Neisseria

Am J Physiol, 1990 Jan, 258(1 Pt 2), R182 - 6
Somnogenic, pyrogenic, and hematologic effects of bacterial peptidoglycan; Johannsen L et al.; Bacterial infections and certain muramyl peptides elicit a variety of pathophysiological effects including increases in body temperature and slow-wave sleep . Bacterial cell wall peptidoglycan is composed of muramyl peptides . To investigate the ability of isolated bacterial cell walls to enhance slow-wave sleep, rabbits were injected intravenously with cell walls isolated from Staphylococcus aureus or with soluble peptidoglycan prepared from Neisseria gonorrhoeae . These injections increased slow-wave sleep, electroencephalographic delta-wave amplitudes, and body temperature, reduced rapid-eye-movement sleep, and induced neutrophilia and lymphopenia . The somnogenic and pyrogenic effects of S . aureus cell walls developed within 1 h and persisted throughout the recording period . Injections of N . gonorrhoeae peptidoglycan induced similar effects but of larger magnitude and shorter duration . We conclude that peptidoglycan is a bacterial component that mediates the increased sleep observed during infectious disease.

JAMA, 1990 Jan 5, 263(1), 54 - 9
Decreased risk of symptomatic chlamydial pelvic inflammatory disease associated with oral contraceptive use; Wolner-Hanssen P et al.; Studies have shown that oral contraceptive use may protect against pelvic inflammatory disease (PID), but it is not known whether oral contraceptives protect against the disease among women already infected with Chlamydia trachomatis or Neisseria gonorrhoeae . The relationship between oral contraceptive use and PID was analyzed in a case-control study of 141 women with verified PID and 739 randomly selected, sexually active women with no clinical evidence of the disease . Case and control subjects were stratified on the basis of infection with C trachomatis, N gonorrhoeae, or neither organism . Among women infected with C trachomatis alone, those with PID were less likely than control subjects to use oral contraceptives . The association was significant when oral contraceptive use was compared with nonuse (odds ratio, 0.22; 95% confidence interval, 0.08 to 0.64) and with noncontraception (odds ratio, 0.17; 95% confidence interval, 0.06 to 0.53) and remained so after adjusting for potential confounding variables by logistic regression analysis . Among women infected with N gonorrhoeae alone, no association was found between use of oral contraceptives and PID . These data suggest that oral contraceptive use protects against symptomatic PID among women infected with C trachomatis but not among those infected with N gonorrhoeae.

Microbios, 1990, 61(248-249), 197 - 205
Cohesion between oral streptococci and Neisseria pharyngis on saliva-coated glass, in the presence and absence of sucrose; Willcox MD et al.; Ten strains of oral streptococci, comprising nine species, were screened for their in vitro cohesive interactions with a freshly isolated strain of Neisseria pharyngis . Strains of mutans streptococci, Streptococcus salivarius, Streptococcus sanguis I, Streptococcus milleri and Streptococcus mitis were able to cohere with N . pharyngis cells attached to a salivary pellicle adsorbed to glass . The cohesion was either due to coaggregation between the different genera or modification of the salivary pellicle by N . pharyngis MW2 . S . sanguis II and Streptococcus oralis strains could not cohere with the N . pharyngis strain . Extracellular polysaccharide formed from sucrose was found to mediate cohesion between certain strains of mutans streptococci or S . oralis and N . pharyngis MW2.

Arctic Med Res, 1990 Jan, 49(1), 43 - 7
Ectopic pregnancy in Greenland . An epidemiological study; Johnsen HM et al.; A retrospective epidemiological investigation was carried out to study the rate and incidence of ectopic pregnancy (EP) in Greenland . Data from 7 of Greenland's 16 medical districts, representing 48% of the population, were available for analysis covering the years 1980-1984 . A total of 4481 pregnancies were reported, including 105 cases of EP . A rate of EP 2.34 was calculated, one of the highest on record, and significantly higher than Scandinavian figures representing the same period . Estimated from our figures there would be 44 cases of EP annually in Greenland . Annual fluctuations, however, were seen, and a positive correlation was found to notified cases of Neisseria infections . Significance from the null hypothesis, however, was only found at the 10% level.

Chemotherapy, 1990, 36(1), 70 - 6
Randomized comparison of ofloxacin and doxycycline for chlamydia and ureaplasma urethritis and cervicitis; Mogabgab WJ et al.; Fifty-eight males and 34 females with nongonococcal urethritis and/or cervicitis were treated to compare the efficacy and safety of 7-day regimens of oral ofloxacin 300 mg twice daily and doxycycline hyclate 100 mg twice daily . Forty-seven patients were randomized to receive ofloxacin and 45 patients to receive doxycycline . The microbiologic response rate was 97% (32/33) for both ofloxacin and doxycycline; the combined microbiologic and clinical cure rates were 98% for both treatment groups (ofloxacin 46/47, doxycycline 44/45) . Ofloxacin was as effective as doxycycline in the treatment of chlamydial infections (96% vs . 100%) . In patients with Ureaplasma urealyticum, the initial response was complete with either drug, but recurrence of infection was observed with both treatment groups (1 of 4 patients in the ofloxacin group and 2 of 11 patients in the doxycycline group) . In the treatment of mixed Chlamydia trachomatis and U . urealyticum infections, all 5 patients treated with ofloxacin and 3 of 4 patients treated with doxycycline were cured . In symptomatic patients whose initial cultures were negative, clinical cures were complete with both drugs, but Ureaplasma was isolated at 3 or more weeks post-treatment in 2 patients treated with ofloxacin . In a study of single-dose ofloxacin treatment of uncomplicated gonorrhea, Neisseria gonorrhoeae was eradicated in all subjects, but C . trachomatis was not reliably eradicated . Both drugs were well tolerated with only minimal adverse effects reported in either treatment group . A multiple-dose regimen of ofloxacin appears to be a highly effective and well-tolerated alternative to doxycycline in nongonococcal sexually transmitted disease.

Can J Vet Res, 1990 Jan, 54(1), 151 - 6
The effect of Pasteurella haemolytica and the leukotoxin of Pasteurella haemolytica on bovine lung explants; Wilkie IW et al.; Bovine lung explants were used in a study designed to compare the pathogenic effects of Pasteurella haemolytica type 1, a nonpathogenic organism Neisseria subflava, or the crude leukotoxin of P . haemolytica on alveolar macrophages and lung parenchymal cells . Concentrated, purified peripheral blood neutrophil suspensions were added with the bacteria to some explants . Duplicate pairs of cultures from each treatment group were fixed at regular intervals up to 24 hours after seeding and morphological changes were assessed by light and electron microscopy . Pasteurella haemolytica caused deterioration of alveolar macrophages within one hour but did not affect parenchymal cells for more than 12 hours . Neisseria subflava did not affect alveolar macrophages initially, but caused an accelerated deterioration after four hours . After 24 hours, bacterial overgrowth caused similar deterioration of all cells in explants seeded with either bacterium . Alveolar macrophages phagocytosed large numbers of N . subflava but rarely ingested P . haemolytica . Added neutrophils did not have any discernible effect on any of the explants and did not potentiate bacterial effects . Addition of crude leukotoxin of P . haemolytica to the culture medium significantly accelerated alveolar macrophage deterioration without apparent effect on parenchymal cell survival . These results support the hypothesis that the severe tissue destruction of fulminant pneumonic pasteurellosis is not a direct result of bacterial infection.

Scand J Infect Dis Suppl, 1990, 70, 52 - 67
Antimicrobial prophylaxis in gynaecological and obstetric surgery; Gjonnaess H; Gynaecologic and obstetric surgery generally is prone to infections caused by bacteria from vagina . The vaginal flora contains normally more than 40 different microorganisms . Some of them are obligate pathogens, such as Chlamydia trachomatis, Neisseria gonorrhoeae and serogroup B streptococci, for other microbial species, like mycoplasmas and staphylococci, the pathogenicity is uncertain . The vaginal flora is under the influence of a great number of variables, such as endocrine factors, life style, contraception, and the use of tampons/pads . The recent literature on antibiotic prophylaxis in gynaecology and obstetrics is surveyed . The conclusions are: Antibiotic prophylaxis is recommended in: Abdominal hysterectomy (in high risk cases), in vaginal hysterectomy, fertility surgery, elective abortion and miscarriage (in carriers of C . trachomatis or N . gonorrhoeae), in cerclage (in endocervical colonization), Caesarean section (in high risk cases), and premature rupture of membranes . Great importance is attached to the prevention of infection of the neonates, with emphasis on the transmission of serogroup B streptococci and herpes simplex virus . The prevention of postoperative and postpartum urinary tract infections is discussed.

J Int Med Res, 1990, 18 Suppl 4, 85D - 89D
Single-agent therapy for acute pelvic inflammatory disease: sulbactam/ampicillin versus cefoxitin; Hemsell DL et al.; A total of 54 women with acute salpingitis were treated intravenously with ampicillin/sulbactam or cefoxitin in a prospective, randomized, ongoing study . Of the organisms isolated, Gram-negative species (excluding Neisseria gonorrhoeae) were considerably more likely to produce beta-lactamase than were Gram-positive species . Clinical efficacy was 94% for 2 g ampicillin plus 1 g sulbactam and 89% for 2 g cefoxitin, all given intravenously every 6 h . The addition of sulbactam, an irreversible beta-lactamase inhibitor, to ampicillin restored both the microbiological and clinical activities of ampicillin . Both regimens were equally safe and demonstrated good efficacy in the treatment of the acute, symptomatic phase of infection.

Scand J Infect Dis Suppl, 1990, 69, 69 - 76
Gonorrhoea and syphilis in Sweden--past and present; Danielsson D; Gonorrhoea and syphilis that belong to our oldest recognized sexually transmitted diseases (STD) are also the prototypes of curable STDs . After the discovery of the causative organisms, Neisseria gonorrhoeae in 1879 and Treponema pallidum in 1905, diagnostic tests were developed and by this, in conjunction with instituted regulations and legislation, means were created for public health authorities to collect statistical data . Sweden has fairly reliable statistics of both syphilis and gonorrhoea from 1912 and onwards, and these data show many interesting characteristics . Syphilis was prevalent in Sweden among both males and females during World War (WW) I and peaked in 1920 with an incidence rate of 150 and 75 per 100,000 population, respectively . The incidence figures fell rapidly after 1920 and reached a low of less than 30 cases per 100,000 in the mid 1920s, probably as a result of systemic treatment with Salvarsan in conjunction with vigorous contact tracing, two important measures to bring an infectious disease under epidemiological control . There was a slight increase of male syphilis in the late 1920s and early 1930s, and of both male and female cases during WW II which never reached the incidence figures of WW I . Penicillin was introduced in the mid 1940s for treatment and was proved superior to Salvarsan . The incidence figures have been very low ever since the early 1950s.(ABSTRACT TRUNCATED AT 250 WORDS)

J Antimicrob Chemother, 1990 Jan, 25(1), 39 - 47
The 25.2 MDa tetracycline-resistance plasmid is not derived from the 24.5 MDa conjugative plasmid of Neisseria gonorrhoeae; Gascoyne DM et al.; High-level tetracycline resistance in strains of Neisseria gonorrhoeae is due to the presence of a 25.2 MDa conjugative plasmid . This plasmid has been shown to carry the streptococcal tetM determinant, and has been thought to have evolved from the 24.5 MDa conjugative plasmid found in N . gonorrhoeae . We have derived a physical map of the 25.2 MDa plasmid pUS100 using seven restriction endonucleases . Comparison of the physical map with the previously published physical map of the conjugative plasmid pLE2451 shows there to be no obvious similarity between the two plasmids . The location of the tetM determinant has been established, by Southern hybridization, confirming the restriction endonuclease map . This has also provided evidence that the transposition functions normally associated with the tetM determinant have been lost.

J Antimicrob Chemother, 1990 Jan, 25 Suppl A, 115 - 21
Comparative studies of azithromycin in skin and soft-tissue infections and sexually transmitted infections by Neisseria and Chlamydia species; Lassus A; Two open, randomized, single centre studies have investigated the efficacy and safety of azithromycin (CP-62,993) in the treatment of infections by azithromycin-sensitive pathogens: (A) acute bacterial infections of skin or soft tissue (compared with erythromycin; n = 82); and (B) urethritis and/or cervicitis caused by Neisseria gonorrhoeae and/or Chlamydia trachomatis (compared with doxycycline; n = 108) . In study A, azithromycin was administered to 42 patients for five days at a dosage of 250 mg bd on day 1 and 250 mg once daily on days 2-5; erythromycin was given to 40 patients for seven days at a dosage of 500 mg every 6 h . In study B, azithromycin was administered either as a single 1 g dose or as a single 500 mg dose on day 1 and 250 mg once daily on days 2 and 3; doxycycline was given at a dose of 100 mg every 12 h for seven days . In study A, 68 patients were clinically assessed: clinical cure or improvement in patients receiving azithromycin or erythromycin was achieved in 86% and 82%, respectively . The principal causative pathogen was Staphylococcus aureus; there was eradication of 15/25 pathogens (60%) with azithromycin and 13/23 (57%) with erythromycin . In study B, 94 and 93 patients were clinically assessed at weeks 1 and 2, respectively: clinical cure was achieved with all treatment regimens at week 1; at week 2 there was reappearance of symptoms in one patient with a mixed infection who had received 3-day azithromycin.(ABSTRACT TRUNCATED AT 250 WORDS)

J Antimicrob Chemother, 1990 Jan, 25 Suppl A, 109 - 14
Azithromycin in the treatment of sexually transmitted disease; Steingrimsson O et al.; One hundred and eighty-two patients were enrolled in a randomized third-party blinded study to assess the efficacy and safety of azithromycin in the treatment of sexually transmitted diseases . Three regimens of azithromycin, including a single oral dose, were compared with a standard treatment with doxycycline . The patients were followed for four weeks . Efficacy was evaluated in 168 patients (113 azithromycin, 55 doxycycline) . Fourteen patients had negative cultures or did not come for all follow-up visits . Of the 168, 138 were infected with Chlamydia trachomatis, 43 with Neisseria gonorrhoeae, and 45 with Ureaplasma urealyticum . Ninety-six per cent of patients with chlamydial infections and 92% of those with gonorrhoea were cured with azithromycin . Two patients infected with N . gonorrhoeae, four with C . trachomatis and six with U . urealyticum had positive cultures on follow-up visits after receiving azithromycin . Of these 11 patients with positive cultures on follow-up visits, seven (five with U . urealyticum and two with C . trachomatis) violated the protocol by having intercourse with infected individuals during the study . Azithromycin was very well tolerated; one patient complained of mild abdominal pain shortly after receiving the drug, seven patients complained of mild nausea and two patients had mild diarrhoea.

Proc Natl Acad Sci U S A, 1990 Jan, 87(1), 333 - 7
Identification and characterization of a Neisseria gonorrhoeae gene encoding a glycolipid-binding adhesin; Paruchuri DK et al.; We recently identified a set of mammalian cell receptors for Neisseria gonorrhoeae that are glycolipids . These receptors, lactosylceramide {Gal(beta 1-4)Glc(beta 1-1)Cer}, gangliotriosylceramide {GalNAc( beta 1-4)Gal(beta 1-4)Glc(beta 1-1)Cer}, and gangliotetraosylceramide {Gal(beta 1-3)GalNAc(beta 1-4)Gal(beta 1-4)Glc(beta 1-1)Cer}, were shown to be specifically bound by a gonococcal outer membrane protein distinct from pilin and protein II . Here we report the isolation of the gene encoding the gangliotetraosylceramide-binding adhesin from a N . gonorrhoeae MS11 gene bank in Escherichia coli . Transposon mutagenesis studies in E . coli indicate that the adhesion is a protein with a molecular mass of 36,000 Da . The gene encoding the 36-kDa protein is duplicated in MS11 since two transposon insertions were required to abolish expression of the gene in this bacterium . This protein is present on the surface of the gonococcus and is not associated with the pilus.

J Bacteriol, 1990 Jan, 172(1), 40 - 6
Shuttle mutagenesis of Neisseria gonorrhoeae: pilin null mutations lower DNA transformation competence; Seifert HS et al.; The method of shuttle mutagenesis has been extended to Neisseria gonorrhoeae . We have constructed a defective mini-Tn3 derivative that encodes chloramphenicol resistance in both N . gonorrhoeae and Escherichia coli and selected for mutations in the chloramphenicol resistance gene that express higher levels of antibiotic resistance in N . gonorrhoeae . Isogenic N . gonorrhoeae strains that differ only in pilin expression were constructed and used to test the effect of pilin null mutations on DNA transformation competence.

Acta Obstet Gynecol Scand, 1990, 69(7-8), 635 - 40
Lower genital tract infection with Neisseria gonorrhoeae and Chlamydia trachomatis in women requesting induced abortion and in their sexual partners; Oskarsson T et al.; The prevalence and patterns of gonococcal and chlamydial infection were investigated in a prospective microbiological study on 3,395 women requesting abortion and the sexual partners of culture positive women (organism identified) . Neisseria gonorrhoeae was found in only 1.8% of 3,395 women during the whole study period of 7 years, but Chlamydia trachomatis in 13.5% of 1,635 women in the last 3 years . Women with positive cultures were significantly younger (p less than 0.001), and more frequently single (p less than 0.001) than those with negative cultures . Single women had more partners (mean 1.5) than those in an established relationship (mean 1.1) . Almost all women with gonorrhea were single . Of the males, 62.7% were examined, of whom 47.3% had positive cultures . Twenty per cent of culture positive males had gonorrhea . A high prevalence of positive cultures in the males was only found where chlamydial cultures had been positive in the female . All women and men with positive culture results received antibiotic treatment before or after the abortion procedure . The incidence of laparoscopically verified post-abortion salpingitis was low, at 0.57%, while a clinical diagnosis of endometritis was made in 3.3% . Routine pre-operative microbial screening for Chlamydiae trachomatis should be considered for all women requesting abortion . Tracing and screening for chlamydial and gonorrheal infection of sexual partners of culture-positive women is necessary as a preventive measure.

Scand J Infect Dis Suppl, 1990, 69, 77 - 82
Epidemiology of antibiotic resistant Neisseria gonorrhoeae in industrialized and developing countries; Lind I; The in vitro susceptibility of Neisseria gonorrhoeae to antimicrobial drugs has been studied currently for around fifty years, and it has been convincingly demonstrated that the results of the in vitro determinations can be used as a guideline for choice of an efficient standard treatment regimen as well as for the choice of therapeutic agent in individual cases . During these past 50 years, the susceptibility of gonococci to antimicrobial drugs has undergone dramatic changes . The genetic background is chromosomal mutations as well as the acquisition of R plasmids . The selective pressure has been exerted both by use (and misuse) of antibiotics in treatment of patients and by factors in the micro-environment of the gonococcus . Review of the current spectrum of antimicrobial susceptibility patterns of N . gonorrhoeae in industrialized and developing countries and a comparison with the changing epidemiology of gonorrhoea, rises the question as to what extent antimicrobial resistance and the choice of treatment regimen influence the spread of gonorrhoea (and other sexually transmitted diseases) . In the developed countries, in spite of the access to an optimal antibiotic treatment, the prevalence of gonorrhoea increased significantly in the beginning of the 1970s and remained at a high level until around 1985 . Then--within the following subsequent few years--the gonorrhoea rate fell dramatically e.g . in Scandinavia . This fall coincides with the establishment of comprehensive educational programmes for the promotion of changes in sexual lifestyle . It is therefore tempting to conclude that the impact of increasing antimicrobial resistance on the changing epidemiology of gonorrhoea is minor.

Scand J Infect Dis Suppl, 1990, 69, 149 - 56
Markers of Neisseria gonorrhoeae for epidemiological studies; Sandstrom EG et al.; Numerous attempts have been made to subclassify Neisseria gonorrhoeae . The properties of these various systems are reviewed . Classification based on the nutritional requirements, i.e . auxotyping, or on the reactivity against epitopes on protein I, the major outer membrane protein, i.e . serovar determination, are the most widely used systems . With the aid of these two classification systems, gonococcal infection can be viewed as a number of microepidemics each with its own dynamics . The tools now exist for a better understanding of gonococcal epidemiology . In many settings it is now feasible to amplify the decreasing prevalence of gonococcal infection by programs aimed at eradication of endemic gonorrhoea.

Trop Geogr Med, 1990 Jan, 42(1), 17 - 21
Human immunodeficiency virus (HIV) infection in patients attending a sexually transmitted diseases clinic in Borno State of Nigeria; Chikwem JO et al.; Results of a study to determine if patients attending sexually transmitted diseases (STD) clinics are at high risk to human immunodeficiency virus (HIV) infection are presented . The 206 patients who attended the STD clinic at the Maiduguri General Hospital consisted of 200 males and 6 females, most of whom were aged between 20 and 29 years and were single . Only one of the 206 serum samples (0.49%) was confirmed seropositive for HIV-1 antibodies . However, cultures from 143 of 174 swabs taken from the subjects yielded significant growth of which Staphylococcus aureus was the predominant isolate followed by Neisseria gonorrhoea . Antibodies to Treponema pallidum were also detected in 3.9% of the serum samples . This study shows that HIV-1 infection is relatively rare in Borno state of Nigeria . In spite of this, a well-planned health education campaign for STD patients is indicated if HIV infection is to be effectively controlled.

Acta Histochem, 1990, 88(2), 103 - 7
Adenylate cyclase activity of cultural strains of Neisseria gonorrhoeae and Staphylococcus aureus; Buchwalow IB et al.; Adenylate cyclase of gonococci and staphylococci from patients with gonorrhoeae and pyoderma was studied ultracytochemically . Adenylate cyclase activity was mainly revealed on the inner side of the plasma membrane and septa of dividing cells . The enzymic activity is markedly higher in penicillinase producing strains and dividing bacteria . These data may be useful for the diagnostics and treatments of the infections concerned.

Int Urol Nephrol, 1990, 22(2), 167 - 71
Isolation of Neisseria gonorrheae and concomitant bacterial microflora from urine obtained by suprapubic bladder puncture in women with gonococcal urethritis; Pec J Jr et al.; The authors examined 38 non-pregnant women with gonococcal urethritis . Thirty-three (86.8%) of them suffered also from endocervical gonorrhea . Neisseria gonorrheae (N . go) was isolated from the midstream of urine in a quantity of 1 x 10(2) to 9 x 10(8) in 1 ml of urine with an average of 5.08 x 10(4) N . go per 1 ml of urine and S . E . M . +/- 3.85 x 10(4) N . go per 1 ml of urine . On the basis of suprapubic puncture ascendent propagation of bacteria to the bladder was observed by cultivation in 13 (34.2%) patients, with isolation of N . go in 5 cases.

East Afr Med J, 1990 Jan, 67(1), 51 - 7
Pattern of genito-urinary parasitic infections at the Teaching Hospital, Sokoto, Nigeria; Osisanya JO et al.; Urinary schistosomiasis was more frequently observed among subjects aged 10-19 years old; and the degree of exposure to the infection was found to be high among the males . Comparative analysis of T . vaginalis infection among the females revealed a ten-fold increase in the detection rate for the flagellate in the urine samples collected from the Special Treatment Clinic than those from Out-patient department . The age-specific morbidity pattern for Trichomonal vaginitis was remarkably high among females of maximum sexual activity (i.e . 20-29 years old), 6(12.24%) and 4(8.16%) of the 49 cases of Trichomonal vaginitis had mixed infections with Neisseria gonorrhoae and Candida albicans respectively . The association between detection of haematuria, proteinuria and urinary schistosomiasis was supported . Age, sex and social behaviour were identified as important determining factors on pattern of genito-urinary parasitic infectionsPIP: Urinary schistosomiasis was more frequently observed among subjects aged 10-19 years old; and the degree of exposure to the infection was found to be high among the males . comparative analysis of T . vaginalis infection among the females revealed a 10-fold increase in the detection rate for the flagellate in the urine samples collected from the Special Treatment Clinic than those from the out-patient department . The age- specific morbidity pattern for Trichomonal vaginitis was remarkably high among females of maximum sexual activity (i.e . 20-29 years old); 6 (12.24%) and 4 (8.16%) of the 49 cases of Trichomonal vaginitis had mixed infections with NEisseria gonorrhea and Candida albicans respectively . The association between detection of hematuria, proteinuria and urinary schistosomiasis was supported . Age, sex and social behavior were identified as important determining factors on pattern of genito-urinary parasitic infections . (Author's) .

J Gen Microbiol, 1990 Jan, 136 ( Pt 1), 45 - 50
Exploitation of the broad specificity of the membrane-bound isoenzyme of lactate dehydrogenase for direct selection of null mutants in Neisseria gonorrhoeae; Hendry AT et al.; Lactic acid is readily utilized as a carbon and energy source by Neisseria gonorrhoeae . The oxidation of lactate is coupled to electron transport via a membrane-bound lactate dehydrogenase (iLDH) which is independent of pyridine nucleotide . The broad substrate specificity of iLDH endows N . gonorrhoeae with the novel ability to convert phenyllactate to L-phenylalanine via phenylpyruvate . N . gonorrhoeae ATCC 27628 typifies a class of clinical isolate whose growth is inhibited by phenylpyruvate (or L-phenylalanine) . Exploiting resistance to growth inhibition by phenyllactate as a strategy of positive selection, mutant derivatives of strain ATCC 27628 lacking iLDH activity were readily obtained . These mutants are incapable of oxidizing phenyllactate, and lack the parent-strain ability to reduce c-type cytochromes in the presence of lactate, phenyllactate or 4-hydroxyphenyllactate . They retain, however, a cytoplasmic NAD(+)-linked lactate dehydrogenase (nLDH) . Since the mutants retained the ability to grow on lactate as a sole source of carbon, nLDH presumably can function in an opposite-to-normal physiological direction in the absence of iLDH . This would explain the failure to isolate iLDH-deficient mutants by selection for inability to grow on lactate.

Can J Microbiol, 1990 Jan, 36(1), 64 - 7
Molecular epidemiology and novel combinations of auxotype, serovar, and plasmid content in tetracycline-resistant Neisseria gonorrhoeae isolated in Canada; Dillon JA et al.; Between October 1987 and June 1989, 84 isolates of Neisseria gonorrhoeae carrying the TetM resistance determinant (TRNG) were received at the Laboratory Centre for Disease Control, Ottawa, from six Canadian provinces and were characterized into classes based on auxotype, serovar and plasmid content . One-fifth (17/84) of the TRNG were also penicillinase producing (PPNG) . The PPNG-TRNG isolates comprised six classes based on auxotype, serovar, and plasmid content . Most (16/17) PPNG-TRNG carried 3.2-MDa beta-lactamase plasmids and the 25.2-MDa TetM-containing plasmid . We report, for the first time, the association of a 4.5-MDa beta-lactamase plasmid with the 25.2-MDa plasmid in a clinical TRNG isolate . Non-PPNG TRNG isolates comprised 11 classes based on auxotype, serovar, and plasmid content, including two previously unreported auxotype-serovar classes, P/IB-26 and P/IB-20.

Antibiot Khimioter, 1990 Jan, 35(1), 23 - 6
{Stimulation of nonspecific antibacterial resistance of mice to opportunistic gram-negative microorganisms with triterpene glycosides from Holothuroidea}; Sedov AM et al.; A total fraction of triterpenic glycosides from Cucumaria japonica named cucumarioside was used as a stimulator of nonspecific resistance to bacterial infections in mice . After intraperitoneal administration to mice subsequently infected with various strains of E . coli and Proteus mirabilis, cucumarioside provided survival of 40 to 90 per cent of the infected animals against 100 per cent in the control group . The protective effect directly depended on the dose of cucumarioside . It was optimal to administer the preparation 3 days before the infection . When the preparation was administered at such periods LD50 for Neisseria meningitidis BT-2 and Salmonella minnesota SF 1111 lowered 5 and 4.3 times, respectively . Therefore, the total fraction of triterpenic glycosides from Far Eastern holothuria had a marked ability to increase natural resistance of the animals to infections caused by various gram-negative organisms.

Microbios, 1990, 61(248-249), 185 - 96
Production and partial purification of a gonococcal growth inhibitor produced by a strain of Neisseria meningitidis isolated from a homosexual man; Dubreuil D et al.; A Neisseria meningitidis strain isolated from the oropharynx of a homosexual man was shown to produce antigonococcal activity in vitro . A production method, on solid medium, was developed which yielded a soluble activity . The activity was detected at the end of logarithmic growth phase and the maximum activity was reached after 24 h of incubation . The antigonococcal substance was purified more than 300 times by ammonium sulphate precipitation, gel filtration on Ultrogel AcA 54, and chromatography on DEAE-Sephacel . The molecular weight of the inhibitory substance, estimated by molecular filtration, was 29 X 10(3) daltons . The partially purified inhibitor showed two major bands, 32 and less than 12.5 X 10(3) daltons by sodium dodecyl-sulphate polyacrylamide electrophoresis . The chemical nature of the inhibitor is probably proteic on the basis of trypsin sensitivity and the absorbance spectrum.

Antimicrob Agents Chemother, 1990 Jan, 34(1), 148 - 9
Comparison of ofloxacin and ceftriaxone in the treatment of uncomplicated gonorrhea caused by penicillinase-producing and non-penicillinase-producing strains; Covino JM et al.; Eighty-nine patients with uncomplicated gonorrhea, including 31 patients (34.8%) infected with penicillinase-producing strains of Neisseria gonorrhoeae, were treated with oral ofloxacin (single 400-mg dose) or intramuscular ceftriaxone (250-mg dose) . All 47 patients who received ofloxacin and 41 of 42 patients who received ceftriaxone were cured.

Microbiol Immunol, 1990, 34(1), 1 - 9
Intrinsic penicillin resistance in penicillinase-producing Neisseria gonorrhoeae strains; Ikeda F; The minimal inhibitory concentrations (MICs) of ampicillin for fifty strains of beta-lactamase-producing Neisseria gonorrhoeae (PPNG) isolated in Japan ranged from 1.56 to 200 micrograms/ml, and all the strains harbored a 4.5 megadalton plasmid . These strains were classified into two groups: dicloxacillin-susceptible (28%) and -resistant group (72%) . A linear correlation was found in the dicloxacillin-susceptible strains between their beta-lactamase activity and the susceptibility to ampicillin, but not in the dicloxacillin-resistant strains . This suggests that the high ampicillin resistance in PPNG is due not only to acquiring the beta-lactamase producing plasmid, but also to some intrinsic resistance of the strains . To investigate a cause of the high ampicillin resistance, the beta-lactamase-producing plasmid, pTMS1, was transferred by conjugation to a penicillin-susceptible gonococcal strain as well as to its isogenic multiply antibiotic-resistant transformants, and the susceptibility of the transconjugants to ampicillin was determined . Acquisition of pTMS1 by a penicillin-susceptible strain resulted in a 32-fold increase in resistance to ampicillin, whereas the increase was 128-fold for its isogenic strains which contain some chromosomal mutations . These results suggest that reduced permeability of the outer membrane to ampicillin underlies the high ampicillin resistance of PPNG.

FEMS Microbiol Lett, 1990 Jan 1, 54(1-3), 75 - 80
A surface polysaccharide forms when gonococci are converted to serum resistance by cytidine 5'-monophospho-N-acetyl neuraminic acid; Fox AJ et al.; A serum-susceptible, guinea-pig chamber-passaged, laboratory strain (BS4 (agar)) of Neisseria gonorrhoeae was converted to serum resistance by incubation with cytidine 5-monophospho-N-acetyl neuraminic acid (CMP-NANA) and examined by electron microscopy after staining with ruthenium-red . In contrast to serum susceptible gonococci incubated without CMP-NANA, the majority (60-70%) of the serum resistant organisms showed a surface accumulation of polysaccharide . This surface polysaccharide was enhanced on all the resistant gonococci after incubation with fresh human serum . Control susceptible gonococci were devoid of the polysaccharide after incubation with heated human serum . Identical results were obtained with a fresh gonococcal isolate which had lost serum resistance on subculture but which, in common with 3 other isolates, was restored to serum resistance by incubation with CMP-NANA.

Sex Transm Dis, 1990 Jan-Mar, 17(1), 10 - 4
Serologic evidence for the role of Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis in the etiology of tubal factor infertility and ectopic pregnancy; Miettinen A et al.; The authors used enzyme immunoassay to determine the prevalence of serum antibodies to the sexually transmitted disease (STD) organisms Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis among 104 infertile women undergoing in vitro fertilization . Altogether, 55 (72%) out of 76 women with tubal abnormalities tested positive for one or more STD organisms, compared with only 6 (21%) out of 28 infertile women with normal tubes (P less than .001) . The authors obtained positive test results for C . trachomatis, N . gonorrhoeae, and M . hominis in 40%, 14%, and 37% of the patients with tubal abnormalities, respectively; of women without tubal abnormalities, the test results were 7%, 0%, and 14%, respectively . Out of 20 patients with a history of ectopic pregnancy, the authors obtained positive findings for C . trachomatis, N . gonorrhoeae, and M . hominis in 8 (40%), 1 (5%), and 7 (35%), respectively . These results indicate an independent role for all three STD organisms in the etiology of tubal factor infertility and ectopic pregnancy following both symptomatic and asymptomatic pelvic inflammatory disease (PID) . The correlation between positive mycoplasmal serology and secondary infertility and tubal abnormalities may suggest a link between M . hominis infections during pregnancy and delivery complications and consequent development of tubal factor infertility.

J Clin Microbiol, 1990 Jan, 28(1), 126 - 7
Evaluation of Bacto TB hydrolysis reagent (Tween 80) for the identification of Branhamella catarrhalis; Weiner M et al.; An investigation of the hydrolysis of Tween 80 reagent by Branhamella catarrhalis and related organisms (Neisseria and Moraxella species) revealed that only B . catarrhalis gave a positive result . A total of 226 strains, including reference organisms and clinical isolates, were studied . B . catarrhalis changed the color of the reagent from amber to pink-red after overnight incubation . We recommend this simple and cost-effective test as an alternative procedure to DNase testing or tributyrin hydrolysis or as a supplemental procedure for the identification of B . catarrhalis in clinical specimens.

Immunol Ser, 1990, 52, 33 - 51
Complement components and receptors: deficiencies and disease associations; Bartholomew WR et al.; The complement system, accessory to many immunological functions, consists of a number of interdependent components and receptors . Numerous in vitro approaches have elucidated the biological role of these components and receptors . However, it is the in vivo "natural" experiments that underscore their importance . The phagocytosis and subsequent digestion of pyogenic bacteria is significantly enhanced by the fixation of the third complement component to the bacterial cell wall . Equally important is the intact expression of a receptor (CR3) for the C3b cleavage fragment . Breakdown in this ligand-receptor interaction due to either C3 or CR3 deficiency leads to pyogenic infection . Interestingly, C3-deficient individuals do not demonstrate leukocytic infiltration at the site of infection . Undoubtedly, this is due to the lack of C5 convertase and failure to produce C5a . CR3-deficient individuals, on the other hand, do demonstrate leukocytosis since the third complement component is functional . C3 deficiency is not necessarily a primary lesion and may be secondary to factor I deficiency . In this case, the C3b fragment, along with factor B, acts as a C3 convertase . Inefficient inactivation of C3b, due to factor I deficiency, leads to the uncontrolled consumption of the third component, resulting in C3 deprivation . It appears that phagocytosis by neutrophils and monocytes followed by enzyme-interaction is not sufficient for destruction of the Neisseria organisms . In addition to this leukocyte activity, an intact membrane attack complex, composed of the late complement components C5, 6, 7, 8, and 9, is required for the lysis of these bacteria . This is supported by findings that individuals deficient in late components are highly susceptible to systemic Neisseria infections . Diseases of an autoimmune nature are frequently associated with a deficiency of one of the early complement components C1, C2, or C4 and a deficiency of erythrocytic CR1 receptors as well . This may suggest that proper interaction between a complement fragment of the immune complex with the complement receptor expressed on the erythrocyte is important for proper management and clearance of the complex . Deficiency of the early complement components would prevent the activation of C3 and the fixation of a resulting C3 cleavage product . In this case, erythrocytes would be unable to participate in the transport of the immune complex to the reticuloendothelial system . Instead, tissue deposition of the complex would occur more readily, contributing to the pathologic process . Provided that the early complement cascade were intact, deficiency of erythrocytic CR1 receptors would contribute to the pathologic response for the same reason.(ABSTRACT TRUNCATED AT 400 WORDS)

Infection, 1990, 18 Suppl 3, S145 - 6
{Cefixime therapy in patients with proven gonorrhea}; Backhaus A et al.; Cefixime is a new third generation oral cephalosporin that exhibits excellent antibacterial activity against Neisseria gonorrhoeae, including beta-lactamase-positive strains . In an open uncontrolled clinical trial 14 male patients suffering from acute gonorrhea, aged 23 to 48 years, were treated with a single dose of 400 mg of cefixime . All 13 fully evaluable patients were clinically and bacteriologically cured . Side effects were not reported.

Am J Med, 1989 Dec 29, 87(6C), 69S - 74S
Single-dose efficacy of ofloxacin in uncomplicated gonorrhea; Lutz FB Jr; Two multicenter trials compared single-dose oral therapy with 400 mg of ofloxacin or 3 g of amoxicillin plus 1 g of probenecid in the treatment of uncomplicated gonorrhea in 160 men and 102 women . Patients with a known diagnosis of Chlamydia trachomatis infection were excluded . All pretreatment isolates of Neisseria gonorrhoeae were susceptible to ofloxacin (minimal inhibitory concentration less than or equal to 2 micrograms/ml), whereas roughly 50 percent exhibited intermediate susceptibility to ampicillin (minimal inhibitory concentration, 0.125 to 2.0 micrograms/ml) . Post-treatment culture results showed that ofloxacin had eradicated N . gonorrhoeae in 97.5 percent (41 men) of 42 men and all 28 women evaluated . Amoxicillin-probenecid achieved microbiologic cures in 92.7 percent (51 men) of 55 men and 92.6 percent (25 women) of 27 women evaluated . Clinical cure rates among initially symptomatic patients were 84.6 percent (33 men) of 39 men and 81.8 percent (nine women) of 11 women with ofloxacin and 83.0 percent (44 men) of 53 men and 66.7 percent (10 women) of 15 women with amoxicillin-probenecid . No drug-related adverse effects were noted in ofloxacin-treated patients . One patient each in the amoxicillin-probenecid group reported nausea, diarrhea, and vaginitis . These results demonstrate that single-dose ofloxacin is as effective as amoxicillin-probenecid in eradicating N . gonorrhoeae and relieving clinical signs and symptoms of gonococcal infections in both men and women.

Rev Saude Publica, 1989 Dec, 23(6), 443 - 6
{Detection of Chlamydia trachomatis in urethral samples by direct immunofluorescence}; Schuster MW et al.; The presence of Chlamydia trachomatis was studied by the direct immunofluorescence test, as also was that of Neisseria gonorrhoeae, Mycoplasma and Ureaplasma by the standard methods, in 82 patients with urethral discharge . Ch . trachomatis was found in 19.5% (16) of the cases and in 11 of them (68.8%) there was association with the other bacteria investigated . This eleven patients presented a scanty gelatinous discharge.

J Clin Invest, 1989 Dec, 84(6), 1957 - 61
Complete and partial deficiencies of complement factor D in a Dutch family; Hiemstra PS et al.; A young man suffering from recurrent Neisseria infections was shown to lack detectable serum complement factor D hemolytic activity . Addition to the patient's serum of purified factor D to a final concentration of 1 microgram/ml resulted in full restoration of the activity of the alternative pathway . Using an enzyme-linked immunosorbent assay, it was shown that the patient's serum did not contain measurable amounts of factor D antigen either . The sister, the father, as well as the parents of the mother had factor D levels within the normal range, and the factor D level of the mother was decreased . The capacity of the patient's serum, at concentrations up to 5%, to promote phagocytosis of Escherichia coli by normal human granulocytes was low when compared to normal serum . Substitution of the patient's serum with purified factor D resulted in a full restoration of opsonic activity . This study describes the first complete deficiency of factor D, and demonstrates its possible relation to recurrent Neisseria infections.

Vrach Delo, 1989 Dec, (12), 39 - 40
{The importance of microbiological and immunologic studies for selecting the method of treating patients with acute pneumonia}; Kondratenko GP et al.; Quantitative microbiological examinations of the sputum allowed to establish the role of pneumococci and different bacterial associations in the development of acute pneumonia . The most typical were associations of Str . pneumoniae, staphylococci and neisseriae . The sensitivity of isolated pathogens is shown and recommendations on the use of most effective antibiotics are given . The indications to immunocorrective agents are outlined.

Vet Microbiol, 1989 Dec, 21(2), 185 - 8
Isolation of Neisseria cuniculi from a case of ovine pneumonia; Elad D; Neisseria cuniculi was isolated in pure culture from the lungs of a 2-month-old pneumonic lamb . Mouse LD50, evaluated by intraperitoneal and pulmonary inoculation of the microorganism, was 2 X 10(7) colony-forming units in both cases . The role of the organism in pathogenesis of the disease could not be determined . This organism has not previously been reported in sheep.

Am J Dis Child, 1989 Dec, 143(12), 1437 - 42
Clinical predictors of Chlamydia trachomatis endocervicitis in adolescent women . Looking for the right combination; Remafedi G et al.; Chlamydial disease in adolescent women is a serious public health problem, but secondary preventive efforts through early detection and treatment are encumbered by the cost and complexity of mass screening . This study was undertaken to identify clinical predictors of infection that might narrow the scope of screening adolescent populations . Demographic/clinical data and endocervical smears for the direct-specimen fluorescein-conjugated monoclonal antibody test for Chlamydia trachomatis were collected from 244 consecutive women, 21 years of age or less, attending an adolescent health clinic . Positive direct-specimen fluorescein-conjugated monoclonal antibody test for C trachomatis results were associated with a past history of chlamydial infection, multiple sexual partners, sexual contact with men with urethritis, nonuse of condoms, metrorrhagia, exocervicitis, mucopurulent endocervical discharge, abnormal cervical cytologic features, and isolation of Neisseria gonorrhoeae from the endocervix . These variables were entered into a discriminant analysis to predict direct-specimen fluorescein-conjugated monoclonal antibody test for C trachomatis results . The discriminant function was statistically significant but explained only 17% of between-group variance . Two variables alone, exocervicitis and partners with urethritis, correctly predicted direct-specimen fluorescein-conjugated monoclonal antibody test for C trachomatis results in 79% of all cases (negative predictive value 90%; positive predictive value 35%) . When routine screening with reliable laboratory tests is not feasible, selective testing or empirical treatment of adolescent women with either risk factor may be cost-effective alternatives.

Antimicrob Agents Chemother, 1989 Dec, 33(12), 2049 - 51
In vitro activities of lomefloxacin, tetracycline, penicillin, spectinomycin, and ceftriaxone against Neisseria gonorrhoeae and Chlamydia trachomatis; Talbot H et al.; In vitro lomefloxacin was highly active against 208 penicillin-susceptible and -resistant isolates of Neisseria gonorrhoeae . However, its MIC and MBC against 10 isolates of Chlamydia trachomatis were 2 and greater than 4 micrograms/ml, respectively.

J Clin Microbiol, 1989 Dec, 27(12), 2758 - 66
Standardization of disk diffusion and agar dilution susceptibility tests for Neisseria gonorrhoeae: interpretive criteria and quality control guidelines for ceftriaxone, penicillin, spectinomycin, and tetracycline; Jones RN et al.; A six-laboratory study developed a standardized method for determining the susceptibilities of Neisseria gonorrhoeae strains to penicillin, tetracycline, spectinomycin, and ceftriaxone . Three quality control organisms were also selected, and quality assurance guidelines were initially generated for the disk diffusion and agar dilution methods . The medium recommended for gonococcal susceptibility testing was GC agar with a defined "XV-like" supplement . The supplement should be free of cysteine, a component implicated in the inactivation of some newer beta-lactam compounds . Penicillin, tetracycline, spectinomycin, and ceftriaxone were stable in agar plates stored at 3 to 5 degrees C for at least 2 weeks . Numerous GC agar and drug disk lots were used during the trials without significant variation in test results . Several other gonococcal strains were recommended for additional medium quality assurance . The disk quality control zone limits were established for N . gonorrhoeae ATCC 49226 (formerly CDC F-18) and Staphylococcus aureus ATCC 25923 . MIC quality control ranges were also developed for N . gonorrhoeae ATCC 49226 and S . aureus ATCC 29213 . The interpretive criteria for penicillin were as follows: susceptibility, greater than or equal to 47 mm (diameter of inhibition zone) (less than or equal to 0.06 micrograms/ml {MIC}); resistance, less than or equal to 26 mm (greater than or equal to 2 micrograms/ml) . For tetracycline they were as follows: susceptibility, greater than or equal to 38 mm (less than or equal to 0.25 microgram/ml); resistance, less than or equal to 30 mm (greater than or equal to 2 micrograms/ml) . For spectinomycin they were as follows: susceptibility, >/= 18 mm (</= 32 micrograms/ml); resistance, </= 14 mm (>/= 128 micrograms/ml) . For ceftriaxone susceptibility, the criterion was >/= 35 mm (</= 0.25 micrograms/ml) with no other category . Criteria of </= 19 mm for plasmid-mediated resistances to penicillin and tetracycline were also confirmed . The false-susceptibility errors were </= 1% with these criteria.

Zentralbl Bakteriol, 1989 Dec, 272(2), 181 - 5
Evaluation of a non-radioactive DNA probe for confirmatory identification of Neisseria gonorrhoeae; Naher H et al.; A biotinylated DNA probe combined with a streptavidin-peroxidase complex for the identification of culture isolates of N . gonorrhoeae (Ortho diagnostic systems, Neckargemund, FRG) was compared with the conventional carbohydrate utilisation test as reference . All 118 strains identified by the reference method as N . gonorrhoeae also gave positive reactions with the DNA hybridisation assay . However, with this test 2 of 23 non-gonococcal Neisseria or Branhamella species were identified as N . gonorrhoeae as well . The study shows that the DNA hybridisation technique can principally be used for the confirmatory identification of N . gonorrhoeae, but since specificity is particularly essential for confirmatory identification, the DNA hybridisation assay evaluated cannot be recommended for routine diagnosis.

Can J Microbiol, 1989 Dec, 35(12), 1069 - 75
Biochemical and genetic studies with arginine and proline auxotrophs of Neisseria gonorrhoeae; Picard FJ et al.; The prevalence of specific arginine biosynthesis gene defects was studied for 319 arginine-requiring clinical isolates of Neisseria gonorrhoeae by using the ability of the strains to utilize intermediates of arginine biosynthesis . Only 11% of the uracil-requiring strains defective in the carbamylation of ornithine to yield citrulline had a defective carbamoylphosphate synthetase gene (carAB) . Strains defective in carAB were of auxotype CUH . The other strains (89%) having a dual requirement for citrulline and uracil, which were mostly of auxotype PCU, were defective in the ornithine transcarbamoylase gene (argF) . Over 90% of the strains were defective either in argJ (174 strains) or in argF (126 strains) . Three argininosuccinate-requiring strains (i.e., defective in argG) of auxotype PAU were identified . Some of the arginine auxotrophs of N . gonorrhoeae defective in carAB, argJ, argF, or argG were complemented by genetic transformation with DNA from recombinant bacteriophages carrying characterized gonococcal arginine biosynthesis genes . Gene defects in proA (five strains) and in proB (six strains) were identified by gonococcal transformation assays with recombinant bacteriophages or plasmids carrying proline biosynthesis genes from N . gonorrhoeae . None of the 11 proline-requiring strains tested was defective in proC.

Genitourin Med, 1989 Dec, 65(6), 382 - 7
Bacterial vaginosis: prevalence in outpatients, association with some micro-organisms and laboratory indices; Cristiano L et al.; Seven hundred and ninety three women were investigated, aged between 16 and 78 years, to evaluate the prevalence of bacterial vaginosis (BV) and some associated micro-organisms, and to discuss the significance of laboratory indices correlated to this pathology . BV was diagnosed on the basis of four distinct criteria: a positive result of the test for amines with 10% KOH (odour-test), the presence of clue cells on fresh microscopic examination, a pH greater than 4.5 and direct Gram stain positive (the presence of more than 40 Gram negative or Gram variable coccobacilli per microscopic field by 1000 magnifications under oil immersion) . The total prevalence of BV was 20.5% (163); similar percentages were found in both fertile and pregnant women, whereas a lower percentage (12.7%) was found in menopausal women . Gardnerella vaginalis was present in 235 (29.6%) of the 793 women, in 144 (88.3%) of the 163 with BV and in 91 (14.4%) of the 630 women without BV . Mobiluncus species was present in 8.2% (65) of the total population, in 38.6% (63) of the women with BV and only in two (0.3%) of the women without BV . In the women with BV lower percentages were found for Trichomonas vaginalis, yeasts, Chlamydia trachomatis and Neisseria gonorrhoeae . The absence of a definite relationship between BV and cultural isolation of G vaginalis is confirmed whereas the role played by Mobiluncus spp still has to be clarified . It is concluded that it is not necessary to screen with all four laboratory indices . Two positive indices from a panel of three (excluding pH greater than 4.5 and direct Gram stain positive in the same panel) allows the correct diagnosis of BV in almost all cases.

Mil Med, 1989 Dec, 154(12), 598 - 600
The management of dermal necrosis after acute Neisseria infection; Seyfer AE et al.; Although the occurrence of dermal necrosis following Neisseria meningitidis is rare, it portends a grave prognosis with a high mortality rate . A child having this complication is described who sustained a loss of over 30% of the body skin surface . She was successfully treated with aggressive nutritional support, meshed split-thickness skin grafting, and early rehabilitation . The pathophysiology of this complication is discussed, along with principles that are important in the day-to-day management of the patient.

J Med Microbiol, 1989 Dec, 30(4), 239 - 44
Changes in penicillinase-producing Neisseria gonorrhoeae isolated in London; Ison CA et al.; To investigate changes in the gonococcal population over time, the plasmid content, serotype and auxotype have been determined for strains of penicillinase-producing Neisseria gonorrhoeae (PPNG) isolated from patients attending the Praed Street Clinic for Sexually Transmitted Diseases between 1978 and 1987 . Three distinct changes have been identified: (i) in the main plasmid type, from PPNG with the 3.2-Mda plasmid before 1982 to strains with the 4.4-Mda plasmid between 1982 and 1985; (ii) the decline during this time of strains also carrying the 24.5-Mda conjugal plasmid; (iii) the re-emergence of PPNG with the 3.2-Mda plasmid in 1986 . The three typing methods used have identified eight clusters of strains which have been prevalent in different years between 1978 and 1987.

J Clin Microbiol, 1989 Dec, 27(12), 2784 - 8
Rapid in situ generation of DNA restriction endonuclease patterns for Neisseria gonorrhoeae; Poh CL et al.; Restriction endonuclease (RE) digestion patterns of 26 isolates of Neisseria gonorrhoeae representing different serovars of serogroups WI, WII, and WIII were generated by agarose pellet entrapment and in situ digestion with HinfI and BglII . The method was fast, simple, and reproducible, and stable RE patterns were produced from subsequent in vitro passages . The cost of culture materials was reduced considerably, and no toxic or flammable solvents needed to be used . Excellent resolution of DNA fragments of higher molecular weights was obtained as a result of minimal mechanical shearing of the DNA . The REs HinfI and BglII were discriminative in the fragment length ranges of 2 to 6.5 and 2.5 to 21.5 kilobases, respectively . On the basis of densitometric scanning of electrophoretograms generated by HinfI digestion, the 26 isolates representing 12 serovars were divided into seven groups . BglII was found to be more discriminative; 15 RE patterns were established among the 26 isolates . Patterns generated by both REs showed that there was no correlation between a particular RE pattern and a serovar, since strains with identical RE patterns were from different serovars . With the exception of two strains (D3 and D14), which demonstrated positive correlation when both enzymes were used, all strains with identical serovar patterns had different RE patterns.

J Clin Microbiol, 1989 Dec, 27(12), 2692 - 6
Probe directed at a segment of Rickettsia rickettsii rRNA amplified with polymerase chain reaction; Wilson KH et al.; In an effort to explore a sensitive taxon-specific detection system for bacteria, we sequenced the 16S rRNA from two strains of Rickettsia rickettsii, five other rickettsiae, and Coxiella burnetti to find a probe site unique to R . rickettsii . We then synthesized a 16-mer that hybridized only to the rRNA of R . rickettsii . Using a primer complementary to a sequence found only in rickettsial rRNA, we then generated a cDNA . We amplified the probe site in a 180-base segment of the cDNA by using the cDNA primer and a second primer also unique to rickettsiae in a polymerase chain reaction . The segments of rRNA from each of the rickettsiae were amplified 10(6)- to 10(7)-fold, and the R . rickettsii probe hybridized only to the amplified segment from R . rickettsii . The rRNAs from Staphylococcus aureus, C . burnetii, and Neisseria meningitidis were not amplified and did not hybridize with the probe . The approach detailed below may prove clinically useful in the direct detection of pathogens that are difficult to cultivate.

J Infect Dis, 1989 Dec, 160(6), 1064 - 7
The immunogenicity of Hemophilus influenzae type B polysaccharide-Neisseria meningitidis group B outer membrane protein complex vaccine in infants and young children; Shapiro ED et al.; Hemophilus influenzae type b polysaccharide-Neisseria meningitidis group B outer membrane protein complex vaccine was administered in a single dose to 38 children ages 24-53 mo (group 1) and to 78 children ages 12-23 mo (group 2) and in two doses to 84 children ages 2-11 mo (group 3) . The geometric mean concentration of the capsular antibody before and after the vaccine regimen, respectively, were 0.35 microgram/ml and 12.59 micrograms/ml in group 1, 0.18 microgram/ml and 4.79 microgram/ml in group 2, and 0.15 microgram/ml and 3.80 micrograms/ml in group 3 . After completing the vaccine regimen, concentrations of capsular antibody were greater than or equal to 0.15 microgram/ml in 199 (99.5%) of the 200 children and greater than or equal to 1.0 microgram/ml in 168 (84%) of the children . There were no serious and few minor adverse reactions to the vaccine . This vaccine is immunogenic in infants and young children.

J Infect Dis, 1989 Dec, 160(6), 1012 - 7
Serovars and serum resistance of Neisseria gonorrhoeae from disseminated and uncomplicated infections; Morello JA et al.; Two hundred and seventy-four gonococcal strains isolated from patients with either disseminated (DGI) or uncomplicated (UG) infection were examined to determine their serotypes/serovars by two typing systems as well as their resistance to the bactericidal action of normal human serum . The bactericidal assays were performed in particular to determine whether isolates from patients with the clinical syndrome of DGI but negative systemic cultures (suspected DGI) were serum-susceptible . When strains containing protein IA in their outer membranes and having auxotypes other than the arginine-hypoxanthine-uracil requirement were serotyped, a significant difference was found in the distribution of serovars among strains from DGI and suspected DGI compared with UG . The two typing systems revealed both antigenic similarities and differences of gonococci from Chicago and isolates from Germany reported in another study . Like DGI strains, most suspected DGI strains contained protein IA and were resistant to the bactericidal action of serum.

Am J Med, 1989 Nov 30, 87(5A), 142S - 147S
Efficacy of single-agent therapy for the treatment of acute pelvic inflammatory disease with ciprofloxacin; Crombleholme WR et al.; A prospective, randomized, controlled, non-blind clinical trial was conducted to compare the efficacy of monotherapy with ciprofloxacin with that of a combination of clindamycin plus gentamicin in the treatment of patients with acute pelvic inflammatory disease . Pretreatment and post-treatment cervical culture specimens were obtained for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum . Pretreatment and post-treatment endometrial culture specimens were obtained for those organisms plus facultative and anaerobic bacteria . Minimal inhibitory concentrations were determined on all isolates by agar dilution . Clinical resolution of infection was seen in 31 of 33 (94 percent) ciprofloxacin-treated patients compared with 34 of 35 (97 percent) clindamycin/gentamicin-treated patients . N . gonorrhoeae was eradicated in all cases and C . trachomatis in 12 of 13 cases (92 percent) . Ciprofloxacin appeared less effective than clindamycin/gentamicin in eradicating bacterial-vaginosis-associated organisms from post-treatment culture specimens obtained from the endometrium . Comparable clinical response was seen with both regimens . The significance of persistent bacterial-vaginosis-associated organisms following ciprofloxacin therapy is unclear . However, since one goal of treatment of pelvic inflammatory disease should be to eliminate organisms from the upper genital tract, ciprofloxacin may not provide optimal single-agent therapy for pelvic inflammatory disease.

Ugeskr Laeger, 1989 Nov 20, 151(47), 3157 - 9
{Chlamydia trachomatis in at-risk groups in legal abortion in the first trimester}; Knudsen A et al.; Examination for the presence of C . Trachomatis in the cervix and urethra and bacteriological examination of the cervix were performed in a material of 224 patients for legal abortion in the first trimester of pregnancy . Chlamydia was demonstrated in 8.9% of the patients, Neisseria gonorrhoeae in 0.5% and, in 41%, growth of Gardnerella vaginalis predominated . It proved possible to define a group at risk for the presence of Chlamydia consisting of all the patients under the age of 25 years and nulliparae aged 25-29 years . 17% in this group had positive Chlamydia tests as compared with 1.7% in the patients in other groups . Patients in the above mentioned risk group should be examined for C . trachomatis in cases of legal termination of pregnancy so that appropriate treatment can be administered prior to evacuation.

Am J Ophthalmol, 1989 Nov 15, 108(5), 516 - 23
Treatment of adult gonococcal keratoconjunctivitis with oral norfloxacin; Kestelyn P et al.; We evaluated the efficacy of oral norfloxacin in 15 patients with culture-proven gonococcal eye disease caused by Neisseria gonorrhoeae . The first seven patients received 1,200 mg of oral norfloxacin for three consecutive days . The other eight patients were each treated with a single oral dose of 1,200 mg of norfloxacin . All control cultures were negative, and there was no progression of the corneal lesions after treatment was initiated . No adverse effects were observed . The results of this study suggested that a single dose of oral norfloxacin may be a valuable alternative to the currently recommended treatment regimens for gonococcal eye disease because it combines high efficacy and low toxicity with low cost and excellent patient compliance.

JAMA, 1989 Nov 10, 262(18), 2562 - 6
Urinary leukocyte esterase screening test for asymptomatic chlamydial and gonococcal infections in males; Shafer MA et al.; We evaluated the ability of the urinary leukocyte esterase test to predict culture-verified chlamydial and gonococcal urethritis among asymptomatic adolescent males . Nine hundred forty-eight sexually active males provided first-catch urine samples for esterase screening, and 76 (8%) tested positive (greater than or equal to 1+) . Among 435 boys who agreed to undergo urethral culture, the esterase was positive in 66 (15%), Chlamydia trachomatis was isolated from 39 (9%), and Neisseria gonorrhoeae was isolated from 14 (3%) . The sensitivity, specificity, and positive and negative predictive values for the esterase test were 72%, 93%, and 58% and 96%, respectively . Using the esterase test to screen asymptomatic males for urethritis, we identified 38 culture-verified infections that otherwise would have remained undetected . The urinary leukocyte esterase test is a noninvasive and cost-effective screening method to detect urethritis among asymptomatic adolescent males.

Ohio Med, 1989 Nov, 85(11), 905 - 7
Asymptomatic Chlamydia infection in pregnant women; Hagley MT et al.; Chlamydia trachomatis infection is currently among the most prevalent sexually transmitted diseases in the United States . A review of three textbooks of obstetrics reveals that none of them recommend routine chlamydia screening in prenatal patients, although two recommend routine screening for gonorrhea . A study was done at the Barberton Citizens Hospital Family Practice Residency Program to determine the incidence of asymptomatic chlamydia infection in pregnant women and to compare this to the incidence of asymptomatic Neisseria gonorrhoeae infection in the same population . A total of 69 patients were screened for Neisseria gonorrhoeae and Chlamydia trachomatis as part of their routine prenatal evaluations at the first prenatal visit and the visit of 36 weeks gestation . Neisseria gonorrhoeae was detected by growth on standard Martin-Lewis culture plates . Chlamydia trachomatis was detected by positive immunofluorescence using a standardized specimen kit (Syva Company, Palo Alto, California) . The data were collected over a 12-month period from July of 1987 through July of 1988 . There were no positive cultures for Neisseria gonorrhoeae (0%) in this group of patients . On the other hand, five patients tested positive for Chlamydia trachomatis (7.2%) . The results of this study indicate that routine screening for Chlamydia trachomatis should be considered as part of the routine prenatal care . A larger, multi-centered study could be done in the future to confirm these results, as well as to determine if any regional differences exist.

Hautarzt, 1989 Nov, 40(11), 713 - 7
{Spectinomycin resistant gonococcal infections in West Germany . Detection in 7 patients and occurrence of post-gonorrheal epididymitis caused by the spectinomycin-resistant PPNG strain}; Orfanos CE et al.; Seven patients (four men, three women) with gonococcal urethritis resistant to spectinomycin treatment were seen in May and June 1989 in the Department of Dermatology in Berlin (West), and strains of Neisseria gonorrhoeae (NG) resistant to spectinomycin were detected, cultured in vitro from these individuals . In five of the seven patients penicillin-resistant strains were found, including a penicillinase-producing strain in one case; the other two patients had penicillin-sensitive strains . In all cases the NG-populations detected were sensitive to cephalosporin and cipro(oxo)floxacin . In a 17-year-old young man with the PPNG strain severe gonococcal epididymitis developed after repeated infection that had been inadequately treated with spectinomycin . All seven patients mentioned sexual contact with individuals who lived in Southeast Asia or had their origins there; in at least four cases the contact persons came from Thailand . This is the first report on spectinomycin-resistant Neisseria gonorrhoeae infections (PPNG and non-PPNG) in the Federal Republic of Germany . The necessity for monitoring the results of penicillin and/or spectinomycin treatment of gonorrhoea are underlined for the dermatovenereologist, and some guidelines for therapy are given.

Rev Med Chil, 1989 Nov, 117(11), 1267 - 70
{Neisseria gonorrhoeae: 3 years of surveillance of antibiotic susceptibility and search of beta-lactamase-producing strains}; Tejero A et al.; 247 strains of N gonorrhoeae were isolated from 453 patients with acute urethritis from 1985 to 1987 . 19 strains produced beta-lactamase for a 7, 13 and 3% incidence in each of the 3 years . MIC between 1 and 8 micrograms/ml or between 65 and 256 micrograms/ml were found in 2 groups of beta lactamase producing strains . An increase in the sensitivity rate (81%) to penicillin of non beta-lactamase producing strains was observed in this period . The sensitivity to erythromycin and chloramphenicol remained constant while a slight increase in resistance to tetracycline was observed.

J Infect, 1989 Nov, 19(3), 251 - 6
The significance of Branhamella catarrhalis in bronchopulmonary infection--a case-control study; Yuen KY et al.; Data, including clinical features of bronchopulmonary infections, i.e . cough with purulent sputum, fever, peripheral blood leucocytosis, patchy pulmonary shadows on chest radiographs and the presence of crepitations or dullness on examination of the chest, were prospectively recorded in 107 consecutive adult patients whose expectorated sputum yielded Branhamella-like bacterial colonies in routine cultures . Subsequently, isolates from 26 patients were confirmed to be Branhamella catarrhalis . Of 81 patients (unmatched controls) with confirmed commensal Neisseria species, 40 (matched controls) were age and sex matched with the 26 patients (cases) positive for B . catarrhalis . Clinical features of bronchopulmonary infection were significantly more among cases compared to unmatched controls . Compared with matched controls, significantly more of the cases had three or more clinical features of bronchopulmonary infection (P less than 0.05) . This is the first study of the clinical significance of B . catarrhalis in expectorated sputum that included controls to circumvent the confounding effects of oropharyngeal and airway colonisation in patients with bronchopulmonary infections . The isolation of this organism in routine sputum culture was found to be significantly related to clinical infection.

J Clin Microbiol, 1989 Nov, 27(11), 2471 - 4
New selective medium for the isolation of Neisseria gonorrhoeae; Evans GL et al.; GC-Lect, a new selective medium for the isolation of Neisseria gonorrhoeae which contains five antimicrobial agents, was evaluated with stock cultures and with 500 clinical specimens . With stock cultures, vancomycin-resistant Staphylococcus epidermidis that grew on modified Thayer-Martin medium (MTM) was inhibited on the new medium . Also, vancomycin-susceptible strains of N . gonorrhoeae were much less inhibited on the new medium than on Martin-Lewis agar or MTM . With oropharyngeal cultures of healthy volunteers, Capnocytophaga species were frequently isolated on MTM from two of three manufacturers but were completely inhibited on GC-Lect . In the clinical study, visible growth of N . gonorrhoeae occurred within 24 h in 72% of the positive cultures on GC-Lect, compared with only 52% on the reference medium . A total of 50 positive cultures were obtained with GC-Lect, compared with 49 obtained with MTM . The selectivity of GC-Lect was superior, with only 19 cultures producing growth of normal flora, compared with 78 cultures on MTM after 24 h of incubation . The selectivity was especially improved on GC-Lect with regard to yeasts (2 versus 30 cultures) and gram-positive cocci (5 versus 31 cultures).

Infect Immun, 1989 Nov, 57(11), 3612 - 8
Identification and characterization of peptidoglycan-associated proteins in Neisseria gonorrhoeae; Hill SA et al.; The principal proteins associated with Neisseria gonorrhoeae peptidoglycan (PG), as identified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, are the following: two proteins at approximately 90 kilodaltons (kDa), single major species at both 60 and 44 kDa, a 34- to 36-kDa protein, and three proteins between 28 and 32 kDa . A protein analogous to Escherichia coli Braun lipoprotein was not detected with gonococcal cell wall preparations . The identity of the PG-associated proteins was confirmed immunologically with antibody generated against purified cell walls . Two types of protein species, dithiothreitol extractable (the majority) and alkylation dependent (primarily the 34- to 36-kDa protein), appeared to be associated with the N . gonorrhoeae cell wall fraction . It was found that a crucial step in the extraction of the proteins from the PG fraction was the inclusion of an acetone-water wash of the purified PG pellet . Studies with cell wall preparations obtained from N . gonorrhoeae intrinsically labeled with 32P revealed that the acetone wash was removing phospholipid from the cell wall fraction and thus facilitating protein extraction . Autoradiographic analysis with PG material derived from 125I-surface-labeled cells indicated that the 44-kDa protein is exposed on the surface of the organism even when associated with the PG layer . Radioimmunoprecipitation with anti-PG antibody confirmed these findings . Lectin analysis (wheat germ agglutinin conjugated to horseradish peroxidase) suggested that the 34- to 36-kDa protein is covalently attached to the PG layer.

Infect Immun, 1989 Nov, 57(11), 3395 - 402
Stable expression of lipooligosaccharide antigens during attachment, internalization, and intracellular processing of Neisseria gonorrhoeae in infected epithelial cells; Weel JF et al.; Immunoelectron microscopy enables the detection and localization of bacterial antigens during in vitro infection (J.F.L . Weel and J.P.M . van Putten, Microb . Pathog . 4:213-222, 1988) . In this study, we have used this method to get information on the role of lipooligosaccharides (LOS) in the pathogenesis of neisserial infections at the mucosal level . Ultrathin cryosections of Chang conjunctive epithelial cells infected with Neisseria gonorrhoeae (3 to 18 h) were incubated with LOS-specific monoclonal antibodies and gold-labeled protein A and viewed in the electron microscope . Our results demonstrate that the probed LOS determinants are stably expressed during the adherence, internalization, and intracellular processing of the bacteria . There was no indication of an adaptation of the gonococcal LOS expression to the host cell environment or of a degradation of the probed epitopes . The gold particles, representing LOS molecules, were predominantly located at the bacterial membranes, but sometimes the host cell plasma membrane was labeled as well, suggesting that LOS or LOS-containing membrane fragments interacted with the eucaryotic cells . This was confirmed when purified LOS was added to the cells . Two hours after LOS exposure, gold particles were observed at the plasma membrane of a subpopulation of the cells . After 18 h of LOS exposure, gold particles were also found in large vacuoles inside the cells, suggesting that LOS molecules were internalized by the cells . The function of observed LOS binding and endocytosis in the pathogenesis of neisserial infections remains to be defined.

Obstet Gynecol Surv, 1989 Nov, 44(11), 780 - 8
Disseminated neisserial infection in pregnancy: the empress may have a change of clothing; Mitchell SR et al.; A case of disseminated neisserial disease during pregnancy with good perinatal outcome is presented along with two examples of disseminated N . meningitidis from endocervical site . Upon close review, it is clear that the biological similarities of both N . gonorrhoeae and N . meningitidis may outweigh their differences . The two organisms may behave in clinically indistinguishable fashion and probably justify a more cautious approach to the clinical syndromes we have considered the inviolate domain of the gonococcus . The management of disseminated neisserial disease in pregnancy should include prompt empiric parenteral therapy while aggressive diagnostic confirmation of the organism is pursued . In addition, neonatal conjunctivitis caused by a Gram-negative diplococci should be treated parenterally until clinical response and identity of the organism is confirmed.

FEMS Microbiol Lett, 1989 Nov, 53(1-2), 129 - 35
Epitopes of serogroup B Neisseria meningitidis analysed in vitro and directly from cerebrospinal fluid; Wall RA et al.; Two type B15 P1.16 strains of Neisseria meningitidis were examined by immunogold electron microscopy for accessibility of two outer membrane protein (OMPs) to monoclonal antibodies . Both strains exhibited cell-to-cell variation of one epitope of the Class 3 OMP (P3.15) and one of the Class 1 OMPs (P1.16) when grown in vitro . One strain, a nasopharyngeal isolate revealed this variation to be growth-phase independent and double labelling of both epitopes showed independent variation . CSF containing N . meningitidis was stored in liquid nitrogen without laboratory processing at the time of isolation of the second strain . Direct analysis of the organisms showed no cell-to-cell variation and immunoglobulin G on the surface . However, while there were similar labelling densities of the Class 1 epitope in vivo compared with either strain grown in vitro, there was a lower labelling density of the Class 3 epitope in vivo that was not caused by freeze-thawing . This reduction may be due to decreased expression of this epitope in vivo which casts doubts on the use of the Class 2/3 OMP as a vaccine candidate.

Pediatrics, 1989 Oct, 84(4), 623 - 5
Pharyngeal gonorrhea screening in adolescents: is it necessary?
Brown RT, Lossick JG, Mosure DJ, Smeltzer MP, Cromer BA.
A prospective study was performed to examine the prevalence of pharyngeal gonorrhea in two urban female adolescent populations and to compare pharyngeal infection with a history of orogenital activity and concurrent genital gonorrhea . Group I was drawn from a children's hospital adolescent clinic and group II was drawn from a public health clinic for sexually transmitted diseases . None of the 240 adolescents in group I had a pharyngeal culture positive for Neisseria gonorrhoeae compared with 3.4% in group II . Only 2.5% of group I had genital gonorrhea, but 33% of group II had positive genital cultures . In only two of the 20 patients with pharyngeal gonococcal infection was the pharynx the only infected site . The addition of routine pharyngeal culturing for gonorrhea yielded only 1% additional gonorrhea cases . There was a significant relationship between concurrent genital and pharyngeal gonorrhea . These findings indicate that routine screening for pharyngeal gonorrhea is not productive in some adolescent populations . A more economic approach would be to use gonorrhea treatment that is effective against both genital and pharyngeal gonorrhea or to obtain pharyngeal cultures in those adolescents returning for test-of-cure cultures after antibiotic treatment for genital gonorrhea.

Sex Transm Dis, 1989 Oct-Dec, 16(4), 190 - 1
Enoxacin in the therapy of anal and pharyngeal gonococcal infections; Romanowski B et al.; In this randomized double-blind study, 51 patients with uncomplicated anal or pharyngeal Neisseria gonorrhoeae infection were evaluated to determine the efficacy and safety of 200- or 400-mg of enoxacin twice a day for two days . Enoxacin cured all anal infections and 12 out of 13 pharyngeal infections . All 82 isolates of N . gonorrhoeae tested were inhibited by 1 microgram of enoxacin/ml.

Q J Med, 1989 Oct, 73(270), 919 - 29
Recurrent pyogenic meningitis--a retrospective study; Maitra S et al.; Records of 17 patients who had two or more attacks of pyogenic meningitis were collected from eight centres in the United Kingdom for retrospective analysis . Thirteen patients had intracranial abnormality; of seven with head injury five produced cerebrospinal fluid rhinorrhoea . The first of the 28 attacks seen in these occurred between a few weeks and 12 years of the head injury . Pneumococci were identified in 25 episodes in cerebrospinal fluid . Of six patients without a history of head injury, one had 'spontaneous cerebrospinal fluid rhinorrhoea' and five had pathological changes of the ear . Various organisms were found in the cerebrospinal fluid during the 12 attacks in these five . Four of the 17 patients had primary complement deficiency (C7, C5, C4 and C3b inhibitor); 10 (possibly 11) of 16 attacks in these cases were due to Neisseria meningitidis . Routine radiological investigations including computerized tomography did not always identify the abnormality; radioactive cisternography can help to establish cerebrospinal fluid leak . All 58 episodes of pyogenic meningitis in these 17 patients with different underlying disease responded to conventional treatment with antibiotics without mortality and without undue morbidity . Surgical procedures in intracranial disease had variable success . Correction of complement deficiency is not practical at present . In some patients prophylaxis with antimicrobial drugs is the only method of preventing future attacks.

Mol Microbiol, 1989 Oct, 3(10), 1337 - 48
Nucleotide sequences of the pbpX genes encoding the penicillin-binding proteins 2x from Streptococcus pneumoniae R6 and a cefotaxime-resistant mutant, C506; Laible G et al.; Development of penicillin resistance in Streptococcus pneumoniae is due to successive mutations in penicillin-binding proteins (PBPs) which reduce their affinity for beta-lactam antibiotics . PBP2x is one of the high-Mr PBPs which appears to be altered both in resistant clinical isolates, and in cefotaxime-resistant laboratory mutants . In this study, we have sequenced a 2564 base-pair chromosomal fragment from the penicillin-sensitive S . pneumoniae strain R6, which contains the PBP2x gene . Within this fragment, a 2250 base-pair open reading frame was found which coded for a protein having an Mr of 82.35kD, a value which is in good agreement with the Mr of 80-85 kD measured by SDS-gel electrophoresis of the PBP2x protein itself . The N-terminal region resembled an unprocessed signal peptide and was followed by a hydrophobic sequence that may be responsible for membrane attachment of PBP2x . The corresponding nucleotide sequence of the PBP2x gene from C504, a cefotaxime-resistant laboratory mutant obtained after five selection steps, contained three nucleotide substitutions, causing three amino acid alterations within the beta-lactam binding domain of the PBP2x protein . Alterations affecting similar regions of Escherichia coli PBP3 and Neisseria gonorrhoeae PBP2 from beta-lactam-resistant strains are known . The penicillin-binding domain of PBP2x shows highest homology with these two PBPs and S . pneumoniae PBP2b . In contrast, the N-terminal extension of PBP2x has the highest homology with E . coli PBP2 and methicillin-resistant Staphylococcus aureus PBP2' . No significant homology was detected with PBP1a or PBP1b of Escherichia coli, or with the low-Mr PBPs.

Kansenshogaku Zasshi, 1989 Oct, 63(10), 1195 - 200
{Detection of Chlamydia trachomatis antigen for diagnosis of respiratory infection I . Cross reaction with bacteriae consisting normal flora respiratory tract}; Yamazaki T et al.; We examined the cross reaction of Chlamydia trachomatis (C . trachomatis) by antigen detection method using EIA against the aerobic bacteria which colonize in the respiratory tract of children . Chlamydiazyme showed a cross reaction among 5 out of 7 species of Gram negative bacteria (= 71.4%) and Neisseria and Branhamella catarrhalis showed a cross reaction even in low concentrations of 1 X 10(3-4) CFU/ml . There were no Gram positive bacteria which showed cross reaction . IDEIA Mark III did not react to Gram negative bacteria even in high concentrations of 1 X 10(7-10) CFU/ml . One strain of coagulase positive staphylococcus (CPS) showed positive at a concentration of 1 X 10(8): however, other Gram positive bacteria including two other strains of CPS exhibited no cross reaction . The detectable concentration of C . trachomatis (D/UW 3 strain) using IDEIA Mark III was 1 X 10(3) IFU/ml . Low cross reaction rate and sensitivity suggest IDEIA Mark III is preferable for diagnosis of respiratory infection of C . trachomatis though further clinical studies are necessary.

J Clin Microbiol, 1989 Oct, 27(10), 2359 - 63
Molecular techniques for the detection of Chlamydia trachomatis; Peterson EM et al.; A DNA probe assay (PACE; Gen-Probe, San Diego, Calif.) was compared with a culture reference method for the detection of Chlamydia trachomatis . Using stock isolates of each of the 15 serovars (A to K, Ba, L1, L2, and L3) of C . trachomatis, the lower limit of sensitivity for the DNA probe ranged between 1,086 inclusion-forming units (IFU) for serovar E (Bour) to 2,930 IFU for serovar L1 (440), with the only exception being serovar C (TW-3), with which 99 IFU was detected . There was no cross-reactivity with Chlamydia psittaci (Texas turkey) and Chlamydia pneumoniae (TWAR-183) . Bacterial and fungal isolates representing 14 species of normal vaginal flora as well as Neisseria gonorrhoeae gave negative results with the DNA probe when tested at a level of 1.5 X 10(7) CFU/ml . In addition, the DNA probe, a direct fluorescent-antibody stain (DFA) (MicroTrak; Syva Corp., Palo Alto, Calif.), and an enzyme-linked immunosorbent assay (Chlamydiazyme; Abbott Laboratories, North Chicago, Ill.) were compared with culture for the detection of C . trachomatis, using 196 clinical cervical samples . Of the 196 samples, 20 (10%) were culture positive . Of the 176 culture-negative samples, 1 was not evaluated by DNA probe and 4, because of a lack of cellular material, were not evaluated by DFA . The sensitivities of the DNA probe, DFA, and enzyme-linked immunosorbent assay were 60, 75, and 85%, respectively, and specificities were 95, 99, and 97%, respectively . Of the false-positive direct results, there was only one specimen with which more than one direct method was positive, and with this specimen all three direct methods were positive . The majority of false-negative results by the direct methods were from specimens which by the culture method gave <100 IFU per culture.

J R Coll Gen Pract, 1989 Oct, 39(327), 418 - 20
Sexually transmitted diseases and Chlamydia trachomatis in women consulting for contraception; Avonts D et al.; PIP: The prevalence of genital micro-organisms was investigated in 248 women who presented to a family practice in Belgium in 1981-84 to obtain contraception . 141 were seeking a new or replacement IUD, while the remaining 107 were oral contraceptive (OC) users . Study participants had no signs or symptoms of a genital infection at the time of screening . The cultures revealed clue cells in 21.0%, Candida albicans in 12.9%, Trichomonas vaginalis in 2%, and Neisseria gonorrhoeae in 0.5% . Chlamydia trachomatis was isolated in 14 women (6.3%); among women requesting an IUD, the prevalence of C trachomatis was 7.5% . A history of 2 or more sex partners in the preceding 3 month period and previous use of OCs each conferred a 2.5 times increased risk of a positive chlamydia finding . Isolation of C trachomatis was not correlated with age at first intercourse, gravidity, an abnormal cervix, or a history of pelvic inflammatory disease (PID), however . 9 of the 14 women infected with chlamydia had nonspecific symptoms of a genital infection, e.g., vulval irritation, odor, or vaginal discharge, and 2 had an abnormal bimanual palpation . Available evidence suggests that IUD linked PID is caused by genital micro-organisms, especially C trachomatis and N gonorrhoeae, that enter the uterine cavity during IUD insertion . Given the 6% prevalence of C trachomatis in the young women presenting for contraception in this study, screening for this micro-organism is urged before an IUD is inserted in order to reduce the complication of PID .

G E N, 1989 Oct-Dec, 43(4), 295 - 7
{Chlamydial proctitis in homosexual men}; Mora M et al.; We present 3 homosexual male patients, with lesions confined to the rectum, produced by chlamydia trachomatis . In the 3 patients the lesions were confined to the first 10 cm from of the anal margin, they were nodular, ulcerated and with stenotic tendency, difficult to differentiate macroscopically from a neoplasm . Multiple biopsy specimens from all patients reported chronic unspecific proctitis . In the 3 patients the presence of chlamydia trachomatis was confirmed by staining with lugol and giemsa from samples obtained by rectal smear, two of them presented simultaneous infection by neisseria gonorrhoeae, all were positive for HBsAg and one for HIV . Symptoms were tenesmus rectal urge, pain, thin feces and mucosanguinolent discharge . Treatment with 100 mg . Doxycycline BID for 21 days resulted in total remission in two patients; one patient with significant clinical improvement needed rectal bougienage.

Genitourin Med, 1989 Oct, 65(5), 342 - 6
Effect of penicillin and spectinomycin given for urethritis and cervicitis with Neisseria gonorrhoeae: high prevalence of penicillin-resistant isolates; Kouri YH et al.; Efficacy of single-dose spectinomycin (TRO: 2 g intramuscularly) was compared with that of aqueous procaine penicillin G (APPG:4.8 x 10(6) units) plus 1 g of probenecid for treatment of gonococcal urethritis and cervicitis . Cure rates of the 210 patients who received TRO and 190 patients who received APPG were 97.6% and 91.1%, respectively . MICs of antibiotics were determined using the agar dilution method . Those isolates with MICs of APPG of less than 1.0 microgram/ml had low failure rates (2.9%), while strains with increased resistance to APPG (MICs greater than or equal to 1.0 microgram/ml) had higher failure rates (24%) . Treatment failures seen with TRO were not correlated to isolates with the higher MICs . Clinical results suggest TRO could be given for treatment of genital gonorrhoea in Puerto Rico due to the high prevalence of both chromosomally-mediated penicillin-resistant Neisseria gonorrhoeae (20%) and penicillinase-producing Neisseria gonorrhoeae (7.5%) strains and the high rate of failure seen with the use of APPG.

Z Gesamte Hyg, 1989 Oct, 35(10), 610 - 2
{Diagnosis of gonorrhea using a microfluorimetric Neisseria gonorrheae-specific enzyme detection test}; Grabert E et al.; The diagnostic importance of a new approach for the detection of N . go . by 1,2-Propanediol: NAD+-Oxidoreductase (1,2-PDOR) counting was demonstrated . The advantages are established in supporting of the culture diagnosis of cervical and urethral swabs and in the shorting of the diagnostic way by isolation of N . go . colonies and biochemical differentiation.

Pathol Biol (Paris), 1989 Oct, 37(8), 897 - 900
{Evaluation of a biotinylated probe for identification of Neisseria gonorrhoeae}; Bollet C et al.; We evaluated a DNA biotinylated probe for the rapid identification of Neisseria gonorrhoeae in culture (Ortho Diagnostics System, Raritan, NJ) . Twenty-one strains of N . gonorrhoeae, including type strain, 57 strains of other Neisseria species, and 104 strains of other genera were studied . The probe was highly sensitive (100%) and specific (96%) . All N . gonorrhoeae strains gave strong signals, and only two cross-reaction were observed with N . lactamica, which has a close genetic relationship to N . gonorrhoeae . Our results indicate that specific recombinant DNA probe should offer a reliable and rapid method for routine diagnosis of Neisseria gonorrhoeae.

Mol Microbiol, 1989 Oct, 3(10), 1433 - 9
Subcellular localization of proteins encoded by the phenotypically cryptic plasmid of Neisseria gonorrhoeae: biological evidence for outer membrane association of the cppB gene product; Aalen RB et al.; Almost all clinical isolates of Neisseria gonorrhoeae harbour a plasmid of 4.2 kb with no known function . A genetic model based on the DNA sequence of the plasmid, with ten open reading frames, has been proposed by Korch et al., (1985) . To address the question of the function of the encoded proteins, some of which are expressed when the plasmid is harboured by Escherichia coli, the subcellular locations of such proteins were investigated in minicells of Escherichia coli DS410 . The protein CppB, earlier proposed to be a membrane-spanning polypeptide, was found associated with the outer membrane . Up to five other cryptic plasmid proteins were found to be localized in the periplasm.

Kansenshogaku Zasshi, 1989 Oct, 63(10), 1178 - 81
In vitro effect of menfegol on Neisseria gonorrhoeae; Yamai S et al.; Bacteriostatic and bactericidal effect of Menfegol, which has been used as a spermicide, on Neisseria gonorrhoeae was investigated in vitro . The distribution of the MICs of N . gonorrhoeae to Menfegol consisted of 2 groups . Resistant strains showed the MICs of more than 3200 micrograms/ml while the MICs of sensitive strains were less than or equal to 200 micrograms/ml . When the resistant strains were suspended in several concentrations of Menfegol and were incubated at 35 degrees C, no concentrations inactivated gonococci completely . However, the number of organisms was remarkably decreased within 30 minutes.

Sex Transm Dis, 1989 Oct-Dec, 16(4), 195 - 7
Monoclonal antibody direct immunofluorescence for the identification of Neisseria gonorrhoeae strains grown on selective culture media; Cavicchini S et al.; Commercially available reagents for monoclonal antibody immunofluorescence, polyclonal antibody immunofluorescence, and coagglutination were employed in comparison with a rapid sugar fermentation test used for identifying clinical isolates of Neisseria gonorrhoeae recovered on modified Thayer-Martin media . Of 68 gonococcal strains, 68 were positive by the monoclonal immunofluorescent antibody . Of 16 nongonococcal gram-negative, oxidase-positive diplococci, all were negative by this reagent . Monoclonal antibody immunofluorescence was more specific and more sensitive than polyclonal antibody immunofluorescence and more sensitive than coagglutination.

Antimicrob Agents Chemother, 1989 Oct, 33(10), 1721 - 3
Evaluation of difloxacin in the treatment of uncomplicated urethral gonorrhea in men; Smith BL et al.; Difloxacin is a new quinolone antimicrobial agent with in vitro activity against both Neisseria gonorrhoeae and Chlamydia trachomatis and a long (26-h) half-life . A single oral dose of 200 mg of difloxacin was used to treat 30 men with uncomplicated urethral gonorrhea in an open trial . Of the isolates of N . gonorrhoeae, three produced penicillinase and two were resistant to tetracycline . N . gonorrhoeae was eradicated from all 29 evaluable patients . The geometric mean MIC of difloxacin for 30 pretreatment N . gonorrhoeae isolates was 0.014 (range, less than or equal to 0.0039 to 0.03) microgram/ml . Four (13.3%) of the 30 subjects with gonococcal urethritis also had C . trachomatis recovered from their pretreatment cultures . Treatment with difloxacin was associated with the eradication of C . trachomatis from all four men . In addition, C . trachomatis was isolated from the posttreatment culture of only one man who had a negative culture before treatment . Nineteen patients (65.5%) reported adverse experiences, and 17 of them (58.6%) developed symptoms suggestive of central nervous system dysfunction . An oral dose of 200 mg of difloxacin is effective treatment for uncomplicated urethral gonorrhea and may also eliminate a coexisting infection with C . trachomatis . Side effects may limit the utility of this agent.

Dan Med Bull, 1989 Oct, 36(5), 483 - 5
Vaginal microbial flora in women with and without vaginal discharge registered in general practice; Bro F; To compare the microbiological findings for patients with and without vaginal discharge, 29 general practitioners registered 361 women with and 229 women without complaints of vaginal discharge in a multi-practice study in the county of Aarhus, Denmark . In five of the patients (1.4%) with vaginal discharge, Neisseria gonorrhoeae was isolated compared with one (0.4%) in women without vaginal discharge . Chlamydia trachomatis was isolated in 30 (8.3%) and nine (3.9) respectively, Candida in 113 (31.3%) and 44 (19.2%), Gardnerella vaginalis in 187 (51.8%) and 93 (40.6%), and Trichomonas vaginalis in 10 (2.8%) and one (0.4%) . The criteria of bacterial vaginosis were fulfilled by 129 (35.7%) women with vaginal discharge, and by 19 (8.3%) without symptoms . Except for T . vaginalis and N . gonorrhoeae, the microorganisms were significantly (p less than 0.05) more frequent among patients with than without vaginal discharge . C . trachomatis was found in 25 (11%) women under the age of 25, compared to 14 (4%) aged 25 years or older (p less than 0.01) . The isolation rates of the other microorganisms were not related to age . G . vaginalis was found in high concentrations in 73% of those harbouring this bacterium . No difference in concentration was found between women with and without vaginal discharge (p less than 0.05).

J Med Chem, 1989 Oct, 32(10), 2407 - 11
Tetrapeptide inhibitors of the IgA1 proteinases from type I Neisseria gonorrhoeae; Wood SG et al.; The six series of unique tetrapeptides and their blocked N-acetyl, C-amide, and N-acetyl-C-amide analogues which comprise the hinge region of human IgA1 (Ser224 to Ser240) have been synthesized and tested as inhibitors of the type 1 IgA1 proteinase elaborated by Neisseria gonorrhoeae (EC 3.4.24.13) . Most series had at least one member with an IC50 value less than 1 mM . The most effective inhibitors came from the series Ser-Thr-Pro-Pro (P4-P1) and Pro-Thr-Pro-Ser (P1-P3') . One member from each series had an IC50 value in the low microM range . Magnetic resonance studies (Siemion, I . Z.; et al . Biophys . Chem . 1988, 31, 35) indicate that the various tetrapeptide series appear to have different preferred solution conformations . However, these do not appear to be correlated with affinity for the neisserial proteinase . The most effective inhibitors tend to have a threonine residue adjacent to the N-terminus and the P1 or P1' residues at either the N- or the C-terminus . These relationships are not exclusive however, as other inhibitors, which do not meet these criteria, bind reasonably well . The most effective substrate analogues outlined here are about one-half the size and bind to the neisserial proteinase 2 orders of magnitude more tightly than previously reported inhibitors.

S Afr Med J, 1989 Sep 16, 76(6), 251 - 4
Sexually transmitted pathogens in acute pelvic inflammatory disease; Hoosen AA et al.; The prevalence of sexually transmitted pathogens in two groups of women was studied: 50 women with clinical diagnoses of acute pelvic inflammatory disease (PID) and 50 asymptomatic women attending a family planning clinic (FPC) . Genital specimens, collected by non-invasive procedures, were examined . Endocervical Neisseria gonorrhoeae was present in 62% of the PID group and 10% of the FPC group (P less than 0.0001) . One-third of N . gonorrhoeae isolates were penicillinase-producing strains . Chlamydia trachomatis was isolated from the endocervix in 30% of the PID group and 26% of the FPC group (P = 0.8240 NS) . Mycoplasma hominis was more prevalent in the vaginas and endocervices of the PID group than the FPC group (84% and 72% v . 50% and 42%; P = 0.0006 and 0.0047 respectively) . Trichomonas vaginalis was present in 56% of the PID group and 20% of the FPC group (P = 0.0004) . Syphilis serology was positive in 34% of the PID group and 10% of the FPC group (P = 0.0026) . In the PID group of patients, 8% were positive for HBsAg . Antibody to the human immunodeficiency virus was not detected in any of the 100 women . The high prevalence of recognised sexually transmitted pathogens underlines the need for appropriate antimicrobial agent(s) active against N . gonorrhoeae, C . trachomatis and M . hominis in patients with PID . In view of the high prevalence of penicillinase-producing strains of N . gonorrhoeae, routine use of an antibiotic active against such strains is desirable.

J Adolesc Health Care, 1989 Sep, 10(5), 376 - 81
Chlamydia trachomatis cervical infection and oral contraceptive use among adolescent girls; Oh MK et al.; This study examines the relationship between oral contraceptive use and Chlamydia trachomatis cervical infection in women less than 19 years of age . The clinical and epidemiologic data of 73 (19.4% prevalence rate) girls with chlamydial infection were analyzed, with special attention given to contraceptive use . The findings were compared with data from 303 girls who were chlamydia negative to assess the relationship between oral contraceptive use and C . trachomatis infection . Use of an oral contraceptive for 6 months or longer was associated with chlamydial infection (p = 0.005; odds ratio = 2.41; 95% confidence interval 1.53-3.29) . Oral contraceptive use was not associated with an increased rate of Neisseria gonorrhoeae or Trichomonas vaginalis infection . Association of oral contraceptive use with chlamydial infection remained significant after adjustments were made for confounding variables in a logistic regression process (p = 0.013) . This study suggests that oral contraceptive use may promote chlamydial infection of the cervix or enhance the detection of the C . trachomatis from the cervix in this population.

J Pediatr, 1989 Sep, 115(3), 487 - 93
Differences in biologic maturation, sexual behavior, and sexually transmitted disease between adolescents with and without cervical intraepithelial neoplasia; Moscicki AB et al.; Because several cofactors may influence the development of cervical intraepithelial neoplasia (CIN) in young women, we compared differences in behaviors (sexual activity, contraception, and cigarette use), sexually transmitted disease (STD) infection rates (Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus), and cervical maturation (age of menarche and percentage of cervical ectopy) in groups of sexually active female adolescents with and without CIN . Those with CIN were compared with three non-CIN groups: (1) teenagers who were referred to a teen colposcopy clinic but had no evidence of CIN (high-risk group), (2) teenagers seen at a gynecology clinic without STD symptoms (asymptomatic group), and (3) teenagers seen at the gynecology clinic with STD symptoms (symptomatic group) . The percentage of cervical ectopy was measured by colpophotography . Subjects with CIN had more lifetime sexual partners than the asymptomatic group (p less than 0.001) and were more likely to smoke cigarettes than either gynecology clinic group (p less than 0.01) . No differences in behaviors existed between the CIN and high-risk groups . The mean age of menarche in those with CIN was 1 year older than all three non-CIN groups (p less than 0.05), and those with CIN had a greater area of ectopy than those without CIN (p less than 0.02) . Those with CIN were more likely to have a past or present history of C . trachomatis infection than the two gynecology clinic groups; no difference was found between the CIN and high-risk groups . We conclude that cofactors such as smoking, sexual promiscuity, and C . trachomatis infection may influence cervical vulnerability . However, cervical biologic immaturity is an important risk factor for development of CIN in adolescent girlsPIP: From April-September 1986, researchers asked all 14-19 year old females attending the University of California at San Francisco's Teen Colposcopy Clinic to take part in an epidemiologic study of risk factors for cervical intraepithelial neoplasia (CIN) . The 4 comparison groups consisted of a CIN group, a high risk group (external warts or abnormal Pap smear, no CIN, similar behavioral risk factors as CIN group), as asymptomatic group, and a symptomatic group (negative Pap smears and lower genital tract infection complaints) . The CIN group was more likely to smoke or have smoked than the asymptomatic and symptomatic groups (p.01) and to use oral contraceptives than the asymptomatic group (p.02) . In addition, patients with CIN had more lifetime sexual partners than did the asymptomatic group (p.001) . The teens in the CIN group reached menarche on average 1 year later than did those in any of the comparison groups (p.05) . This also had a greater area of ectopy than the other 3 groups (p.02) . External genital warts occurred more often in the CIN group than in either the asymptomatic or symptomatic groups (p.001) . Further, the CIN and high risk groups were more likely to have had any sexually transmitted disease than the asymptomatic (p.001) or symptomatic (p.01) groups . In addition, chlamydiosis occurred more often in the CIN group than in the asymptomatic (p.001) or symptomatic groups (p.03) . The results indicate that cervical biologic immaturity may play an important role in development of CIN in adolescents . They also showed that CIN patients had more ectopy than the others thereby demonstrating that cervical biologic immaturity may rend the epithelium vulnerable to human papilloma virus invasion and neoplastic change .

Infect Immun, 1989 Sep, 57(9), 2726 - 32
Somnogenic activity of O-acetylated and dimeric muramyl peptides; Johannsen L et al.; Slow-wave sleep-promoting factors in brain and urine were identified as muramyl peptides (MPs), the building blocks of bacterial cell wall peptidoglycan . In this study, structural variations of MPs that occur naturally in bacterial peptidoglycan were investigated for somnogenic activity . Monomeric and dimeric MPs were isolated and purified from Neisseria gonorrhoeae and Actinomadura sp . strain R39 . The structures of these MPs were verified by fast atom bombardment mass spectroscopy and tandem mass spectroscopy . After intracerebroventricular administration of MPs, electroencephalograms and brain temperatures of rabbits were recorded for 6 h and were analyzed to determine durations of slow-wave sleep, rapid-eye-movement sleep, and wakefulness . The 6-O acetylation of muramic acid enhanced the somnogenic effects of certain monomeric MPs relative to their non-O-acetylated (but otherwise identical) counterparts . Two monomeric MPs containing an unsubstituted amide (i.e., Iso-Gln) were inactive, thus confirming previous results showing that amidation of a variety of MPs can block somnogenic activity . Two peptide-cross-linked MP dimers tested had no effect on slow-wave sleep, although a third peptide-cross-linked MP containing a 1,6-anhydro muramyl end on one of its monomeric subunits, a structure that enhances somnogenic potency of un-cross-linked monomers, was somnogenic . Two dimers connected by glycosidic bonds and containing an Iso-Gln moiety were inactive . Two other glycosidically linked dimers that also contained an Iso-Gln moiety, but were of lower molecular weight, were somnogenic . In summary, 6-O acetylation of muramic acid in somnogenic MPs enhances activity, and as a class, peptide-linked dimeric MPs tend to be less active than their constituent monomers.

Infect Immun, 1989 Sep, 57(9), 2786 - 93
Immunological characterization of a human homolog of the 65-kilodalton mycobacterial antigen; Dudani AK et al.; A human mitochondrial protein, designated P1 (63 kilodaltons {kDa}, shows extensive sequence homology (47% identical residues and an additional approximately 20% conserved changes) to the 65-kDa mycobacterial antigen . To understand the relationship of these proteins, the cross-reactivity of several monoclonal antibodies directed against the 65-kDa Mycobacterium leprae antigen towards human, Chinese hamster, chicken, and bacterial cells has been examined . A number of antibodies (Y1-2, ML 30-A2, and F47-9-1) were found to cross-react with a 63-kDa antigen in vertebrate cell extracts and stained mitochondria in immunofluorescence studies . Some of these antibodies also reacted with a P1-beta-galactosidase fusion protein in recombinant Escherichia coli cells, expressing part of the human P1 protein . These results provide strong evidence that P1 is the mammalian homolog of the 65-kDa antigen . The human P1 protein also shows significant similarity (P less than 0.001) to a number of other bacterial and viral proteins including the pol polyprotein of human immunodeficiency viruses and the penicillin-binding protein of Neisseria gonorrhoeae . The observed similarity between human P1 protein and the major antigenic proteins of pathogenic organisms (e.g., 60- to 65-kDa mycobacterial antigen) suggests its possible involvement in autoimmune diseases (e.g., rheumatoid arthritis) by antigenic mimicry.

Bol Oficina Sanit Panam, 1989 Sep, 107(3), 220 - 5
{Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in 3 groups of Ecuadorian women with different sexual behaviors}; Narvaez M et al.; In order to examine the relationship between sexual conduct and infection with Chlamydia trachomatis and Neisseria gonorrhoeae (gonococcus), the prevalence of these two microorganisms was studied in three groups of Ecuadorean women with different patterns of sexual behavior: 116 prostitutes, 136 women from Borbon Parish who had numerous sexual partners, and 61 pregnant women who had sexual relations with only one partner . The prevalence of infection from one or both of the agents was 53.4% in the prostitutes (n = 62), 34.5% in the women from Borbon (n = 47), and 1.6% in the pregnant women (n = 1) . These results bear out the relationship between sexual behavior and risk of sexually transmitted disease.

Rev Odontostomatol (Paris), 1989 Sep-Oct, 18(5), 409 - 11
{Oral isolation of Neisseria gonorrhoeae in the presence of gonococcal urethritis}; Kolokotronis A et al.; The Neisseria Gonorrhoeae, the etiologic agent of the gonococcic urethritis, can produce other clinical manifestations, such as stomatitis, TMJ arthritis and sialadenitis . The investigation of this germ in the oral cavity of 50 patients with gonorrhea, was positive in only one case, which did not present any buccal symptom . It was concluded from this study that an oral gonococcic infection is extremely rare, and that the transmissibility of this germ orally is not frequent eventhough possible in theory . However the infection can spread through the blood stream and can induce other pathology.

Infection, 1989 Sep-Oct, 17(5), 309 - 10
Meningitis in a child due to Neisseria meningitidis group K; Grahlow WD et al.; A four-year-old boy with meningitis due to Neisseria meningitidis group K, serotype 14, serosubtype P1.6, is reported to be, we believe, the first case caused by this strain.

Obstet Gynecol Clin North Am, 1989 Sep, 16(3), 467 - 78
Gonococcal infections in women; McNeeley SG Jr; Gonorrhea is the most common sexually transmitted disease in the United States . This article discusses the epidemiology, pathogenesis of Neisseria gonorrhoeae, diagnosis, clinical manifestations, and treatment of this important disease.

West J Med, 1989 Sep, 151(3), 292 - 5
Penicillinase-producing Neisseria gonorrhoeae in California . Report of a major outbreak and control recommendations; Kizer KW et al.; A major outbreak of penicillinase-producing Neisseria gonorrhoeae occurred in California beginning in late 1986 . After a state public health emergency was declared in April 1987, a statewide, cooperative federal-state-local treatment and control program was implemented . It was successful in reducing the reported incidence by 59% . Despite the success of this effort, penicillinase-producing N gonorrhoeae is not controlled in California, and, while not nearly the magnitude reported in Florida, an increasing number of cases are again being reported in California . We present recommendations for clinicians and local public health officials, including the epidemiologic and empiric treatment of suspected gonorrhea cases with ceftriaxone when the incidence of penicillinase-producing gonococcal cases in a community exceeds 1% of all reported gonorrhea cases.

EMBO J, 1989 Sep, 8(9), 2737 - 44
Mosaic-like organization of IgA protease genes in Neisseria gonorrhoeae generated by horizontal genetic exchange in vivo; Halter R et al.; IgA protease is a putative virulence factor that exists in several allelic forms in Neisseria gonorrhoeae . However, extracellular secretion of these variant IgA proteases occurs by the same pathway involving three steps of autoproteolytic maturation from a large precursor . Two principal precursor types (H1 and H2) can be distinguished with respect to the location of autoproteolytic sites and the sizes of the mature products . By partial DNA sequence analysis, additional variations have been detected which are not unique to one particular gene; rather, otherwise unrelated iga genes often share homology, thus revealing a composite organization . In the context of other gonococcal features, this observation implies that recombination has occurred in vivo between iga genes of different strains, probably via the route of species-specific DNA transformation . This process may be of general significance for the modulation and the natural exchange of virulence properties among pathogenic Neisseriae.

Clin Ther, 1989 Sep-Oct, 11(5), 633 - 9
Respiratory symptoms due to Branhamella catarrhalis and other Neisseria species infections--response to erythromycin therapy; Hamedani P et al.; Neisseria microorganisms (Neisseria lactamica, Neisseria sicca, and Neisseria mucosa) are regarded as normal respiratory commensals . Branhamella catarrhalis (formerly Neisseria catarrhalis) has also been regarded as a normal respiratory commensal, but reports indicate that it can be pathogenic . The role of Neisseria spp was studied in 160 patients with chest infections and symptoms and signs of obstructive respiratory disease . Group I patients (n = 140) had a history of asthma, bronchitis, and emphysema . Group II patients (n = 20) had an initially responsive pulmonary tuberculosis but presented with fever and obstructive airway disease . Group I patients had disease that was difficult to control despite increased bronchodilator therapy, but they responded dramatically after two to three days of appropriate antibiotic therapy . Patients in group II showed a similar response to erythromycin . Neisseria infection was responsible for precipitating or exacerbating respiratory distress in both groups . Accordingly, it is concluded that Neisseria can be pathogenic and that patients with fever and obstructive respiratory symptoms require treatment.

Clin Lab Med, 1989 Sep, 9(3), 445 - 80
Gonorrhea; Ehret JM et al.; Laboratory methods for the isolation and identification of Neisseria gonorrhoeae are updated . The antimicrobial susceptibility patterns of the gonococcus are changing and becoming less predictable . Methods for monitoring susceptibility are presented . The use of serotyping, auxotyping, and molecular techniques to characterize gonococcal isolates and the epidemiological applications are reviewed.

J Med Microbiol, 1989 Sep, 30(1), 33 - 6
Resistance of mice to genital infection with Neisseria gonorrhoeae; Johnson AP et al.; Five strains of mice (C3H, CBA, BALB/c, TO and ICR) were inoculated intra-vaginally with Neisseria gonorrhoeae in an attempt to produce an animal model of gonorrhoea . Of a total of 68 mice inoculated, only three (4.4%) were culture-positive after 3 days . Histological examination of both the genital mucosa of inoculated animals, and the mucosa of genital tract organ cultures inoculated in vitro failed to show any evidence of gonococcal adherence or colonisation . Mice of these strains, therefore, appear resistant to gonococcal infection of the genital tract.

J Clin Microbiol, 1989 Sep, 27(9), 2125 - 7
Analysis of an outbreak of penicillinase-producing Neisseria gonorrhoeae in Rhode Island, 1987; Debuono BA et al.; In June of 1987, an outbreak of penicillinase-producing Neisseria gonorrhoeae (PPNG) occurred in Rhode Island . PPNG persists as an endemic pathogen despite a concerted statewide effort to eradicate the organism . Detailed analysis of PPNG isolates demonstrated that multiple strains are circulating concurrently, complicating control measures.

Obstet Gynecol, 1989 Sep, 74(3 Pt 1), 295 - 8
Concomitant infection with Neisseria gonorrhoeae and Chlamydia trachomatis in pregnancy; Christmas JT et al.; Gonorrhea is an important marker for endocervical chlamydial infections in nonpregnant women . Concomitant infection rates as high as 50% have been reported . There are few data on concomitant infection rates in pregnant patients . The purpose of this study was to examine the prevalence of endocervical chlamydial infections in pregnant women with gonorrhea . Patients with cervical cultures positive for Neisseria gonorrhoeae at their initial prenatal visit had endocervical specimens for Chlamydia trachomatis culture obtained before anti-gonorrheal therapy . Control patients were selected at random from the same prenatal population . The prevalence of C trachomatis in patients with gonorrhea was significantly greater than that in the control population (46 versus 5%; P less than .001) . Patients with gonorrhea were younger, less often married, and more often black than the control population, but these demographic differences did not account for the large difference in the chlamydial prevalence . Erythromycin 500 mg four times daily provided an excellent cure rate without intolerable side effects . Pregnant patients being evaluated or treated for gonorrhea should also be considered at high risk for concomitant cervical chlamydial infection.

Infect Immun, 1989 Sep, 57(9), 2847 - 52
Molecular analysis of lipooligosaccharide biosynthesis in Neisseria gonorrhoeae; Petricoin EF 3rd et al.; A HindIII gene bank of Neisseria gonorrhoeae MUG116 was constructed in the cosmid vector pHC79 . A cosmid (pSY81) was isolated that was able to convert N . gonorrhoeae FA5100 to reactivity with monoclonal antibody (MAb) 2-1-L8 . Several MAb-reactive transformants were isolated and characterized with respect to lipooligosaccharide (LOS) production as analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, their ability to react with two other LOS-specific MAbs (3F11 and O6B4), and Southern blot analysis . Escherichia coli containing the clone had altered lipopolysaccharide expression as determined by electrophoretic analysis; however, no reactivity was seen with gonococcus-specific MAbs . The introduction of pSY81 into FA5100 had a pleiomorphic effect, giving rise to transformants having the full parental phenotype or transformants lacking reactivity to a combination of LOS-specific MAbs . Southern blot analysis indicated that the LOS biosynthetic mutation in FA5100 was not due to chromosomal rearrangement or large deletions.

Infect Immun, 1989 Sep, 57(9), 2653 - 9
Cloning and DNA sequence of the omc gene encoding the outer membrane protein-macromolecular complex from Neisseria gonorrhoeae; Tsai WM et al.; The omc gene, encoding the outer membrane protein-macromolecular complex (OMP-MC), was cloned in two pieces from Neisseria gonorrhoeae 2686 . The 5' fragment of the omc gene included a promoter sequence, as indicated by its unregulated expression in Escherichia coli . Attempts to reconstruct an intact omc gene were unsuccessful, suggesting that expression of the complete OMP-MC protein was toxic to E . coli . Complete sequence determination revealed a coding sequence of 2,133 nucleotides; the deduced amino acid sequence indicated a mature protein of 687 amino acids with an NH2-terminal signal peptide of 24 amino acids . Analysis of the deduced amino acid sequence revealed that the NH2-terminal half of OMP-MC is generally hydrophilic, while the COOH-terminal portion contains alternating hydrophobic and hydrophilic regions . Serological analyses demonstrated that the NH2-terminal portion of OMP-MC is exposed on the gonococcal surface and the COOH-terminal portion is membrane associated.

Genitourin Med, 1989 Aug, 65(4), 276 - 80
Sexually transmitted pathogens in pregnant women in a rural South African community; O'Farrell N et al.; One hundred and ninety three consecutive pregnant women attending peripheral antenatal clinics attached to Ngwelezana Hospital, Empangeni, Kwa-Zulu, were examined for evidence of sexually transmitted pathogens . The following incidences were found: Trichomonas vaginalis 49.2% (95), Candida spp 38.3% (74), Chlamydia trachomatis 11.4% (22), Gardnerella vaginalis 6.2% (12), Neisseria gonorrhoeae 5.7% (11), positive syphilis serology results 11.9% (23), hepatitis B surface antigen 4.1% (eight) . No woman had antibody to human immunodeficiency virus (HIV) . Dyskaryotic smears were found in 20 (10.4%) . Human papillomavirus (HPV) was detected cytologically in 11 (5.7%) . The range of sexually transmitted pathogens found in this rural community was similar to that found in urban groups studied in South Africa.

J Med Chem, 1989 Aug, 32(8), 1949 - 58
2,4-Diamino-5-benzylpyrimidines as antibacterial agents . 13 . Some alkenyl derivatives with high in vitro activity against anaerobic organisms; Roth B et al.; A series of 2,4-diamino-5-(3,5-dialkenyl-4-methoxy- or -4-hydroxybenzyl)pyrimidines was prepared from {(allyloxy)benzyl}pyrimidines by Claisen rearrangements, and the resulting allyl phenols were further modified by methylation and rearrangement to 1-propenyl analogues . Analogous 3,4-dimethoxy-5-alkenyl derivatives were prepared by similar techniques . High in vitro antibacterial activity was obtained against certain anaerobic organisms, such as Bacteroides species and Fusobacterium, which was equal to or better than the control, metronidazole, in several cases . The profile was similar against Neisseria gonorrhoeae and Staphylococcus aureus . The 3,5-bis(1-propenyl)-4-methoxy derivative 8 was 1 order of magnitude more active against Escherichia coli dihydrofolate reductase than its saturated counterpart, and it was also more active than trimethoprim, 1 . However, it was considerably less active in vitro against the Gram-negative organisms . The 3,4-dimethoxy-5-alkenyl, -5-alkyl, and -5-alkoxy analogues had very high broad-spectrum antibacterial activity . However, pharmacokinetic studies of four of the compounds in dogs and rats and in vivo studies with an abdominal sepsis model in rats showed no advantages over trimethoprim.

J Reprod Med, 1989 Aug, 34(8 Suppl), 555 - 64; discussion 564-5
Advances in diagnostic testing for vaginitis and cervicitis; Eschenbach DA et al.; An accurate diagnosis of vaginal and cervical infection is the key to proper treatment . New tests are available to aid in the diagnosis of both vaginitis and cervicitis . The systematic employment of traditional office tests provides an accurate diagnosis of vaginitis . Except for candidiasis, vaginal cultures generally are not helpful in the diagnosis of vaginitis . In contrast, cervical cultures greatly aid the diagnosis of cervicitis . New direct immunofluorescence monoclonal antibody tests and enzyme-linked immunosorbent assays are generally more rapid but less accurate than culture for the identification of Neisseria gonorrhoeae and Chlamydia trachomatis.

Epidemiol Infect, 1989 Aug, 103(1), 203 - 9
Sampling methods for monitoring changes in gonococcal populations; Bindayna KM et al.; A total of 160 consecutive isolates of Neisseria gonorrhoeae was collected over a 3-month period . They were tested for their susceptibility to penicillin, erythromycin and spectinomycin and the auxotype and the serotype determined . We have evaluated two sampling methods, the collection of every fifth isolate and the first 20 isolates (10 male and 10 female) each month, to determine whether either is representative of the total population . There was no significant difference between either method of sampling and the total for detecting the predominant auxotypes and serovars or the distributions in antibiotic susceptibility . It is possible to monitor major changes in a gonococcal population, particularly susceptibility to antibiotics, using a sample of the total population.

Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi, 1989 Aug, 22(3), 213 - 6
A previously undescribed plasmid and African R plasmid in Neisseria gonorrhoeae isolated in Taiwan; Ding MJ et al.; A new undescribed plasmid, 15.6-Mdal in size, was detected in Neisseria gonorrhoeae isolates in Taiwan . The plasmid was co-existent with 2.6-Mdal and 7.8-Mdal plasmids in three out of 190 clinical isolates . It appeared to be consisted of six copies of the 2.6-Mdal plasmids as evidenced by restriction endonuclease cleavage . In addition, African 3.2-Mdal R plasmids have also been detected in penicillinase-producing N . gonorrhoeae (PPNG) isolates in Taiwan . They accounted for 7% of PPNG.

FEMS Microbiol Lett, 1989 Aug, 51(3), 305 - 9
Determination of the number of tuf genes in Chlamydia trachomatis and Neisseria gonorrhoeae; Goldstein BP et al.; Restriction endonuclease fragments of DNA from Neisseria gonorrhoeae and Chlamydia trachomatis (mouse pneumonitis biovar) were hybridized to probes from the N-terminal and C-terminal portions of the Escherichia coli tufA gene . In common with other Gram-negative bacteria, the genome of N . gonorrhoeae was found to contain two homologous sequences (presumptive tuf genes) . The C . trachomatis genome contained a single tuf sequence.

J Appl Bacteriol, 1989 Aug, 67(2), 185 - 9
A note on susceptibility of Branhamella catarrhalis to heavy metals; Riley TV et al.; The susceptibility of 56 strains of Branhamella catarrhalis and ten Neisseria spp . to arsenate, silver, nickel, mercury, lead, cadmium, chromium, manganese, iron, cobalt and molybdenum was tested with an agar dilution technique . All but two strains of B . catarrhalis were resistant to multiple metal ions . There were not sufficient differences in susceptibility, however, to allow the development of a typing scheme based on resistograms . Heavy metal resistance in Branhamella was unrelated to beta-lactamase production . Neisseria spp . were more susceptible to metal ions than B . catarrhalis and this may form the basis of a simple diagnostic test.

J Clin Microbiol, 1989 Aug, 27(8), 1885 - 6
Fluorescent-antibody-negative penicillinase-producing Neisseria gonorrhoeae; Walton DT; The incidence of monoclonal-fluorescent-antibody-negative penicillinase-producing Neisseria gonorrhoeae is not known . Two isolates which could not be identified by using a commercial monoclonal fluorescent-antibody conjugate are described . The use of more than one confirmatory method is recommended.

J Med Microbiol, 1989 Aug, 29(4), 251 - 4
The phenotypic relationship of Neisseria polysaccharea to commensal and pathogenic Neisseria spp; Cann KJ et al.; Eight of 22 non-capsulate strains of Neisseria meningitidis previously isolated from primary school children were re-identified as N . polysaccharea by aminopeptidase reactions and polysaccharide production . N . polysaccharea was not identified amongst 91 non-capsulate strains of N . meningitidis isolated from adults attending the Genito-urinary Medicine clinic, Westminster Hospital, London . The biochemical reactions of N . polysaccharea strains were similar to those of N . lactamica and N . gonorrhoeae, but N . polysaccharea could be distinguished from these organisms by examination of beta-galactosidase activity, carbohydrate reactions and polysaccharide production . Sodium dodecyl sulphate-polyacrylamide gel electrophoresis revealed closer similarity of N . polysaccharea to N . lactamica than to the pathogenic Neisseria spp . An additional finding was variation in the position of one of the major proteins of N . lactamica in the 34-39-Kda region.

Clin Chem, 1989 Aug, 35(8), 1571 - 5
Application of a rapid non-radioisotopic nucleic acid analysis system to the detection of sexually transmitted disease-causing organisms and their associated antimicrobial resistances; Urdea MS et al.; We devised a versatile method for detecting nucleic acids in crude lysates of biological samples . A controlled network of nucleic acid hybrids composed of the target fragment, several oligonucleotide probes, branched DNA amplifiers, and labeled oligonucleotides is produced on a solid phase to ultimately incorporate 60 to 300 molecules of alkaline phosphatase, which are detected with a chemiluminescent substrate . The visible light output can be recorded on a luminometer or on instant black-and-white film . Assays have been developed for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and for genes conferring penicillin and tetracycline resistance . Conducted much like ELISAS, the assays are performed in about 4 h (for 96 samples) in microliter dishes . The molecular detection limit of approximately 50,000 molecules of double-stranded DNA has permitted us to detect 1 to 10 x 10(3) of C . trachomatis and N . gonorrhoeae with specific probe sequences . Both plasmid and genomic target sequences can be detected by the same procedure . All of the assay components, except for a set of unmodified oligonucleotide probes, are universally applicable for all targets.

J Bacteriol, 1989 Aug, 171(8), 4196 - 201
DNA-binding proteins in cells and membrane blebs of Neisseria gonorrhoeae; Dorward DW et al.; Naturally elaborated membrane bleb fractions BI and BII of Neisseria gonorrhoeae contain both linear and circular DNAs . Because little is known about the interactions between DNA and blebs, studies were initiated to identify specific proteins that bind DNA in elaborated membrane blebs . Western immunoblots of whole-cell and bleb proteins from transformation-competent and DNA-uptake-deficient (dud) mutants were probed with single- or double-stranded gonococcal DNA, pBR322, or synthetic DNA oligomers containing intact or altered gonococcal transformation uptake sequences . The specificity and sensitivity of a nonradioactive DNA-binding protein assay was evaluated, and the assay was used to visualize DNA-protein complexes on the blots . The complexes were then characterized by molecular mass, DNA-binding specificity, and expression in bleb fractions . The assay effectively detected blotted DNA-binding proteins . At least 17 gonococcal DNA-binding proteins were identified; unique subsets occurred in BI and BII . Certain DNA-binding proteins had varied affinities for single- and double-stranded DNA, and the intact transformation uptake sequence competitively displaced the altered sequence from a BI protein at 11 kilodaltons (kDa) . A dud mutant, strain FA660, lacked DNA-binding activity at the 11-kDa protein in BI . The segregation of DNA-binding proteins within BI and BII correlates with their distinct protein profiles and suggests that these vesicles may play different roles . Although the DNA-binding proteins expressed in BII may influence the nuclease-resistant export of plasmids within BII vesicles, the BI 11-kDa protein may bind transforming DNA.

J Gen Microbiol, 1989 Aug, 135 ( Pt 8), 2269 - 76
The potential protective effect of immunization with outer-membrane protein I from Neisseria gonorrhoeae; Heckels JE et al.; Immunization of rabbits with outer membranes (OM) of Neisseria gonorrhoeae produced antibodies directed against outer-membrane proteins PI and PIII . The antibodies directed against PIII reacted equally well on Western blots with all strains tested, but antibodies directed against PI reacted only with the homologous strain . When purified PIB was used for immunization the immune response was quite different: the sera obtained reacted with both homologous and heterologous PIB types and also reacted with strains expressing PIA . Western blotting of peptides produced by sequential cleavage of PIB revealed that the antigenic determinants recognized by anti-OM sera were predominantly located in the central surface-exposed region of PIB, as is the epitope recognized by the protective anti-PIB monoclonal antibody SM24 . In contrast antibodies produced by immunization with purified PI reacted with antigenic determinants in the N-terminal portion of PIB . Nevertheless these determinants are accessible to immune attack on the native protein since the anti-PI sera were opsonic and were strongly bactericidal for both PIA- and PIB-expressing strains.

Malays J Pathol, 1989 Aug, 11, 21 - 4
Evaluation of the GO Slide, a growth transport system for the laboratory diagnosis of gonorrhoea; Lim YS et al.; A growth transport system, the GO Slide (Roche Diagnostica), for the isolation of Neisseria gonorrhoeae from clinical specimens was evaluated . This system was compared with culture on chocolate agar (CA) and modified Thayer-Martin (MTM) agar, and Gram-stained smear for the diagnosis of gonorrhoea . Of 94 urethral specimens from symptomatic males, 77.7% were positive on MTM, 80.9% were positive on CA and Gram stain, and 81.9% were positive on GO Slide . Of the 77 isolates, 26.0% were penicillinase producers, 12.3% belonged to WI serogroup and 87.7% belonged to WII/III serogroup . The ease of transportation and the easy examination of growth on agar surfaces make the GO Slide an attractive system . It would be particularly useful for general practitioners without culture facilities to transport specimens to the laboratory for the isolation of N . gonorrhoeae.

Biochemistry, 1989 Jul 11, 28(14), 6001 - 9
Affinity purification of the voltage-sensitive sodium channel from electroplax with resins selective for sialic acid; James WM et al.; The voltage-sensitive sodium channel present in the eel (Electrophorus electricus) has an unusually high content of sialic acid, including alpha-(2----8)-linked polysialic acid, not found in other electroplax membrane glycopeptides . Lectins from Limax flavus (LFA) and wheat germ (WGA) proved the most effective of 11 lectin resins tried . The most selective resin was prepared from IgM antibodies against Neisseria meningitidis alpha-(2----8)-polysialic acid which were affinity purified and coupled to Sepharose 4B . The sodium channel was found to bind to WGA, LFA, and IgM resins and was readily eluted with the appropriate soluble carbohydrates . Experiments with LFA and IgM resins demonstrated binding and unbinding rates and displacement kinetics, which suggest highly specific binding at multiple sites on the sodium channel protein . In preparative-scale purification of protein previously fractionated by anion-exchange chromatography, without stabilizing TTX, high yields were reproducibly obtained . Further, when detergent extracts were prepared from electroplax membranes fractionated by low-speed sedimentation, a single step over the IgM resin provided a 70-fold purification, yielding specific activities of 3200 pmol of {3H}TTX-binding sites/mg of protein and a single polypeptide of approximately 285,000 Da on SDS-acrylamide gels . No small peptides were observed after this 5-h isolation . We further describe a cation-dependent stabilization with millimolar levels of monovalent and micromolar levels of divalent species.

Lancet, 1989 Jul 8, 2(8654), 86 - 8
Contamination of endoscopes used in AIDS patients; Hanson PJ et al.; Contamination of twenty endoscopes used in patients with AIDS was assessed . The suction-biopsy, air, and water channels and the insertion tube were sampled after use, after washing in detergent, and after disinfection for 2 min in 2% alkaline glutaraldehyde . The polymerase chain reaction with Southern blotting, cell cultures, and antigen immunoassay were used to detect human immunodeficiency virus (HIV) . Samples were also examined for cytomegalovirus, adenoviruses, enteroviruses, herpes simplex virus, myxoviruses, hepatitis B surface antigen, fungi, and bacteria . Seven of twenty unwashed endoscopes were contaminated by HIV . Commensal bacteria were found in all endoscopes, Candida albicans in six, Staphylococcus aureus in five, and Pseudomonas aeruginosa in five . Washing alone removed all detectable organisms from 66 of 68 contaminated sites; Neisseria spp were recovered from two air channels after washing but not after disinfection . Washing achieved a mean reduction of 4.93 (95% confidence interval 3.69-6.17) colony forming units per ml.

Pediatr Infect Dis J, 1989 Jul, 8(7), 445 - 8
Ceftriaxone treatment of penicillinase-producing Neisseria gonorrhoeae infections in children; Rawstron SA et al.; The incidence of penicillinase-producing Neisseria gonorrhoeae (PPNG) among adults with gonorrhea in Brooklyn now exceeds 24% . Because children usually acquire their infection from adults, it follows that we have had a concomitant rise in PPNG among sexually abused children . The Centers for Disease Control now recommends ceftriaxone for the first line treatment of gonorrhea but there are no data as to its use in children for this indication . From May, 1987, through March, 1989, 33 children, 4 days to 10 years of age, were admitted to Kings County Hospital for 34 episodes of gonorrhea . Nine (26.5%) were caused by PPNG . Twenty-three were female; 10 were male . There were 17 isolates from the vagina, 3 from the urethra, 9 from the pharynx, 9 from the rectum and 6 from the eye . Eight children (all girls) had infections at greater than or equal to 1 site; 2 were infected at 3 sites . Twenty-eight children were sexually abused and 5 were neonates with ophthalmia (1 PPNG) . All isolates were susceptible to ceftriaxone by disc diffusion testing . Agar dilution was performed for 18 isolates; minimal inhibitory concentrations to ceftriaxone were less than or equal to 0.06 mg/liter . The 5 PPNG isolates tested had minimal inhibitory concentrations to penicillin of 2 to 16 mg/liter and 3 isolates were resistant to tetracycline with minimal inhibitory concentrations of 32 mg/liter . Twenty-eight children were treated with a single dose of ceftriaxone, including the 5 neonates with ophthalmia; the dose was 125 mg if less than 45 kg or 250 mg if greater than 45 kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Eur Respir J, 1989 Jul, 2(7), 685 - 7
Neisseria sicca pneumonia and bronchiectasis; Gris P et al.; Neisseria sicca, although considered a harmless saprophyte, has been recognised as an etiologic agent in three cases of pneumonitis, and rare cases of endocarditis, meningitis, and osteomyelitis, particularly in immunocompromised hosts . We report the case of a 76-year-old man with a community-acquired pneumonia, in whom both sputum samples and bronchial secretions obtained with bronchoscopic protected catheter brush grew pure culture of N . sicca with abundant polymorphonuclear neutrophils . Dramatic clinical improvement only occurred after initiation of an appropriate antibiotherapy according to susceptibility spectrum of the isolated N . sicca . Bronchiectasis underlying lesions were disclosed by computed tomography . N . sicca should be added to the list of commensal organisms able to cause pulmonary infection . Moreover, the association of N . sicca and bronchiectasis has never been published.

J Clin Microbiol, 1989 Jul, 27(7), 1673 - 4
Isolation of Neisseria canis in mixed culture from a patient after a cat bite; Guibourdenche M et al.; We report a case of identification of Neisseria canis in a human patient after a cat bite . This organism was isolated from a mixed culture together with Pasteurella multocida and Eikenella corrodens . It is the second case report of a human infection.

Surg Gynecol Obstet, 1989 Jul, 169(1), 32 - 4
Aerobic and anaerobic microbiology of Bartholin's abscess; Brook I; Aspirates of pus from an abscess of Bartholin's gland in 28 patients were studied for aerobic and anaerobic bacteria . Bacterial growth was obtained on culture in 26 specimens . A total of 67 bacterial isolates (43 anaerobic and 24 aerobic and facultative) were recovered, accounting for 2.6 isolates per specimen (1.7 anaerobic and 0.9 aerobic and facultatives) . Anaerobic bacteria only were present in eight patients, aerobic and facultatives in five and mixed aerobic and anaerobic flora in 13 . Single bacterial isolates were recovered in six infections . The predominant anaerobic organisms were Bacteroides species (23 isolates, including six Bacteroides melaninogenicus group, five Bacteroides fragilis group and four Bacteroides bivius) and Peptostreptococcus species . The predominant aerobic and facultative bacteria were Escherichia coli and Neisseria gonorrhoeae . In this study, the polymicrobial nature of abscess of Bartholin's gland is highlighted.

Kansenshogaku Zasshi, 1989 Jul, 63(7), 720 - 5
{Study of organisms isolated from non-infected patients with pneumoconiosis}; Usami I et al.; Studies on the sputum organisms and their seasonal incidences were conducted on non-infected patients with pneumoconiosis . A total of 3318 organisms were isolated from 1427 sputum examinations, an average of 4 examinations per patient . alpha-Streptococcus, GPC, Neisseria and GNC were isolated in 74.1, 22.1, 64.8, 21.3% of the patients respectively . In addition, organisms to cause respiratory infection were isolated in the non-infected phase . S . pneumoniae, S . aureus, B . catarrhalis, H . influenzae, E . coli, K . pneumoniae and P . aeruginosa were isolated in 1.5, 5.1, 2.5, 3.3, 2.9, 6.4, 2.8% of the patients respectively . Studies of the seasonal incidences in these organisms showed that H . influenzae, B . catarrhalis and S . pneumoniae were isolated mostly in winter, S . aureus mostly in spring, E . coli and K . pneumoniae mostly in summer . On the other hand, P . aeruginosa showed no seasonal incidence . In relation to the causing organisms of respiratory infection with pneumoconiosis, it is very interesting that many organisms were isolated in the non-infected phase, and seasonal incidences were observed.

Zentralbl Bakteriol, 1989 Jul, 271(2), 158 - 70
Interaction of non-piliated Neisseria gonorrhoeae strain 7122 and protein IA with an epithelial cell monolayer; Layh-Schmitt G et al.; Studies with {14C} uracil-labelled bacteria revealed that the interaction of Neisseria gonorrhoeae with epithelial cells occurred in a time-dependent reaction which is slightly pH-dependent and optimal at pH 6.5 . Immunofluorescence tests and immunoelectron microscopy of ultrathin sections confirmed the attachment of these bacteria to the epithelial cell membrane . The interaction of purified protein I with epithelial cells was time-dependent and reached equilibrium after four hours as shown by tracer experiments with 125I-labeled protein I . Cleavage experiments with trypsin followed by SDS-PAGE and autoradiography indicated that protein I (labeled with 125I) was associated with the membrane of the epithelial cells and only partly accessible by trypsin after its interaction with these mammalian cells . Immunofluorescence tests as well as immunoelectron microscopy with the monoclonal antibody G7A2C and gold-labeled protein A confirmed a dense association pattern of protein I with the cell monolayer.

Infect Immun, 1989 Jul, 57(7), 2173 - 8
Oxidant stress in Neisseria gonorrhoeae: adaptation and effects on L-(+)-lactate dehydrogenase activity; Fu HS et al.; Neisseria gonorrhoeae, an obligate human pathogen, is subjected to oxidant stress when attacked by O2 reduction products formed by neutrophils . In this study, exposure of gonococci to sublethal concentrations of superoxide and hydrogen peroxide (and related O-centered radicals) resulted in phenotypic resistance to oxidant stress . Adaptation required new protein formation but was not related to increases in superoxide dismutase or catalase . We have previously demonstrated that gonococci use phagocyte-derived L-(+)-lactate . Oxidant stress of greater magnitude than that required for adaptation led to a generalized increase in bacterial metabolism, particularly in L-(+)- and D-(-)-lactate utilization and lactate dehydrogenase activity . Increased lactate utilization required new protein synthesis . These results suggest the possibility that lactate metabolism is of importance to N . gonorrhoeae subjected to oxidant stress . Use of lct mutant organisms unable to use L-(+)-lactate should allow examination of this hypothesis.

Eur J Clin Microbiol Infect Dis, 1989 Jul, 8(7), 626 - 8
Comparative in vitro activity of norfloxacin against resistant Neisseria gonorrhoeae; Ponticas S et al.; The in vitro activity of seven antibiotics against 52 isolates of Neisseria gonorrhoeae was determined . Against penicillinase-producing Neisseria gonorrhoeae, ceftriaxone was the most active agent (MIC90 0.015 micrograms/ml), followed by ceftizoxime and norfloxacin (MIC90 0.03-0.125 micrograms/ml) . Against spectinomycin-resistant Neisseria gonorrhoeae, the most active agents were ceftizoxime, ceftriaxone and norfloxacin (MIC90 0.015-0.125 micrograms/ml) . Ceftizoxime, ceftriaxone and norfloxacin were also the most active agents against tetracycline-resistant Neisseria gonorrhoeae (MIC90 0.06-0.125 micrograms/ml) . Overall, the rank order of activity from the most to the least active agent was as follows: ceftizoxime (MIC90 0.015 micrograms/ml); ceftriaxone (MIC90 0.06 micrograms/ml); norfloxacin (MIC90 0.125 micrograms/ml); cefoxitin (MIC90 2 micrograms/ml); tetracycline (MIC90 8 micrograms/ml); penicillin (MIC90 greater than 8 micrograms/ml); and spectinomycin (MIC90 greater than 128 micrograms/ml).

Sex Transm Dis, 1989 Jul-Sep, 16(3), 148 - 51
Multicenter, comparative study of enoxacin and ceftriaxone for treatment of uncomplicated gonorrhea; Pabst KM et al.; The efficacy of single dose enoxacin, 400 mg was compared to ceftriaxone, 250 mg IM for therapy of uncomplicated gonorrhea in 152 evaluable patients attending sexually transmitted disease clinics in Baltimore, Indianapolis and Seattle . Anogenital gonorrhea was cured in 75 (99%) of 76 patients treated with enoxacin and 73 (97%) of 75 patients treated with ceftriaxone . Three of three patients with pharyngeal gonorrhea were not cured by enoxacin while all three ceftriaxone treated cases of pharyngeal gonorrhea were cured . All cases of anogenital gonorrhea caused by beta-lactamase producing Neisseria gonorrheae (11 patients), gonococci with high-level, plasmid-mediated tetracycline resistance (11 patients), or gonococci with chromosomally mediated penicillin resistance (22 patients) were cured . The IC90 for enoxacin of N . gonorrhoeae isolated in this study was 0.06 microgram/ml . Enoxacin appears to be a well tolerated, efficacious alternative to currently recommended therapy for patients with uncomplicated, anogenital gonorrhea including cases potentially caused by antibiotic resistant N . gonorrhoeae.

Sex Transm Dis, 1989 Jul-Sep, 16(3), 137 - 40
Etiology of urethritis in Thai men; Kuvanont K et al.; The etiology of urethritis was determined for 303 Thai men with urethral discharge containing 5 or more polymorphonuclear cells (PMN)/high power field (hpf) and 132 men with a discharge containing less than 5 PMN/hpf . Neisseria gonorrhoeae was isolated significantly more often from men with greater than or equal to 5 PMN/hpf than from men with less than 5 PMN/hpf (42% vs 1%, P less than .0001) . Chlamydia trachomatis was also isolated more often from patients with greater than or equal to 5 PMN/hpf than from men with less than 5 PMN/hpf (16% vs 8%, P less than .03) . Ureaplasma urealyticum was isolated with nearly equal frequency from both groups of patients (45% vs 37%) . Among men with a urethral exudate containing greater than or equal to 5 PMN/hpf, N . gonorrhoeae was isolated as the only pathogen from 19% and in combination with C . trachomatis or U . urealyticum in 23% of these men . C . trachomatis or U . urealyticum, but not N . gonorrhoeae, was isolated from 30%, and no pathogen was isolated from 28% of these men . Among men with urethral exudate containing less than 5 PMN/hpf, N . gonorrhoeae was isolated from only 1%, C . trachomatis or U . urealyticum from 41%, and no pathogen from 58% . These findings suggest that all Thai men with urethral discharge containing greater than or equal to 5 PMN/hpf should be treated for non-gonococcal urethritis and for gonococcal urethritis if gram-negative diplococci are demonstrated on gram stain of the urethral discharge . Men with urethritis with less than 5 PMN/hpf should be treated for only non-gonococcal urethritis.

Sex Transm Dis, 1989 Jul-Sep, 16(3), 132 - 6
Risk factors for infection with plasmid-mediated high-level tetracycline resistant Neisseria gonorrhoeae; Telzak EE et al.; This study was done to determine whether the increase in high-level tetracycline resistant Neisseria gonorrhoeae (TRNG) was associated with increased tetracycline use . From 547 persons with positive cultures seen consecutively at a sexually transmitted disease (STD) clinic, 51 (9%) isolates were resistant to tetracycline . Of these 51 isolates, 37 (73%) had high-level resistance (TRNG) which was mediated by the tetM determinant located on a 25.2-megadalton plasmid . Women were twice as likely as men to have TRNG . Previous visits to an STD clinic and oral antibiotic use for a sexually transmitted disease within a one to five month period were used as surrogates for prior tetracycline use . Patients who had been to an STD clinic were almost twice as likely to have TRNG (RR = 1.9, 95% CI: 1.01, 3.46), and those who took an oral antibiotic had a relative risk of 1.8 . The authors postulate that previous tetracycline use selects for tetM-containing microorganisms in the genitourinary tract that, at the time of gonococcal infection, have the ability to transfer the determinant to N . gonorrhoeae . The above findings might have implications for modifying the current Centers for Disease Control (CDC) recommendation to prescribe tetracycline for suspected Chlamydia infection among patients with gonorrhea.

J Nat Prod, 1989 Jul-Aug, 52(4), 797 - 809
Faeriefungin: a new broad-spectrum antibiotic from Streptomyces griseus var . autotrophicus; Nair MG et al.; Faeriefungin, a polyol polyene macrolide lactone antibiotic, was isolated from the mycelium of Streptomyces griseus var . autotrophicus, MSU-32058/ATCC 53668, collected from the soil sample of a fairy ring in an old lawn in Lansing, Michigan . Faeriefungin has some properties similar to the previously reported polyene macrolides, mycoticin and flavofungin, but possesses different physiochemical and biological properties . Aspergillus, Fusarium, Microsporum, Trichophyton, and Alternaria spp . were completely inhibited by faeriefungin at 3.2 micrograms/ml, Candida spp . at 5.5 micrograms/ml, and Pythium, Phialophora, Leptosphaeria spp., and some selected Gram-negative penicillin-resistant strains of Neisseria gonorrhoeae at 16.0 micrograms/ml . At a concentration of 100 ppm, it caused 100% mortality of mosquito larvae (Aedes aegypti, Rockefeller strain) and free-living nematodes (Panagrellus redivivus) . Unlike the related polyene macrolides, faeriefungin is crystalline and stable with broad-spectrum antimicrobial and insecticidal activity . Preliminary cytotoxicity studies with human erythrocytes and rat liver epithelial cells indicated that faeriefungin and amphotericin B have comparable toxicity . Solution nmr study has indicated that faeriefungin is a mixture of two compounds, faerifungins A {1} and B {2}, and that they differ in the attachment of a H or an Me at C-33.

Taiwan Yi Xue Hui Za Zhi, 1989 Jul, 88(7), 734 - 9
{Epidemiological characterization of Neisseria gonorrhoeae isolates from Taiwan . Part II: Distribution of auxotyping, serogrouping and plasmid profile}; Chu ML et al.; Epidemiology of gonococcal infection in Taiwan was investigated . Six hundred twelve isolates from 7 cities in 1983-1984 were examined for auxotyping by Hendry and Stewart's method, for serotyping by coagglutination of monoclonal antibodies with the antigenic specificity of gonococcal protein I molecules and for plasmid profile by the alkaline quick method . The results are described below: (1) Thirty-six auxotypes were found . Prototropic (Prototype) 45.4% (284/612) and Proline type (Pro) 38.7% (237/612) were the two dominant auxotypes . Arg- Hyp- Ura- which was thought to be correlated with disseminated gonococcal infection was not found . (2) Fifty-five percent penicillinase producing Neisseria gonorrheal (PPNG) were prototype and 48.8% non-PPNG were Pro . (3) Sixteen serotypes were identified among 56 strains . There was 17.8 (10/56 which belonged to the IA group and 82.2% (46/56) to the IB group . (4) Five molecular weight plasmids were found . They were 2.6 Mdal, 3.05 Mdal, 4.7 Mdal, 7.8 Mdal and 24.5 Mdal . (5) There were 7 plasmid profiles including 2.6 Mdal (26.4%); 2.6 Mdal +24.5 Mdal (23.2%); 2.6 Mdal+7.8 Mdal+24.5 Mdal (0.4%); 2.6 Mdal+4.7 Mdal (8.9%); 2.6 Mdal+4.7 Mdal+24.5 Mdal (38.2%); 2.6 Mdal+4.7 Mdal+24.5 Mdal (0.2%) and 2.6 Mdal+3.05 Mdal+24.5 Mdal (2.4%) . (6) All the isolates harbored cryptic 2.6 Mdal plasmid . Eighty three percent of the PPNG and 48.6% of the non-PPNG harbored 24.5 Mdal plasmid . Twelve out of 305 PPNG isolates were "Toronto" type 3.05 Mdal plasmid . Others were "Asian" 4.7 Mdal plasmid . There were no "African" type 3.2 Mdal plasmids found.

Indian J Med Res, 1989 Jul, 89, 243 - 8
Prevalence of PPNG strains & in vitro sensitivity pattern of Neisseria gonorrhoeae in Varanasi (Uttar Pradesh, India); Mishra D et al.; Forty one consecutive gonococcal isolates were tested by disc method for their sensitivity to penicillin and seven other antimicrobials . Nineteen (46.34%) strains of N . gonorrhoeae were found to be relatively resistant to penicillin (MIC over 0.25 IU/ml) including 2 (4.88%) strains with complete resistance to penicillin (MIC over 1 IU/ml) . None of the gonococcal strains tested was penicillinase-producing (PPNG) . A decline in the proportion of sensitive strains of gonococci with a non-significant rise in median value of MIC for penicillin from 2.16 IU/ml in 1980-81 to 2.52 IU/ml in 1986-87 and other antimicrobials was observed.

Electrophoresis, 1989 Jul, 10(7), 456 - 63
The application of high resolution two-dimensional polyacrylamide gel electrophoresis to the identification and purification of a protein, NG8.4, present in Neisseria gonorrhoea and the subsequent development of a radioimmunoassay; Jackson P et al.; A soluble protein of unknown function was shown, by two-dimensional polyacrylamide gel electrophoresis, to be present in Neisseria gonorrhoeae at significantly higher concentrations than in the other related bacteria tested . The data indicate the possibility of this protein being specific to Neisseria gonorrhoeae . This protein was designated as NG 8.4 and purified . A radioimmunoassay was developed for the measurement of this protein and subsequently used to determine the degree of cross reaction exhibited by a number of species of bacteria . Of the bacteria tested only those of the genus Neisseria gave a significant reaction in the assay.

J Clin Microbiol, 1989 Jul, 27(7), 1456 - 9
Detection of Neisseria meningitidis and Yersinia pestis with a novel silicon-based sensor; Libby JM et al.; A light-addressable potentiometric (silicon) sensor was used in an immunofiltration procedure for the detection of pathogenic bacteria . Yersinia pestis was detected by filtering the cells onto nitrocellulose membranes and then filtering anti-Y . pestis mouse monoclonal antibody and anti-mouse immunoglobulin G-horseradish peroxidase conjugate . For Neisseria meningitidis detection, mouse monoclonal antibody to the major outer membrane protein of this bacterium was coupled directly to horseradish peroxidase . N . meningitidis cell suspensions were filtered onto polycarbonate membranes, and the enzyme conjugate was allowed to react with the filtered bacteria . The presence of both enzyme conjugates was determined potentiometrically with the silicon sensor . The sensitivity of this technique relative to that of an enzyme-linked immunosorbent assay for N . meningitidis was determined . Fewer than 1,000 bacterial cells could be detected with the silicon sensor in a 20-min assay, whereas a 2.5-h enzyme-linked immunosorbent assay with the same antigen and antibody preparations was significantly less sensitive.

Am J Obstet Gynecol, 1989 Jul, 161(1), 128 - 35
Randomized treatment of mucopurulent cervicitis with doxycycline or amoxicillin; Paavonen J et al.; A randomized trial of doxycycline versus amoxicillin was performed to treat mucopurulent cervicitis . Chlamydia trachomatis, the most common single agent associated with mucopurulent cervicitis, was isolated from 30 (47%) and Neisseria gonorrhoeae from five (8%) of 64 patients . Patients were followed up for 3 months, and the effect of treatment was assessed by clinical (presence of endocervical mucopus, cervicitis severity score, and number of polymorphonuclear leukocytes on Gram-stained smears of endocervical secretions) and microbiologic criteria . Doxycycline and amoxicillin were equally effective for treating chlamydial and nonchlamydial cervicitis . However, endocervical mucopus was still present in 18% of the patients in both treatment groups after 2 months and in 23% of the doxycycline group and 33% of the amoxicillin group after 3 months of therapy . The cause of persistent/recurrent mucopus after antimicrobial treatment was not explained by relapse or reinfection with Chlamydia trachomatis, Neisseria gonorrhoeae, genital mycoplasmas, or Gardnerella vaginalis, but persistence was associated with the degree of cervical ectopy.

J Gen Microbiol, 1989 Jul, 135 ( Pt 7), 1895 - 9
Location of a blocking epitope on outer-membrane protein III of Neisseria gonorrhoeae by synthetic peptide analysis; Virji M et al.; A series of overlapping peptides spanning the deduced amino acid sequence of outer-membrane protein PIII of Neisseria gonorrhoeae have been synthesized on solid-phase supports . The peptides were used in an attempt to locate the epitopes recognized by anti-PIII monoclonal antibodies with defined biological properties . Four bactericidal and two nonbactericidal antibodies were reacted with the synthetic peptides . None of the bactericidal antibodies reacted with the linear peptides . However, the two nonbactericidal antibodies were found to react within the disulphide loop thought to be exposed on the bacterial surface . Monoclonal antibody SM51 recognized a decapeptide corresponding to amino acid residues 24-33, while monoclonal antibody SM50 recognized an octapeptide contained within the decapeptide . The difference in the ability of the two antibodies to block the bactericidal effect of antibodies directed against other surface antigens therefore appears to be related to a difference in their ability to activate complement rather than to the location of the epitope recognized.

Sex Transm Dis, 1989 Jul-Sep, 16(3), 127 - 31
Comparison of direct fluorescent antibody, acridine orange, wet mount, and culture for detection of Trichomonas vaginalis in women attending a public sexually transmitted diseases clinic; Bickley LS et al.; To define the performance characteristics of two newer tests for Trichomonas vaginalis (TV), the authors compared direct fluorescent antibody (DFA) (mixed monoclonal antibody, Integrated Diagnostics, Inc, Berkeley, CA) and acridine orange (AO) tests to standard wet mount (WM) preparations and culture (modified Diamond medium) of vaginal wash specimens in consecutively examined women presenting to a public sexually transmitted diseases (STD) clinic . Cultures for Neisseria gonorrhoeae (GC), Chlamydia trachomatis (CT), and yeast were also performed on all patients . Of 104 women, 59 (57%) were infected with one or more pathogens . Trichomonas vaginalis was detected by WM and/or culture in 38 (37%) women and was the most prevalent infection . Of the 38 patients with TV, 95% were detected by culture, 83% by DFA, 66% by AO, and 66% by WM . An additional patient was DFA positive but negative for TV by all other methods . The sensitivity of DFA was superior to AO and WM in women with TV infection alone (96% compared to 67% and 53%, respectively) . It was comparable to AO and WM in women with multiple infections (67% compared to 53% and 73%) . Even in the presence of other pathogens, DFA appears to be a reasonable alternative to culture for detection of TV . In addition, DFA is rapid, easy to perform, and relatively inexpensive.

J Clin Microbiol, 1989 Jul, 27(7), 1700 - 3
Direct detection of Neisseria gonorrhoeae with monoclonal antibodies characterized by serotyping reagents; Rajasekariah GR et al.; A panel of monoclonal antibodies (MAbs) directed to outer membrane protein I were generated with the ultimate aim of detecting Neisseria gonorrhoeae in patient samples by a direct immunofluorescence (IF) test . In an initial evaluation of the sensitivity of these reagents, a cocktail of six IF MAbs recognized 491 (91%) of 540 gonococci isolates from several centers in Sydney, Australia . IF MAbs designated 185 and 228 recognized serovars of WI serogroup and IF MAbs 208, 210, and 312 recognized serovars of WII/III serogroup . IF MAb 198 recognized serovars within both serogroups . Three additional IF MAbs, designated 322, 323, and 330, were then generated by using strains which failed to react with the original MAb cocktail and which belonged to particular serovars . The new cocktail of nine IF MAbs recognized 96% of the gonococcal isolates, which incidentally contained representatives of serovars shown to have a worldwide distribution in previous studies . Although subtle differences were apparent in the reaction patterns found with coagglutination (serotyping) and IF, there nonetheless seems to be merit in the approach of continually evaluating the sensitivity of diagnostic reagents such as MAbs . This is especially true with an organism such as N . gonorrhoeae, which has the capacity to regularly alter the antigenic structure of its outer membrane proteins.

J Bacteriol, 1989 Jul, 171(7), 3713 - 8
Identification of subunits of gonococcal RNA polymerase by immunoblot analysis: evidence for multiple sigma factors; Klimpel KW et al.; Heparin-agarose and single-stranded DNA-cellulose chromatography were used to purify RNA polymerase 25-fold from Neisseria gonorrhoeae, and the activity of the polymerase was characterized in altered assay systems . The core subunits (beta, beta', and alpha) were tentatively identified as major proteins copurifying with polymerase activity . The identification of the core subunits was confirmed by Western (immunoblot) analysis with polyclonal antisera to Escherichia coli core RNA polymerase . Gonococcal sigma factor heterogeneity was examined by Western blot analysis with polyclonal antiserum to the major E . coli sigma factor, sigma 70, to the E . coli heat shock sigma factor, sigma 32, and with a monoclonal antiserum to Salmonella typhimurium NtrA (sigma 54) . Purified RNA polymerase and whole-cell extracts from type 1, type 4, heat-shocked, and anaerobically grown gonococci were examined . Four putative gonococcal sigma factors were detected in purified RNA polymerase preparations and in whole-cell extracts from all cell types . Two of these bands appeared as a doublet, which had an estimated Mr of 80,000 . A single lower-Mr band, estimated to be 40,000, was also present . All three of these bands reacted with antisera to E . coli sigma 70 and to E . coli sigma 32 . A fourth gonococcal protein reacted solely with a highly specific monoclonal antibody to sigma 54 and had an Mr of 90,000 . We conclude that N . gonorrhoeae may contain multiple sigma factors, which it may use to regulate gene expression.

Ugeskr Laeger, 1989 Jun 26, 151(26), 1671 - 2
{Prevalence of positive gonococcal and chlamydial findings in women applying for termination of pregnancy . A screening evaluation}; Prien-Larsen JC et al.; All 335 pregnant women referred for termination of pregnancy in the first trimester were examined preoperatively for infection with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) and were questioned about symptoms of gynaecological infection . Only 0.6% had positive cultures for gonorrhoeae while CT infection was demonstrated in 7.8% . Half of the women with infection had one of the following symptoms: discharge, pain or dysuria . These same symptoms were, however, also found in half of the women without infection . All gynaecological special departments in Denmark and a few of the surgical departments which carry out termination of pregnancy replied to a questionnaire about routine examinations for NG and CT in cases of termination of pregnancy . Only 29.2% of the departments made routine preoperative examinations for CT, NG or both . It is concluded that there are no indications for routine examination for gonococcal infection whereas screening for CT infection appears to be indicated.

Dtsch Med Wochenschr, 1989 Jun 23, 114(25), 989 - 92
{Recurrent meningitis in a familial defect of the beta-subunit of the 8th complement component}; Nurnberger W et al.; Bacterial meningitides occurred in two members of a Yugoslavian family . In one case meningitis remained a singular event, Neisseria meningitidis being identified in the CSF . The second patient developed five episodes of recurrent purulent meningitis associated with petechiae and in one instance also with arthritis of the left knee but no causative germ was found . In both patients the Western blot technique revealed a defect of the beta-subunit of the eighth component of complement that was completely eliminated by purified C8 . This proved that the C8 defect was isolated and that no other component was deficient.

Z Hautkr, 1989 Jun 15, 64(6), 439 - 43
{Gonococcal diseases today--a review of the diagnostic and therapeutic development of the past years}; Krempl-Lamprecht L et al.; The diagnosis of gonococci in vitro is reliable and simple nowadays . Investigations are still based on direct microscopic control and on culturing . With the help of coagglutination by monoclonal antibodies and enzymatically controlled color reactions, we are able to take Neisseria gonorrhoeae apart from other gram-negative and oxidase-positive diplococci . In the therapy of common gonorrhea, we now use antibiotics more recently developed than penicillin . The complicated extragenital and disseminated forms of the disease require special modes of treatment usually provided in hospital.

Orv Hetil, 1989 Jun 11, 130(24), 1259 - 62
{A microbiology clinic in outpatient gynecologic service}; Orsos M et al.; The authors report on their experiences gained at the sexually transmitted disease clinic they established at the First Department of Obstetrics and Gynecology of Semmelweis Medical University . A total of 456 patients presenting with signs and symptoms of lower genital tract infection have been examined in one year . The investigation of patients included aerobic and anaerobic culture of vaginal bacteria, vaginal smear and the identification of sexually transmitted Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasmatales and Gardnerella vaginalis . The authors conclude that a sexually transmitted disease clinic is appropriate to contribute to the prevention of horizontal and vertical spread of the sexually transmitted bacterial infections.

Zh Mikrobiol Epidemiol Immunobiol, 1989 Jun, (6), 8 - 11
{Importance of associated microorganisms in the development of acute pneumonia}; Kondratenko GP et al.; Sputum samples obtained from 106 patients with acute pneumonia have been studied by the quantitative microbiological method . Different microbial associations have been shown to play an important role in the development of acute pneumonia (67.9%) . Microbiological studies have revealed the prevalence of pneumococci in the etiological structure of the disease . Staphylococci, hemophilic bacteria and Neisseria have been found to take part in the development of acute pneumonia in a lesser number of cases and more often occur in combination with pneumococci or form different associations themselves . The so-called "etiological" type of microbial associations has been determined, two or three microbial species being isolated at high concentrations (10(6) and over) and the percentage of patients with such combinations being 59.7 +/- 5.8% . The analysis of the clinical course of the disease has revealed that the presence of different microbial species in patients linked, to a great extent, with the clinical picture of the disease . These data may be used for prescribing adequate etiotropic therapy and for prognostication . Quantitative bacteriological studies carried out in the dynamics of the disease permit timely detection of changes in the microflora of the respiratory tracts, the evaluation of the effectiveness of antibacterial therapy in the process of its implementation and the rational correction of therapeutic measures.

Am J Epidemiol, 1989 Jun, 129(6), 1247 - 57
Association of Chlamydia trachomatis and Mycoplasma hominis with intrauterine growth retardation and preterm delivery . The John Hopkins Study of Cervicitis and Adverse Pregnancy Outcome; Detecting Chlamydia trachomatis in men with urethritis: serology v isolation in cell culture; Division of Obstetrics and Gynecology, Ben-Gurion University of the Negev, Beer-Sheva, IsraelThe accuracy of single serovar (L2) inclusion immunoperoxidase assay (IPA) to show serum IgG and IgA antibodies specific to chlamydiae was compared with culture for Chlamydia trachomatis to diagnose chlamydial infection in 73 men with acute urethritis . C trachomatis only was isolated from 18 (25%), Neisseria gonorrhoeae only from 17 (23%), and both organisms from six (8%) . Thus 24 (33%) yielded chlamydiae . Assays based on IgG antibodies to chlamydiae at a titre of 1/64 or more showed high sensitivity (96%) and a good negative predictive value (80%), but low specificity (13%) and agreement (48%) compared with culture . IgG antibodies to chlamydiae at a titre of 1/128 or more showed lower sensitivity (75%) but higher specificity (72%), negative predictive value (79%), and agreement (73%) . IgA antibodies to chlamydiae at a titre of 1/8 or more showed a sensitivity of 88%, specificity of 72%, negative predictive value of 88%, and agreement of 79% . An appreciable (fourfold or more) decrease in IgA and IgG titres was observed in most (10) of the 15 men from whom second blood samples were obtained one to two years after treatment . Measuring specific IgA and IgG antibodies to chlamydiae by IPA may serve as a useful complementary test for diagnosing and following up patients with urethritis.

Bangladesh Med Res Counc Bull, 1989 Jun, 15(1), 8 - 11
Penicillinase-producing Neisseria gonorrhoeae in Dhaka, Bangladesh; Miah MR et al.; Among the 52 strains of Neisseria gonorrhoeae isolated from cases of acute urethritis attending the dermatovenerology department of different hospitals of Dhaka city, 5(9.6%) strains were identified as penicillinase-producing (PPNG) and had minimum inhibitory concentration (MIC) of penicillin 4.0 micrograms/ml or more . Of the rest 47 (90.4%) non-penicillinase-producing strains (non-PPNG), 18(38.3%) were fully sensitive to penicillin (MIC = 0.06 micrograms/ml or less), 25(53.2%) had diminished sensitivity (MIC = 0.125 to 0.5 micrograms/ml) and 4(8.5%) were resistant to penicillin (3 had MIC 1 micrograms/ml and 1 had MIC 2 micrograms/ml).

Rev Esp Fisiol, 1989 Jun, 45(2), 105 - 9
Changes in surface hydrophobicity and charge in Neisseria meningitidis and their correlation with the association to phagocytic cells; Ferreiros CM et al.; Pairwise correlations among surface charge, relative hydrophobicity and association with phagocytes were studied in two strains of Neisseria meningitidis both under normal conditions and after different surface modifying treatments . The variations in the values of the three variables depended on both strains and treatment, and correlations were highly significant, although the biological significance of these correlations is questionable.

Eur J Epidemiol, 1989 Jun, 5(2), 170 - 2
Plasmid content, serotypes, and antimicrobial susceptibility of Neisseria gonorrhoeae strains isolated in Munich in 1987-88; Abeck D et al.; Eighty-four strains of Neisseria gonorrhoeae isolated in Munich between January 1987 and June 1988 were characterized in terms of their plasmid content, protein I serovar and susceptibility or resistance to four antimicrobial agents . Eighty two percent of the strains belonged to serogroup 1B, the three most prevalent serovars being 1B-1, 1B-2 and 1B-6 . Among the serogroup 1A strains, 1A-2 was the commonest serovar . Fourteen strains (16.7%) lacked the 2.6 Md cryptic plasmid, although two of these strains contained the conjugative gonococcal plasmid . Although some degree of resistance to penicillin and tetracycline was noted, all the strains were sensitive to spectinomycin and cefotiam.

J Antimicrob Chemother, 1989 Jun, 23(6), 825 - 30
In-vitro activity of pristinamycin and its components against gram-negative anaerobic bacilli and Gardnerella vaginalis; Weber P et al.; The comparative in-vitro activities of pristinamycin, its components pristinamycins I and IIA, erythromycin, clindamycin and metronidazole were studied against 174 clinical isolates of Gram-negative anaerobic bacilli and 24 strains of Gardnerella vaginalis . Susceptibilities were determined with an agar-dilution method . Against Bacteroides and Fusobacterium, pristinamycin was slightly less active than both clindamycin and metronidazole and more active than erythromycin . Against G . vaginalis, the activity of pristinamycin was similar to that of clindamycin and slightly inferior to that of erythromycin . Both pristinamycins I and IIA alone were generally inactive against the strains tested . Additionally, MICs for the B . fragilis group determined by a broth microdilution technique were one to two log2 lower than MICs obtained by agar-dilution . The bactericidal activity of pristinamycin and clindamycin was moderate and varied according to the strains tested . The chequerboard broth microdilution test against 20 strains of the B . fragilis group confirmed the synergy between pristinamycins I and IIA at every PI/PIIA ratio . Along with the activity against Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma and both aerobic and anaerobic Gram-positive bacteria, our results suggest that pristinamycin could be an effective drug in the treatment of gynaecological infections.

Genitourin Med, 1989 Jun, 65(3), 171 - 6
Serological classification in relation to auxotypes, plasmid contents, and susceptibilities to antimicrobials of PPNG and non-PPNG strains isolated in Greece; Tzanakaki G et al.; Thirty three penicillinase producing Neisseria gonorrhoeae (PPNG) and 152 non-PPNG strains were serologically classified in relation to their patterns of resistance to antimicrobials, nutritional requirements (auxotypes), and plasmid contents . Of the 185 strains, 65 (35%) belonged to the WI and 120 (65%) to the WII/III serogroup, the predominant serovars of which were Arost and Bropt, respectively . Associations between serotype and susceptibility to antimicrobial agents, auxotype, and plasmid content were observed . Of the 152 non-PPNG strains, 112 (74%) belonged to serogroup WI . The WI non-PPNG strains were more sensitive to penicillin, thiamphenicol, tetracycline, and cefotaxime than the WII/III non-PPNG strains . Auxotyping and serogrouping the strains showed no differentiation other than that arginine, hypoxanthine, and uracil dependent (AHU-) strains belonged to serogroup WI . The proline, citrulline, and uracil dependent (PCU-) strains belonged, as expected, to serogroup WII/III . Analysing the 33 PPNG strains showed that of 21 carrying the 4.5 megadalton (Asian type) penicillin resistance plasmid, 17 (81%) belonged to serogroup WI, with serovar Arst predominating, and only four (19%) to serogroup WII/III . Of 11 isolates carrying the 3.2 megadalton (African type) resistance plasmid, seven (64%) belonged to serogroup WI (serovar Av predominating) and four (36%) to WII/III (with serovar Bropyst predominating) . One strain carried the 3.05 megadalton penicillin resistance plasmid (Toronto type), belonged to the WI serogroup, and had serovar Arost.

J Clin Microbiol, 1989 Jun, 27(6), 1390 - 1
Identification of Branhamella catarrhalis in 2.5 min with an indoxyl butyrate strip test; Dealler SF et al.; Branhamella catarrhalis, an occasional cause of human respiratory infections, unlike most other members of the family Neisseriaceae, produces a butyrate esterase . This is capable of breaking the ester linkage between butyryl groups and carrier molecules . B . caviae and B . ovis, which are rarely encountered in pathological specimens, also produce butyrate esterase . This property can be used as a rapid test in the identification of B . catarrhalis . The recently reported rapid test for butyrate esterase relies on the release of methylumbelliferate, which can be detected only by using UV light after 5 min of incubation . In the rapid test described here, indoxyl is liberated from indoxyl butyrate by butyrate esterase and spontaneously forms indigo in the presence of oxygen . B . catarrhalis can be distinguished from other oxidase-positive, gram-negative cocci after 2.5 min by inoculating the organism onto a filter paper strip containing this compound.

Mol Microbiol, 1989 Jun, 3(6), 777 - 86
Expression and phase variation of gonococcal P.II genes in Escherichia coli involves ribosomal frameshifting and slipped-strand mispairing; Belland RJ et al.; Expression and phase variation of Neisseria gonorrhoeae P.II genes in Escherichia coli were studied using TnphoA fusions . Fusions were created in the P.IIc gene of N . gonorrhoeae JS3 using lambda TnphoA-1 and were characterized by restriction digestion and dideoxy sequencing . Three fusions were chosen for further study; Tnp7 (fusion junction at mature amino acid 7), Tnp57 (amino acid 57), Tnp66 (amino acid 66) . All fusions were in frame with the P.IIc coding sequence but were out of frame with the purported initiation codon . All fusion constructions were shown to phase vary in E . coli in an analogous fashion to that seen in N . gonorrhoeae, i.e . phase changes (in a recA background) at a frequency of c . 10(-3) accompanied by an alteration at the DNA level of the number of coding repeats (CRs) . In vitro mutagenesis of the fusion constructions indicated that expression of out of frame P.II genes in E . coli was probably the result of ribosomal frameshifting within the run of 'A' residues immediately preceding the CR region and not due to low-level false initiation at codons other than the ATG initiation codon (as had previously been suggested) . The mechanism for P.IIc::phoA phase variation appears to be related to the 'slipped-strand mispairing' mechanism responsible for frameshift mutations in a number of other bacterial genes containing short, direct, tandem repeats.

Cutis, 1989 Jun, 43(6), 599 - 601
Mupirocin (2 percent) ointment in the treatment of primary and secondary skin infections; Odom RB; Mupirocin (2 percent) ointment is a unique topical agent recently developed for use in the treatment of superficial skin infections . It has shown excellent in vitro and in vivo activity against gram-positive staphylococci and streptococci, which are the predominant pathogens in most superficial skin infections, and against gram-negative Hemophilus influenzae and Neisseria gonorrhoeae . At present, mupirocin (2 percent) ointment has been approved for use in the treatment of impetigo, but an analysis of several recent clinical trials has also indicated the potential for mupirocin treatment of other primary and secondary skin infections . Furthermore, because mupirocin apparently has fewer adverse effects than systemic antibiotics, is less expensive, easier to administer, and less likely to induce antibiotic resistance, it should be considered as an alternative to oral agents in the antimicrobial therapy of a variety of primary and secondary skin disorders.

J Exp Med, 1989 Jun 1, 169(6), 2199 - 209
The construction and characterization of Neisseria gonorrhoeae lacking protein III in its outer membrane; Wetzler LM et al.; Protein III (PIII) is a highly conserved, antigenically stable gonococcal outer membrane protein that is closely associated with the major outer membrane protein, protein I (PI) . We have previously reported the cloning of the PIII gene . This gene was inserted into the Eco RI site of the runaway plasmid pMOB45 . The beta-lactamase (beta la) Bam HI restriction fragment from the gonococcal plasmid pFA3 was inserted at the Xba I site in the PIII gene . The plasmid construct was Hae III methylated and the PIII/beta la insert was excised with Eco RI and used to transform gonococcal strain F62 . One beta la+, ampicillin-resistant transformant was isolated and designated 2D . A Western blot of 2D whole cell lysate was probed with affinity-purified polyclonal PIII antisera . No PIII reactivity was detected . Southern blot analysis was performed on F62 and 2D chromosomal DNA that were cut with Eco RI or Cla I . A PIII DNA probe hybridized with fragments 2.2 kb larger in strain 2D than strain F62 . This corresponds to the size of the beta la insert . A beta la-specific probe hybridized with the same 2D restriction fragments as above, but did not react with any F62 fragments, confirming that homologous recombination had occurred . There were minimal phenotypic changes between 2D and its parent strain, F62 . Chromosomal DNA from 2D was able to transform gonococcal strains F62, UU1, and Pgh 3-2, rendering these PIII- . 2D and other PIII- transformants can now be used to study the role of PIII in gonococcal physiology, metabolism, membrane structure, and pathogenesis . Moreover, we now have organisms from which we can purify gonococcal proteins without PIII contamination.

J Gen Microbiol, 1989 Jun, 135 ( Pt 6), 1735 - 45
Specific Neisseria gonorrhoeae DNA-probes derived from ribosomal RNA; Rossau R et al.; Eighteen sequences complementary to less-conserved regions within the 16S and 23S ribosomal ribonucleic acid (rRNA) of Neisseria gonorrhoeae were subcloned or chemically synthesized and used as probes in a dot-spot deoxyribonucleic acid (DNA): DNA hybridization format . Some of these probes exclusively detected Neisseria gonorrhoeae nucleic acid, whereas others also showed hybridization signals with nucleic acid from other bacterial species . Our results indicate that rRNA-derived DNA-probes can be used to differentiate between very closely related taxa without the use of Southern-blot analysis.

Med Clin (Barc), 1989 May 27, 92(20), 765 - 8
{Study of the antimicrobial sensitivity, auxotype, serotype and plasmid analysis of 75 strains of Neisseria gonorrhoeae isolated in Barcelona}; Baro T et al.; The sensitivity of five antimicrobials (penicillin, cefoxitin, tetracycline, ceftazidime and spectinomycin) was assayed in 75 Neisseria gonorrhoeae strains, isolated from May 1986 to December 1987 in a general hospital in Barcelona . Auxotype, serotype and plasmid analysis studies were also performed on these strains . Twenty-six (34%) penicillinase-producing strains were found . 49% of the non-penicillinase-producing strains showed intermediate resistance to penicillin and 12% were resistant with MIC greater than 1 mg/1 . 6% were resistant to tetracycline and cefoxitin, respectively, and all were sensitive to ceftazidime and spectinomycin . All the penicillinase-producing strains had the plasmid Africa and three of them had a diffuser plasmid of 24.5 mD . With regard to the auxotype study, most of the strains were prototrophic (38%) followed by the proline dependent ones (38%) . 64% of the penicillinase-producing strains belonged to the serogroup W I, while 77% of the non-penicillinase-producing strains were in the W II/III serogroup.

Z Hautkr, 1989 May 15, 64(5), 388, 391 - 2
{Chlamydia infections in dermatology}; Hartmann AA; The serovares D-K of Chlamydia trachomatis (CT) are associated with inclusion conjunctivits, non-gonoccoccal urethritis (NGU), post-gonoccoccal urethritis (PGU), epididymitis, and ensuing male infertility . CT can be isolated from testicular tissue, in sexually acquired reactive arthritis (SARA) and in proctitis . Female partner infection primarily involves the cervix with ascending infection and ensuing infertility . Asymptomatic CT infection of the urogenital tract does not only present epidemiological problems, but also calls for smear examination in the asympotomatic partner . Double infection with CT and Neisseria gonorrhoeae is not necessarily followed by PGU . Incomplete detection of CT must be taken into account especially after application of penicillin and in the isolation procedures from sperm . The serovares L1-L3 are the infectious agents in venereal lymphogranuloma . Tetracyclines and erythromycin are usually recommended as the therapy of choice in CT infection . Sulfonamides should be applied with caution, since resistent CT isolates have been made known . There is still further clinical study required regarding the efficacy of quinolines in urogenital infections with chlamydiae.

Z Hautkr, 1989 May 15, 64(5), 403 - 5
{The modern diagnosis of gonorrhea}; Kohl PK; Modern identification of Neisseria gonorrhoeae may be either accomplished by direct detection of gonococcal antigen, i.e . without microbiological culturing, or, following culturing, by rapid culture confirmation . The direct detection of gonococcal antigen in an enzyme immuno-assay (Gonozyme) shows reduced specifity especially with mixed microbial flora, and decreased sensitivity with small numbers of organisms . Culture confirmation may be achieved by a rapid sugar degradation test (API----quadFERM+), by specific enzyme detection using chromogenic substrates (Gonochek II), or by demonstration of protein I specific for Neisseria gonorrhoeae by means of monoclonal antibodies (Mikrotrak, Phadebact monoclonal GC, Gonogen II) . Detection of protein I is highly sensitive and specific in both the tests of immunofluorescence and coagglutination.

Am J Ophthalmol, 1989 May 15, 107(5), 511 - 4
Treatment of gonococcal conjunctivitis with single-dose intramuscular ceftriaxone; Haimovici R et al.; We treated 13 consecutive patients with culture proven Neisseria gonorrhoeae conjunctivitis with single-dose intramuscular injections of ceftriaxone . Pretreatment conjunctival cultures and Gram stains were obtained from all patients . The patients were admitted for antibiotic administration, a single conjunctival saline lavage, and follow-up conjunctival cultures six and 12 hours after treatment . Three of 13 organisms (23%) were penicillinase producing . All patients responded to treatment, and all six- and 12-hour posttreatment cultures were negative for N . gonorrhoeae . These results indicate that a single intramuscular dose of ceftriaxone is curative treatment for non-neonatal gonococcal conjunctivitis.

West J Med, 1989 May, 150(5), 543 - 4
Chlamydia trachomatis and Neisseria gonorrhoeae in asymptomatic family planning patients in rural New Mexico; Bell TA et al.; We tested 98 asymptomatic women seen in state-funded contraception clinics in rural New Mexico . A fluorescein-conjugated monoclonal antibody stain revealed Chlamydia trachomatis infection in 25% of asymptomatic unmarried women and 3% of married women (P = .03) . Neisseria gonorrhoeae was detected in only one woman . As in urban clinics providing contraception, the prevalence of gonorrhea is rare in rural New Mexico, but chlamydial infections are common in young unmarried women.

J Gen Microbiol, 1989 May, 135 ( Pt 5), 1101 - 11
Genetic basis of the association of sulphonamide resistance with methionine auxotrophy in Neisseria gonorrhoeae; Catlin BW; Selection by sulphonamides was investigated in Neisseria gonorrhoeae because a sulphonamide-resistant (Sulr), methionine-requiring (Met-) phenotype that was common in the era of sulphonamide therapy became rare in the penicillin era . Cultures of wild-type (SulsMet+) gonococci on a conventional medium containing sulphadiazine (2-10 micrograms ml-1) yielded numerous, nonidentical mutations of two met genes . The requirement of MetI- mutants was satisfied only by methionine, whereas MetII- mutants utilized either homocysteine or methionine . My theory that increased resistance to sulphonamides is a pleiotropic effect of methionine auxotrophy was confirmed by the return of sulphonamide susceptibility in all Met+ spontaneous mutants . Furthermore, the SulrMet- traits were introduced or eliminated together by DNA-mediated transformation . Sulphonamides are known to inhibit dihydropteroate synthase; consequently, they interrupt the entire sequence of reactions in the folate pathway including the methyl group transfer from N5-methyltetrahydrofolate to homocysteine to form methionine . The increased sulphonamide resistance of these Met- mutants is discussed in terms of conservation of the pool of essential tetrahydrofolate derivatives . The ease with which spontaneous forward and reverse met mutations can be obtained is unique among gonococcal genes.

Diagn Microbiol Infect Dis, 1989 May-Jun, 12(3), 271 - 3
Stability of SM-7338, a new carbapenem in mediums recommended for the susceptibility testing of anaerobic bacteria and gonococci; Jones RN et al.; The stability of SM-7338 was compared to that of imipenem in media used for susceptibility testing anaerobic bacteria and Neisseria gonorrhoeae . SM-7338 was more stable in all media than imipenem . For tests with anaerobic bacteria, the broth-disk elution (in thioglycolate) and other methods recommended by the National Committee for Clinical Laboratory Standards can be accurately used for SM-7338 . However, the cysteine content of IsoVitaleX (25.9 g/L) supplement inactivates SM-7338 (20-fold reduction) in gonococcal susceptibility test systems with GC agar base . A cysteine-free supplement would be advised for tests with the carbapenems and clavulanic acid . The SM-7338 disk diffusion test (10 micrograms) results were not significantly influenced by the inactivating substances in the media.

Microb Pathog, 1989 May, 6(5), 343 - 50
Complement binding on serum-sensitive and serum-resistant transformants of Neisseria gonorrhoeae: effect of presensitization with a non-bactericidal monoclonal antibody; Joiner KA et al.; The binding of C3 and C9 on serum sensitive (FA635) and serum resistant (FA638) transformants of serum sensitive Neisseria gonorrhoeae strain F62 was examined . Previous studies showed that these transformants have Protein IAs which are minimally different by proteinase K cleavage and primary structural and peptide mapping and bear LPS which vary slightly on SDS-PAGE . Binding of C3 and C9 on FA635 exceeded binding on FA638 in NHS and in adsorbed NHS . Monoclonal antibody 4G5, which binds to PI on FA638 but not FA635, increases C9 binding on FA638 to levels 3-3.5 fold greater than on FA635 but does not result in killing . The majority of additional 125IC9 deposited on FA638 following presensitization with 4G5 is released from the bacterial surface by trypsin . These results extend our earlier results with N . gonorrhoeae by showing that, although PI monoclonals can lead to substantial deposition of non-bactericidal C5b-9, this C5b-9 is not fully inserted into the gonococcal outer membrane.

Mol Microbiol, 1989 May, 3(5), 663 - 71
Expression of gonococcal protein II in Escherichia coli by translational fusion; Palmer L et al.; A protein II (P.II) gene from Neisseria gonorrhoeae was cloned in Escherichia coli and characterized by DNA sequence analysis . As with other reported P.II sequences, this gene contains an ATG initiation codon which is out of frame with respect to the remainder of the P.II amino acid sequence . A translational fusion was constructed in E . coli which linked the P.II sequence to the signal peptide of beta-lactamase . This P.II fusion differs from the gonococcal protein only in the first seven residues at the N terminus . In E . coli, the P.II fusion product exhibits properties analogous to those of P.II in N . gonorrhoeae . The P.II fusion product is a major component of the E . coli outer membrane and it is exposed on the cell surface . The P.II fusion protein also exhibits the heat-modifiable phenotype of gonococcal P.II.

Mol Microbiol, 1989 May, 3(5), 637 - 43
Topographical alterations in proteins I of Neisseria gonorrhoeae correlated with lipooligosaccharide variation; Judd RC et al.; Four transformant strains of Neisseria gonorrhoeae were generated, two of which (WS3 and WS5) had protein I subclass A (P.IA) and two which (WS2 and WS4) had protein I subclass B (P.IB) . Analysis of the strains demonstrated that the two P.IA-bearing strains differed in lipooligosaccharide (LOS) and H.8 antigen, as assessed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting . The WS5 strain had slow-migrating LOS and H.8 antigen, and the WS3 strain had fast-migrating LOS and H.8 antigen . The P.IB-bearing strains also had either slow-migrating LOS and H.8 antigen (WS4) or fast-migrating LOS and H.8 antigen (WS2) . Structural and exposure analysis revealed that although the P.IAs were identical in the WS3 and WS5 strains, there was a slight alteration of the exposure of the proteins which correlated with altered LOS and/or H.8 antigen . The P.IBs were also shown to be structurally identical, but the LOS and/or H.8 antigen variation in these strains correlated with a more pronounced alteration in the exposure of the P.IB molecules . The differences in protein I (P.I) exposure were generally found in highly negatively charged regions of the molecule, suggesting that the immunogenicity and/or antigenicity of the P.I molecules may vary as a result of LOS and/or H.8 antigen alterations.

J Appl Bacteriol, 1989 May, 66(5), 401 - 5
Comparison of dot blot with in-situ hybridization for the detection of Neisseria gonorrhoeae in urethral exudate; Schoone GJ et al.; Dot blot hybridization and in-situ hybridization with DNA probes prepared from total genomic gonococcal DNA were compared with Gram staining and culturing for the detection of gonococci in urethral exudates . Fifteen of 60 patients were positive by at least one of the four methods . Gram staining and in-situ hybridization scored best with 13 positives but culture and dot blot hybridization yielded only 10 and 9 positives respectively . The failure to detect gonococci in culture can be explained by overgrowth in one case and possibly self medication with ampicillin before culture in another . The in-situ hybridization test is a fast and sensitive hybridization method for the detection of gonococci in urethral exudate from men.

J Clin Microbiol, 1989 May, 27(5), 808 - 11
Comparison of GC-Lect and modified Thayer-Martin media for isolation of Neisseria gonorrhoeae; Reichart CA et al.; A new selective medium, GC-Lect, was compared with modified Thayer-Martin medium (MTM) for isolation of Neisseria gonorrhoeae . Cultures from 620 sexually transmitted disease clinic patients were directly inoculated onto both media, placed in candle extinction jars, and incubated . N . gonorrhoeae was isolated from 175 (29%) of 607 genital cultures, 3 (3%) of 88 pharyngeal cultures, and 6 (29%) of 21 rectal cultures . Ten cultures were positive only on GC-Lect, and 3 were positive only on MTM . In 3 of the 10 cultures positive only on GC-Lect, overgrowth of a Capnocytophaga sp . may have obscured growth on MTM . In this study, vancomycin-susceptible (MIC, less than 4.0 micrograms/ml) N . gonorrhoeae was isolated on both media, and none of the isolates missed by either medium were susceptible to vancomycin . No differences were noted between the two media in time required for isolation of N . gonorrhoeae . While isolation rates of N . gonorrhoeae were similar, suppression of nongonococcal bacterial species by GC-Lect was superior to that by MTM . GC-Lect is equal to MTM for detection of N . gonorrhoeae and is superior for suppression of normal flora.

J Clin Microbiol, 1989 May, 27(5), 1130 - 1
B.CAT CONFIRM, a rapid test for confirmation of Branhamella catarrhalis; Janda WM et al.; B.CAT CONFIRM (Scott Laboratories, Inc., Fiskeville, R.I.), a rapid test for detection of tributyrin hydrolysis, was evaluated for its ability to identify strains of Branhamella catarrhalis and to differentiate them from Neisseria species and related species . On initial testing, B.CAT CONFIRM was positive for 65 (96%) of 68 B . catarrhalis strains within 30 min after inoculation . Retesting of the remaining three strains resulted in their correct identification . B.CAT CONFIRM was negative for all Neisseria spp . (130 strains) and for Kingella spp . (3 strains) . Two of the three Moraxella spp . were weakly positive in the B.CAT CONFIRM after 60 min, but these reactions were easily distinguishable from the strong reactions of B . catarrhalis strains . This test will be helpful in the clinical laboratory for the rapid identification of B . catarrhalis in clinical specimens.

FEMS Microbiol Lett, 1989 May, 50(1-2), 83 - 6
Competition between Neisseria gonorrhoeae and Staphylococcus epidermidis during iron-limited or replete continuous culture; Keevil CW et al.; Neisseria gonorrhoeae strain P9-2 was grown in iron-limited or replete continuous culture at a dilution rate of 0.05 h-1, in the presence and absence of Staphylococcus epidermidis . Gonococci maintained expression of pili (P+) and the transparent colony phenotype in pure culture during transitions of iron- and cystine-limited growth . They competed well with staphylococci during iron-limited co-culture and comprised greater than 95% of the population . Transition to cystine-limited growth allowed the staphylococcus to predominate but the gonococcus did not wash out . Furthermore, the gonococcal opaque colony phenotype (O+), indicating synthesis of outer membrane proteins II, was now expressed . Restoration of iron limitation returned the co-culture to its original composition but with P+O+ gonococci dominating . These results suggest that environments might exist in Man where gonococci can compete successfully with normal indigenous bacteria during infection.

J Infect Dis, 1989 May, 159(5), 900 - 7
Determinants of emergence of antibiotic-resistant Neisseria gonorrhoeae; Hook EW 3rd et al.; Studies were carried out to evaluate the prevalence and risk factors for antibiotic-resistant Neisseria gonorrhoeae infections . Monthly surveillance of gonococcal isolates showed the prevalence of gonococci with high-level, plasmid-mediated tetracycline resistance (TRNG) to be about 15% for three consecutive 6-mo periods . Over the same period, the prevalence of gonococci with chromosomally mediated resistance to penicillin G steadily increased, from 0% to 9% and then to 21% . From April to July 1987, while chromosomally mediated penicillin resistance was rapidly increasing, a more intensive study was conducted . Patients infected with TRNG reported significantly more lifetime sexual partners (P less than .05) but otherwise resembled patients infected with antibiotic-sensitive gonococci . Patients infected with chromosomally mediated penicillin-resistant gonococci differed from other patients . In addition to reporting more lifetime partners (P less than .05), patients with chromosomally mediated penicillin-resistant gonorrhea were more likely to be older (P less than .05) and more often reported past episodes of gonorrhea (P less than .05), greater numbers of recent sexual partners (P less than .05), new sexual partners (P less than .05), prostitute contact (P = .06), and parenteral drug use or sexual partners who were drug users (P = .07) . The introduction of antibiotic-resistant N . gonorrhoeae into communities may be attributable to a subset of patients who practice "risky behaviors" and who could be targeted for disease intervention activities.

J Clin Invest, 1989 May, 83(5), 1472 - 6
Epidemiologic evidence for the development of serovar-specific immunity after gonococcal infection; Plummer FA et al.; We tested the hypothesis that strain-specific immunity occurs after gonococcal infection in a longitudinal study of 227 prostitutes resident in one small community who experienced frequent gonococcal infections . Women were examined and cultured for Neisseria gonorrhoeae at 2-wk intervals . Gonococcal isolates were typed according to protein 1 serovar, auxotype, and beta-lactamase plasmid type, and classified as to serovar and strain . The hypothesis was tested by comparing the predictions of the hypothesis with the observations of the study . Over the 14-mo period of the study, major changes in the prevalence of specific serovars were observed in the gonococcal population infecting these women . Women with HIV infection experienced a higher rate of gonococcal infection (0.56 +/- 0.03 vs . 0.46 +/- 0.04, P less than 0.05, t test) compared with HIV-negative women and were more likely to experience multiple infections with the same strain . The duration of prostitution was inversely related to the frequency of gonococcal infection . Women experiencing an infection with a specific gonococcal serovar were at a 2- to 10-fold reduced risk of reinfection with the same serovar, except for the 1B-1 serovar . The results of the study were consistent with all four predictions of the hypothesis . Infection with a specific gonococcal serovar results in specific but incomplete protection against subsequent infection with the homologous serovar . The mechanism of this protection remains to be determined.

J Bacteriol, 1989 May, 171(5), 2499 - 505
Export and intercellular transfer of DNA via membrane blebs of Neisseria gonorrhoeae; Dorward DW et al.; Naturally elaborated membrane bleb material is frequently observed in cultures of Neisseria gonorrhoeae . This material was purified and analyzed for protein, lipopolysaccharide, and nucleic acid content . The electrophoretic protein profiles of two bleb-rich fractions, called BI and BII, were distinct, with only BII containing lipopolysaccharide and outer membrane proteins I and III . Both fractions contained RNA, circular DNA, and linear DNA . Exogenous pancreatic DNase I appeared to hydrolyze all bleb-associated DNA in fraction BI and the linear DNA in fraction BII . The circular DNA molecules associated with fraction BII resisted digestion . Electron microscopy of the bleb fractions verified their DNA content . Fixing blebs with glutaraldehyde before mounting them for microscopy prevented release of internal DNA . Such fixation produced little change in the micrographs of BI; however, only traces of DNA were observed in fixed BII preparations . Incubation of wild-type gonococci in mixtures of DNase and blebs purified from antibiotic-resistant strains resulted in efficient exchange of penicillinase-specifying R plasmids . Recipients incorporated plasmids independently of endogenous and exogenous chromosomal streptomycin resistance markers . These in vitro results suggest that bleb formation by N . gonorrhoeae may serve to transfer plasmids intercellularly in vivo, perhaps constituting a previously unexplored genetic exchange mechanism in these bacteria.

J Clin Microbiol, 1989 May, 27(5), 1045 - 9
Comparison of isolates of Neisseria gonorrhoeae causing meningitis and report of gonococcal meningitis in a patient with C8 deficiency; Del Rio C et al.; We studied a previously healthy 20-year-old woman who presented with gonococcal meningitis . The gonococcal isolate, HT-1, was prototrophic by auxotyping, was protein I serovar IB-1, and agglutinated with wheat germ lectin . This isolate differed from the proline-requiring, serovar IA-1 and IB-4, wheat germ-agglutination-negative gonococcal isolates recovered from three patients during a recent outbreak of gonococcal meningitis in Philadelphia . HT-1 was killed by normal pooled human sera (greater than or equal to 98% at 30 min) but not effectively killed by the convalescent-phase sera of the patient (greater than 30% survival at 30 min) . Similar results were obtained when mucosal and cerebrospinal fluid isolates from a Philadelphia patient were exposed to these sera, but mucosal and blood isolates from another Philadelphia case showed increased resistance to killing by normal pooled human sera . Further characterization revealed multiple differences in outer membrane and cellular proteins and lipopolysaccharide between case isolates . Absence of the L8 lipopolysaccharide epitope was noted for all isolates . Sera of our patient were found to have low total hemolytic complement (CH100 = 21 U/ml; normal = 55 to 100 U/ml) due to deficiency of C8 (C8 less than 1,000 CH50 U/ml; normal = greater than or equal to 16,000 CH50 U/ml) . This is the first reported case of gonococcal meningitis occurring in a patient with a terminal-complement deficiency . Gonococcal meningitis is a rare complication of gonococcal bacteremia . Both defects in host defenses (e.g., terminal-complement deficiency) and organisms with unusual virulence appear to contribute to the pathogenesis of this complication of gonococcal bacteremia.

JAMA, 1989 Apr 28, 261(16), 2357 - 61
Localized outbreak of penicillinase-producing Neisseria gonorrhoeae . Paradigm for introduction and spread of gonorrhea in a community; Handsfield HH et al.; In King County, Washington, penicillinase-producing Neisseria gonorrhoeae infections increased from 0.8% of reported cases of gonorrhea in 1986 to 6.8% of cases in the third quarter of 1987, then stabilized at 2.7% to 3.6% of cases . Of 268 penicillinase-producing N gonorrhoeae isolates tested, 159 (59%) belonged to a single clone, as evidenced by auxotyping, protein-I serotyping, plasmid analysis, and antimicrobial susceptibility testing . As this strain spread, the predominance of cases shifted from whites to blacks and from men to equal numbers of men and women . The proportion of cases associated with illicit drug use rose steadily from 19% in the first quarter of 1987 to 82% in the fourth quarter . Sixty percent of cases occurred in prostitutes or recent sexual contacts of prostitutes . These results suggest that core gonorrhea transmitters in King County are predominantly black illicit drug users, prostitutes, and their sexual partners . These are priority target populations for behavioral intervention and other measures to control the spread of all sexually transmitted diseases, including human immunodeficiency virus infection.

Nature, 1989 Apr 20, 338(6217), 651 - 2
Reassortment of pilin genes in Neisseria gonorrhoeae occurs by two distinct mechanisms; Gibbs CP et al.; Phase and antigenic variation of pilin expression in Neisseria gonorrhoeae result from recombination events in which variant sequences from one of the silent loci (pilS) are transferred to the expression locus (pilE) . Such rearrangements were originally thought to be gene conversions, but findings showing that phase variation is partially inhibited by DNase I, that piliated (P+) cells are highly competent for DNA uptake and that gonococci readily undergo autolysis in culture, led to the suggestion that pilin variation occurs through transformation by exogenous DNA . We have developed a simple method for the selection of non-piliated (P-) cells and have evaluated naturally occurring P+ to P- transitions . Two primary pathways of pilin variation can be distinguished--transformation-mediated recombination, which is influenced by culture conditions and inhibited by DNase I, and intragenomic reciprocal recombination, which is unaffected by DNase I . Furthermore, we demonstrate that both piliated and revertible P- cells are competent for DNA uptake, an essential prerequisite of the first pathway.

Br J Obstet Gynaecol, 1989 Apr, 96(4), 473 - 7
Infection with Chlamydia trachomatis and Neisseria gonorrhoeae in women with lower abdominal pain admitted to a gynaecology unit; Scott GR et al.; One hundred and sixty-five women admitted to a gynaecology unit with lower abdominal pain were screened for infection with Neisseria gonorrhoeae and Chlamydia trachomatis by members of a department of genitourinary medicine . C . trachomatis alone was detected in 21 patients . N . gonorrhoeae alone was isolated from five patients, and dual infection was present in six patients, giving a total of 32 (19%) patients in whom a sexually transmitted disease (STD) was diagnosed . The combination of an endocervical swab placed in Amies transport medium for gonococcal isolation and an endocervical slide for immunofluorescent detection of chlamydiae proved to be a simple and accurate method of screening for STD . As a result of contact tracing, 16 sexual partners of women in whom STD was detected were examined . Three cases of gonococcal and nine cases of non-gonococcal urethritis were diagnosed . None of the sexual partners had symptoms suggestive of genitourinary infection.

Neurologia, 1989 Apr, 4(3), 82 - 7
{Infectious meningitis in the adult: 3-year clinical experience}; Martinez-Martin P et al.; In order to establish the epidemiologic features of infectious meningitis in the adult population in our environment, the experience of the Department of Neurology of the Hospital del Rey during the 3-year period, from 1984 to 1986, has been analyzed . Three-hundred-ninety episodes were handled, of which, 51% were acute bacterial meningitis, 45% were acute lymphocytic meningitis, 26% were tuberculous meningitis, 1% were brucellar meningitis and 0.5% were due to Candida albicans . Acute bacterial meningitis predominated in winter, whereas acute lymphocytic meningitis predominated in summer (p less than 0.001) . Forty-seven percent of acute bacterial meningitis were due to Neisseria meningitidis and 14.5% of acute lymphocytic meningitis with virologic study, were due to Herpesviridae . The mortality rate of acute bacterial meningitis was 8.5% and that of tuberculous meningitis was 10% . In order to emphasize the importance of these processes, the main epidemiologic data are compared with that of other studies.

Singapore Med J, 1989 Apr, 30(2), 167 - 9
Endocervical chlamydial infection in women attending a sexually transmitted disease clinic in Singapore; Lim KB et al.; Two hundred women attending the sexually transmitted disease (STD) clinic at Middle Road Hospital were investigated . Chlamydia trachomatis was isolated from 32% of women who were contacts of men with nongonococcal urethritis, 15% of contacts of gonococcal urethritis, 27% of contacts of unspecified STD, and 13% of women without any history of STD in their sex partners . Overall, Chlamydia trachomatis was isolated from 17% of 200 women, Neisseria gonorrhoeae from 13% of 199 women, Candida albicans from 34% and Trichomonas vaginalis from 6% of 197 women . Three per cent of the patients had positive VDRL results . A history of bilateral lower abdominal pain and the presence of cervicitis were significantly associated with chlamydial infection . Forty one per cent of the 34 chlamydia-positive women were asymptomatic . The results of this study show that C . trachomatis infection is more common than infection with N . gonorrhoeae in women who attend STD clinics . The need for routine screening and treatment on the basis of epidemiological and clinical markers of infection has to be carefully examined.

Singapore Med J, 1989 Apr, 30(2), 164 - 6
Endocervical chlamydial infection in female contacts of patients with nongonococcal urethritis; Lim KB et al.; Eighty-five female contacts of patients with nongonococcal urethritis attending Middle Road Hospital were examined . Chlamydia trachomatis was isolated from the cervix in 39% of them . Forty-five per cent of the chlamydia-positive patients were asymptomatic and 79% of them showed signs of a cervicitis . None of the patients developed complications . Neisseria gonorrhoeae was not isolated from any of the patients . Clinical markers other than cervicitis are not useful for detecting chlamydial infections in female contacts of NGU . Until such time when cheaper, more convenient and accurate methods of laboratory diagnosis of C . trachomatis are put to routine use, it would seem prudent to treat all female contacts of NGU patients after exclusion of other sexually transmitted diseases.

J Clin Microbiol, 1989 Apr, 27(4), 654 - 6
Poor performance of BACTEC NR 730 blood culture system in early detection of Neisseria meningitidis; Schnur ER et al.; During an 8-month period at Children's Hospital, Oakland, Calif., a 9% rate for positive blood culture for children with Neisseria meningitidis meningitis was identified . The blood culture system used in each case was the BACTEC NR 730 . This rate seemed significantly lower than previous rates (33 to 55%) (P.R . Dodge and M.N . Swartz, N . Engl . J . Med . 272:1003-1010, 1965; A.L . Hoyne and R.H . Brown, Ann . Intern . Med . 28:248-259, 1948; S . Levin and M.B . Painter, Ann . Intern . Med . 64:1049-1057, 1966) . The low rate prompted our study . With 14 test strains, anaerobic and aerobic BACTEC bottles were evaluated for their ability to support and detect the growth of N . meningitidis . Sodium polyanetholesufonate (SPS) and inoculum size, two factors thought to affect the growth of N . meningitidis, were controlled for by use of bottles with and without SPS and by inoculum sizes simulating the magnitudes of bacteremia previously described for children infected with N . meningitidis (L.J . La Scolea, Jr., D . Dryja, T.D . Sullivan, L . Mosovich, N . Ellerstein, and E . Neter, J . Clin . Microbiol . 13:478-482, 1981) . BACTEC failed to detect growth in aerobic bottles after 6 h of incubation, while 76 of 80 bottles (95%) showed growth when subcultured . At 24 h, BACTEC detected growth in only 29 of 80 bottles (36%); when subcultured, all 80 cultures grew confluently . At 48 h, BACTEC detected growth in the remaining 53 bottles . BACTEC failed to detect growth in anaerobic bottles at 6 h and at 1, 2, 4, and 5 days of incubation despite growth in subculture . Subcultures from bottles with tryptic soy broth with and without SPS showed growth in 63 to 76 bottles in 6 h and in all bottles after 24 h . The presence of SPS in BACTEC bottles had no effect on growth detection . On the basis of these studies and our clinical experience, we find the NR 730 system to be insensitive and unsuitable for detection of N.meningitidis in </= 24h . However, all test strains were detected after 48h.

Antimicrob Agents Chemother, 1989 Apr, 33(4), 569 - 72
Antibacterial activity of trospectomycin (U-63366F) and initial evaluations of disk diffusion susceptibility tests; Barry AL et al.; The in vitro activities of trospectomycin sulfate were compared with those spectinomycin against 632 aerobic microorganisms, including 66 Neisseria gonorrhoeae isolates . Against species other than gram-negative bacilli, trospectomycin was about 4- to 16-fold more active than spectinomycin . For disk diffusion tests, a 30-micrograms disk is recommended, with tentative zone size breakpoints of less than or equal to 13 mm for resistance (MIC, greater than or equal to 64 micrograms/ml) and greater than or equal to 17 mm for susceptibility (MIC, less than or equal to 16 micrograms/ml).

Rev Med Chil, 1989 Apr, 117(4), 406 - 10
{Uncomplicated acute male and female gonorrhea: treatment with a single oral dose of epicillin-probenecid}; Salvo A et al.; We treated 142 patients with acute uncomplicated gonorrhea with a single oral dose of epiciline-probenecid . All cases were confirmed by culture on Thayer Martin medium at the first day and they were all laboratory tested seven days after treatment . At the control time the patients were asked about drug tolerance . All isolated strains were tested for beta-lactamase producing capacity and susceptibility to epiciline and penicillin . All patients who were culture positive seven days after treatment were considered to be treatment failures . The treatment was effective in 94.4% and we detected 8 Neisseria gonorrhoeae strains resistant to penicillin (5.6%); seven of these were PPNG strains . Tolerance to the drug was excellent in 90% of all cases; 9% presented minor adverse reactions for a short period of time . Therefore, the combination of epiciline-probenecid is a valid alternative for routine treatment of acute uncomplicated gonorrhea.

Enferm Infecc Microbiol Clin, 1989 Apr, 7(4), 206 - 9
{Type TEM beta-lactamase activity in a Neisseria meningitidis strain}; Roy C et al.; We studied the beta-lactamase activity characteristics of a penicillin G resistant N . meningitidis strain (MIC = 8 micrograms/ml) isolated from a septicemic process, in an eleven month old girl, attended in the Sabadell Hospital (Barcelona) . The beta-lactamase substrate profile was broad-spectrum (it hydrolyses penicillin G and cephaloridine) and the nitrocefin hydrolysis was inhibited by clavulanic acid . The analytical isoelectric focusing of the enzyme showed that the isoelectric point of the main band and, the secondary bands, were compatible with those of the type TEM-1 standard enzyme . We also obtained a positive DNA-DNA hybridization with the TEM-1 beta-lactamase (pBR322 plasmid).

J Gen Microbiol, 1989 Apr, 135 ( Pt 4), 851 - 63
Influence of iron-limited and replete continuous culture on the physiology and virulence of Neisseria gonorrhoeae; Keevil CW et al.; Neisseria gonorrhoeae strains P9-2 (PenS) and KW2 (PenR) were grown in chemostats of nonferrous design at constant growth rate, pH and dissolved oxygen tension . Iron limitation (micromax 0.1 h-1) was imposed by omitting iron salts from the defined medium and titrating increasing concentrations of the non-metabolizable iron chelators ovotransferrin and Desferal, to progressively decrease the growth yield . Metabolic activity during iron limitation was very high, with a qGlc which was 2- or 11-fold greater than during cystine- or glucose-limited growth, respectively . More aspartate and isoleucine were metabolized during cystine-limited growth, while more glutamate, proline and serine were metabolized during glucose- or iron-limited growth . Significant concentrations of alanine or valine were excreted during cystine- or glucose-limited growth, respectively . Iron-limited growth of an initial inoculum of non-piliated, transparent colony-forming (P-O-) gonococci resulted in the selection of 100% piliated bacteria . Initial inocula of P+O- gonococci retained this phenotype for over 100 generations . Iron-limited gonococci were extremely virulent in the guinea-pig subcutaneous chamber model and inocula of even 12 bacteria grew rapidly and persisted . By contrast, cystine-limited (iron-replete) gonococci retained piliation but did not survive in the chambers . Transition from iron-limited to glucose-limited growth resulted in marked loss of piliation but the bacteria remained virulent . Loss of virulence did not correlate with susceptibility to killing by normal human serum, nor with changes in the content or composition of lipooligosaccharide, which contained 2.9, 3.7, 4.3 and 4.8 kDa moieties . Additional proteins were detectable in Sarkosyl-purified outer membranes of iron-limited gonococci but several proteins with molecular masses similar to those described in the literature for iron-restricted gonococci were detectable in cystine- or glucose-limited bacteria.

Cent Afr J Med, 1989 Apr, 35(4), 367 - 71
Antimicrobial susceptibility of Neisseria gonorrhoeae isolated from maternal and child infections in Harare . The Puerperal Sepsis Study Group; Mason PR et al.; The in vitro antimicrobial susceptibilities of 29 PPNG and 26 non-PPNG isolated from women and neonates in Zimbabwe were investigated . There was evidence of chromosomal resistance to penicillin in many of the non-PPNG strains, with over 60 percent of all isolates having an MIC greater than 1 mg/litre . Reduced susceptibility to tetracycline was evident in about 20 percent of PPNG strains, particularly those containing the 4.4Md plasmid, while over 10 percent of non-PPNGs showed partial resistance to cefuroxime . Less than half of the strains were susceptible to erythromycin (MIC50 greater than 0.5 mg/litre) while all were susceptible to kanamycin and spectinomycin . PPNG containing the 3.2 Md plasmid were very susceptible to thiamphenicol (MIC50 0.25 mg/litre), while other strains were only moderately susceptible (MIC50 2 mg/litre) . These findings suggest that penicillin, tetracycline or erythromycin may no longer be relied on for the successful treatment of gonococcal infection in women and babies . Thiamphenicol, Blactamase stable cephalosporins, kanamycin or spectinomycin may be useful alternatives, effective against most strains of both PPNG and non-PPNG . Continued surveillance is recommended to monitor changes in this susceptibility pattern.

Genitourin Med, 1989 Apr, 65(2), 86 - 91
Associations between serotype and susceptibility to antibiotics of Neisseria gonorrhoeae; Woodford N et al.; A serological classification scheme for Neisseria gonorrhoeae was used to investigate the epidemiological associations between gonococcal serotype and other bacterial and host characters . Six hundred and fifty clinical isolates of non-penicillinase producing N gonorrhoeae from the Praed Street Clinic, St Mary's Hospital, were included in this study . The strains collected represented 41 serovars, although 485 (75%) of the 650 strains belonged to five serovars . Strains of serovar IA-1/2 were commonly isolated from the cervix and tended to be sensitive to penicillin and moderately resistant to erythromycin . Strains of serovar IB-1 showed bimodal patterns of susceptibility to both penicillin and erythromycin and were obtained equally from all anatomical sites . Strains of serovar IB-2 were isolated more often from the rectum and were associated with homosexually acquired infections, whereas those of serovar IB-3 were sensitive to erythromycin and were rarely isolated from the rectum . Strains of IB-5/7 were more resistant to penicillin and erythromycin than strains of other serovars . The serological classification of N gonorrhoeae is thus a powerful tool that may be used to study biological characteristics of the gonococcus, such as susceptibility to antimicrobials and site tropism.

Mol Gen Genet, 1989 Apr, 216(2-3), 380 - 7
Nucleotide sequence and genetic organization of the NgoPII restriction-modification system of Neisseria gonorrhoeae; Sullivan KM et al.; The NgoPII restriction endonuclease, which recognizes the sequence 5'-GG decreases CC-3', differs from its isoschizomer HaeIII in being sensitive to methylation at the external cytosine residue . The entire nucleotide sequence of a cloned 3.3 kb segment of Neisseria gonorrhoeae strain P9 chromosomal DNA which harbours the NgoPII restriction-modification system has been determined . This data, coupled with sub-cloning experiments, indicates that the restriction endonuclease (R.NgoII) and modification (M.NgoII) genes are transcribed from separate promoters but are arranged in tandem, with the R.NgoPII gene being located on the 5' side of the M.NgoPII gene . Unlike all previously reported restriction systems the 3' end of the endonuclease open reading frame overlaps the 5' end of the methylase open reading frame by 8 codons . This overlap may have implications for the regulation of the NgoPII restriction-modification system.

Sex Transm Dis, 1989 Apr-Jun, 16(2), 91 - 4
Transfer frequency of various 25.2 Mdal tetracycline resistance plasmids in Neisseria gonorrhoeae; Roberts MC et al.; We examined ten Neisseria gonorrhoeae strains, all of which carried the tetracycline resistant 25.2 Mdal plasmid, for their ability to act as donors in conjugation . All strains transferred the 25.2 Mdal plasmid and tetracycline resistance to the recipient N . gonorrhoeae strain F62 at a frequency that ranged from 10(-2) to 10(-7) per recipient . The four strains carrying the beta-lactamase plasmid and the 25.2 Mdal plasmid transferred the beta-lactamase plasmid at a frequency of 10(-6) to 10(-8) per recipient . The results indicate that most of the N . gonorrhoeae strains carrying the 25.2 Mdal plasmid can act as donors of this plasmid and can also mobilize the transfer of the 3.2 Mdal plasmid and the 4.4 Mdal plasmid to recipient strains.

Sex Transm Dis, 1989 Apr-Jun, 16(2), 79 - 83
Frequency in the United States of non-beta-lactamase-producing strains of Neisseria gonorrhoeae possessing the 24.5-Mdal conjugative plasmid; Knapp JS et al.; We characterized 475 non-beta-lactamase-producing gonococcal isolates from five U.S . cities by auxotype, serovar, and plasmid content to determine the frequency of isolates with the 24.5-Mdal gonococcal conjugative plasmid . A total of 150 (32%) of all isolates possessed the 24.5-Mdal plasmid; these isolates represented between 10% and 53% of isolates from each city . Isolates possessing the 24.5-Mdal plasmid belonged to 45 (56%) of 81 auxotype/serovar (A/S) classes, or between 24% and 70% of the A/S classes isolated in each city . Overall, a higher proportion of strains isolated in the southern cities possessed the 24.5-Mdal plasmid than did those from northeastern or northwestern cities . These strains appear to have spread independently of the spread of beta-lactamase-producing Neisseria gonorrhoeae strains . The prevalence of N . gonorrhoeae strains with the 24.5-Mdal conjugative plasmid has increased substantially and may have important implications for the epidemiology of gonorrhea caused by beta-lactamase-producing strains.

Sex Transm Dis, 1989 Apr-Jun, 16(2), 57 - 9
Comparison of the QuadFERM+ 2-hr identification system with conventional carbohydrate degradation tests for confirmatory identification of Neisseria gonorrhoeae; Gradus MS et al.; The QuadFERM+ (Analytab Products, Plainview, NY) rapid identification system was evaluated for its ability to identify correctly Neisseria gonorhoeae isolates from specimens obtained at a sexually transmitted disease clinic . One hundred eighty-five isolates (115 N . gonorrhoeae, 45 Neisseria meningitidis, 16 Neisseria species, and nine Branhamella catarrhalis; fresh isolates, frozen stock cultures, and cultures referred from local health agencies) were tested with the QuadFERM+ system and conventional biochemical tests . The two discrepant results were obtained with QuadFERM+, for a lactose-positive isolate of Neisseria sicca and a maltose-positive N . meningitidis . Both were negative by conventional sugar degradation tests . The N . sicca was negative when repeated in the QuadFERM+, and the N . meningitidis reverted from maltose-positive to maltose-negative after 3 hr . Twelve beta-lactamase positive organisms (six N . gonorrhoeae plus six B . catarrhalis) and 173 beta-lactamase-negative organisms showed 100% agreement between the acidometric QuadFERM+ beta-lactamase test and the conventional starch-iodine method . Thus the QuadFERM+ is a rapid and acceptable alternative for the identification of N . gonorrhoeae in a sexually transmitted disease clinic.

Sex Transm Dis, 1989 Apr-Jun, 16(2), 118 - 21
A reappraisal of the epidemiology of phenotypes of Neisseria gonorrhoeae; Bell TA et al.; We analyzed published data from studies of the epidemiology of gonococcal auxotype/serovar phenotypes in Seattle and King County, Washington; Denver, Colorado; and Miami and Dade County, Florida, to determine whether the numbers of new phenotypes were within the ranges of numbers predicted from previous observations in the same populations . For this analysis, we used the model of Fisher and Good and Turing . In all the analyses, the observed number of new species was within the 95% confidence region for the expected number . In contrast to the original interpretation of the data--that phenotypes of Neisseria gonorrhoeae pass through the human population in waves, our analysis is compatible with random sampling of a larger population of gonococcal phenotypes . This suggests that transmission of gonorrhea is sustained as much by failure to cure core-group transmitters as by failure to prevent introductions from other populations.

Sex Transm Dis, 1989 Apr-Jun, 16(2), 114 - 7
Single dose enoxacin for the treatment of uncomplicated urogenital gonorrhea; Albrecht LM et al.; Enoxacin, a new broad spectrum azaquinolone, has demonstrated in-vitro activity against Neisseria gonorrhoeae including penicillinase producing strains . We evaluated the safety and efficacy or oral enoxacin 400 mg versus intramuscular ceftriaxone 250 mg for the treatment of uncomplicated genital N . gonorrhoeae infections . Of the 57 patients enrolled, 48 patients (26 men, 22 women) were culture positive and returned for the follow up visit . Six patients (12.5%) had penicillinase producing strains of N . gonorrhoeae, and eleven patients (23%) had concomitant Chlamydia trachomatis infections . Genital gonorrhea was eradicated in 98% of the patients, with a cure rate of 22/23 (96%) in the enoxacin group and 25/25 (100%) in the ceftriaxone group . There were no consequential side effects noted for either agent . Oral enoxacin is a safe and efficacious alternative for the treatment of uncomplicated N . gonorrhoeae infections.

J Clin Microbiol, 1989 Apr, 27(4), 632 - 5
Evaluation of a prototype DNA probe test for the noncultural diagnosis of gonorrhea; Granato PA et al.; A prototype, nonisotopic, chemiluminescent DNA probe test called the Gen-Probe PACE (Probe Assay-Chemiluminescence Enhanced) system for Neisseria gonorrhoeae (Gen-Probe, San Diego, Calif.) was compared with conventional Martin-Lewis culture medium in JEMBEC plates for the laboratory diagnosis of gonorrhea . This 2-h noncultural assay is based upon the use of an acridinium ester-labeled DNA probe . The rRNA-directed DNA probe hybridizes with the target rRNA, and the hybridized probe is separated from the unhybridized probe through the use of magnetic microparticles . The esterified acridinium is hydrolyzed from the hybridized probe by the addition of an alkaline hydrogen peroxide solution, resulting in the production of visible light which is measured in a luminometer . The amount of light generated is directly proportional to the amount of gonococcal target rRNA present in the sample . A total of 407 clinical specimens (203 urethral and 204 endocervical) were collected from high-risk walk-in patients attending a sexually transmitted disease clinic . Separate patient specimens were collected for culture on Martin-Lewis medium in JEMBEC plates and for DNA probe assay . Statistical analysis of the overall comparative results showed that the DNA probe assay had a sensitivity, specificity, and positive and negative predictive values of 93, 99, 97, and 99%, respectively, in a patient population with a gonococcal disease prevalence of 21% . The results of this comparative study showed that the prototype chemiluminescent DNA probe assay is a rapid and reliable noncultural alternative for the laboratory diagnosis of gonorrhea.

APMIS, 1989 Apr, 97(4), 347 - 50
The in vitro activity of norfloxacin, ofloxacin and ciprofloxacin and other antibiotics in current use against Neisseria gonorrhoeae; Melby K et al.; One hundred non-beta-lactamase-producing and 50 beta-lactamase-producing strains of Neisseria gonorrhoeae serogroup WI and WII/III were tested in vitro by an agar dilution method against a panel of antibiotics including ciprofloxacin, ofloxacin and norfloxacin . All strains irrespective of beta-lactamase production and serogroup allocation, were inhibited by 0.125 mg/l of all quinolones . Ciprofloxacin turned out to be most active followed by ofloxacin and norfloxacin . All strains were also inhibited by low concentrations of cefotaxime (MIC less than 0.25 mg/l) . Many strains mostly among the beta-lactamase-producing strains were resistant (MIC greater than 4 mg/l) to doxycycline . Ampicillin is still active against the majority of non-beta-lactamase-producing strains . The majority of the strains belonged to serogroup WII/III which are known to be less sensitive to penicillin G and ampicillin.

APMIS, 1989 Apr, 97(4), 343 - 6
Pyrimidine 5'-nucleosidase in Neisseria meningitidis . An enzyme specific for uridine 5'-monophosphate; Jyssum S; A previously unknown pyrimidine 5'-nucleosidase (pyrimidine 5'-nucleotide phosphoribohydrolase) specific for uridine 5'-monophosphate (5'-UMP) was present in crude extract from Neisseria meningitidis . Of seven strains, six were found to degrade the N-glycosidic linkage of 5'-UMP . One strain showed negligible activity . The substrate was quantitatively converted to uracil and ribose 5'-phosphate (R5P) . Cytidine 5'-monophosphate (5'-CMP) or the 2-deoxy 5'-monophosphates of the pyrimidine nucleosides (5'-dUMP, 5'-dCMP, 5'-dTMP) were found not to be degraded . Neither was uridine 3'-monophosphate (3'-UMP) degraded by extracts from the three strains selected for this test.

J Am Board Fam Pract, 1989 Apr-Jun, 2(2), 123 - 5
Neisseria gonorrhoeae dissemination and gonococcal meningitis; Anan TJ et al.; Disseminated infection is a serious complication in approximately 2 percent of primary gonococcal infections . Meningeal infection is very rare; only 23 cases have been reported since 1922 . We report a sexually active teenager with an acute febrile illness . From her cerebrospinal fluid cultures, Neisseria gonorrhoeae was identified . She recovered completely after treatment with ceftriaxone and penicillin . Possible explanations for gonococcal dissemination include unique strains of the organism as well as particular complement deficiencies of the host . Aggressive efforts by physicians to prevent, identify, and treat primary gonococcal diseases should continue because this will reduce the frequency of serious complications.

Infect Immun, 1989 Apr, 57(4), 1025 - 9
Genetic diversity of penicillin G-resistant Neisseria meningitidis from Spain; Mendelman PM et al.; Genotypic and phenotypic diversity among 16 penicillin G-resistant (Penr) isolates of Neisseria meningitidis recovered from human blood or cerebrospinal fluid in Spain was compared with that among 12 penicillin-susceptible (Pens) isolates by the use of multilocus enzyme electrophoresis, serotyping, auxotroph testing in chemically defined media, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis of penicillin-binding proteins (PBPs) . Thirteen distinctive multilocus enzyme genotypes (electrophoretic types {ETs} ) were identified among the 28 isolates . There was slightly less genetic diversity among the eight ETs of Penr isolates (H = 0.385) than among the eight ETs of Pens isolates (H = 0.431) . Cluster analysis demonstrated two distinctive complexes of ETs and one ET that was not closely related to either complex . The possibility of a singular clonal origin of penicillin G-resistant isolates was excluded by the observations that resistance occurred in isolates of each of the two distantly related complexes of ETs, that three of the four ETs represented by multiple isolates included both susceptible and resistant strains, and that serotypes and growth requirements were not associated with the resistance phenotype . The 28 isolates showed a relatively homogeneous pattern of four PBPs, with apparently reduced penicillin G binding by PBP 3 of the Penr isolates.

Microb Pathog, 1989 Apr, 6(4), 251 - 64
Immunization of guinea pigs with epitope C-rich lipopolysaccharide from Neisseria gonorrhoea; in vivo selection of gonococcal variants; Senior KE et al.; The immunogenic potential of lipopolysaccharide (LPS) of a variant of Neisseria gonorrhoeae strain Gc 40 selected by growth in vivo (vivo variant) was investigated in guinea pigs . LPS extracts obtained from the water (WLPS) and the phenol (PLPS) phases of a hot phenol-water extraction were compared for their antigenic capacity and protective effect against infection in subcutaneous chambers . Immunization with PLPS induced significant levels of anti-LPS and anti-epitope C antibodies but WLPS was not antigenic . Two days after challenge, all guinea pigs immunized with WLPS had infections similar to those seen in unimmunized control animals while most animals immunized with PLPS and challenged with either 10(3) or 10(5) gonococci per ml showed low numbers of or no viable gonococci in their chambers . Five days after challenge, however, the same animals had chamber infections with high viable counts similar to controls . Gonococci reisolated from three such animals had physically and antigenically altered lipopolysaccharide and showed patterns of serum sensitivity to pre-challenge chamber fluid from immunized animals which were different from those of the parent vivo variant used for immunization and challenge . The results demonstrate that selection of LPS variants occurs in vivo . This could constitute an immune evasion mechanism.

Z Hautkr, 1989 Mar 15, 64(3), 218 - 22
{Immunobiologic aspects of Neisseria gonorrhoeae}; Kohl PK; Surface structures of Neisseria gonorrhoeae (NG), which can mediate properties of virulence like adhesion and inflammation, try to escape the human immune response with the help of their highly variable antigenicity . In addition there are surface-exposed structures, like protein 1, which have relatively constant antigenetical powers and are likely to play an important part in both the uptake of nutrients and the infection process . Protein 1 shows no intrastrain and only limited interstrain variability . Anti-protein 1 monoclonal antibodies have gained practical significance with regard to serotyping and detection of NG in clinical specimens . Conserved epitopes of pilin and protein 1 may serve as the basis of a gonococcal vaccine.

Rev Infect Dis, 1989 Mar-Apr, 11(2), 299 - 309
Role of ceftriaxone in sexually transmitted diseases; Le Saux N et al.; Ceftriaxone is a third-generation cephalosporin with antibacterial and pharmacokinetic characteristics that make it an excellent choice for the treatment of gonococcal infection and chancroid . Adverse effects are unusual . Clinical efficacy in all reported studies has been excellent . Additional studies are required for further elucidation of the role of ceftriaxone in the treatment of pelvic inflammatory disease and syphilis . Chlamydial infections are not altered by ceftriaxone, and additional treatment is necessary if Chlamydia is present concurrently with Neisseria gonorrhoeae.

Rev Infect Dis, 1989 Mar-Apr, 11(2), 246 - 54
Epidemiology of sexually transmitted diseases in rape victims; Glaser JB et al.; Rape is a violent crime that is increasing rapidly in incidence . Victims can include male and female adults and children . These victims may be at risk for the acquisition of many sexually transmitted conditions . The risk will vary with the sex and socioeconomic status of the assailant as well as with the nature of the sexual contact . Infections with Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, herpes simplex virus, human papillomavirus, and Treponema pallidum have all been found to occur following sexual assault of female adults or children . Although data are lacking, male victims of homosexual rape are presumably at risk for the acquisition of the above infections as well as hepatitis B, the acquired immunodeficiency syndrome, and other infections prevalent among homosexual men . All victims of sexual assault should undergo a comprehensive physical examination with a complete history . Baseline and follow-up laboratory tests should be performed . In some instances, prophylactic administration of antimicrobial agents may be warranted.

Mol Microbiol, 1989 Mar, 3(3), 429 - 35
The biochemical basis for growth inhibition by L-phenylalanine in Neisseria gonorrhoeae; Bhatnagar RK et al.; Clinical isolates of Neisseria gonorrhoeae are commonly subject to growth inhibition by phenylpyruvate or by L-phenylalanine . A blockade of tyrosine biosynthesis is indicated since inhibition is reversed by either L-tyrosine or 4-hydroxyphenylpyruvate . Phenylalanine-resistant (PheR) and phenylalanine-sensitive (PheS) isolates both have a single 3-deoxy-D-arabino-heptulosonate 7-phosphate (DAHP) synthase that is partially inhibited by L-phenylalanine (80%) . However, PheS and PheR isolates differ in that the ratio of phenylpyruvate aminotransferase to 4-hydroxyphenylpyruvate aminotransferase is distinctly greater in PheS isolates than in PheR isolates . A mechanism for growth inhibition is proposed in which phenylalanine exerts two interactive effects . (i) Phenylalanine decreases precursor flow to 4-hydroxyphenylpyruvate through its controlling effect upon DAHP synthase; and (ii) phenylalanine is largely transaminated to phenylpyruvate, which saturates both aminotransferases, preventing transamination of an already limited supply of 4-hydroxyphenylpyruvate to L-tyrosine.

Can J Microbiol, 1989 Mar, 35(3), 409 - 15
Comparative analysis of the transferrin and lactoferrin binding proteins in the family Neisseriaceae; Schryvers AB et al.; Intact cells of several bacterial species were tested for their ability to bind human transferrin and lactoferrin by a solid-phase binding assay using horseradish peroxidase conjugated transferrin and lactoferrin . The ability to bind lactoferrin was detected in all isolates of Neisseria and Branhamella catarrhalis but not in isolates of Escherichia coli or Pseudomonas aeruginosa . Transferrin-binding activity was similarly detected in most isolates of Neisseria and Branhamella but not in E . coli or P . aeruginosa . The expression of transferrin- and lactoferrin-binding activity was induced by addition of ethylenediamine di-o-phenylacetic acid and reversed by excess FeCl3, indicating regulation by the level of available iron in the medium . The transferrin receptor was specific for human transferrin and the lactoferrin receptor had a high degree of specificity for human lactoferrin in all species tested . The transferrin- and lactoferrin-binding proteins were identified after affinity isolation using biotinylated human transferrin or lactoferrin and streptavidin-agarose . The lactoferrin-binding protein was identified as a 105-kilodalton protein in all species tested . Affinity isolation with biotinylated transferrin yielded two or more proteins in all species tested . A high molecular mass protein was observed in all isolates, and was of similar size (approximately 98 kilodaltons) in all species of Neisseria but was larger (105 kilodaltons) in B . catarrhalis.

J Med Microbiol, 1989 Mar, 28(3), 199 - 204
Identification and comparative analysis of the lactoferrin and transferrin receptors among clinical isolates of gonococci; Lee BC et al.; Neisseria gonorrhoeae expresses receptors for both lactoferrin (LF) and transferrin (TF) . To determine whether qualitative or quantitative changes in these receptors, or both, correlate with the pattern of disease due to N . gonorrhoeae, a dot binding assay with whole cells was used to measure the absolute receptor levels expressed during iron-limited growth of strains isolated from asymptomatic patients and patients with urethritis, cervicitis, pelvic inflammatory disease and disseminated infection . Lactoferrin and transferrin receptor complexes were purified by affinity chromatography and their protein profiles were compared . The molecular weights of the LF and TF receptor complexes from a representative sample of gonococci were homogeneous . We conclude that there is no relationship between the LF and TF receptor levels and disease manifestation, auxotype or serotype.

J Antimicrob Chemother, 1989 Mar, 23(3), 335 - 9
Conjugal transfer of penicillin resistance plasmids to proline-citrulline-uracil dependent strains of Neisseria gonorrhoeae; Mavrommati L et al.; Proline-, citrulline-, uracil (PCU)-dependent Neisseria gonorrhoeae represented only 2% of all Neisseria gonorrhoeae isolated in Greece during 1984-1987 . We investigated whether these strains could be recipients of gonococcal plasmids . We carried out bacterial conjugation experiments and obtained the transfer of the African (3.2 Mdal) and of the Asian (4.5 Mdal) penicillin resistance plasmid from clinical penicillinase producing N . gonorrhoeae (PPNG) isolates to PCU gonococcal strains . The transfer frequency was very low, which suggests an explanation of the fact that the wild type PCU strains do not harbour either of these two plasmids . The conjugative plasmid of 24.5 Mdal was not transferred to any of the transconjugants carrying either the African or the Asian type plasmids.

Eur J Obstet Gynecol Reprod Biol, 1989 Mar, 30(3), 263 - 74
Second look laparoscopy; evaluation of two different antibiotic regimens after treatment of acute salpingitis; Brihmer C et al.; In order to have their diagnoses verified, etiology determined and treatment evaluated, 64 patients with suspected acute salpingitis (AS) underwent laparoscopy during which specimens were taken . The patients were referred to groups of either a mild (16/64), a moderate (26/64), or a severe (22/64) form of salpingitis . They were then randomized to one of two groups for treatment with either doxycycline/bensylpenicillin-procain (DC/BP) or trimethoprim-sulfamethoxazole (TMP-SMZ) . The results were evaluated by second-look laparoscopy 3-6 months later when adhesions and tubal passage were looked for . Isolates from the cervix were culture positive for Chlamydia trachomatis (CT) in 36/64 (56%) (9/16 with a mild form, 13/26 with moderate form and 14/22 with a severe form of salpingitis) . Neisseria gonorrhoeae (NG) was isolated from the cervix in 15/64 (23%) (5/16 with a mild form, 4/26 with a moderate form and 6/22 with a severe form of the disease) . Oviductal cultures for CT were found in 12/64 (19%) (1/16 with a mild form, 4/26 with a moderate and 7/25 with severe form of salpingitis) . Oviductal isolates for NG were found in 2/64 (13%) (2/16 from the group with a mild form of the disease) . Second-look laparoscopy revealed totally occluded oviducts in two patients from the group with a severe form of salpingitis (one from each treatment group).

Enferm Infecc Microbiol Clin, 1989 Mar, 7(3), 140 - 3
{In situ hybridization with DNA probe for the diagnosis of Neisseria gonorrhoeae infections}; Palomares JC et al.; A comparative study of a DNA probe for the detection of Neisseria gonorrhoeae with Gram stain and modified Thayer-Martin medium was performed . The probe was the 2.6 megadaltons (Mda) cryptic plasmid of N . gonorrhoeae, labeled with a nonradioactive system combining sulphonation of DNA with the antibody detection of sulphonated groups (Organics Chemiprobe) . Overall 101 samples were evaluated: 39 urethral exudates, 3 rectal exudates, and 59 cervical exudates, from 42 males and 54 females in whom gonococcal infection was suspected . Simultaneously, Gram stain and culture of the several exudates were carried out . The in vitro sensitivity of the method was evaluated with different dilutions of N . gonorrhoeae, from 1 to 1000 cfu/ml, and a minimum of 50 cfu/ml were detected . In the detection of N . gonorrhoeae in clinical samples, there was a 100% sensitivity and a specificity of 83% (males) and 79% (females), with positive predictive value of 97% in males and 53% in females . The negative predictive value was 100% both for males and females.

J Commun Dis, 1989 Mar, 21(1), 41 - 5
Nasopharyngeal, vaginal and anal carriage of Neisseria meningitidis in Nigeria; Gugnani HC et al.; The incidence of carriers of Neisseria meningitidis was investigated in Borno State, an epidemic area for cerebrospinal meningitis and in Anambra State a non-epidemic area for this disease in Nigeria . The nasopharyngeal carriage rate in Maiduguri in Borno State was 18 per cent as compared with 11.8 per cent and 9.6 per cent in Nsukka and Enugu respectively in Anambra State . N . meningitidis was also isolated from anus and vagina in one and three females respectively . Majority of the isolates (71.9 per cent) belonged to serogroup B . The rare group x was recorded on two occasions . Majority of the isolates were sensitive to tetracycline, streptomycin and chloramphenicol; a few multiple drug resistant strains were also encountered.

J Commun Dis, 1989 Mar, 21(1), 24 - 6
An outbreak of meningitis caused by Neisseria meningitidis Group A; Annapurna ME et al.; During a period of six months from September, 1985 to March, 1986, there were twenty seven cases of pyogenic meningitis due to Neisseria meningitidis Group A . Maximum number of cases could be diagnosed by antigen detection by latex agglutination test . The organism was sensitive to all commonly used antibiotics . The patients affected were mostly young adults . The mortality rate was eleven per cent.

Southeast Asian J Trop Med Public Health, 1989 Mar, 20(1), 147 - 51
A penicillinase test incorporated in the rapid carbohydrate fermentation method for rapid detection of beta-lactamase producing Neisseria gonorrhoeae; Lesmana M et al.; A modification of the acidometric (phenol red) test for penicillinase producing N . gonorrhoeae was incorporated into the rapid fermentation method for rapid screening and identification of PPNG strains . Two hundred and twenty-four non-penicillinase-producing N . gonorrhoeae, 55 penicillinase-producing N . gonorrhoeae, 87 N . meningitidis and 89 N . lactamica were included in this study . Results of the modified test were comparable with the iodometric and penicillin disk diffusion susceptibility and were obtainable within 1 to 5 minutes.

Diagn Microbiol Infect Dis, 1989 Mar-Apr, 12(2), 129 - 32
Identification of Neisseria gonorrhoeae with the ORTHOProbe DNA probe test; Kuritza AP et al.; We evaluated and compared the ORTHOProbe DNA hybridization test (Ortho Diagnostic Systems, Inc., Raritan, NJ) with conventional carbohydrate fermentation and commercial rapid tests for identifying gonococci (GC) . The ORTHOProbe system employs a biotinylated DNA probe that hybridizes specifically with chromosomal target sequences of GC . Hybridization is detectable visually following the addition of a streptavidin-peroxidase conjugate in a rapid 10-min . assay . A total of 200 clinical isolates resembling Neisseria (gram-negative, oxidase-positive diplococci) cultured from various sites were tested . The ORTHOProbe test reacted strongly with all GC (94) and not with nongonococcal organisms (106), yielding a sensitivity and specificity of 100% . The ORTHOProbe system provides a convenient and reliable test for identifying Neisseria gonorrhoeae.

Mol Cell Probes, 1989 Mar, 3(1), 59 - 72
The specificity of pilin DNA sequences for the detection of pathogenic Neisseria; Kolberg JA et al.; A nucleic acid hybridization assay for the detection of the pilin gene of Neisseria gonorrhoeae has been devised . The method involves solution hybridization of pilin specific synthetic oligonucleotide probes to genomic DNA in crude cell lysates . This is followed by capture of the probe-target complex onto a microtitre dish well, signal amplification and labelling based on horseradish peroxidase conjugated to oligonucleotides . Detection is achieved with a chemiluminescent enzyme substrate . With a detection limit of about 20,000 cells, the 4-h assay is as sensitive as a radioactive dot-blot method . Over 150 strains of Neisseria gonorrhoeae collected from a variety of sources were detected with the assay . Several N . meningitidis serogroups were also found to react positively . No reactivity was observed with non-pathogenic Neisseria spp . or with other known pathogenic or normal microbial inhabitants of the human urogenital tract.

Mol Cell Probes, 1989 Mar, 3(1), 13 - 26
Isolation of a species-specific DNA probe for Neisseria gonorrhoeae using a novel technique particularly suitable for use with closely related species displaying high levels of DNA homology; Donegan JJ et al.; The use of nucleic acid probes has become an increasingly common method for detecting pathogenic micro-organisms in clinical specimens . In the course of our efforts to isolate species-specific DNA probes for bacterial pathogens, we encountered a special problem with regard to Neisseria gonorrhoeae . As a consequence of the high degree of DNA homology that this organism displays with its nearest relative, Neisseria meningitidis, the isolation of such probes could not be readily achieved . We therefore developed a novel method of probe isolation which overcomes this problem . This methodology relies upon the application of a 'sandwich' hybridization assay to screen an M13 'shotgun' library derived from N . gonorrhoeae genomic DNA . For this, genomic DNA from N . gonorrhoeae and N . meningitidis was immobilized on nitrocellulose filters and probed with recombinant phage DNA from candidate clones . Those clones which had hybridized to target sequences were then detected using labelled vector sequences in a second hybridization step . By this means we obtained a numerical assessment of the degree of specificity of candidate clones for the target organism as compared to one or more related species . Using this technique we have isolated three DNA probes which are highly specific for N . gonorrhoeae and which display no cross-reactivity with N . meningitidis or other members of the Neisseriaceae . This paper presents the basis of the methodology and describes the isolation and characterization of three N . gonorrhoeae-like specific probes.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1989 Mar, 270(4), 517 - 26
Monoclonal antibodies to protein I for serotyping of Neisseria gonorrhoeae: correlation of serotype with bactericidal activity; Kohl PK et al.; Seven monoclonal antibodies have been used for the serotyping of one hundred Neisseria gonorrhoeae wild strains, randomly selected from nine U.S . cities, and seven serotype reference strains by the co-agglutination method . As determined by gel-immunoradioassay, the monoclonal antibodies recognized the protein I trimer of a single or a limited subset of serotype reference strains . All but three strains were typable by one or two of the antibodies . The most common serotypes were 1.3 (26%), 1 (20%), 5 (17%), 5.7 (11%) and 9 (10%) . To correlate typing results with ability for killing of these antibodies, susceptibility of typed and non-typed strains to killing was studied . Susceptibility was significantly associated with typing by the serotype 7 (p = 0.011) and serotype 9 (p = 0.033) specific monoclonal antibodies . Reaction of antibodies recognizing epitopes on the protein IB molecule with a given strain predicted in an average of 43% of strains (49% of strains of serotype 5, 62% of serotype 7, 29% of serotype 8, and 33% of serotype 9) its susceptibility to killing by the typing antibodies . In contrast, only 15% of the strains (15% of strains of serotype 1 and 15% of serotype 3) were killed by their typing antibodies, recognizing epitopes on the protein IA molecule . These monoclonal antibodies might prove to be important for the isolation and structural characterization of epitopes responsible for susceptibility of the gonococcus to killing and thus for the development of a vaccine against invasive gonococcal disease.

J Bacteriol, 1989 Mar, 171(3), 1644 - 51
Cloning and organization of seven arginine biosynthesis genes from Neisseria gonorrhoeae; Picard FJ et al.; A genomic library for Neisseria gonorrhoeae, constructed in the lambda cloning vector EMBL4, was screened for clones carrying arginine biosynthesis genes by complementation of Escherichia coli mutants . Clones complementing defects in argA, argB, argE, argG, argIF, carA, and carB were isolated . An E . coli defective in the acetylornithine deacetylase gene (argE) was complemented by the ornithine acetyltransferase gene (argJ) from N . gonorrhoeae . This heterologous complementation is reported for the first time . The carAB operon from E . coli hybridized with the gonococcal clones that carried carA or carB genes under conditions of high stringency, detecting 80% or greater similarity and showing that the nucleotide sequence of the carbamoylphosphate synthetase genes is very similar in these two organisms . Under these conditions for hybridization, the gonococcal clones carrying argB or argF genes did not hybridize with plasmids containing the corresponding E . coli gene . Cocomplementation experiments established gene linkage between carA and carB . Clones complementing a gene defect in argE were also able to complement an argA mutation . This suggests that the enzyme ornithine acetyltransferase from N . gonorrhoeae (encoded by argJ) may be able to complement both argA and argE mutations in E . coli . The arginine biosynthesis genes in N . gonorrhoeae appear to be scattered as in members of the family Pseudomonadaceae.

Am J Med, 1989 Mar, 86(3), 297 - 302
Should women be tested for gonococcal infection of the cervix during routine gynecologic visits? An economic appraisal; Phillips RS et al.; PURPOSE, PATIENTS, AND METHODS: We used decision analysis to calculate the economic implications of routine testing for Neisseria gonorrhoeae infection of the cervix . This study compared performing endocervical cultures in all women seeking routine gynecologic care to a no-test strategy . Estimates derived from the medical literature were varied in a sensitivity analysis, and a Monte Carlo technique was used to incorporate the estimates of experts into the analysis . RESULTS: We found that routinely testing for gonorrhea reduced overall medical costs when the prevalence of infection exceeded 1.5 percent . This result was most sensitive to variation in the cost of the culture and the assumption that treatment prevents adverse sequelae . Reducing the estimated cost of the culture from $9 to $5 decreased the threshold prevalence from 1.5 to 0.8 percent . When we considered the variation in estimates of experts, the threshold prevalence increased from 1.5 to 2.1 percent . CONCLUSION: We conclude that a strategy of testing and treating selected women with risk factors for gonorrhea will not only reduce the likelihood of the development of serious adverse sequelae but will also result in a reduction of medical costs.

Infect Immun, 1989 Mar, 57(3), 785 - 90
Energy is required for maximal adherence of Neisseria gonorrhoeae to phagocytic and nonphagocytic cells; Weber RD et al.; The possibility that gonococcal energy might play a role in the interaction of Neisseria gonorrhoeae with both phagocytic and nonphagocytic cells was examined . Respiratory chain inhibitors including KCN and amobarbital resulted in reduction in gonococcal association with human neutrophils . Similar results were seen with HeLa cells and the human promyelocytic (HL-60) cell line . Identical conditions did not affect the opsonin-dependent association of Staphylococcus aureus with the same cell types . New protein synthesis by gonococci did not account for the observed reduction in association . These results suggest that energy is needed for maximal opsonin-independent association of gonococci with mammalian cells.

Cell, 1989 Feb 24, 56(4), 539 - 47
Phase variation of gonococcal protein II: regulation of gene expression by slipped-strand mispairing of a repetitive DNA sequence; Murphy GL et al.; Expression of outer membrane protein II (P.II) of Neisseria gonorrhoeae is subject to reversible phase variation at a rate of 10(-3)-10(-4)/cell/generation . The signal peptide coding regions of P.II genes contain variable numbers of tandem repeats of the sequence CTCTT . Changes in the number of CTCTT units, leading to frameshifting within the gene, are responsible for changes in P.II expression . Phase variation mediated by the CTCTT repeat also occurred in E . coli, as assayed with a P.II-alkaline phosphatase (phoA) gene fusion . Phase variation in both the gonococcus and E . coli was recA-independent, occurred at similar rates, and involved insertions or deletions of one or more repeat units . The characteristics of the phase variation process were consistent with a model in which expression of P.II genes is regulated by slipped-strand mispairing of the DNA in the CTCTT repeat region.

Biochemistry, 1989 Feb 21, 28(4), 1744 - 9
Primary structure of the peptidoglycan-derived tracheal cytotoxin of Bordetella pertussis; Cookson BT et al.; The etiological agent of whooping cough, Bordetella pertussis, destroys the ciliated epithelial cells lining the large airways of infected individuals . This cytopathology can be reproduced in respiratory epithelium by tracheal cytotoxin (TCT), a small peptidoglycan-related molecule purified from the culture supernatant of growing B . pertussis organisms . Using fast atom bombardment mass spectrometry, we analyzed the positive- and negative-ion spectra of the purified, biologically active material and assigned a mass of 921 daltons to TCT . Analysis of fragment ions in these spectra as well as the spectra of the methyl ester and acetylated derivatives of TCT unambiguously defined the primary structure of TCT as N-acetylglucosaminyl-1,6-anhydro-N-acetylmuramylalanyl-gamma- glutamyldiaminopimelylalanine . TCT is therefore identical with the ciliostatic anhydropeptidoglycan monomer released by Neisseria gonorrhoeae and with the neurologically active slow-wave sleep-promoting factor FSu . These and other structurally related glycopeptides containing muramic acid thus form a family of molecules with remarkably diverse biological activities.

Med J Aust, 1989 Feb 20, 150(4), 174 - 7
Chlamydia trachomatis infections--the Royal Women's Hospital experience; Garland SM et al.; During the 18-month period from December 1, 1985 to May 31, 1987 Chlamydia trachomatis was the most-common sexually-transmitted agent to be identified at the Royal Women's Hospital, Melbourne . It was isolated from 4% of all specimens for which such culture was requested and was found five-times more frequently than was Neisseria gonorrhoeae . A review of the clinical presentation and the management of the 100 public patient for this period whose cervical specimens were found to give positive results for the presence of chlamydiae revealed that 77% of the women were less than 25 years of age, 78% of the women were single and 65% of the women were nulliparous . Thirty-five women were asymptomatic carriers of chlamydiae . Of the remaining 65 patients with symptoms, 46% experienced pelvic pain, 39% experienced a vaginal discharge and 26% experienced irregular bleeding . The importance of abnormal bleeding is emphasized . In patients who presented for therapeutic abortions, morbidity occurred in 19% of those who were carriers of Chl . trachomatis; accordingly, screening for chlamydiae as routine is recommended in such patients . Furthermore, because of the risk of pelvic inflammatory disease and its consequences, it is important not only to treat female patients in whom chlamydiae have been isolated, but also to treat and to follow-up their sexual partners simultaneously.

S Afr Med J, 1989 Feb 4, 75(3), 118 - 9
High-level penicillin-resistant gonococcal infections in Port Elizabeth; Meiring JA et al.; The prevalence of penicillin-resistant Neisseria gonorrhoeae in black men with acute urethritis at two clinics for sexually transmitted diseases in Port Elizabeth was assessed during the latter half of 1986 . Gonococcal aetiology was confirmed in 80% of 290 patients . Penicillinase-production was detected in 4.3% culture-positive cases, while intermediate penicillin resistance was demonstrated in another 28 isolates (13.9%) . At least two strains exhibited high-level penicillin resistance without producing beta-lactamase . All isolates tested were susceptible to tetracycline and spectinomycin . The emergence of penicillin-resistant gonococci throughout southern Africa will require new approaches to the treatment of acute urethritis in men.

Am J Obstet Gynecol, 1989 Feb, 160(2), 396 - 402
Oral contraceptive use and the risk of chlamydial and gonococcal infections; Louv WC et al.; Oral contraceptive users were compared with nonusers with respect to the rate of cervical infections by Chlamydia trachomatis and Neisseria gonorrhoeae . The comparison was adjusted for differences in demographic and behavioral characteristics between the two groups . The rates of infection among oral contraceptive users were increased by approximately 70% (statistically significant) for both pathogens . Cervical ectopy was implicated in the increased rate of chlamydia but not gonorrhea . Rates of gonorrheal infection differed significantly among oral contraceptive formulations; rates were higher for formulations containing more androgenic progestinsPIP: The rate of cervical infections by Chlamydia trachomatis and Neisseria gonorrhoeae was compared in 617 oral contraceptive (OC) users and 101 controls who were either IUD users or were sterilized . Study subjects were drawn from an Alabama sexually transmitted diseases clinic; 89% were black and the average age was 23 years . OC use was associated with a 73% increase in chlamydial risk and a 70% increase in the risk of gonococcal infection . The number of sexual partners was positively correlated with the rates of both infections, while age was negatively related . 46% of the OC users compared with 19% of nonusers had cervical ectopy . However, the difference of the effect of ectopy on chlamydia and gonorrhea was not statistically significant between OC users and nonusers . The amount of estrogen in the OC was not associated with ectopy, chlamydia, or gonorrhea . In contrast, gonorrhea rates were higher for women taking OCs that contained norethindrone and norgestrel . Formulations containing the less androgenic progestin, norethindrone acetate, were not associated with increased gonococcal risk . These findings suggest that women using OCs, especially OCs that contain norgestrel, should be screened more aggressively than nonusers of OCs for both gonorrhea and chlamydia .

CMAJ, 1989 Feb 1, 140(3), 297 - 301
Endocervical Chlamydia trachomatis infection in Canadian adolescents; Hughes EG et al.; The highest prevalence rate of sexually transmitted chlamydial infection is among adolescent girls . To determine the rate among predominantly asymptomatic girls who were seen at a pediatric gynecology unit and to identify those at high risk we screened 541 such patients from Jan . 1 to Dec . 31, 1986, by means of direct fluorescent antibody testing; 422 (78.0%) were asymptomatic . The most common reason for presentation was a request for contraceptive advice (the reason for 59.2% of the patients) . Of the 446 patients (82.4%) who were sexually active 66 (14.7%) had evidence of chlamydial infection; none of the 93 sexually inactive patients were infected . Neisseria gonorrhoeae was isolated from eight (1.5%) of the patients . The risk factors that correlated with chlamydial infection were abnormal vaginal discharge, abdominopelvic pain and an abnormal Papanicolaou test result . Because of the high morbidity rate associated with genital chlamydial infection and the high prevalence rate among adolescent girls, most of whom are asymptomatic, all sexually active teenagers should be screened.

Clin Invest Med, 1989 Feb, 12(1), 50 - 60
Quinolones in the treatment of sexually transmitted diseases; Megran DW; Many of the new quinolone-carboxylic acids possess in vitro activity against a variety of sexually transmitted pathogens . Neisseria gonorrhoeae and Hemophilus ducreyi are particularly susceptible to those antimicrobial agents while the in vitro sensitivities of Chlamydia trachomatis and genital mycoplasmas vary widely amongst the quinolones and range from poor to modest . Clinically, single dose therapy with many of the quinolones has been highly effective in curing gonorrhea and appears to be promising in the management of chancroid . In contrast, however, the quinolones (even when used in multiple dose, 7 to 10 day regimens) have been disappointing to date in the treatment of chlamydial and nongonococcal infections . Currently there is little data available with regard to other sexually transmitted diseases but it appears that the quinolones will not be useful in the therapy of syphilis or bacterial vaginosis.

J Bacteriol, 1989 Feb, 171(2), 657 - 64
Transformation-deficient mutants of piliated Neisseria gonorrhoeae; Biswas GD et al.; Seven transformation-deficient mutants of piliated, competent Neisseria gonorrhoeae were isolated by screening them for their inability to be transformed by chromosomal DNA after chemical mutagenesis . Three distinct classes of mutants were obtained, each of which was piliated, as determined by electron microscopy . One class exhibited abnormal colony morphology and was unable to take up DNA into a DNase-resistant state . A second class was morphologically normal and took up DNA into a DNase-resistant state normally, but was deficient in both chromosomal and plasmid transformation; mutations in these mutants may affect entry of DNA into the cell proper . A third class was similar to the second but was fully competent for plasmid transformation, suggesting that there was a defect in a late stage of chromosomal transformation.

J Immunol, 1989 Feb 1, 142(3), 948 - 53
Multiple forms of IFN-beta 2/IL-6 in serum and body fluids during acute bacterial infection; Helfgott DC et al.; Many of the major alterations in plasma proteins characteristic of the hepatic acute phase response are regulated by IFN-beta 2/IL-6 . Using a specific bioassay for IFN-beta 2/IL-6, which relies on the induction of the hepatic acute phase plasma protein alpha 1-antichymotrypsin in the human hepatoma cell line Hep3B clone 2 and its inhibition by anti-rIFN-beta 2/IL-6 antiserum, we have detected high levels of IFN-beta 2/IL-6 in the body fluids of patients with acute bacterial infections . Cerebrospinal fluid from four patients with acute bacterial meningitis (Streptococcus pneumoniae, Staphylococcus aureus, two cases of Listeria monocytogenes) all had high levels of IFN-beta 2/IL-6 (up to 500 ng/ml) . Two of these patients with concomitant bacteremia had lower concentrations of IFN-beta 2/IL-6 in the serum (5 to 70 ng/ml) . Three additional patients with Escherichia coli, Pseudomonas aeruginosa, and Neisseria meningitidis bacteremia had high levels of serum IFN-beta 2/IL-6, as did the ankle fluid of a patient with Streptococcus canis arthritis . Normal cerebrospinal fluid and serum had little detectable IFN-beta 2/IL-6 . A combination of immunoaffinity chromatography and immunoblotting procedures were used to characterize the IFN-beta 2/IL-6 species present in a representative sampling of serum and cerebrospinal fluids . Multiple immunoreactive species of IFN-beta 2/IL-6 in the size range 23 to 30 kDa as well as immunoreactive complexes in the range 60 to 70 kDa were detected in human body fluids . This is the first demonstration that previous descriptions of heterogeneity in human IFN-beta 2/IL-6 species produced in cell culture correspond to observations in the infected host.

J Gen Microbiol, 1989 Feb, 135 ( Pt 2), 353 - 60
The broad-specificity, membrane-bound lactate dehydrogenase of Neisseria gonorrhoeae: ties to aromatic metabolism; Bhatnagar RK et al.; Neisseria gonorrhoeae can convert phenyllactate (PL) to phenylalanine and 4-hydroxyphenyllactate (HPL) to tyrosine . This was demonstrated by nutritional and physiological approaches . The enzymic basis for this unusual ability was shown to be the broad specificity of a particulate, unidirectional, pyridine-nucleotide-independent lactate dehydrogenase . This enzyme, denoted {iLDH}, has been implicated in a pathogenic mechanism whereby host-derived lactate is linked to increased gonococcal oxygen consumption and electron transport . A similar role for HPL, a metabolite available in human host tissues, may provide a selective basis to explain evolution of broadened {iLDH} specificity in Neisseria . The interplay between aromatic metabolism and {iLDH} suggests new approaches for manipulating the host-pathogen relationship.

Mol Microbiol, 1989 Feb, 3(2), 131 - 9
The class 1 outer membrane protein of Neisseria meningitidis: gene sequence and structural and immunological similarities to gonococcal porins; Barlow AK et al.; The class 1 protein is a major protein of the outer membrane of Neisseria meningitidis, and an important immunodeterminant in humans . The complete nucleotide sequence for the structural gene of a class 1 protein has been determined . The sequence predicts a protein of 374 amino acids, preceded by a typical signal peptide of 19 residues . The hydropathy profile of the predicted protein sequence resembles that of the Escherichia coli and gonococcal porins . The predicted protein sequence of the class 1 protein exhibits considerable structural similarity to the gonococcal porins PIA and PIB . Western blot studies also reveal immunologically conserved domains between the class 1 protein, PIA and PIB . A restriction fragment from the class 1 gene hybridizes to gonococcal genomic fragments in Southern blots . In addition to the class 1 gene coding region there is a large open reading frame on the opposite strand.

Antimicrob Agents Chemother, 1989 Feb, 33(2), 233 - 4
Comparison of broth microdilution and agar dilution for susceptibility testing of Neisseria gonorrhoeae; Geers TA et al.; Broth microdilution was compared with agar dilution to test the susceptibilities of 170 clinical isolates of Neisseria gonorrhoeae to several antimicrobial agents . Percents agreement between the two methods within 1 doubling dilution were 98.8% for enoxacin, 94.3% for penicillin G, 93.5% for spectinomycin, and 98.4% for ceftriaxone.

Antimicrob Agents Chemother, 1989 Feb, 33(2), 164 - 6
Susceptibility to cephalosporins of penicillin-susceptible and penicillin-resistant strains of Neisseria gonorrhoeae from Philadelphia; Fekete T et al.; Using agar dilution, we determined MICs of penicillin, cefoxitin, ceftriaxone, cefmetazole, tetracycline, and spectinomycin for 129 strains of Neisseria gonorrhoeae . All strains were susceptible to ceftriaxone (MIC range, less than or equal to 0.008 to 0.06 micrograms/ml) and spectinomycin (16 to 32 micrograms/ml) . The MICs for 50, 90, and 100% of strains tested were 1.0, 2.0, and greater than 8.0 micrograms/ml; 0.12, 1.0, and greater than 8.0 micrograms/ml; 0.5, 1.0, and 2.0 micrograms/ml; and 1.0, 2.0, and greater than 8.0 micrograms/ml for cefmetazole, penicillin, cefoxitin, and tetracycline, respectively . Seven strains were beta-lactamase producers; eight were chromosomally resistant to penicillin . There was a log-linear relation for non-beta-lactamase-producing strains between the MICs of cefmetazole, cefoxitin, and tetracycline and the MIC of penicillin (Pearson r = 0.787, 0.544, and 0.358, respectively).

Am Fam Physician, 1989 Feb, 39(2), 125 - 8
Branhamella catarrhalis infections; Wright PW et al.; Branhamella (Moraxella) catarrhalis is responsible for a significant number of bronchopulmonary infections in adults, as well as otitis media and sinusitis in children . This gram-negative diplococcus is indistinguishable from Neisseria gonorrhoeae on gram-stained smear . Many strains of the organism produce beta-lactamase and are resistant to the penicillins and other beta-lactam antibiotics . When B . catarrhalis is the probable pathogen, a beta-lactamase-resistant antibiotic is the initial drug of choice in both adults and children.

J Clin Invest, 1989 Feb, 83(2), 397 - 403
Interaction of Neisseria gonorrhoeae with classical complement components, C1-inhibitor, and a monoclonal antibody directed against the Neisserial H.8 antigen; Schweinle JE et al.; Strains of Neisseria gonorrhoeae were used to evaluate bactericidal and opsonic properties of McAb 10 directed against the Neisserial outer membrane antigen, H.8 . Gonococci were either serum resistant in the absence but serum sensitive in the presence, of McAb 10, or serum sensitive or serum resistant regardless of the presence of McAb 10 . Strain JS3, which fell in the former category, was used in subsequent studies . C1 zymogen formed by reassociation of isolated C1 subunits was not directly activated by JS3 in the presence or absence of C1-inhibitor . JS3 thus was unable to directly activate the classical pathway independently of antibody . When purified classical pathway components were used to deposit C3 on JS3 in the absence of serum regulatory proteins or antibodies, added C1-inhibitor reduced C3 binding to background levels . When McAb 10 was present, C3 binding was unaffected by C1-inhibitor . Covalently bound, large molecular weight C3 alpha-chain-gonococcal complexes were disbanded by methylamine release of ester linkages . Released 125I-C3 migrated as C3b without degradation by gonococcal proteases . Purified classical components alone or McAb 10 alone facilitated JS3 killing by neutrophils; when combined, the two provided maximal killing . Levels of McAb 10 that only slightly increase C3 deposition on JS3 are bactericidal in serum and maximally opsonic in combination with purified classical pathway components.

Ginecol Obstet Mex, 1989 Feb, 57, 41 - 6
{Etiology of cervicovaginal infection in pregnant and non-pregnant patients}; Narcio Reyes ML et al.; A prospective study to evaluate the prevalence of specific microorganisms in pregnant and nonpregnant women with cervicovaginitis attended at the Instituto Nacional de Perinatologia, was done; Candida sp, Gardnerella vaginalis, Replasma urealitycum, Chlamydia trachomatis, Group B Streptococcus, Trichomonas vaginalis, Neisseria gonorrhoeae were investigated . Two hundred thirty four patients were studied, 105/234 (44.9%) pregnant and 129/234 (55.1%) nonpregnant women, with a mean age of 26.5 years (range 14 to 44 years) . One hundred eighty one (77.5%) women had only one sexual partner . The most common microorganisms seen were Candida sp (31.6%), Gardnerella vaginalis (27.7) and Ureaplasma urealyticum (15.8%) . Infection by Chlamydia trachomatis was documented in 9.8% of the population . Trichomonas vaginalis was identified in 1.7%, there was not any case of Neisseria gonorrhoeae infection . Candida sp and Ureaplasma urealyticum were founded more frequent in the pregnant women than nonpregnant women, 41.9% vs . 24.8% (p less than 0.01) and 20% vs . 12.4% (p less than 0.05) respectively . Group B Streptococci was isolated as a single agent in 4.8% in pregnant women . There were not found any pathogenic microorganisms in 29.9% of the cases, as a causal agent of symptomatic cervicovaginitis.

Genitourin Med, 1989 Jan, 65(1), 14 - 7
Treating genitourinary and pharyngeal gonorrhoea with single dose ceftriaxone; Christophersen J et al.; The efficacy of ceftriaxone 250 mg given as a single intramuscular dose to treat genitourinary and pharyngeal gonorrhoea is compared with the outcome of the Danish standard treatment for uncomplicated genitourinary gonorrhoea, pivampicillin 1.4 g and probenecid 1 g, both given by mouth . The study comprised 327 patients for whom the diagnosis of gonorrhoea was made by microscopy of a methylene blue stained smear at their first visit to the clinic and for whom the diagnosis was later confirmed by culture of Neisseria gonorrhoeae . One hundred and seventy patients with genitourinary gonorrhoea (18 with and 152 without concomitant pharyngeal infection) were treated with ceftriaxone . One hundred and fifty seven (17 with and 140 without concomitant pharyngeal infection) were treated with pivampicillin . One week after treatment N gonorrhoeae was isolated from none of 18, 1/152, (1%), 11/17 (65%), and 6/140 (4%) patients, respectively . At a second attendance two weeks after treatment no further treatment failure was found . During the study period, a further 52 patients with pharyngeal infection (with or without concomitant genitourinary infection) that was shown by culture only were treated with a single intramuscular injection of 250 mg ceftriaxone . No treatment failure was observed in this group . Only minor adverse drug reactions were seen . Ceftriaxone 250 mg as a single intramuscular injection is therefore safe and effective in treating gonorrhoea, including pharyngeal infection.

Suppl Int J Gynecol Obstet, 1989, 2, 13 - 9; discussion 47-8
Sulbactam/ampicillin in the treatment of acute pelvic inflammatory disease; Sweet RL et al.; Acute pelvic inflammatory disease is associated with significant adverse reproductive sequelae . To prevent these serious sequelae, treatment regimens must cover the major etiologic agents which are Neisseria gonorrhoeae, Chlamydia trachomatis, and mixed anaerobic-aerobic bacteria . This report concerns the prospective evaluation of the efficacy of the combination of sulbactam with ampicillin in patients hospitalized with acute pelvic inflammatory disease . Clinical cure was noted in 33 (94%) of 35 patients and post-treatment cultures demonstrated eradication of N . gonorrhoeae and C . trachomatis in all cases.

Dermatol Monatsschr, 1989, 175(7), 443 - 9
{The incidence of genital chlamydial infections in patients of a venereologic consultation clinic}; Breustedt W; Chlamydia trachomatis represents today's most important agent of genital contact infections . It occurs more frequently than Neisseria gonorrhoeae . A prevalence-study of Chlamydia trachomatis (C.t.) and Neisseria gonorrhoeae (N.g.) among venerological out-patients is presented . C.t . was grown in cycloheximide treated McCoy cell culture, N.g . on human blood agar . Our of 551 patients (321 males, 230 females) C.t . was isolated in 17.8%, whereas N.g . was isolated in 8.5% . The isolation rate for males was estimated as 23% for C.t., 12% for N.g., compared to 5% for C.t . and 2% for N.g . in women . Nearly half of gonococcal infections was accompanied by C.t . (men 42.1%, women 55.6%) . Age related, both C.t . and N.g . infections occurred mainly between 21 and 26 years (about 50%) . Infection with C.t . occurred earlier than infections with N.g., 16 years and 18 years respectively . The high prevalence of C . trachomatis infection demand some consequences: 1 . Extensing the number of diagnostic facilities . 2 . Inauguration of new methods (monoclonal antibody-test, enzymimmunoassays) . 3 . Diagnostic and treatment of sexual partner . 4 . Treatment with tetracyclines . 5 . Therapy regiment for gonococcal infection: single high dose penicillin combined with probenicide followed by tetracycline therapy for 7-10 days . 6 . Establishing of a chlamydial diagnostic on a broad base.

Chemotherapy, 1989, 35(4), 296 - 303
Treatment of childhood bacterial meningitis with ceftriaxone once daily: open, prospective, randomized, comparative study of short-course versus standard-length therapy; Kavaliotis J et al.; Fifty-two children were included in this study to evaluate and compare short- versus standard-length ceftriaxone therapy for bacterial meningitis . The duration of the short-course regimens was 4, 6 and 7 days for Neisseria meningitidis, Hemophilus influenzae and Streptococcus pneumoniae, respectively . The standard-length regimens were twice as long . On the basis of a computer-generated randomization list, 26 children were assigned either to the short- or to the standard-treatment regimen . Ceftriaxone was given intravenously once daily in a dose of 60 mg/kg after an initial loading dose of 100 mg/kg . The population characteristics, the severity of disease and the cerebrospinal fluid (CSF) findings were similar in the two study groups at admission . Bacteriological and clinical response were comparable . There were no significant differences in the incidence of neurological complications, prolonged fever (greater than or equal to 10 days), persistent pleocytosis and side effects between the two groups . Hearing loss occurred in 3 patients in the standard-length group and in no patients in the short-course group . Diarrhea was the only side effect and occurred in 14% of the patients . The results of the study indicate that the short-duration regimen was adequate for the treatment of meningitis caused by the three major meningeal pathogens . However, the small number of patients do not justify the adoption of the short-course regimen for all children with meningitis . At present, prolongation of ceftriaxone therapy or discontinuation of the drug under strict clinical observation of the patient should be considered in some cases.

Scand J Infect Dis Suppl, 1989, 60, 66 - 73
A comparison of ciprofloxacin with doxycycline plus metronidazole in the treatment of acute pelvic inflammatory disease; Heinonen PK et al.; We studied the clinical and microbiological response to two treatment regimens in 36 patients with acute pelvic inflammatory disease (PID) . All patients were hospitalized and underwent laparoscopy and endometrial biopsy . Cervical, endometrial, tubal and peritoneal cultures for Chlamydia trachomatis, Neisseria gonorrhoeae, genital mycoplasmas, facultative and anaerobic bacteria and Herpes simplex virus were obtained . The patients were randomly assigned to two treatment groups: 16 women received ciprofloxacin 200 mg b.i.d . iv . for two days, followed by oral administration with 750 mg b.i.d . to complete a 14-day course of treatment . Twenty women received the combination of doxycycline and metronidazole according to a similar scheme of administration . The response was evaluated with repeated clinical examinations, monitoring of the erythrocyte sedimentation rate and serum C-reactive protein concentration, and repeated microbial culture from the cervix . Ciprofloxacin treatment was successful in all nine patients with chlamydial or gonococcal PID and in six of seven with nonchlamydial nongonococcal PID . Doxycycline plus metronidazole regimen was successful in five of seven patients with chlamydial or gonococcal PID and in nine of 13 patients with nonchlamydial nongonococcal PID . Thus, the overall success rate was 94% (15 of 16) with ciprofloxacin and 70% (14 of 20) with doxycycline plus metronidazole . Our study suggests that ciprofloxacin is a promising new alternative for the treatment of acute PID.

Child Abuse Negl, 1989, 13(2), 217 - 24
Vaginal introital diameter in the evaluation of sexual abuse; White ST et al.; Physical objective markers to aid in the diagnosis of sexual abuse are few . We therefore studied 242 females, ages 1 through 12 years, to determine if the vaginal introital diameter is useful in evaluating a child for sexual abuse . The children were divided into three groups: Group I, history of sexual contact and/or Neisseria gonorrhoeae; Group II, no history of sexual contact but at risk; and Group III, nonabused . A vaginal introital transverse diameter of greater than 4 mm was more prevalent among children in Group I (94%) than in Group II, (5%); or in Group III (0%) (chi 2, p less than .001) . Eighty-eight percent of children who complained of penile-vaginal penetration had a vaginal introital diameter greater than 4 mm as compared to 18% of children with no penetration (chi 2, p less than .001) . Forty-six percent of children who complained of fondling with penetration had a vaginal introital diameter of greater than 4 mm as compared to 14% in those without a history of penetration (chi 2, p less than .008) . Fifty-eight percent of children with more than one encounter had a vaginal introital diameter greater than 4 mm as compared to 29% in those with one encounter (chi 2, p less than .006) . In a logarithmic regression analysis, the greatest proportion of children with a vaginal introital diameter greater than 4 mm was observed in the penile-vaginal contact group (chi 2, p less than .00003) . The test is not very sensitive but highly specific . The sensitivity drops precipitously at greater than 5 mm without losing the specificity . A vaginal introital diameter of greater than 4 mm is highly associated with sexual contact in children less than 13 years of age.

J Urol (Paris), 1989, 95(1), 41 - 4
{Acute epididymitis and antibiotherapy . Measurement of the epididymal diffusion of pefloxacin}; Costa P et al.; Acute epididymitis is a common infection in the young sexually active adult . Etiologically, the organisms most frequently found are Chlamydia trachomatis, Neisseria gonorrhea and gram negative bacilli . Pefloxacin is a novel quinolone whose antibacterial spectrum and bactericidal activity allow it to be considered for use in the treatment of orchitis and epididymitis Prior to clinical study the authors investigated the degree of epididymal diffusion of Pefloxacin . Ten subjects underwent extraction of an epididymal sample by direct access to the epididymis through a transverse scrotal incision under peridural anesthesia . Three days before surgery, Pefloxacin was administrated at the rate of 400 mg every 12 hours by the oral route . On the day of the operation, the subject receive a 400 mg infusion over one hour, 2 hours before epididymal biopsy . Blood specimens were also extracted . Pefloxacin assays were performed by HPLC following a method derived from that of Montay . The trough concentration of Pefloxacin inhibiting 90% of sensitive strains (MIC 90) is less than or equal to 2 micro-g/ml . The majority of sensitive organisms have minimum bactericidal concentrations equal to twice the MIC 90 . The epididymal concentrations that the authors measured are situated at values of 8.15 to 21.80 miro-g/g tissue (mean 13.44) . These data allow the use of Pefloxacin to be considered an option in the treatment of epididymitis.

Complement Inflamm, 1989, 6(1), 49 - 64
The complement profile in clinical medicine . Inherited and acquired conditions lowering the serum concentrations of complement component and control proteins; West CD; The serum complement profile of patients with systemic or discoid lupus erythematosus, synovitis, vasculitides, certain recurrent or chronic skin rashes, recurrent or fulminant infections, particularly with Neisseria, may reveal homozygous deficiencies of complement components causally related to the illness . The nephritis of systemic lupus erythematosus (SLE) is often accompanied by a distinctive complement profile which indicates classical pathway activation and which can be used as an index of the success of treatment . In membranoproliferative glomerulonephritis (MPGN), the hypocomplementemia may reflect classical pathway activation in type I, the nephritic factor of the amplification loop in type II, or a nephritic factor activating terminal components in type III . In acute poststreptococcal glomerulonephritis, the cause of the hypocomplementemia is not known but the profile usually differs from that of MPGN or SLE . In these acquired hypocomplementemias, the profile supplements the renal biopsy in providing diagnostic information.

J Pediatr, 1989 Jan, 114(1), 138 - 43
Pelvic inflammatory disease in adolescents; Golden N et al.; Clinical, laboratory, and sonographic data were collected prospectively from 100 female adolescents hospitalized with acute pelvic inflammatory disease (PID) . The endocervical isolation rates for Chlamydia trachomatis and Neisseria gonorrhoeae were 44.7% and 36.4%, respectively . In comparison with adolescents with chlamydia-associated PID, those with gonococcus-associated PID had a shorter duration of pain before admission (p less than 0.05), higher mean maximum temperatures (p less than 0.01), and higher leukocyte counts (p less than 0.01) . Pelvic ultrasound studies showed adnexal enlargement or tubo-ovarian abscess (TOA) in 85.2% of the patients . Of the 88 adolescents in whom adequate sonograms were obtained, 17 (19.3%) had TOA . In 12 of the 17 adolescents, the abscesses were identified sonographically before being diagnosed clinically . With clinical criteria alone, only the leukocyte count and prior history of PID differed significantly between those with TOA and those with uncomplicated PID . These findings support a more liberal use of pelvic ultrasound studies in teenagers with PID . Our high detection rate of C . trachomatis and the difficulty in predicting the cause of the infection in an individual patient support treating all adolescents with PID with agents effective against both C . trachomatis and N . gonorrhoeae.

Comp Immunol Microbiol Infect Dis, 1989, 12(4), 115 - 27
Further data to the aetiology, pathogenesis and therapy of infectious bovine keratoconjunctivitis; Nagy A et al.; Out of a total of 224 bovine eye secretions, 126 Moraxella bovis and 64 Neisseria ovis strains were isolated . The pathogenesis and histological lesions caused by Neisseria ovis have been studied on the eyes of three calves naturally affected with IBK, using electron microscopy . Neisseria ovis caused in 1-12 weeks old calves acute, transient and mostly benign serous conjunctivitis with only slight affection of the cornea . More rarely erosions and even ulceration of the cornea have been observed . Moraxella bovis and Neisseria ovis strains proved nearly unanimously sensitive in vitro to chloramphenicol, neomycin, oxytetracyclin, nitrofurantoin, erythromycin and cefoperazone . Other antibiotics and chemotherapeutics inhibited the growth of these agents only partly or were ineffective . Experimental therapy has been carried out using a single i.m . injection of Terramycin/LA inj . (Pfizer) in a dose of 20 mg/kg body mass, repeated if necessary after 72-96 h . This formulation proved more effective and practical than treatments used earlier.

Bull World Health Organ, 1989, 67(5), 471 - 7
Epidemiology and control of gonococcal ophthalmia neonatorum; Laga M et al.; PIP: Ophthalmia neonatorum is a purulent conjunctivitis in infants less than 30 days old, where the Gram stain of an eye smear shows at least one polymorphonuclear leukocyte per high-power field . The two main causes of the condition are Neisseria gonorrhoea and Chlamydia trachomatis . Gonococcal ophthalmia neonatorum (GCON), however, tends to appear earlier and to be more severe than chlamydial infection . GCON can rapidly lead to blindness . The frequency of GCON is determined by the prevalence of maternal gonococcal infection . In most industrialized countries, the prevalence of gonorrhea in pregnant women is less than 1% . In developing countries, however, prevalence is in the range of 3-15%, with more than 50% of cases caused by penicillinase-producing Neisseria gonorrhoea strains . There is a 30-50% mother-to-newborn transmission rate . Strategies to control GCON include the prevention of gonococcal infection in women of childbearing age, detection and treatment of gonococcal infection in pregnant women, eye prophylaxis in the newborn at birth, and diagnosis and treatment of GCON . Eye prophylaxis by the instillation immediately after birth of either 1% silver nitrate eye drops or 1% tetracycline eye ointment is very effective, reducing the incidence of GCON by 80-95% . The approach is highly cost-effective, especially in high-risk settings .

Dermatol Monatsschr, 1989, 175(3), 163 - 9
{Studies on the detection of antibodies to Neisseria gonorrheae using pilus antigen}; Ziems KD et al.; The formation of antibodies against pilus antigen of strain F-62 was studied by indirect hemagglutination in the sera of 100 patients . The criterion for the diagnosis of gonorrheal disease was a positive culture of Neisseria gonorrhoeae . A positive smear test (staining with methylene blue) was accepted only in a few cases if the chain of infection could be followed completely . Retrospective studies showed that 75% of our patients with gonorrheal disease had antibodies against pilus antigen . The specificity was 91.7% . Attention is drawn to problems involved in evaluating the test results.

J Clin Pathol, 1989 Jan, 42(1), 72 - 6
Class specific antibody response to gonococcal infection; Miettinen A et al.; An enzyme immunoassay was used to determine IgM, IgG, and IgA antibodies to gonococcal pili in 68 patients with uncomplicated gonorrhoea, 35 women with pelvic inflammatory disease, and in 115 normal controls . A clear difference in response rate in all three antibody classes between patients with gonorrhoea and healthy controls was evident . Among women with gonorrhoea, the magnitude of antibody response was higher than among men with gonorrhoea, especially in the IgM class . No major differences were found in the overall distribution of serological findings between women with uncomplicated gonorrhoea and those with gonococcal pelvic inflammatory disease . Among this last group, however, high IgM antibody levels in acute phase sera were significantly associated with the isolation of Neisseria gonorrhoeae in the upper genital tract.

Acta Cytol, 1989 Jan-Feb, 33(1), 11 - 5
Detection of sexually transmitted diseases by urethral cytology, the ignored male counterpart of cervical cytology; Giacomini G et al.; The detection of sexually transmitted diseases by urethral cytology was investigated in 270 men examined by urethral swabbing smears . Each sample was used to prepare a wet mount smear and smears for staining by the Papanicolaou, Gram and methylene blue techniques . A fifth smear was used for direct staining with fluorescein-conjugated monoclonal antibodies for the detection of Chlamydia trachomatis . The smears were examined for cytoplasmic and nuclear changes as well as for pathogenic organisms and inflammatory changes . Infections with Chlamydia trachomatis, Neisseria gonorrhoeae and human papillomavirus (HPV) produced distinctive cytologic patterns similar to those seen in cervicovaginal smears from women . The patterns in candidiasis, trichomoniasis and herpes simplex virus infection were not as diagnostic . Particularly noteworthy were the nuclear alterations, which appeared to be proplastic in HPV infection but retroplastic in Chlamydia infection . The results of this study indicate that urethral cytology would be an invaluable addition in diagnosing sexually transmitted diseases in men, particularly in the case of Chlamydia and HPV infections . The monomorphic structure of urethral columnar epithelium, as compared to the cervical epithelium, seems to result in a clearer and more constant response to pathogenic infections, as seen in the resulting smears.

J Egypt Public Health Assoc, 1989, 64(5-6), 561 - 9
Observations on sexually transmitted diseases in promiscuous males in Djibouti; Fox E et al.; Observations are reported on 7 sexually transmitted diseases in a heterosexual population of 105 promiscuous males in Djibouti, East Africa . Neisseria gonorrhoeae was cultured from urethral swabs from 34 subjects . Six isolates were beta lactamase positive (18%) . High levels of resistance to antimicrobials were noted with penicillin, spectinomycin and cotrimoxazole, while tetracyclines and erythromycin were unvariably effective . Six patients had Chlamydia urethritis, one of whom had concomitant gonococcal urethritis . Half of the sera reacted positive for antibodies to Chlamydia . A total of 31 subjects had a positive treponemal FTA-Abs test; of these, only 14 had a reactive RPR test . Nineteen individuals were positive for HBsAg . One subject had a western blot confirmed HIV-1 infection, while none had antibodies to HIV-2 or HTLV-I.

Chemotherapy, 1989, 35(6), 441 - 8
One-shot treatment of uncomplicated gonorrhoea with third-generation cephalosporins with differing serum half-life . Results of a controlled trial with ceftriaxone and cefotaxime; Korting HC et al.; The highest minimum inhibitory concentrations of ceftriaxone and cefotaxime in 89 analysed Neisseria gonorrhoeae isolates amounted to 0.008 and 0.031 micrograms/ml, respectively . In a randomized controlled trial the single intramuscular injection of ceftriaxone 250 mg and cefotaxime 500 mg cured bacteriologically 35 out of 35, and 29 out of 30 patients, respectively, with uncomplicated gonorrhoea . Facing the different phenotypes of the isolates grown before and after therapy in the case of the non-cured patient within the cefotaxime treatment group, reinfection rather than failure has to be presumed . Postgonococcal urethritis occurred about as often in both groups, the percentage amounting to 24.2 and 28.6%, respectively . If side effects were noted at all, they were considered minor: 4 patients belonging to the first and 3 belonging to the second treatment group complained temporarily about pain at the injection site . Due to the data presented here, ceftriaxone and cefotaxime appear equally effective and safe when used in the dose generally preferred, irrespective of differences in in vitro activity and pharmacokinetic behaviour.

Infection, 1989, 17 Suppl 1, S6 - 10
{Multi-step increase in resistance of Neisseria gonorrhoeae isolates after repeated in-vitro subinhibitory concentrations of second-generation quinolones}; Korting HC et al.; Five recent gonococcal isolates were exposed to subinhibitory concentrations of several antibiotics in vitro 25 times . In the presence of rifampicin all strains quickly became resistant . In the presence of penicillin, enoxacin and ciprofloxacin, antimicrobial susceptibility also decreased . Here development of resistance, however, corresponded to the multi- and not to the one-step type . It seems remarkable that even at the end of the experiments no strain grew at concentrations of ciprofloxacin exceeding 0.064 mg/l . In conclusion, quick development of resistance need not be expected after the introduction of newer quinolones into the therapy of gonorrhoea on a large scale.

Med Lab Sci, 1989 Jan, 46(1), 6 - 10
Fluorescent monoclonal antibody test for the confirmation of Neisseria gonorrhoeae; Moyes A et al.; The Microtrak fluorescein labelled monoclonal antibody test for the culture confirmation of Neisseria gonorrhoeae was evaluated with 157 clinical isolates of oxidase-positive Gram-negative diplococci, including 110 strains of N . gonorrhoeae . Seventy-eight stock cultures of neisseria were tested to confirm the results from clinical samples . The test gave a specificity of 100% and sensitivity of 98% . Only four strains of the rare serovar Behj were non-reactive . As the prevalence of this serovar influences the utility of the test, the rarity of this serovar in different geographical locations is discussed.

Chemotherapy, 1989, 35(2), 105 - 12
Metronidazole and spiramycin therapy of mixed Bacteroides spp . and Neisseria gonorrhoeae infection in mice; Brook I; The in vitro and in vivo activity of metronidazole and spiramycin, used singly or in combination, was tested in the eradication of infection caused by Bacteroides spp . and Neisseria gonorrhoeae alone or in combination . The in vitro tests consisted of determinations of the minimal inhibitory concentrations (MIC), carried out with or without the addition of a constant amount of the other antimicrobials . The MIC of both Bacteroides bivius and Bacteroides fragilis for metronidazole were significantly reduced by the addition of spiramycin (from 0.5 to 0.125 micrograms/ml) . The in vivo tests were carried out in mice and consisted of measurements of the effects of the antimicrobial agents on the bacterial contents of abscesses induced by subcutaneous injection of bacterial suspension . Synergism between metronidazole and spiramycin was noted against Bacteroides spp . in abscesses caused by either Bacteroides spp . alone, or in combination with N . gonorrhoeae . Furthermore, an additional reduction in the number of N gonorrhoeae was noted in mixed infection with Bacteroides that was treated with metronidazole alone . This study demonstrates the in vitro and in vivo efficacy of the combination of metronidazole and spiramycin in the treatment of infections caused by either Bacteroides spp . alone or in combination with N . gonorrhoeae.

Sex Transm Dis, 1989 Jan-Mar, 16(1), 28 - 31
Effectiveness of Gonozyme for detection of gonorrhea in low-risk pregnant and gynecologic populations; Thomason JL et al.; The Gonozyme Diagnostic Kit (Abbott Laboratories, North Chicago, IL) was evaluated in a population at low-risk for gonorrhea . Two hundred seventy-two female patients, consisting of 152 obstetrical patients and 120 gynecologic patients attending a family-planning clinic, were tested for Neisseria gonorrhoeae by use of culture and Gonozyme testing of specimens from the endocervical canal . The average ages were 16.1 years for the obstetric patients and 17.8 years for the gynecologic patients . The overall sensitivity of Gonozyme as compared with culture was 60.8% (57.1% for obstetric patients and 62.5% for gynecologic patients); the overall specificity was 98.4% . An association was observed between the number of colony-forming-units (cfu) per plate and a positive Gonozyme test; specimens with less than 60 cfu/plate usually yielded a negative Gonozyme result . We conclude that Gonozyme is a highly specific test but its low sensitivity as compared with that of culture does not allow it to replace standard culture media for screening of low-risk women for infection with N . gonorrhoeae.

Scand J Infect Dis Suppl, 1989, 60, 58 - 61
Ciprofloxacin versus amoxycillin and probenecid in the treatment of uncomplicated gonorrhoea; Lassus A et al.; In a randomized study 100 patients, 78 males and 22 females, with uncomplicated gonorrhoea were treated with either a single oral dose of 250 mg of ciprofloxacin or a single oral dose of 3 g of amoxycillin and 1 g of probenecid . Three of the gonococcal strains produced penicillinase and, in addition, nine strains had MIC-values of amoxycillin ranging between 0.6 and 1.2 mg/l and five other strains MIC-values higher than 1.2 mg/l . Twenty-two patients had a concomitant infection due to Chlamydia trachomatis . All patients treated with ciprofloxacin were cured, while two patients treated with amoxycillin had treatment failures . Neither treatment regimen had any effect on the chlamydial infections . No adverse effects were observed . It was concluded that ciprofloxacin is the drug of choice in the treatment of uncomplicated infections due to Neisseria gonorrhoeae.

Drugs Exp Clin Res, 1989, 15(1), 33 - 5
Clinical trial of norfloxacin in the treatment of uncomplicated gonococcal urethritis: preliminary report; Cristiano P; Fifteen male outpatients with uncomplicated gonococcal urethritis were treated by a single oral dose of norfloxacin (800 mg) . Fourteen patients completely recovered from infection and a recurrence was noted in only one . Five of the Neisseria gonorrhoeae isolated (33.3%) were penicillin-resistant . However, the extremely low MICs confirm that norfloxacin possesses high antibacterial activity against N . gonorrhoeae . Norfloxacin was well tolerated with only a transient nausea occurring in four patients.

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