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