Men (85) aged 16-22 years inclusive, were recruited from a job-training program to participate in this study . Urethral specimens were obtained after prostatic massage for the isolation of Neisseria gonorrhoeae, Chlamydia trachomatis, and trichomonads . The diagnosis of trichomonas infection was made by urethral culture, urine sediment culture, direct examination of urine sediment, direct specimen test (DFA), and Papanicolaou (PAP) smear of urethral swab . Trichomonas vaginalis was seen in 58% of the men, gonorrhoea in 23.5%, chlamydia in 29%, pediculosis in 6%, and condyloma acuminata in 7%, respectively . There was no statistically significant difference in age of the participants, frequency of intercourse, and number of sexual partners in the last 3 months in men with positive and negative trichomonas test results . After controlling for gonorrhoea, pyuria was significantly associated with trichomonas-positive urine (P = .01) . No single test was ideal for the diagnosis of trichomonas infection . Using a combination of urethral culture and urine sediment culture as the "gold standard," DFA was 60% sensitive and 73.0% specific . However, urine sediment culture along with DFA identified 94% of all men with positive trichomonas test results.

Monatsschr Kinderheilkd, 1991 Jul, 139(7), 376 - 87
{Pre- and perinatal infections with sexually transmissible microorganisms}; Schiefer HG et al.; The sexually transmissible pathogenic microorganisms, which are also capable of initiating pre- or perinatal infections, include Neisseria gonorrhoeae, Treponema pallidum, Chlamydia trachomatis serovars D through K, group B streptococci, urogenital mycoplasmas, herpes simplex viruses types I and II, cytomegalovirus, hepatitis B virus, human immunodeficiency viruses, human papillomaviruses, Candida spp . and Trichomonas vaginalis . With special emphasis on paediatric and neonatological aspects, brief discussions of the following topics are presented: the epidemiology of these agents, the diseases they can induce in pregnancy, the mode of infection of and the diseases in the fetus and neonate, the preventive measures, the diagnosis and therapy.

Kansenshogaku Zasshi, 1991 Jul, 65(7), 844 - 50
{A novel approach to the detection of Neisseria gonorrhoeae employing DNA probe method}; Harada Y et al.; The present study was undertaken to establish a novel detection method for Neisseria gonorrhoeae (N . gonorrhoeae) . DNA probe obtained from Gen-probe Inc . was employed and clinically isolated strains (18 species, 81 strains) were applied to verify the quality and quantity of the method . The present data revealed that the method is specific to detect N . gonorrhoeae (30/30): neither gram positive nor negative oraganisms were detectable by the method (0/51) . It has been shown, further more, that there exists a significant correlation between the number of the bacteria and the relative light units (r = 0.96) . The threshold of cell numbers, on the other hand, was found to be 5 X 10(3) cfu/tube . The detection sensitivity for N . gonorrhoeae was not influenced by the presence of other bacteria, and not decreased by using heat-treated or drug-treated N . gonorrhoeae organisms . The present study also provides some experimental evidences that the method can also be applicable for the detection of bacteriolytic action of drugs.

J Clin Microbiol, 1991 Jul, 29(7), 1439 - 46
Comparisons of standard curve-fitting methods to quantitate Neisseria meningitidis group A polysaccharide antibody levels by enzyme-linked immunosorbent assay; Plikaytis BD et al.; We examined several of the more commonly used models (log-log, two forms of the logit-log, and the four-parameter logistic-log transformations) for forming standard or calibration curves by using a standardized enzyme-linked immunosorbent assay (ELISA) . Assay range, accuracy, and error for each function were measured and compared . Antibody levels to Neisseria meningitidis group A polysaccharide were estimated by calculating antibody concentrations of a serially diluted standard reference serum of known concentration . Each function achieved a high squared correlation coefficient (r2 greater than 0.97), indicating a high degree of accuracy in forming the standard curves . However, when predicted antibody concentrations were compared with the known values, the log-log function exhibited the least precision, with extreme percentages of error occurring at several dilutions . A partially specified logit-log transformation performed better than the log-log model over a reduced range of standard dilutions . This indicated that a high r2 alone was not a reliable measure of the accuracy of the standard curve . Of the methods surveyed, the logistic-log and fully specified logit-log functions were the most accurate models for forming standard curves and for interpolating antibody concentrations from the standard curve . The accuracy of the fully specified logit-log function is highly dependent on the precise specification of two unknown quantities, the optical densities at zero and infinite concentrations, prior to fitting the model to a typical set of calibration data . The four-parameter logistic-log function was the preferred choice for quantitating N . meningitidis group A total polysaccharide antibody by using a standardized ELISA . The function does not require prespecification of any parameters before estimating the standard curve, and the four parameters are readily interpretable in terms of identifiable physical quantities . This model also has the advantage that it is easiest to visualize since it does not incorporate complex transformations of the optical density scale.

Indian J Pediatr, 1991 Jul-Aug, 58(4), 521 - 4
Latex agglutination test: an adjunct to the laboratory diagnosis of pyogenic bacterial meningitis; Mirdha BR et al.; Gram stain, culture and latex agglutination test (LAT) of cerebrospinal fluid were performed in 50 patients clinically diagnosed as suffering from pyogenic bacterial meningitis . Using all the three techniques, an aetiological diagnosis was made in 27 (54%) . Neisseria meningitidis, Streptococcus pneumoniae and H . influenzae were the infecting organisms in 21 cases (44%) . There were 12 additional cases in which LAT was the only clue to the diagnosis as compared to conventional techniques . Propionibacterium acnes was isolated from one case of anaerobic meningitis . It is concluded that LAT is an adjunct to conventional techniques in the diagnosis of pyogenic bacterial meningitis, where the latter tests fail.

Mikrobiyol Bul, 1991 Jul, 25(3), 235 - 7
{Penicillin resistance in gonococcal urethritis}; Koksalan H et al.; In this study, we researched the resistance of gonococci to penicillin among 30 patients who had urethral discharge because of gonococcal urethritis, between 1990 January and 1990 September at SSK Ankara Hospital . We established 26.6% of isolated 30 Neisseria gonorrhoeae species resistant to penicillin.

Eur J Epidemiol, 1991 Jul, 7(4), 311 - 9
Epidemiological typing of Neisseria gonorrhoeae: a comparative analysis of three monoclonal antibody serotyping panels; Moyes A et al.; Sixteen hundred and thirty seven isolates of Neisseria gonorrhoeae isolated over a two year period were serotyped using three panels of monoclonal antibodies . The isolates comprised 687 serogroup WI strains and 950 serogroup WII/III strains . The antibodies used in the panels were those developed by Pharmacia (Ph) and Genetic Systems (GS) . The GS antibodies were used as two separate panels; the American (GS-A) panel which designates serovars by a simple numerical nomenclature and the Swedish (GS-S) panel which designates serovars by a more detailed descriptive nomenclature . Using only a single panel the Ph panel gave the greatest discrimination yielding 42 serovars compared with 28 serovars with the GS-S panel and 23 serovars with the GS-A panel . Using two panels in combination, the GS-A/Ph panel combination gave the greatest discrimination with 81 serovar combinations while a combination of the GS-S and Ph panels yielded 77 serovar combinations . A compilation of antibodies from all three panels yielded 90 serovar combinations . As the combination of GS-A and Ph panels gave a greater degree of discrimination than the combination of the GS-S and Ph panels we advocate that first-stage serotyping should be performed with the more widely used GS-A panel while second-stage serotyping should be performed with the Ph panel . We propose that serovar combinations should be reported using a dual nomenclature e.g . IA-1/Arost, IB-1/Bropt, IB-1/Bropyt etc . The use of such a dual system would allow "core comparison" between all centres while maintaining a degree of flexibility regarding the extent of discrimination required.

J Fam Pract, 1991 Jul, 33(1), 73 - 8
Noninvasive detection of Chlamydia trachomatis urethritis in men by a rapid enzyme immunoassay test; Ferris DG et al.; BACKGROUND . The purpose of this investigation was to evaluate the ability of a rapid enzyme immunoassay test to noninvasively detect Chlamydia trachomatis urethritis in men from a urine specimen . METHODS . Urethral samples and urine from 207 patients were evaluated . Urethral and urine sediment Gram stains, leukocyte esterase dipstick tests, and enzyme immunoassay analyses of centrifuged and uncentrifuged urine were compared with urethral C trachomatis culture . RESULTS . The prevalence of infection in this population was 10.3% . Sensitivity and specificity of the enzyme immunoassay on the centrifuged urine specimen were 70% and 96%, respectively . The positive and negative predictive values were 67% and 97%, respectively . The uncentrifuged urine enzyme immunoassay sensitivity was 35.7% and specificity was 98.9% . Leukocyte esterase test sensitivity compared with that of the Neisseria gonorrhoeae and/or C trachomatis cultures was 83.3%, and specificity was 52% . CONCLUSIONS . The rapid enzyme immunoassay clinically complemented the screening urine sediment Gram stain and the leukocyte esterase test . The judicious use of a noninvasive C trachomatis rapid enzyme immunoassay test to identify organism-specific urethritis may improve patient management of sexually transmitted disease.

J Immunol, 1991 Jul 1, 147(1), 298 - 305
Lysis of Neisseria gonorrhoeae initiated by binding of normal human IgM to a hexosamine-containing lipooligosaccharide epitope(s) is augmented by strain-specific, properdin-binding-dependent alternative complement pathway activation; Griffiss JM et al.; We studied the specificity of naturally acquired IgM bactericidal for strains of Neisseria gonorrhoeae that varied in sensitivity to the lytic action of normal human serum (NHS) and the relative ability of these strains to deplete the classical (CP) and alternative (ACP) C pathways . Lysis of both highly sensitive and relatively insensitive strains was inhibited by the same gonococcal lipooligosaccharides (LOS), as well as by Salmonella minnesota Re LOS and three hexosamine-containing glycose polymers . A polymer of N-acetylgalactosamine phosphate was the most inhibitory; a polymer of N-acetylglucosamine phosphate only partially inhibited . Neither 3-deoxy-D-manno-octulosonic acid (dOc1A) nor a polymer that contained dOc1A but not hexosamine inhibited NHS lysis . A co-polymer of N-acetylgalactosamine-dOc1A inhibited both bactericidal activity and the binding of IgM to the LOS of a highly serum-sensitive (sers) gonococcal strain . Carboxyl reduction of the dOc1A in this polymer did not affect its inhibitory capacity for gonococcal antibody, but abolished its binding to homologous antibody induced by vaccination . CP activity was not affected by vaccination . CP activity was not affected by absorption of NHS with gonococcal strains, whereas ablation of CP activity markedly but variously diminished lytic activity for highly sers strains . ACP activity was variously depleted by gonococcal strains, and the proportion of bacteria that could be lysed through the ACP varied among strains and among different populations of a given strain . The titer at which a strain was sensitive to NHS lysis was a function of its ACP consumption (p = 0.006), which accounted for 70% of the differences in titer among strains . Analyses of the absorbed sera revealed that the gonococci had variously depleted properdin from NHS as assessed by using an Ag-capture solid-phase RIA . Addition of purified properdin to absorbed sera restored ACP activity to normal levels . Western immunoblots of gonococcal lysates showed that purified properdin bound directly to a 39-kDa outer membrane protein . We conclude that both CP activation by IgM binding to LOS epitopes, one of which contains hexosamine, and ACP activation, which is a function of strain-specific direct binding of properdin, can initiate lysis of sers strains and that ACP activation, also enhances lysis and accounts for variations in sensitivity of sers strains.

Mol Microbiol, 1991 Jul, 5(7), 1649 - 56
Cloning and sequencing of the structural gene for the porin protein of Bordetella pertussis; Li ZM et al.; Bordetella pertussis produces a porin protein which is a prominent outer membrane component found in both virulent and avirulent strains . N-terminal amino acid analysis of purified B . pertussis porin was performed and this amino acid sequence was used to design an oligonucleotide that was then utilized to screen a lambda gt11 library containing randomly sheared fragments of DNA from B . pertussis strain 347 . One clone, lambda BpPor, was identified and subcloned into pUC18 . A portion of the DNA insert in this subclone, pBpPor1, was sequenced and shown to contain the N-terminal region of the structural porin gene . This truncated gene sequence was used to design an additional oligonucleotide that was used to identify a clone, pBpPor2, which overlapped with pBpPor1 and contained a termination codon . The structural gene deduced from this sequence would encode a 365-amino-acid polypeptide with a predicted mass of 39,103 daltons . The predicted product also contains a signal sequence of 20 residues that is similar to that found in other porin genes . The predicted B . pertussis porin protein sequence contains regions that are homologous to regions found in porins expressed by Neisseria species and Escherichia coli, including the presence of phenylalanine as the carboxy-terminal amino acid . DNA hybridization studies indicated that both virulent and avirulent strains of B . pertussis contain only one copy of this gene and that Bordetella bronchiseptica and Bordetella parapertussis contain a similar gene.

Antimicrob Agents Chemother, 1991 Jun, 35(6), 1228 - 9
Cocaine hydrochloride and benzoylecgonine have no in vitro inhibitory effect against Neisseria gonorrhoeae; Zenilman JM et al.; We evaluated 72 clinical Neisseria gonorrhoeae isolates for in vitro susceptibility to cocaine hydrochloride and its metabolite benzoylecgonine and to penicillin, tetracycline, erythromycin, ceftriaxone, and ofloxacin . Although there was a wide range of susceptibilities to the antimicrobial agents, cocaine and its major metabolite, benzoylecgonine, had no demonstrable antigonococcal activity . Cocaine use is frequently associated with outbreaks of sexually transmitted disease . We hypothesized that the dramatically decreasing incidence of gonorrhea over the past 15 years may be in part due to pharmacological effects of cocaine . However, since cocaine and its metabolite have no in vitro antigonococcal activity, this hypothesis is unlikely.

J Gen Microbiol, 1991 Jun, 137 ( Pt 6), 1313 - 21
Isolation and characterization of a mutant of Neisseria gonorrhoeae that is defective in the uptake of iron from transferrin and haemoglobin and is avirulent in mouse subcutaneous chambers; Genco CA et al.; Iron-uptake mutants of Neisseria gonorrhoeae strain 340 were obtained following treatment with streptonigrin, and one such mutant (Fud14) was characterized . N . gonorrhoeae strain Fud14 was unable to grow with human transferrin or haemoglobin as the sole source of iron, but grew normally with heat-inactivated normal human serum or haemin . Internalization of 55Fe from transferrin by strain Fud14 was only 25% of the parent level . Strain Fud14 (less than or equal to 1 x 10(8) c.f.u.) did not grow in subcutaneous chambers implanted in mice, whereas the parent strain was infective at an ID50 of 4.3 x 10(1) c.f.u . Supplementation of chambers with either normal human serum or haemin resulted in the establishment of strain Fud14 in vivo for at least 240 h post-inoculation . Electroporation of Fud14 with wild-type DNA and selection for growth on medium containing human transferrin resulted in a recombinant (Fud15) that was capable of utilizing haemoglobin, and was virulent in mice . These results suggest that a gonococcal strain defective in the ability to utilize in vivo iron sources is not capable of survival in vivo.

Kansenshogaku Zasshi, 1991 Jun, 65(6), 703 - 9
{Usefulness of the mailed specimens for mass examination of Chlamydia trachomatis and Neisseria gonorrhoeae with EIA}; Kobayashi Y et al.; The infections with C . trachomatis and N . gonorrhoeae have recently been determined routinely with the commercial kits for detecting the antigens of these organisms in both the clinical and mass examination laboratories . In mass examination, a change during transporting the specimens must be avoided . Hence, a study on whether the antigens were changed with atmospheric temperature was carried out . As for C . trachomatis, no change in antigen was found on the enzyme immunoassay (EIA) absorbance of the antigen quantity corresponding to the cell of 4.8 x 10(4), 2.4 x 10(4) and 6.0 x 10(3) (IFU/ml) until 5 days at 4, 25 and 37 degrees C respectively after sampling . The coefficient variation was found out to be ca . 10% . In a test on antigen stability of N . gonorrhoeae, similar results to that of C . trachomatis were obtained on the following antigen quantity: 2.4 x 10(3), 3.3 x 10(2) and 9.0 x 10 (CFU/ml) under the same conditions as in the above . The coefficient variation was found out to be 10% or less . To investigate whether there is any difference on the stability of C . trachomatis antigen between mailing and hand carrying, a total of 133 specimens collected from many clinics were subjected to the detection of antigen with the commercial EIA kits . The results of comparison on both transport methods were as follows: agreement rate 96.2%, positive rate 100% and negative rate 95.2% . The highly correlation between the both transportation was confirmed in the detection of antigen; that is, Y = 1.03X + 0.03, r = 0.936.(ABSTRACT TRUNCATED AT 250 WORDS)

Eur J Clin Microbiol Infect Dis, 1991 Jun, 10(6), 511 - 4
Penetration of ciprofloxacin into human cerebrospinal fluid in patients with inflamed and non-inflamed meninges; Gogos CA et al.; The penetration of ciprofloxacin into the cerebrospinal fluid (CSF) in 25 patients with non-inflamed meninges and in 9 patients with inflamed meninges was studied . In the patients with non-inflamed meninges plasma and CSF were obtained 1-10 h after the second dose of ciprofloxacin and in the patients with inflamed meninges 1, 2, 3, 5, 7 and 9 h after the second dose . In the first group (non-inflamed meninges) data from 6 patients were obtained 4, 5 and 6 h post-dose . Mean ciprofloxacin concentrations in the CSF ranged from 0.073 mg/l to 0.106 mg/l during this observation time, while in the second group (inflamed meninges) they ranged from 0.089 to 0.260 mg/l . These results demonstrate that ciprofloxacin diffuses into the CSF at concentrations which exceed the MICs of Neisseria meningitidis and most gram-negative aerobic bacilli.

Hinyokika Kiyo, 1991 Jun, 37(6), 663 - 8
{Bacteriological and clinical studies on fleroxacin in male gonococcal urethritis}; Saito I et al.; We performed basic and clinical studies on the effects of a new oral antimicrobial agent, fleroxacin (FLRX), a new quinolone derivative in male gonococcal urethritis . The antibacterial activity of FLRX against clinical strains of Neisseria gonorrhoeae was roughly comparable to that of norfloxacin and ofloxacin . FLRX was administered to 58 males with gonococcal urethritis . Two different schedules of administration were adopted . One was a single-dose of 300 mg given orally (17 cases) and the other was the oral administration of 200 mg once a day for 3 to 10 days (41 cases) . Clinical evaluation was made according to the criteria of the Japanese UTI Committee . The overall efficacy rate was 98% (49/50) . For complications of Chlamydia trachomatis (11 cases), the efficacy rate was 90.9% (10/11) . No subjective or objective adverse reaction occurred.

Zhonghua Liu Xing Bing Xue Za Zhi, 1991 Jun, 12(3), 136 - 9
{Study on periodically prevalent feature for epidemic cerebrospinal meningitis in China}; Hu X; A study on periodically prevalent feature for epidemic cerebrospinal meningitis (ECM) in China was carried out by means of cluster analysis of multilocus enzyme electrophoresis, as well as chromosomal DNA fingerprinting and subserotyping of outer membrane protein class 1 of Neisseria meningitidis group A . Two hundred strains tested were isolated from the patients for ECM and carriers during the 1960s to 1980s in 17 provinces and municipalities . Overall analysis on the bacterial types of the strains above mentioned and data of morbidity of this disease for recent 40 years was undertaken . The research results indicated that ECM really possessed the feature of cyclic prevalence in China, the cyclic epidemics were caused by the different predominant types of Neisseria meningitidis group A and the strains of predominant types could be periodically spread . Every epidemic was basically spread from the north to the south of China . However, the patterns of cyclic epidemic of this disease were not uniform in the country . The above study has established the preliminary base to reveal the prevalent mechanism for ECM by use of molecular biological methods in China.

J Adolesc Health, 1991 Jun, 12(4), 329 - 34
First catch urine sediment for Chlamydia trachomatis and Neisseria gonorrhoeae culture in adolescent males with pyuria; Woods ER et al.; Traditionally, only symptomatic males or those with a history of exposure are tested for sexually transmitted diseases (STDs) . Since urethral infections with Chlamydia trachomatis and Neisseria gonorrhoeae are frequently asymptomatic, a practical, sensitive, and acceptable screening method is desirable . Fifty sexually active males with pyuria (age 13 to 22 years old) diagnosed with 1+ or 2+ leukocyte esterase (LE) dipstick on first catch urine (FCU) were further evaluated by culture of urethral swabs and centrifuged FCU samples for N . gonorrhoeae and C . trachomatis . Eighty-six percent had one or more positive cultures: 17 (34%) N . gonorrhoeae, 18 (36%) C . trachomatis, and 8 (16%) both organisms . FCU culture for N . gonorrhoeae had a 100% sensitivity, specificity, and positive and negative predictive value when compared to urethral swab cultures . FCU culture for C . trachomatis had a 32% sensitivity, 95% specificity, 89% positive predictive value, and a 53% negative predictive value compared to urethral culture . On the basis of the results of this study, one urethral swab can be eliminated when evaluating male adolescents for urethritis by using spun FCU culture for N . gonorrhoeae . Continued efforts should be made to develop optimal tests to detect STDs which are reliable and encourage compliance in this high-risk group.

J Adolesc Health, 1991 Jun, 12(4), 326 - 8
Urinary leukocyte esterase screening for asymptomatic sexually transmitted disease in adolescent males; Werner MJ et al.; The objective of this study was to evaluate the effectiveness of urinary leukocyte esterase on random urine specimens as a screening test for chlamydial and gonococcal urethral infections in asymptomatic males . Random urine specimens were obtained on 106 consecutive asymptomatic adolescent males during intake physical examination at a residential vocational training program . Results of urinary leukocyte esterase were compared to those of urethral cultures for Chlamydia trachomatis and Neisseria gonorrhoeae . Five subjects had positive chlamydia cultures, three subjects had positive gonococcal cultures, and one patient had positive cultures for both organisms . Sixteen subjects had leukocyte esterase tests reported as "trace" or greater . When compare to positive culture results for either Chlamydia or gonorrhea, urinary leukocyte esterase activity had a sensitivity of 78%, specificity of 91%, and positive predictive value of 44% . A random urine specimen for urinary leukocyte esterase activity is a cost-effective screening method for chlamydial and gonococcal urethral infections in asymptomatic adolescent males.

Isr J Med Sci, 1991 Jun, 27(6), 311 - 5
An outbreak of penicillin-resistant Neisseria gonorrhoea in southern Israel; Schlaeffer F et al.; Since the early 1980s the incidence of gonorrhea has been declining worldwide, as well as in Israel . This decline has been attributed to the fear of AIDS . We report an outbreak of penicillin-resistant Neisseria gonorrhoea that occurred in the last quarter of 1988 and throughout 1989 in southern Israel . During 1987 and the first three-quarters of 1988 only 13 new cases were diagnosed, all penicillin sensitive . During the epidemic, 94 new cases were diagnosed, 41% of them penicillin resistant . In March 1989, ceftriaxone was substituted for penicillin for the treatment of gonococcal urethritis . The number of cases of penicillin-resistant gonorrhea dropped dramatically . It is concluded that despite the AIDS panic, outbreaks of gonorrhea can still be encountered, as demonstrated in this study.

J Bacteriol, 1991 Jun, 173(12), 3911 - 3
Species-specific uptake of DNA by gonococci is mediated by a 10-base-pair sequence; Elkins C et al.; Piliated Neisseria gonorrhoeae are known to be transformed less readily if transforming DNA competes with DNA containing the 10-bp sequence GCCGTCTGAA . It has been postulated that the 10-bp sequence is a recognition sequence which is required for efficient DNA uptake . We show that the presence of various forms of this 10-bp sequence results in increased uptake of double-stranded DNA into a DNase-resistant state and allows genetic transformation by an otherwise nontransformable plasmid.

J Exp Med, 1991 Jun 1, 173(6), 1395 - 405
In situ expression and localization of Neisseria gonorrhoeae opacity proteins in infected epithelial cells: apparent role of Opa proteins in cellular invasion; Weel JF et al.; During natural infection, gonococcal opacity proteins (Opa) undergo rapid phase variation, but how this phenomenon contributes to the virulence of the bacteria is not well understood . In the present immunomorphological study we examined the actual Opa status of individual gonococci during various stages of gonococcal infection of Chang epithelial cells, by probing ultrathin sections of infected specimens with Opa-specific monoclonal antibodies . Our results demonstrate a heterogeneous Opa expression during the initial interaction of the bacteria, but an almost 100% expression of one of the probed Opas during their secondary attachment and entry into the host cells, suggesting a role for distinct Opas in cellular penetration . The association between Opa expression, tight attachment, and bacterial invasion into the host cells could be confirmed with isogenic variants that expressed different Opa proteins . Once inside the epithelial cells, both morphologically intact, Opa positive and morphologically disintegrated, Opa negative bacteria were observed . The loss of Opa immunoreactivity in intracellular gonococci could not be related to the presence of a particular Opa protein, but could be mimicked by incubating the organisms with extracts of sonicated uninfected epithelial cells, suggesting that it was caused by host cell proteolytic activity . Taken together, our data suggest that Opa phase transitions confer a functional adaptation of the bacteria enabling host cell penetration.

J Med Microbiol, 1991 Jun, 34(6), 355 - 62
Virulence of transparent and opaque colony types of Neisseria gonorrhoeae for the genital tract of mice; Kita E et al.; The virulence of transparent (Tr) and opaque (Op) colony types of Neisseria gonorrhoeae in the genital tract of female mice was evaluated at two stages of oestrous . Isogenic pairs of Tr and Op variants were isolated from N . gonorrhoeae strain 57-120 . Both variants exhibited a T2 morphology, but only the Op variant possessed protein II (P.II) in outer-membrane fractions . When administered by intravaginal inoculation Op gonococci were highly infective only for mice in late pro-oestrous, whereas Tr gonococci were virulent for mice at both late pro-oestrous and dioestrous . Gonococci recovered from the uterus were of both Tr and Op phenotypes in equal proportions when mice were infected at dioestrous with Tr cells . In contrast, greater than 90% of recovered colonies were of Op phenotype when mice were infected at late pro-oestrous with either Op or Tr cells . These results indicate that the virulence of gonococci for the genital tract of female mice differs from that for the chicken embryo . Furthermore, gonococcal survival in the female genital tract might be attributable to phase variation from Tr to Op phenotypes.

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