Neisseria

J Gen Microbiol, 1987 Dec, 133 ( Pt 12), 3393 - 401
Outer membrane protein III of Neisseria gonorrhoeae: variations in biological properties of antibodies directed against different epitopes; Virji M et al.; Monoclonal antibodies (mAbs) have been raised to gonococcal outer membranes . A panel of six mAbs was identified by several criteria as reacting with outer membrane protein III (P.III) . Competitive radioimmunoassays showed that the mAbs could be grouped into three pairs recognizing different epitopes on P.III . These epitopes are equally present on all pathogenic Neisseria . The mAbs demonstrated differing protective effects in model systems . Those directed against one epitope were particularly effective in protecting Chang conjunctiva epithelial cells against gonococcal challenge . mAbs against this epitope and another promoted complement-mediated bactericidal activity, while those directed against the third epitope were ineffective . Thus the biological effects of mAbs directed against P.III vary according to the epitope recognized.

Br Med J (Clin Res Ed), 1987 Nov 28, 295(6610), 1377 - 9
Diagnosis of ophthalmia neonatorum; Winceslaus J et al.; Ninety consecutively seen babies with eye discharge in the first three weeks of life were examined . Four babies had "sticky eyes" with no evidence of ophthalmia and had uniformly negative cultures and test results for antichlamydial antibody; these babies were excluded . Of the 86 babies with ophthalmia neonatorum, Neisseria gonorrhoeae was isolated from eight, Chlamydia trachomatis from 44, other bacteria alone from 20, and 14 had negative cultures . Three babies with negative cultures had longstanding conjunctivitis and had been treated with chloramphenicol eye ointment; all had antichlamydial IgM antibodies, indicating that the conjunctivitis was chlamydial . Hence the total number of babies whose conjunctivitis was chlamydial was 47 . The result of the Gram stained conjunctival smear correlated well with that of culture and final assessment by the microimmunofluorescence test, enabling an immediate presumptive diagnosis to be made of gonococcal, chlamydial, or bacterial conjunctivitis . Prompt and effective treatment of babies was started . Explanation to the mother and contact tracing were carried out when the confirmatory cultures and antibody tests were completed . The Gram stained conjunctival smear is a highly sensitive, specific, and predictive test for the aetiological agent of ophthalmia neonatorum . By virtue of its simplicity and rapidity the test may be useful in developing countries.

An Esp Pediatr, 1987 Nov, 27(5), 339 - 42
{Cortical evoked auditory evoked potentials in a series of patients who had bacterial meningitis during childhood}; Baselga Asensio C et al.; Cortical auditory evoked potentials (CAEP) were recorded from scalp electrodes in 47 patients, who survived to bacterial meningitis in their childhood . CAEP were obtained from 1 month to 8 years after recovering from acute disease . Neisseria meningitidis was the microorganism more frequently isolated from CSF (43.5%) . Exclusively abnormal values in amplitude of CAEP were registered in 15 cases (32%), mainly at the lower tones explored; 14 of them were subjected to conventional audiometric test, which demonstrated unilateral hearing loss only in 2 . No alterations in the latency of P2 wave were seen . We recommend to include CAEP in search of hearing disorders in younger children after recovering from meningitis, since they can detect lesions in cortical-subcortical auditory tracts, which otherwise could go unnoticed.

Antimicrob Agents Chemother, 1987 Nov, 31(11), 1822 - 5
Cefodizime in serum and skin blister fluid after single intravenous and intramuscular doses in healthy volunteers; Korting HC et al.; In gonorrhea therapy, cephalosporins are conventionally administered by intramuscular (i.m.) injection, which rather frequently leads to local side effects . To investigate whether the well-tolerated intravenous (i.v.) injection of cephalosporins may be of comparable gonocidal effect, levels of cefodizime, a new broad-spectrum cephalosporin, in serum and tissue fluid (suction blister and cantharides blister fluid) were determined in six healthy men . Single doses of 1 g of cefodizime were injected i.v . and i.m . according to a randomized crossover design . On i.m . injection the drug was completely bioavailable, and the peak concentration in serum was 75 +/- 8 micrograms/ml . The terminal half-life of serum levels was 2.4 h . Cefodizime concentrations in the blister fluids increased for 1.5 to 3 h after the i.v . dose and for at least 3 h on i.m . administration . The concentrations of non-protein-bound cefodizime in blister fluid already exceeded the MIC for 90% of Neisseria gonorrhoeae strains 10 min after i.v . injection and 20 to 30 min after the i.m . dose . At 6 h after each dose, active concentrations were still present in serum . The results suggest that cefodizime administered i.v . and i.m . has equivalent high cure rates in uncomplicated gonorrhea . This hypothesis should be tested further by a controlled clinical trial . If equivalent, i.v . administration excels because it is better tolerated locally.

Antimicrob Agents Chemother, 1987 Nov, 31(11), 1744 - 9
Effects of different media and methods of inoculum preparation on results of antimicrobial susceptibility testing of Neisseria gonorrhoeae by agar dilution; Dillon JA et al.; The effects of two methods of inoculum preparation (the opacity standard method and a template method) and three different types of media on the penicillin, tetracycline, spectinomycin, and erythromycin MICs for 191 non-penicillinase-producing, 49 penicillinase-producing, and 5 tetracycline-resistant isolates of Neisseria gonorrhoeae were evaluated . Three World Health Organization reference strains (III, V, and VII) were similarly evaluated . Inoculum preparation method did not significantly alter the MIC (i.e., within a twofold dilution) of either susceptible or chromosomally resistant non-penicillinase-producing isolates; MICs achieved by the template method were slightly higher, but these differences were not significant . However, with penicillinase-producing and tetracycline-resistant isolates, the template method, which delivered 10(4) CFU, produced unequivocal MICs (denoting clinical resistance) which were significantly higher than MICs observed with the opacity standard method (inoculum, 10(3) CFU) . With penicillin-, spectinomycin-, and erythromycin-containing medium, addition of hemoglobin to the medium produced lower, though not significantly different, MICs with all isolates as compared with MICs on medium without hemoglobin . Media supplemented with hemoglobin produced higher tetracycline MICs with all isolates, which were significantly different (greater than twofold) from MICs on the same hemoglobin-free media . Changes in auxotype did not alter overall observations concerning the effects of different media and inocula on MICs.

J Infect, 1987 Nov, 15(3), 243 - 5
Septicaemia due to Neisseria lactamica--initial confusion with Neisseria meningitidis; Brown NM et al.; Neisseria lactamica, isolated from a baby with septicaemia, was at first thought to be Neisseria meningitidis, possibly acquired in hospital . Extensive investigation of contacts was made until the O-nitrophenyl-D-galactopyranoside reaction proved positive . Distinction between the two species, easily made in this way, is important both in individual patients and in population surveys.

Am J Obstet Gynecol, 1987 Nov, 157(5), 1122 - 5
Preliminary observations on lactoferrin secretion in human vaginal mucus: variation during the menstrual cycle, evidence of hormonal regulation, and implications for infection with Neisseria gonorrhoeae; Cohen MS et al.; The concentration of the iron-binding protein lactoferrin was measured in vaginal mucus of women throughout the menstrual cycle . Lactoferrin is proposed to limit growth of mucosal pathogens such as Neisseria gonorrhoeae . Lactoferrin concentration in mucus was highest just after menses (62.9 to 218 micrograms/mg of protein) and lowest (3.8 to 11.4 micrograms/mg of protein) just before menses . Overall concentration of mucus protein showed no variation with menstrual cycle, and little lactoferrin was detectable in cell debris . Plasma lactoferrin did not show the variation seen in vaginal mucus . Because of the suggestion of hormonal influence on vaginal lactoferrin, its concentration was determined in women receiving oral contraceptive therapy . Mean lactoferrin concentration in women taking oral contraceptives was significantly lower than in the control group (never exceeding 19.8 micrograms/mg of protein) and showed no monthly variation . Vaginal lactoferrin appears to be under hormonal control . Variation in vaginal lactoferrin concentration may result in alterations in susceptibility to bacterial pathogens such as Neisseriae gonorrhoeae.

Infect Immun, 1987 Nov, 55(11), 2844 - 9
Expression of a cloned lipopolysaccharide antigen from Neisseria gonorrhoeae on the surface of Escherichia coli K-12; Palermo DA et al.; A gonococcal gene bank maintained in Escherichia coli K-12 was screened by colony immunoblotting, and a transformant expressing a surface antigen reactive to anti-gonococcal outer membrane antiserum was isolated . The isolate carried a recombinant plasmid, pTME6, consisting of approximately 9 kilobases of Neisseria gonorrhoeae DNA inserted into the BamHI site of pBR322 . Surface labeling of E . coli HB101(pTME6) confirmed that the antigen was expressed on the E . coli cell surface . The antigenic material was resistant to proteinase K digestion and sensitive to periodate oxidation, indicating that the material was carbohydrate . Purified lipopolysaccharide (LPS) from HB101(pTME6) produced a unique band on silver-stained polyacrylamide gels that contained immunoreactive material as seen on Western blots of LPS samples . Only two of three E . coli LPS mutant strains carrying pTME6 reacted with the antigonococcal antiserum, suggesting that a certain E . coli core structure is necessary for antigen expression . We conclude that pTME6 contains one or more gonococcal genes encoding an LPS core biosynthetic enzyme(s) which can modify E . coli core LPS to produce a gonococcuslike epitope(s).

Infect Immun, 1987 Nov, 55(11), 2579 - 84
Degradation of gonococcal peptidoglycan by granule extract from human neutrophils: demonstration of N-acetylglucosaminidase activity that utilizes peptidoglycan substrates; Striker R et al.; The degradation of purified Neisseria gonorrhoeae peptidoglycan (PG) by granule extract derived from normal human polymorphonuclear leukocytes was examined . Hen egg lysozyme-resistant, extensively O-acetylated {3H}PG (O-PG) from strain FA19 and lysozyme-sensitive, non-O-acetylated {14C}PG (non-O-PG) from strain RD5 (each containing label in both glucosamine and muramic acid) were mixed and incubated with granule extract at pHs 4.5, 5.5, and 6.5 . The rate of degradation of O-PG was uniformly slower than that of non-O-PG in the same tube, but ultimately, even the O-PG was rendered completely soluble . Molecular-sieve high-performance liquid chromatography revealed that both PGs were degraded by granule extract at the pH values tested to disaccharide peptide monomers and peptide-cross-linked oligomers, reflecting the action of human lysozyme . Of particular interest was the appearance of a peak containing free N-acetylglucosamine which was quite prominent in reaction mixtures at pH 4.5, less prominent at pH 5.5, and not detectable at pH 6.5 . Free N-acetylglucosamine was not released from control PG samples at any pH in the absence of granule extract . Treatment of purified gonococcal PG monomers with granule extract at pH 4.5 yielded exclusively free N-acetylglucosamine and muramyl peptides with no N-acetylglucosamine . These data suggest that granule extract contains a previously undescribed pH-dependent N-acetylglucosaminidase with specificity for PG as well as an N-acetylmuramidase activity that degrades O-PG less efficiently than it does non-O-PG.

Surv Ophthalmol, 1987 Nov-Dec, 32(3), 199 - 208
Gonococcal keratoconjunctivitis; Ullman S et al.; Gonococcal keratoconjunctivitis is a potentially devastating infection, because Neisseria gonorrhoeae can cause a rapid, severe, ulcerative keratitis resulting in visual loss . The therapeutic decision making process is complicated by the necessity for prompt, effective parenteral therapy, frequent coinfection with other sexually transmitted diseases, and emergence of antibiotic resistance . Because of the evolving problem of antibiotic resistance and the need for cost containment, the current recommendations of hospitalization for intravenous penicillin may need to be modified . The third generation cephalosporin, ceftriaxone, has properties that suggest it may be the best available antimicrobial agent as a single-dose treatment of gonococcal conjunctivitis . Spectinomycin may be a useful alternative in the penicillin-allergic adult patient.

Biomed Environ Mass Spectrom, 1987 Nov, 14(11), 591 - 8
Structural determination of lipid A from gram negative bacteria using laser desorption mass spectrometry; Cotter RJ et al.; Laser desorption mass spectrometry has been employed for the structural determination of lipid A components derived from the lipopolysaccharides (LPS) of gram-negative bacteria . Mass spectra were obtained for methylated monophosphoryl lipid A from Neisseria gonorrhoeae and Rhodopseudomonas sphaeroides, for diphosphoryl lipid A from Escherichia coli and for the intact LPS from the Re Mutant of E . coli consisting of triphosphoryl lipid A and two KDO (2-keto-3-deoxyoctonate) units . Fragmentation of the phosphate (or pyrophosphate) on the reducing glucosamine is followed by fragmentation of acyl-linked fatty acids . Also observed are fragment ions which correspond to the distal portion of the molecule.

Genetics, 1987 Nov, 117(3), 391 - 8
Effects of recA mutations on pilus antigenic variation and phase transitions in Neisseria gonorrhoeae; Koomey M et al.; Intragenic recombination between the single complete pilin gene (expression locus) and multiple, distinct, partial pilin gene copies (silent, storage loci) is thought to account for the generation of pilus antigenic diversity and piliation phase (on-off) changes exhibited by Neisseria gonorrhoeae . The mechanisms operating in the genomic rearrangements associated with these forms of pilus variation were investigated through the study of isogenic strains of gonococci bearing either wild-type or altered recA alleles . Examination of the rates of pilus phase variation and the genetic basis for changes in piliation status displayed by these strains show that recA mediated homologous recombination is required for these high frequency events and confirm that the nonpiliated state results from mutations in the expressed pilin gene . In a strain that is deficient in recA mediated homologous recombination, pilus phase variation occurs at a 100-1000-fold reduced rate and results predominantly from one class of spontaneous frameshift mutations within the pilin structural gene.

J Clin Pathol, 1987 Nov, 40(11), 1369 - 73
Characterisation of Branhamella catarrhalis and differentiation from Neisseria species in a diagnostic laboratory; Ahmad F et al.; To distinguish Branhamella catarrhalis from Neisseria species a study of 140 strains was made on simple laboratory media, with particular reference to deoxyribonuclease (DNase) production, superoxol reaction, and growth characteristics . All 97 clinical isolates of B catarrhalis (58 of which were beta-lactamase positive) and eight strains of B catarrhalis from the National Collection of Type Cultures were DNase positive and superoxol positive . None grew on modified New York City medium, modified Thayer Martin medium, MacConkey agar, crystal violet blood agar, nor under anaerobic conditions . Of the 16 different non-pathogenic Neisseria species tested, all were DNase negative, eight (50%) were superoxol reaction negative, and 13 (81%) grew on crystal violet blood agar . Using simple laboratory media, DNase, and superoxol tests, it was possible to identify B catarrhalis and to distingish it from pathogenic and non-pathogenic Neisseria species.

Proc Natl Acad Sci U S A, 1987 Nov, 84(22), 8135 - 9
Porin protein of Neisseria gonorrhoeae: cloning and gene structure; Gotschlich EC et al.; The outer membrane porin molecule of Neisseria gonorrhoeae is known as protein I (PI) . Among different strains of gonococci there is variability of PI, and two main classes, PIA and PIB, have been recognized . A lambda gt11 bank of gonococcal DNA was screened using monoclonal antibodies directed to a PIB-type porin molecule of N . gonorrhoeae, and three immunoreactive clones were isolated . DNA sequence analysis indicated that each contained only portions of the PI structural gene, but that together they contained the complete gene, and its structure was determined . The DNA sequence predicts a protein of 348 amino acids with a typical 19 amino acid signal peptide . The PI protein resembles Escherichia coli porins in size, lack of long hydrophobic sequences, and absence of cysteine residues . Sequence homologies between PI and the E . coli porins were found, particularly in the 100 N-terminal and the 110 C-terminal amino acids . In addition to the coding sequence of PI, the complementary strand contains a large open reading frame . At the 3' end of the PI gene, immediately following an inverted repeat (probably the transcription terminator), the clone contains an unusual sequence consisting of 31 perfect repeats of the heptamer CTGTTTT . Hybridization analysis suggests that there is a single structural gene for PI and that it is homologous to the gene found in a PIA-bearing strain of gonococcus.

J Immunol Methods, 1987 Oct 23, 103(1), 1 - 7
The effect of pH on the aggregation of biotinylated antibodies and on the signal-to-noise observed in immunoassays utilizing biotinylated antibodies; Wadsley JJ et al.; During the development of immunoassays to detect gram-negative bacteria, an effect of pH on the aggregation of some murine monoclonal antibodies directed to Neisseria gonorrhoeae was observed . By reacting positively charged primary amines on these antibodies with the neutral NHS-biotin (N-hydroxy-succinimidobiotin), the surface charge on the antibodies was altered and a concomitant change in the solubility of these antibodies noted . This derivatization produced not only a pH-dependent change in the solubility properties of the antibodies, but also affected the response of immunoassays in which these antibodies were used . Data presented suggests that the signal-to-noise (S/N) observed in these assays is maximized under conditions where the biotinylated antibody is introduced into the assay at a pH at least 2 U above its pI . Our hypothesis is that as the pH of the solution approaches the biotinylated antibodies' isoelectric point, they become 'stickier', perhaps by aggregation (which we have directly measured), leading to high non-specific binding and hence a lower S/N.

JAMA, 1987 Oct 9, 258(14), 1932 - 4
Dipstick leukocyte esterase activity in first-catch urine specimens . A useful screening test for detecting sexually transmitted disease in the adolescent male; Sadof MD et al.; Although sexually active female adolescents are often routinely screened for sexually transmitted diseases, indications for culturing adolescent males for sexually transmitted urethral infections are controversial . A study of 54 sexually active males (14 to 22 years old) was undertaken to assess the reliability of using dipstick leukocyte esterase activity in first-catch urine specimens to detect urethritis caused by Neisseria gonorrhoeae and Chlamydia trachomatis . Eighteen males had sexually transmitted diseases: N gonorrhoeae (nine patients), C trachomatis (eight patients), and N gonorrhoeae and C trachomatis (one patient) . First-catch urine specimens with a 1+ (mild) or 2+ (moderate) reaction on dipstick testing had a leukocyte (WBC) count of 10 WBCs per high-power field or greater on microscopic analysis, with an 83% sensitivity, 100% specificity, a 100% positive predictive value, and a 92% negative predictive value for the presence of N gonorrhoeae, C trachomatis, or both . Clinical criteria for screening (urethral discharge, dysuria, or exposure to a sexually transmitted infection) plus a dipstick-positive first-catch urine specimen had a 94% sensitivity, 89% specificity, an 81% positive predictive value, and a 97% negative predictive value.

J Biol Chem, 1987 Oct 5, 262(28), 13404 - 8
Bacteria form intracellular free radicals in response to paraquat and streptonigrin . Demonstration of the potency of hydroxyl radical; Hassett DJ et al.; The generation of oxygen reduction products by Neisseria gonorrhoeae FA1090 upon exposure to streptonigrin (SNG) and paraquat (PQ2+) and their toxicity was examined . N . gonorrhoeae exhibited maximal cyanide-insensitive respiration, which was employed as an indicator of superoxide (O2-) formation, in the presence of 0.064 mM streptonigrin and 90 mM PQ2+, respectively . Using the concentrations of SNG and PQ2+ described above, complete lethality (greater than 10(8) cells/ml) was observed among cells exposed to SNG, whereas PQ2+ reduced viability by only 3 logs . In an attempt to determine the oxygen radical species generated by gonococci when exposed to SNG, dimethyl sulfoxide, Fe3+, KCN, and the spin trap 5,5-dimethyl-1-pyrroline-N-oxide (DMPO), we were able to detect .OH manifested as the methyl adduct (DMPO-CH3) . The production of the latter species was not inhibited by catalase, suggesting intracellular .OH generation . When PQ2+ was substituted for SNG, only low levels of DMPO-CH3 were observed, the production of which ceased within 8 min . SNG and PQ2+, added to a O2(-)- generating system in the presence of Fe3+, promoted increased .OH generation . The iron chelator diethyl-enetriaminepentaacetic acid enhanced the generation of spin-trapped .OH and O2- in the presence of PQ2+ . The addition of catalase to this system, however, eliminated the DMPO-CH3 signal, showing that the .OH in this system was extracellular . PQ2+-mediated generation of extracellular .OH in the presence of Fe3+-diethylenetriaminepentaacetic acid EDTA did not enhance the killing of gonococci by PQ2+ . These data show that the lethality of SNG relative to PQ2+ is due to the inherent ability of SNG to catalyze the formation of critical levels of intracellular .OH, detectable through the use of spin trapping techniques.

Microbiologica, 1987 Oct, 10(4), 363 - 70
Production of bacteriocin-like substances by human oral streptococci; Fabio U et al.; A sample of human streptococci (mainly Streptococcus mutans species) from dental plaques was examined in order to evaluate the production frequency and activity spectrum of bacteriocin-like substances (mutacins) . 89% of the 55 Streptococcus mutans strains produced substances with a wide spectrum of antibacterial activity . The bacteriocins produced showed a marked inhibitory activity against Gram-positive bacteria . Among the Gram-negative species tested, only Neisseria sicca was inhibited by 25% of Streptococcus mutans strains . Also, 16 strains belonging to oral streptococci other than Streptococcus mutans, were examined for their inhibitory capacity against the same indicator . The authors stress the importance of mutacins production in oral ecology and Streptococcus mutans pathogenicity.

Cutis, 1987 Oct, 40(4), 363 - 4
Oral cavity abscess due to Neisseria gonorrhoeae; Marini D et al.; A patient with an abscess in the oral cavity caused by Neisseria gonorrhoeae is presented . The suspected gonococcal cause was confirmed by the presence of gonococci in smears of material evacuated from the abscess and the growth of bacteria in a modified Thayer-Martin culture medium . This represents, to our knowledge, the first reported case of oral cavity abscess due to N . gonorrhoeae.

Am Fam Physician, 1987 Oct, 36(4), 162 - 4
Fitz-Hugh-Curtis syndrome; Perlman PE et al.; The Fitz-Hugh-Curtis syndrome consists of right upper quadrant abdominal pain, perihepatitis and genital tract infection . Neisseria gonorrhoeae and Chlamydia trachomatis have been identified as causative agents . This syndrome frequently mimics other diseases and typically occurs in sexually active young women . A high index of suspicion is essential for early diagnosis . Laparoscopy may be indicated for diagnosis and for lysis of adhesions.

South Med J, 1987 Oct, 80(10), 1323 - 4
Neisseria mucosus septicemia after near-drowning; Manser TJ et al.; Neisseria mucosus is a normal inhabitant of the upper respiratory tract which may rarely cause serious infection . A 21-year-old woman had N mucosus bacteremia and the adult respiratory distress syndrome (ARDS) after a near-drowning episode . Despite appropriate antibiotic therapy and intensive respiratory support, the patient died . Bacteremia with this organism is rare, and we believe it has not previously been reported in association with near-drowning.

Sex Transm Dis, 1987 Oct-Dec, 14(4), 227 - 30
Ceftriaxone for treatment of uncomplicated gonorrhea: routine use of a single 125-mg dose in a sexually transmitted disease clinic; Handsfield HH et al.; We retrospectively analyzed the efficacy of ceftriaxone in a single dose of 125 mg given intramuscularly for treatment of uncomplicated gonorrhea . Neisseria gonorrhoeae was eradicated from 152 (99%) of 154 patients who returned for test-of-cure, including all 83 heterosexual men and women and 69 (97%) of 71 homosexual men . Cure was achieved for 109 (99%) of 110 urethral or cervical infections, 52 (98%) of 53 rectal infections, and 15 of 15 pharyngeal infections . All infected sites were cured in 58 additional patients treated with ceftriaxone (125 mg) plus tetracycline (500 mg four times daily for seven days) . These results confirm those of earlier clinical trials showing that 125 mg of ceftriaxone is effective therapy for uncomplicated gonorrhea in a geographic area with a high prevalence of gonococci with chromosomally mediated antibiotic resistance.

Sex Transm Dis, 1987 Oct-Dec, 14(4), 231 - 3
Gonococcal endocarditis: a case report and review of the literature; Jurica JV et al.; Despite the increasing incidence of gonococcal urethritis and cervicitis, endocarditis has become an infrequent consequence of infection with Neisseria gonorrhoeae . However, we recently had the opportunity to diagnose and treat a patient with this uncommon infection . He presented with febrile illness and a history of dysuria . After six days of incubation, cultures of blood yielded an isolate of N . gonorrhoeae . Treatment with penicillin plus streptomycin led to rapid resolution of the fever . Sequelae included left ventricular dilatation and aortic valve insufficiency . The latter was corrected by surgery . Our experience with this patient, as well as the 33 other cases reported in the literature since 1949, indicate that the diagnosis of gonococcal endocarditis should be suspected for any sexually active adult who presents with fever and a heart murmur.

Ann Acad Med Singapore, 1987 Oct, 16(4), 645 - 7
Ophthalmia neonatorum--the Middle Road Hospital perspective; Ng SK et al.; In a retrospective study of ophthalmia neonatorum seen in Middle Road Hospital between 1983 and 1986, 68% were caused by Neisseria gonorrhoeae . 40% of the Neisseria gonorrhoeae isolates were PPNG strains . For therapy of gonococcal ophthalmia neonatorum, 1% kanamycin eyedrops combined with a single intramuscular injection of kanamycin or a third generation Cephalosporin (Ceftriaxone or Cefotaxime) were all effective regimens . The use of intramuscular kanamycin was stopped because of concern for ototoxicity . Chlamydia trachomatis remains an uncommon cause of ophthalmia neonatorum in Singapore, in only 2 cases was this agent identified.

Ann Acad Med Singapore, 1987 Oct, 16(4), 636 - 8
Susceptibility of Neisseria gonorrhoeae to pefloxacin; Chan KP et al.; 144 strains each of penicillinase producing (PPNG) and non-penicillinase producing (NPPNG) Neisseria gonorrhoeae were tested for susceptibility to pefloxacin . All isolates but one (99.65%) were susceptible to 0.06 mg/l . No significant difference was detected between the minimum inhibitory concentrations (MICs) of PPNG and NPPNG strains . The MIC50 and MIC90 of both types of strains were 0.015 mg/l and 0.06 mg/l respectively . Since pefloxacin was more effective than norfloxacin and rosoxacin against PPNG as well as NPPNG, it should prove useful in the therapy of gonorrhoea.

Sex Transm Dis, 1987 Oct-Dec, 14(4), 221 - 6
Bactericidal properties of urine for Neisseria gonorrhoeae; Noble RC et al.; Some human urine is bactericidal for the F-62 strain of Neisseria gonorrhoeae . Gonococci of three auxotypes (Pro-; Arg-, Hyx-, Ura-; and Pro-, Arg- . (Orn*), Ura-) were tested by in-vitro exposure to 31 samples of urine from 14 men . Nineteen of the urine specimens were bactericidal, and 12 were not . Except for one sample, all cidal urines came from five men . Cidal activity was associated with acidic, concentrated urines; it was unaffected by exposure to lowered pH, pronase, heat or cold, and was dialyzable with use of a dialysis membrane with a cut-off molecular weight of 1000 . Neutralization of the acid urines removed the antigonococcal activity . Noncidal acid urines became cidal urines when concentrated by lyophilization . Zinc, lysozyme, fluoride ions, and fatty acids are substances that have antibacterial activity and are also present in urine . These substances were examined for antigonococcal activity . Neither zinc salts, fluoride ions, lysozyme, nor fatty acids in concentrations exceeding those found in urine were bactericidal for the gonococci . These results show that sufficiently concentrated, acidic urines kill gonococci by an unknown mechanism.

Antimicrob Agents Chemother, 1987 Oct, 31(10), 1642 - 3
Plasmid-mediated sulfonamide resistance in Neisseria meningitidis; Facinelli B et al.; An 8.5-megadalton plasmid coding for sulfonamide resistance was found in a clinical isolate of Neisseria meningitidis, as demonstrated by plasmid elimination and transformation experiments . The plasmid complemented a mutation which determines the production of a thermosensitive dihydropteroate synthetase in Escherichia coli, thus suggesting that the mechanism of resistance involved a plasmid-encoded dihydropteroate synthetase.

Genitourin Med, 1987 Oct, 63(5), 309 - 11
Single dose piperacillin in treating uncomplicated gonococcal urethritis in men; Thirumoorthy T et al.; A single intramuscular dose of piperacillin 2 g, with probenecid 1 g orally, was used to treat 82 men with uncomplicated gonococcal urethritis due to penicillinase producing strains of Neisseria gonorrhoeae (PPNG) or non-PPNG . All 49 patients infected with non-PPNG strains were cured, as opposed to only 25 (76%) of 33 patients infected with PPNG strains, giving an overall success rate of 90% . No serious side effects of treatment were observed . Post gonococcal urethritis (PGU) occurred in 18% of the patients treated . Antibiotic susceptibility tests showed that 44 (96%) of the 46 non-PPNG strains tested had MICs of piperacillin of 2 mg/l or less and 26 (76%) of the 34 PPNG strains had MICs of 32 mg/l or more . This regimen is not recommended for use as first line treatment in areas where there is a high incidence of infection with PPNG strains . It is, however, highly effective against non-PPNG strains.

Genitourin Med, 1987 Oct, 63(5), 305 - 8
Chromosomally mediated intrinsic resistance to penicillin of penicillinase producing strains of Neisseria gonorrhoeae isolated in Sydney: guide to treatment with Augmentin; Tapsall JW et al.; Single dose Augmentin treatment fails to cure an appreciable proportion of patients infected with penicillinase producing Neisseria gonorrhoeae (PPNG) strains in parts of the world where high levels of chromosomally mediated intrinsic resistance are also present in gonococci . The levels of intrinsic resistance to penicillin of 31 PPNG strains isolated in Sydney were assessed by obtaining beta lactamase negative variants of these strains and measuring the minimum inhibitory concentration of penicillin by agar plate dilution techniques . The levels of intrinsic resistance found in these imported PPNG strains were higher than those recorded for local isolates of non-PPNG strains, which indicates that caution should be exercised in the use of single dose Augmentin treatment of infections with PPNG strains in Sydney.

J Clin Microbiol, 1987 Oct, 25(10), 1982 - 4
Phadebact Monoclonal GC OMNI Test for confirmation of Neisseria gonorrhoeae; Carlson BL et al.; The Phadebact Monoclonal GC OMNI Test (Pharmacia Diagnostics, Piscataway, N.J.) is used for the definitive identification of Neisseria gonorrhoeae . In this test, boiled organisms are examined by using a 1-min coagglutination technique . A total of 776 Neisseria strains, confirmed to the species level by patterns of acid production from carbohydrates incorporated in cysteine-tryptose agar or morphologically consistent with Neisseria meningitidis and fluorescent antibody negative, were tested by the coagglutination technique . Of the 516 isolates of N . gonorrhoeae, 8 (1.6%) were negative with the OMNI Test . Of the 260 isolates of Neisseria spp . other than N . gonorrhoeae, none showed a positive coagglutination reaction . The Phadebact Monoclonal GC OMNI Test provided rapid, accurate identification of N . gonorrhoeae (sensitivity, 98.4%; specificity, 100%).

Ann Acad Med Singapore, 1987 Oct, 16(4), 639 - 44
A decade of PPNG in Singapore; Chan RK et al.; It has been more than 10 years since PPNG was first diagnosed in Singapore . Since then the prevalence of PPNG has increased progressively, and is now maintained at between 30 to 35% of all gonococcal infections inspite of a decrease in the overall incidence of gonorrhoea in Singapore . PPNG infections have been recorded with all forms of complicated gonorrhoea including pelvic inflammatory disease, ophthalmia and disseminated gonococcal infection . Penicillin alone cannot be used to treat gonorrhoea . The use of antibiotics active against PPNG and NPPNG both in uncomplicated and complicated gonorrhoea as first-line therapy is now essential . The medical cost of treatment of gonorrhoea has increased by 100 to 200% as a result of the emergence of PPNGPIP: The prevalence of penicillinase-producing Neisseria gonorrhoea (PPNG) has increased progressively in Singapore since its emergence in 1976, while non-PPNG cases have shown a steady decline since 1979 . The proportion of total gonorrhea cases represented by PPNG has remained at about 35% since 1982, with female prostitutes accounting for 2.3 of PPNG cases . 80% of males in Singapore infected with PPNG in 1984 were 15-29 years of age and over 70% were single . In a 1978 survey, 72% of male patients with PPNG treated at the Middle Road and Singapore General Hospitals acknowledged sexual contact with professional prostitutes . Clinical manifestations of PPNG have included gonococcal ophthalmia neonatorum, epididymo-orchitis, pelvic inflammatory disease, parostitis, and disseminated gonococcal infection . The emergence of PPNG has necessitated a search for antibiotics both resistant to beta-lactamase and effective against chromosomally mediated resistant Neisseria gonorrhoea . Following unacceptably high failure rates with kanamycin and spectinomycin, second and third generation cephalosporins have become the mainstay of treatment . A single 500 mg intramuscular dose of cefotaxime combined with 1 gm of oral probenecid cures 93% of PPNG infections in men and 100% of those in women . Although this treatment regimen has maintained the prevalence of PPNG cases at 35%, the medical costs of treatment have increased 100-200% over those for non-PPNG . Future control of PPNG in Singapore will be based on a multifaced strategy of effective drug treatment, control of infections in prostitutes and efforts to curb their practice of self-medication, increased laboratory bacteriological surveillance, and contact tracing .

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1987 Oct, 266(3-4), 522 - 5
{Spectinomycin sensitivity of Neisseria gonorrhoeae}; Naher H et al.; Using the agar dilution technique minimal inhibitory concentrations (MIC) with respect to spectinomycin were determined . 92 Neisseria gonorrhoeae isolates collected in a STD outpatient clinic and 160 Neisseria gonorrhoeae isolates collected from prostitutes were investigated . One isolate imported from Asia had a MIC of greater than 1024 micrograms/ml and was resistant . All other isolates, three penicillinase producing strains included, had MICs of 4-32 micrograms/ml and were sensitive to spectinomycin.

Sex Transm Dis, 1987 Oct-Dec, 14(4), 191 - 4
Gonorrheal keratoconjunctivitis in African adults; Kestelyn P et al.; We describe six cases of keratoconjunctivitis due to Neisseria gonorrhoeae in adults . All strains tested were penicillinase-producing N . gonorrhoeae (PPNG), and we conclude that the rising incidence of corneal involvement, a classic complication in the pre-antibiotic era, is due to ineffective treatment with penicillin . Indeed, the progression of the ocular lesions was stopped and microbiologic cure was obtained in all our patients after treatment with either spectinomycin or cefotaxime . These results demonstrate that early and effective treatment of adult gonococcal conjunctivitis is mandatory to avoid potentially blinding complications such as corneal ulceration and perforation of the eye.

Epidemiol Infect, 1987 Oct, 99(2), 455 - 62
Analysis of penicillinase-producing Neisseria gonorrhoeae isolates in Madrid (Spain) from 1983-85; Fenoll A et al.; Between April 1983 and December 1985, 576 strains of Neisseria gonorrhoeae were isolated in our laboratory from patients attending Sexually Transmitted Diseases (STD) clinics . Of these, 61 (10.6%) were penicillinase-producing . Studies on these strains by plasmid analysis, auxotyping and serogrouping showed that the predominant type strains harboured the Asian resistance plasmid, were prototrophic, and were of serogroup W II/W III . About half of the strains, both of the African and Asian type, harboured the transfer plasmid . Strains of serogroup W II/W III were less sensitive to tetracycline and cefoxitin than serogroup W I strains.

Sex Transm Dis, 1987 Oct-Dec, 14(4), 201 - 4
Underlying complement deficiency in patients with disseminated gonococcal infection; Ellison RT 3rd et al.; The complement system was evaluated in 22 individuals with disseminated gonococcal infection . Three of the 22 patients exhibited a total serum complement activity that was greater than 2 SD below the normal mean . Of these three, one had a complete deficiency of C1r, a second patient had pre-existing systemic lupus erythematosus with low levels of C4, and the third had a C8 concentration that was 60% of normal . We conclude that the prevalence of inherited or acquired complement deficiency among patients with disseminated gonococcal infection exceeds that among the general population and is an important host factor predisposing to systemic infection with Neisseria gonorrhoeae.

Antimicrob Agents Chemother, 1987 Oct, 31(10), 1507 - 13
Role of extracellular iron in the action of the quinone antibiotic streptonigrin: mechanisms of killing and resistance of Neisseria gonorrhoeae; Cohen MS et al.; The quinone antibiotic streptonigrin is believed to kill bacteria by promoting formation of oxygen radicals . This antibiotic has also been used to select resistant bacterial mutants, some of which vary in iron utilization . We examined the effects of streptonigrin on Neisseria gonorrhoeae and several types of gonococcal mutants . Streptonigrin (0.025 microgram/ml) efficiently killed gonococcal strain FA1090, and this effect depended on iron . Streptonigrin-resistant mutant FA6271 had normal iron uptake but was moderately deficient in total iron . Resistance most likely resulted from failure of FA6271 to divert electrons to streptonigrin, as demonstrated by a reduction in KCN-insensitive respiration (a hallmark of the action of quinones) and superoxide formation . Other mutants selected for inability to use human iron-binding proteins (strains FA6273 and FA6275) had no increase in streptonigrin MIC and no decrease in KCN-insensitive respiration . Mutants did not demonstrate an increase in superoxide dismutase or catalase . Streptonigrin killing of gonococci depended on a reaction(s) in which extracellular iron was important, presumably because iron was required for catalysis of hydroxyl radical . The results suggest that a membrane component may be a target for the actions of streptonigrin.

Am J Ophthalmol, 1987 Sep 15, 104(3), 280 - 2
Neisseria meningitidis conjunctivitis in children; Al-Mutlaq F et al.; We examined two children from the same family who had purulent conjunctivitis . Isolates of Neisseria species were obtained from eye cultures and Gram stain of conjunctival scrapings disclosed many gram-negative intracellular diplococci . Colony structure and growth characteristics of the organism with subsequent carbohydrate fermentation tests and serotyping were consistent with Neisseria meningitidis Group B . The patients had no neurologic signs or symptoms . Results of laboratory investigations and blood cultures were normal . Early diagnosis is mandatory and aggressive systemic therapy with appropriate antibiotics may prevent ocular, neurologic, or systemic complications.

Schweiz Med Wochenschr, 1987 Sep 12, 117(37), 1374 - 9
{Neisseria gonorrhoeae in Zürich . Incidence, minimal inhibiting concentration of various antibiotics and penicillinase-forming strains 1981 to 1985}; Eichmann A et al.; From 1981-1985 2232 strains of Neisseria gonorrhoeae were isolated and examined in the VD laboratory of the Department for Dermatology of the University Hospital of Zurich . 86 isolates were penicillinase producing Neisseria gonorrhoeae strains (PPNG) . The MIC ranges for penicillin of the non-PPNG strains was 0.0035 to 16 mg/l, for tetracycline 0.03 to 8 mg/l, for spectinomycin 3.5 to 120 mg/l and for thiamphenicol 0.125 to 8 mg/l . 42 out of 86 PPNG strains (48.8%) had been imported from South-East Asia . Six patients (6.9%) with PPNG strains had been infected in Zurich . Plasmid patterns of all PPNG strains were determined . The 4.4 MD-plasmid ("Asian" type plasmid) was found in 68 of 86 strains . The 3.2 MD-plasmid ("African" type plasmid) in 8 of 86 and the 24.6 MD-plasmid (transfer plasmid) in 56 PPNG strains respectively . The range of the MIC for penicillin of the PPNG strains was 1-16 mg/l, for tetracycline 0.25-8 mg/l, for spectinomycin 7-30 mg/l and for thiamphenicol 0.125-2 mg/l . The frequency of PPNG strains increased from 1.7% in 1981 to 6.7% in 1985.

Urologe A, 1987 Sep, 26(5), 277 - 82
{Current status of vaccine development in sexually transmissible diseases}; Kohl PK et al.; A prophylactic vaccine represents a major hope for the control of sexually transmitted diseases . The current general vaccine strategies and the status of vaccine development against infections with Neisseria gonorrhoeae, Treponema pallidum, Chlamydia trachomatis and Herpes simplex virus are described . Vaccines consisting of whole infectious agents are replaced by protective subunits . A subunit vaccine has the advantage to be free from other components, which are not relevant for protection and which may confer unwanted side effects . At the present time vaccine development against infections with Neisseria gonorrhoeae and Herpes simplex virus seems to be the most progressed . With monoclonal antibodies several surface components could be identified, which are of importance for the pathomechanism . With Treponema pallidum and Chlamydia trachomatis the development is delayed by unsolved problems of immunity . For the production of vaccines molecular-biologic methods, like protein synthesis or gene-cloning will be used . Genetically modified live vaccines or polytope hybrid vaccines will gain importance in the future.

Urologe A, 1987 Sep, 26(5), 237 - 45
{Uncomplicated gonorrhea and disseminated gonococcal infections--clinical aspects, diagnosis and therapy}; Korting HC; Gonorrhoea is not only the oldest but also still one of the most frequent sexually transmitted diseases . Under therapeutic aspects it seems worthwhile to distinguish between uncomplicated and complicated forms . Uncomplicated gonorrhoea - urethritis being its most important variant - can be cured by adequate single injection treatment while complicated disease cannot . Disseminated infection is one of the major threats of gonococcal infection . The outcome is potentially fatal . Therapeutic considerations today have to take antibiotic-resistant or even multi-resistant Neisseria gonorrhoeaestrains into account . Third-generation cephalosporins and second-generation quinolones represent potential alternatives to conventional agents.

J Gen Microbiol, 1987 Sep, 133 ( Pt 9), 2671 - 8
Evidence that the serum resistance genetic locus sac-3 of Neisseria gonorrhoeae is involved in lipopolysaccharide structure; Stephens DS et al.; The gonococcal chromosome contains a sequence of closely linked genes (for example, sac-1, sac-3, nmp) known or presumed to affect cell envelope structure and which appear to influence susceptibility of gonococci to killing by normal human sera (NHS) . Previous work has shown that the serum-resistant isolate FA19, and FA899, a serum-sensitive transformant of FA19, differ in outer membrane protein I (PI) and at the sac-3 genetic locus . However, the sac-3 locus is separable from changes determined by nmp-3, the gene determining PI species . We found that FA19 and FA899 differ in lipopolysaccharide (LPS) molecular size and in reactivity with a monoclonal antibody which recognizes an LPS (L8) epitope . To address the question of whether the changes in LPS were due to the sac-3 locus, we constructed new transformants of FA19 using donor DNA prepared from FA899 . The new transformants could be divided into three groups: (1) those identical to FA19 in serum resistance (greater than 90% survival at 120 min), in LPS molecular size and in expression of the L8 epitope; (2) those identical to FA899 in serum sensitivity (100% killed at 30 min), in LPS molecular size and in lack of expression of the L8 epitope; (3) those significantly killed by 50% NHS at 120 min, whose LPS molecular size was greater than that of FA19 but less than that of FA899 and which did not express the L8 epitope . Except for PI there were no differences in other outer-membrane proteins (e.g . PII, PIII, H.8) among these transformants.(ABSTRACT TRUNCATED AT 250 WORDS)

J Clin Pathol, 1987 Sep, 40(9), 1088 - 97
Neisseria gonorrhoeae: a versatile pathogen; Easmon CS et al.; Neisseria gonorrhoeae is one of the most important causes of sexually transmitted disease . We do not fully understand the pathogenesis of infection with this organism, although recent improvements in immunological and molecular techniques have brought us closer to an answer . These techniques are now also being used to detect and identify N gonorrhoeae and to analyse the epidemiology of gonorrhoea . Plasmid and chromosomal mediated antibiotic resistance increases the difficulty of controlling gonorrhoea . Resistant strains occur all over the world and new patterns of resistance are still emerging . A better understanding of gonococcal pathogenicity is necessary for the development of an effective vaccine . Despite work on pili and outer membrane proteins no vaccine yet exists . The control of gonorrhoea still depends on diagnosis, treatment, and epidemiological control, facilities that are not widely available in many of those parts of the world where gonorrhoea is a major problem.

J Clin Microbiol, 1987 Sep, 25(9), 1641 - 4
Murine monoclonal antibodies for detection of antigens and culture identification of Neisseria meningitidis group B and Escherichia coli K-1; Krambovitis E et al.; Four murine monoclonal antibodies which reacted with a (2----8)alpha-linked sialic acid polysaccharide were produced . Three of the antibodies reacted specifically with Neisseria meningitidis serogroup B and Escherichia coli K-1 polysaccharide antigens, whereas one antibody cross-reacted with N . meningitidis group C polysaccharide antigen, a (2----9)alpha-linked homopolymer of sialic acid . By using the most avid antibody (MB 62), a latex particle agglutination test was developed which could detect capsular polysaccharide at 10 ng/ml . It also detected antigen in the cerebrospinal fluid (CSF) of all seven N . meningitidis group B- and two E . coli K-1-infected patients, whereas 57 control CSF samples, including 8 from neonates, were negative . Cultures of 21 N . meningitidis group B strains, 7 E . coli K-1 strains, and 1 Moraxella nonliquefaciens strain gave a positive result, whereas 53 strains from other serogroups were all negative . In a separate clinical evaluation, the overall sensitivity of the latex particle agglutination test was 81% (22 of 27) with fresh CSF samples, 48% (15 of 31) with stored CSF samples, and 94% (32 of 34) with blood cultures . No false-positive reactions were recorded with 165 control CSF samples, and the specificity with blood cultures was 99.4% (519 of 522).

South Med J, 1987 Sep, 80(9), 1194 - 5
Neisseria gonorrhoeae endocarditis on a prosthetic valve; Williams C et al.; Neisseria gonorrhoeae is now a rare cause of infective endocarditis . We have reported the first case of N gonorrhoeae infection on a prosthetic valve, showing the possible consequences of a late diagnosis.

Infect Immun, 1987 Sep, 55(9), 2026 - 31
Antigenic and structural differences among six proteins II expressed by a single strain of Neisseria gonorrhoeae; Barritt DS et al.; Gonococci express a family of related outer membrane proteins designated protein II (P.II), which undergo both phase and antigenic variation . Six P.II proteins have been identified in strain FA1090 . We developed monoclonal antibodies specific for each P.II protein . Using these antibodies as probes, we purified the six different P.II proteins of this strain . Despite the relatedness of the proteins, we could not purify all of them by a single purification scheme . Four P.II proteins were purified by chromatofocusing, and the remaining two proteins were purified by hydrophobic interaction chromatography on phenyl-Sepharose . The N-terminal amino acid sequence of the proteins showed a high degree of sequence conservation . However, there was variability at specific amino acid residues, giving each P.II protein a unique N-terminal amino acid sequence . Thus P.II proteins of one strain differ among themselves not only in antigenic determinants and primary structure, but also in other characteristics affecting their properties in different chromatographic systems.

Diagn Microbiol Infect Dis, 1987 Sep, 8(1), 13 - 8
Treatment of ordinary and penicillinase-producing strains of Neisseria gonorrhoeae in Mexico City; Calderon E et al.; Since being recognized in 1976 and 1983, respectively, penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) and chromosomally mediated resistance (CMRNG) have attained a worldwide distribution . The high endemicity of both types of resistance in some regions precludes the continued routine use of procaine penicillin (APPG) as treatment for gonorrhea . In this study, we have evaluated 72/216 men with uncomplicated gonococcal urethritis at the venereal clinic in Mexico City . These men were part of a blinded randomized comparative study for treatment with group (P) penicillin having 33 patients and group (S) spectinomycin having 39 . Efficacy with (P) was 24/33 (72.7%); nine failures retreated and were cured with spectinomycin . Efficacy with (S) was 35/39 (89.7%); four failures retreated and were cured with cefotaxime . We found correlation between MICs and resistance; all the strains with MICs of greater than or equal to 1.0 mcg/ml of penicillin failed to be cured, the MICs of greater than or equal to 32 mcg/ml of spectinomycin failed to be cured . The overall resistance to both regimens was 23/72 to penicillin (31.9%) (22 PPNG and one CMRNG) and 4/72 (5.5%) to spectinomycin.

Ann Trop Paediatr, 1987 Sep, 7(3), 177 - 80
Chlamydial and gonococcal ophthalmia neonatorum in The Gambia; Mabey D et al.; Swabs were taken for isolation of Chlamydia trachomatis and Neisseria gonorrhoeae from 112 infants with ophthalmia neonatorum attending a hospital in The Gambia . C . trachomatis was isolated from 37 (33%) and N . gonorrhoeae from 28 (25%), with both organisms being present in three cases (3%) . A prospective study of 335 neonates was also undertaken in a Gambian town . Fifty-five infants (16%) showed clinical evidence of ophthalmia neonatorum . C . trachomatis was isolated from nine of these (16%) and N . gonorrhoeae from seven (13%).

J Clin Microbiol, 1987 Aug, 25(8), 1574 - 5
Ocular infection in a newborn caused by Neisseria mucosa; Gini GA; Neisseria mucosa was isolated in pure culture from a purulent ocular infection of a newborn . The initial Gram-stained smear revealed intracellular gram-negative diplococci . The organism showed resistance to vancomycin, colistin, and trimethoprim in susceptibility testing and grew well on Thayer-Martin medium.

Aust N Z J Obstet Gynaecol, 1987 Aug, 27(3), 213 - 5
The prevalence of sexually transmitted disease agents in pregnant women in Suva; Gyaneshwar R et al.; Routine testing of 440 women (257 Fijians, 183 Indians) at the first antenatal attendance identified Chlamydia trachomatis in 50% of Fijians and 38% of Indians; the seropositivity rates for syphilis were 14.2% and 1.7% respectively, and the isolation rates for N . gonorrhoeae were 3.1% in Fijians and 1.1% in IndiansPIP: A total of 440 women under 28 weeks' gestation comprising 257 Fijians and 183 Indians attending the antenatal clinic at the Anderson Maternity Unit in Suva, Fiji, between November, 1985, and April, 1986, were selected for the study on their first visit . After an obstetric history was taken and a general physical examination performed, specimens for microbial studies were collected from the cervix and the posterior vaginal fornix . Blood was collected for serological tests for syphilis . Neisseria gonorrhea was identified on colonial morphology, Gram stain and oxidase reactivity . Specimens for Chlamydiazyme immunoassay test were stored at 40 C and tested within 5 days of collection . Tests for syphilis were performed using Venereal Disease Research Laboratory (VDRL) and treponema pallidum hemagglutination (TPHA) tests . Results for chlamydia are available for only 244, as this was introduced midway in the study . All STD pathogens were isolated in significantly higher rates from Fijian compared to Indian women p 0.01) . Chlamydia trachomatis was the most common agent, affecting 50% of Fijian women and 37.5% of Indian women . Candida albicans was the next most common pathogen in both groups, accounting for 40% . Trichomonas vaginalis was found in 8.2% of both groups . N gonorrhea was isolated in 2.3% of the population studied . The average age of women with gonorrhea was 22 years, whereas the average age of the whole population studied was 26.1 years . They were also predominantly single or living in a consensual relationship . Group B beta hemolytic streptococci were identified in only 9 of the 440 women studied . Serological tests were interpreted to be positive for syphilis if both VDRL and TPHA were positive in the absence of a history of previous treatment for syphilis . The difference in infection rates of 14.2% for Fijians and 1.7% for Indians was highly significant (p 0.01) .

Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi, 1987 Aug, 20(3), 262 - 8
Auxotyping of Neisseria gonorrhoeae isolated in Taiwan; Ding MJ et al.; One hundred and seventy eight out of 319 clinical isolates (55.8%) of Neisseria gonorrhoeae isolated in Taiwan were identified as penicillinase-producing Neisseria gonorrhoeae . Two hundred and ninety six isolates were subdivided into 24 distinct auxotypes . The majority of gonococci tested were non-requiring (43.6%) and proline-dependent (43.2%) . No arginine-hypoxanthine-uracil requiring strain was obtained in this study . Only one arginine-requiring strain was obtained from 296 isolates . Different auxotypes of gonococci were isolated from the same patient who had contracted gonorrhea . Each of 17 patients was infected by at least two different auxotypes of gonococci.

Genitourin Med, 1987 Aug, 63(4), 244 - 5
Trends in gonococcal resistance to antibiotics in Rotterdam, The Netherlands, 1975-86; Wagenvoort JH et al.; The incidence of resistance of Neisseria gonorrhoeae to penicillin and tetracycline was periodically monitored during 1975-86 . The incidence of resistance to penicillin (minimum inhibitory concentration (MIC) of more than 1.28 mg/l) of non-PPNG strains remained low (less than 2.5%) . The incidence of penicillinase producing N gonorrhoeae (PPNG) strains decreased after a peak of 14% in 1982 to a mean of 8% in more recent years . After a gradual increase, the incidence of tetracycline resistant (MIC of more than 1.28 mg/l) strains has remained stable at around 20% during the past five years . This indicates that a continuing increase in incidence of resistance was not observed in this outpatient clinic.

Genitourin Med, 1987 Aug, 63(4), 239 - 43
Chromosomal resistance of gonococci to antibiotics; Ison CA et al.; Three hundred and twenty nine strains of non-penicillinase-producing Neisseria gonorrhoeae (non-PPNG) isolated from men and women were tested for their susceptibility to a range of antibiotics, and were also auxotyped and serogrouped . Nearly 6% (18) of 312 strains tested were resistant to 1 mg/l or more penicillin (compared with 4.4% of PPNG strains isolated in 1981) . Many (198, 64%) strains showed intermediate resistance to penicillin (0.12-0.5 mg/l) . Nearly 5% (15) of 312 strains tested were resistant to 0.5 mg/l or more cefuroxime, and there was a high degree of cross resistance between these two antibiotics . High levels of resistance to erythromycin and tetracycline were also found, and there was also appreciable cross resistance between these antibiotics and the beta lactam drugs . Resistance to spectinomycin was rare, and there was no cross resistance between spectinomycin and other agents tested . Levels of resistance between strains isolated from different anatomical sites did not differ, except that resistance to erythromycin was greater in rectal isolates . Four main auxotypes were detected . Strains requiring arginine, hypoxanthine, and uracil (AHU-) were more prevalent from the cervix . We have shown that there is an association between auxotype, serogroup, and level of sensitivity to penicillin, cefuroxime, and tetracycline.

Genitourin Med, 1987 Aug, 63(4), 225 - 32
Serological classification of Neisseria gonorrhoeae with monoclonal antibody coagglutination reagents; Coghill DV et al.; A total of 357 clinical isolates of Neisseria gonorrhoeae from 286 patients were classified serologically using two independently developed panels of monoclonal coagglutination reagents . The Pharmacia (Ph) Diagnostics panel comprised 14 reagents, five specific for serogroup WI strains and nine specific for serogroup WII/III strains, whereas the Genetic Systems (GS) panel comprised 14 reagents, seven specific for serogroup WI strains and seven specific for serogroup WII/III strains . Serogroup WI represented 45% and WII/III represented 55% of the patients . Using the monoclonal antibody reagents, the serogroups could be further subdivided into so-called serovars . The Ph reagents identified four WI serovars and 21 WII/III serovars, whereas the GS reagents identified 10 WI serovars and 18 WII/III serovars . By combining the results obtained with each panel, 15 Ph/GS WI serovars and 33 Ph/GS WII/III serovars were recognised . In the WI isolates, one predominating serovar was recognised, whereas in the WII/III isolates, no single serovar predominated and a much greater variety of serovars was identified . The serovar patterns for men and women patients were very similar, except for one WII/III serovar that was 10 times more common in isolates from men than from women . Most isolates from different anatomical sites in the same patient were of the same serogroup and serovar . Two double infections were found . One patient had a genital infection with serogroup WII/III and a rectal infection with serogroup WI . Another patient with genital, rectal, and throat infections with serogroup WI was found to have gonococci of different GS serovars at each site . It was concluded that the level of discrimination achieved with the monoclonal antibody reagents should prove to be valuable in studying the micro epidemiology of gonococcal infection.

J Am Acad Dermatol, 1987 Aug, 17(2 Pt 1), 197 - 200
A new technic for transport, enrichment, and cultural detection of Neisseria gonorrhoeae; Gernand K et al.; This article describes a new transport and enrichment technic that improves growth conditions of Neisseria gonorrhoeae and that is particularly suitable for use in dermatology clinics with no bacteriology facilities . The deep-prick culture makes use of a simple and proven selective medium, which is placed in small plastic or glass vessels . After inoculation deep into the agar medium, the gonococci themselves create the required microaerophilic environment . Inoculated smear material can therefore be transported without loss . Our experience, which has lasted for more than 3 years and which has included more than 4000 patients, showed that in 98% to 99% of cases of suspected gonorrhea, gonococci can be detected with a contamination rate of less than 3%.

J Bacteriol, 1987 Aug, 169(8), 3414 - 21
Aerobactin utilization by Neisseria gonorrhoeae and cloning of a genomic DNA fragment that complements Escherichia coli fhuB mutations; West SE et al.; Aerobactin, a dihydroxamate siderophore produced by many strains of enteric bacteria, stimulated the growth of Neisseria gonorrhoeae FA19 and F62 in iron-limiting medium . However, gonococci did not produce detectable amounts of aerobactin in the Escherichia coli LG1522 aerobactin bioassay . We probed gonococcal genomic DNA with the cloned E . coli aerobactin biosynthesis (iucABCD), aerobactin receptor (iutA), and hydroxamate utilization (fhuCDB) genes . Hybridization was detected with fhuB sequences but not with the other genes under conditions which will detect 70% or greater homology . Similar results were obtained with 21 additional strains of gonococci by colony filter hybridization . A library of DNA from N . gonorrhoeae FA19 was constructed in the phasmid vector lambda SE4, and a clone was isolated that complemented the fhuB mutation in derivatives of E . coli BU736 and BN3307 . These results suggest that fhuB is a conserved gene and may play a fundamental role in iron acquisition by N . gonorrhoeae.

Infect Immun, 1987 Aug, 55(8), 1792 - 800
Physical heterogeneity of neisserial lipooligosaccharides reflects oligosaccharides that differ in apparent molecular weight, chemical composition, and antigenic expression; Griffiss JM et al.; We studied the oligosaccharides (OS) of outer membrane lipooligosaccharides (LOS) of Neisseria gonorrhoeae and Neisseria meningitidis . OS from the LOS of an individual neisserial strain always eluted from Sephadex G-50S as multiple peaks; the polyacrylamide gel elution profiles were nearly identical to the polyacrylamide gel electrophoresis profiles of the sodium dodecyl sulfate-disaggregated native LOS from which the OS were derived . Neisserial OS coeluted with Dex14 to Dex27 dextran oligomers (Mr, 2,210 to 4,320) . Monosaccharide composition varied among the several OS released from the LOS of a single strain . The two OS of a gonococcal strain sensitive to normal human serum (NHS) bacteriolysis (sers) varied in their ability to inhibit the binding of NHS immunoglobulin M to their parental LOS . The OS that was rich in hexosamines inhibited NHS immune lysis of its parent strain; the OS that was poor in hexosamines did not . We conclude that structural differences in their OS account for the Mr heterogeneity of the LOS of a strain.

Genitourin Med, 1987 Aug, 63(4), 246 - 9
Epidemiology and treatment of uncomplicated gonorrhoea caused by non-PPNG strains in Córdoba, Argentina: auxotypes, susceptibility profiles, and plasmid analyses of urethral isolates from men; Monayar HK et al.; The official records of uncomplicated gonorrhoea for Cordoba state show that between 1975 and 1985, about one in 1000 sexually active people acquired gonorrhoea each year . A study was therefore undertaken to obtain information about treatment of uncomplicated gonorrhoea, as well as the nutritional requirements, plasmid analyses, and susceptibility profiles of gonococci in this geographical area . From August 1983 to April 1984, 219 men with uncomplicated gonorrhoea were treated with one of four antibiotic schedules, all of which were over 95% efficient . All 98 strains isolated and purified were non-penicillinase-producing Neisseria gonorrhoeae (non-PPNG) . The minimum inhibitory concentrations (MICs) of benzylpenicillin, tetracycline, thiamphenicol, spectinomycin, kanamycin, and cefoxitin were assessed . The MIC of benzylpenicillin showed that 88% (86) of the strains were inhibited by 0.5 mg/l of the drug, and also showed a bimodal sensitivity pattern to that antibiotic . The nutritional requirements of the 62 strains tested showed that 53% (33) were of the non-requiring (wild type) auxotype, 42% (26) required proline (pro-) and 5% (3) required proline and arginine (pro- arg-) . Resistance to antibiotics was more notable in the pro- than in the wild type strains.

Antimicrob Agents Chemother, 1987 Aug, 31(8), 1288 - 90
Changing antibiotic susceptibility of Neisseria gonorrhoeae in Franceville, Gabon; Peeters M et al.; Susceptibilities to penicillin, cefotaxime, kanamycin, tetracycline, and spectinomycin were measured for 5 reference strains and 302 Neisseria gonorrhoeae isolates collected between 1980 and 1985 . After an initial rise, the number of penicillinase-producing strains decreased . A gradual decrease in susceptibility to spectinomycin and the appearance of tetracycline-resistant strains were also documented.

Infect Immun, 1987 Aug, 55(8), 1755 - 61
Phenotypic variation in epitope expression of the Neisseria gonorrhoeae lipooligosaccharide; Apicella MA et al.; Gonococcal lipooligosaccharides (LOSs) are a series of antigenically complex heteropolymers . To investigate whether all members of clonally selected populations of Neisseria gonorrhoeae express antigenically similar LOS, we studied gonococcal strains 4505 and 220 with monoclonal antibodies 6B4 and 3F11 which have specificity for different oligosaccharide epitopes on the same or comigrating LOS unit(s) on sodium dodecyl sulfate-polyacrylamide gel electrophoresis . Fluorescent-antibody and immunoelectron microscopy studies indicated that all members of the clonally selected populations were not homogenous for the epitopes these antibodies recognized . Fluorescence-activated cell sorting studies of 3F11-coated strain 220 indicated that the density of epitope expression was a function of time of growth . The population could be separated into two broad groups corresponding to organisms staining strongly or weakly for the 3F11 epitope, and the epitope density decreased during the late-log and stationary phases of growth . Sequentially staining organisms on Formvar grids with 6B4 and 3F11, followed by staining with either 5- or 15-nm colloidal gold spheres conjugated to goat anti-mouse immunoglobulin M demonstrated the following populations of cells among organisms derived from a single clone: organisms which stained for both 6B4 and 3F11 epitopes and organisms which stained for either 6B4 epitopes alone or 3F11 epitopes alone . Immunofluorescence microscopy studies with rhodamine and fluorescein goat anti-mouse immunoglobulin M conjugates sequentially staining organisms on Formvar grids with 3F11 and 6B4 also demonstrated these three populations . Analysis of LOS preparations made over the last 5 years indicated no change in serotype antigen concentration or in sodium dodecyl sulfate-polyacrylamide gel electrophoresis migration pattern . These studies indicate that while clonally selected strains of Neisseria gonorrhoeae undergo phenotypic variation at the epitope level, the impact of this variation on the total LOS of the population has little overall effect on its antigenic or physicochemical properties.

N Engl J Med, 1987 Jul 30, 317(5), 272 - 8
Effect of spectinomycin use on the prevalence of spectinomycin-resistant and of penicillinase-producing Neisseria gonorrhoeae; Boslego JW et al.; Because of the high prevalence of penicillinase-producing Neisseria gonorrhoeae in the Republic of Korea, spectinomycin has been used there in the primary treatment of gonococcal infections in U.S . military personnel since 1981, but there have been increasingly frequent reports of treatment failures with spectinomycin . We conducted a clinical study to determine the efficacy of spectinomycin treatment in 124 U.S . servicemen in the Republic of Korea who had urethral gonococcal infections . Ninety-seven patients were treated with spectinomycin alone and evaluated in a follow-up visit . In eight patients (8.2 percent), this treatment was unsuccessful . Antibiotic-sensitivity testing on isolates from seven of the patients with treatment failure demonstrated that six isolates were highly resistant to spectinomycin (minimal inhibitory concentration, greater than or equal to 100 micrograms per milliliter) . None of the spectinomycin-resistant strains had become resistant to penicillin, either through the production of penicillinase or through a chromosomal mutation . Although the mechanism of spectinomycin resistance appears to be a chromosomal mutation, these isolates were generally sensitive to other antibiotics . The prevalence of resistance to spectinomycin resulted in the substitution of ceftriaxone for the primary treatment of gonorrhea acquired by U.S . military personnel in the Republic of Korea . We believe that the rapid emergence of spectinomycin resistance in this population mandates a cautious approach to widescale use of the drug and indicates a need to broaden current surveillance programs.

Sex Transm Dis, 1987 Jul-Sep, 14(3), 125 - 9
Pelvic inflammatory disease associated with Neisseria gonorrhoeae and Chlamydia trachomatis: clinical correlates; Cromer BA et al.; The purpose of this study was to determine whether selected clinical features can distinguish salpingitis associated with endocervical Neisseria gonorrhoeae from that caused by Chlamydia trachomatis in black, inner-city adolescents . We reviewed retrospectively the charts of teenagers presenting to a university hospital outpatient department between January 1982 and January 1984 who were diagnosed as having salpingitis . We included all teenagers who presented with a history of low abdominal pain plus (1) either cervical motion tenderness (n = 15), adnexal tenderness (n = 13), or both (n = 57); and (2) either cervical cultures positive for N . gonorrhoeae and negative for C . trachomatis (n = 31) or cervical cultures negative for N . gonorrhoeae and positive for C . trachomatis (n = 54) . Discriminant analysis indicated that the presence of breakthrough vaginal bleeding (standard regression coefficient {SRC} = 0.301; P = 0.023), current usage of oral contraception (SRC = 0.408; P = 0.009), and an elevated erythrocyte sedimentation rate (SRC = 0.522; P = 0.0002) were significantly more often related to the presence of endocervical C . trachomatis . However, we found no significant differences between the two groups for other variables that have been described as distinguishing features (i.e., duration of pain, fever, and leukocyte count).

J Antimicrob Chemother, 1987 Jul, 20(1), 117 - 21
Ciprofloxacin versus ampicillin and probenecid in the treatment of uncomplicated gonorrhoea in men; Scott GR et al.; Eighty-six men with uncomplicated gonorrhoea were entered into a study comparing the efficacy of a single oral dose of 250 mg of ciprofloxacin with a single oral dose of ampicillin 2 g and probenecid 1 g for urethral gonorrhoea and a course of ampicillin, 500 mg four times per day for five days in rectal and pharyngeal infection . Two patients were excluded . Of the remaining 84, 45 were treated with ampicillin and 39 with ciprofloxacin . In the ampicillin group there were two treatment failures out of 40 urethral infections . Three patients with rectal infection were cured . Only one patient out of three pharyngeal infections was cured . Ciprofloxacin cured all of 34 urethral and three rectal infections including one penicillinase producing strain of Neisseria gonorrhoeae (PPNG) . Four of five pharyngeal infections were cured but there was one treatment failure . There were no major side effects in either treatment group . In conclusion, a single oral dose of 250 mg of ciprofloxacin is an effective treatment for uncomplicated gonorrhoea in men.

J Infect Dis, 1987 Jul, 156(1), 92 - 8
Postpartum upper genital tract infections in Nairobi, Kenya: epidemiology, etiology, and risk factors; Plummer FA et al.; We investigated the frequency of clinically defined upper genital tract infection (UGTI) and its relation to sexually transmitted diseases and other risk factors among 1,013 women initially studied while in labor at a Nairobi, Kenya maternity hospital . Women were enrolled during labor and followed up at seven days and one month postpartum . Cultures for Neisseria gonorrhoeae and Chlamydia trachomatis were done at enrollment and at day 7 . The prevalence of gonococcal and chlamydial infections was 6.7% and 20.8%, respectively . The overall prevalence of UGTI was 20.3% . The development of UGTI was significantly correlated with gonococcal infection (odds ratio, 4.4; P less than .0001), chlamydial infection (odds ratio, 1.7; P less than .02), presence of ophthalmia neonatorum (odds ratio, 2.6; P less than .0001), labor greater than 12 hr (odds ratio, 1.8; P less than .01), and area of residence (odds ratio, 1.5; P less than .05) . Postpartum UGTI, an enormous public health problem in Nairobi, would be partially susceptible to antenatal intervention programs focusing on sexually transmitted diseases.

Med Trop (Mars), 1987 Jul-Sep, 47(3), 243 - 8
{Sexually transmitted diseases and sterility in black Africa}; Bourgeade A et al.; It is in Africa that sterility of infectious etiology is prevalent: 75% to 85% of female sterility, primary as well as secondary, are the consequence of a pelvic infection . This picture is explained by the high prevalence of genital infections caused by Neisseria gonorrhoeae and by Chlamydia trachomatis in a sanitary under-developed environment . Frequency of such sterilities is such as fecundity rates are significantly reduced.

Rev Infect Dis, 1987 Jul-Aug, 9(4), 665 - 92
Clonal population structure of Neisseria meningitidis serogroup A isolated from epidemics and pandemics between 1915 and 1983; Olyhoek T et al.; A bacterial strain collection has been established consisting of 423 strains of Neisseria meningitidis serogroup A isolated from 23 epidemics or outbreaks that have occurred since 1960 as well as from earlier epidemics and from numerous nonepidemic situations . A combination of starch gel electrophoresis of seven cytoplasmic enzymes and sodium dodecyl sulfate-polyacrylamide gel electrophoresis of two outer membrane proteins was used to resolve the clonal population structure of these bacteria . Fifty electrophoretic types were assigned to 21 clones on the basis of a cluster analysis . The clones were separated into four distinct serogroup A subgroups, all of which were isolated from cases as recently as 1983 . Most epidemics or outbreaks were characterized by their association with a single or predominant clone, although some epidemics were apparently of mixed etiology and others yielded rare isolates belonging to other clones . Seven predominant clones were recognized that have caused sets of epidemics since 1915 . At least two of these sets can be considered to represent mutually exclusive pandemics first detected in 1967 and 1973, respectively . The results define a new typing scheme, which can be used for a comprehensive description of former and future epidemics . A list of strains and their epidemiologic data is appended.

J Gen Microbiol, 1987 Jul, 133 ( Pt 7), 1743 - 50
Progress of O-acetylation and cross-linking of peptidoglycan in Neisseria gonorrhoeae grown in the presence of penicillin; Lear AL et al.; The synthesis, cross-linking and O-acetylation of gonococcal peptidoglycan in growing cells were studied by following incorporation of radioactive glucosamine and separation of the SDS-insoluble peptidoglycan into uncross-linked (monomer) and cross-linked (dimer and oligomer) fragments . Cultures to which penicillin or piperacillin at concentrations near the minimum growth inhibitory concentration (MIC) had been added 20 min before the radioactive label were compared with controls . The beta-lactams affected the early stage of cross-linking (up to 3 min) but had no effect thereafter . The deficit of cross-linking, however, did not recover . The O-acetylation, particularly of the monomer fraction, was decreased by beta-lactams even at concentrations that had no effect on culture optical density, viable counts or overall peptidoglycan synthesis . These effects on O-acetylation occurred mainly after the first 3 min of incorporation, rather than before . O-Acetylation of the oligomer fraction was also followed . Here penicillin led to increased levels of O-acetylation during the early stages of incorporation but the final value was never exceeded; indeed at higher drug concentrations the later stages of O-acetylation of oligomers were inhibited (e.g . almost completely at 2.5 X MIC).

Sex Transm Dis, 1987 Jul-Sep, 14(3), 141 - 6
Auxotype/serovar diversity and antimicrobial resistance of Neisseria gonorrhoeae in two mid-sized American cities; Hook EW 3rd et al.; To characterize the prevalence and heterogeneity of Neisseria gonorrhoeae with chromosomally mediated resistance to penicillin G or tetracycline.HCl in Seattle, Washington, and Denver, Colorado, we auxotyped, serotyped, and determined the MICs of penicillin G and tetracycline for gonococcal isolates collected in both cities during 1984 . In Seattle 37 (18%) and ten (5%) of 205 isolates had MICs for penicillin G of greater than or equal to 1.0 and greater than or equal to 2.0 micrograms/ml, respectively; in Denver eight (3%) of 240 isolates had MICs for penicillin of 1.0 microgram/ml, and none had MICs of greater than 1.0 microgram/ml . For tetracycline.HCl, 107 (52%) and 38 (19%) of Seattle isolates had MICs of greater than or equal to 1.0 and greater than or equal to 2.0 micrograms/ml, respectively, while in Denver the respective figures were 111 (46%) and 48 (20%) . In each city, antimicrobial resistance was present in a number of auxotype/serovar (A/S) classes: isolates with MICs for penicillin G of greater than or equal to 1.0 microgram/ml were identified in 15 of 49 A/S classes in Seattle and in five of 49 A/S classes in Denver . These data indicate that chromosomal resistance to penicillin G and tetracycline.HCl varies geographically in prevalence and is a heterogeneous phenomenon involving multiple gonococcal strains.

Sex Transm Dis, 1987 Jul-Sep, 14(3), 130 - 4
Antibiotic susceptibility in relation to serogroup and auxotype of Neisseria gonorrhoeae isolates from Gabon; Peeters MF et al.; We tested 75 beta-lactamase-positive (penicillinase-producing Neisseria gonorrhoeae; PPNG) and 147 beta-lactamase negative (non-PPNG) strains of N . gonorrhoeae obtained during a two-year period in Franceville, a semirural community in southeastern Gabon, for susceptibility to antimicrobial agents, auxotype, and serotype . The most common auxotypes were the nonrequiring and proline-requiring strains . Of the non-PPNG strains tested, 37% belonged to serogroup WI, 48% to serogroup WII, and 15% could not be grouped with commercially available antisera . Except for four strains that belonged to serogroup WII, the PPNG strains were classified as serogroup WI or ungroupable . We determined the concentrations at which 90% of strains were inhibited (MIC90) for spectinomycin (32 mg/liter for both PPNG and non-PPNG), kanamycin (32 mg/liter for both PPNG and non-PPNG), tetracycline (2 mg/liter for non-PPNG, 1 mg/liter for PPNG), cefotaxime (0.03 mg/liter for non-PPNG, 0.008 mg/liter for PPNG), and penicillin (1 mg/liter for non-PPNG, greater than 32 mg/liter for PPNG) . A MIC of greater than or equal to 2 mg of tetracycline/liter was noted for 17% of the strains . Strains belonging to serogroup WII were more resistant to tetracycline and cefotaxime than other strains . Proline-requiring strains were less susceptible to tetracycline, cefotaxime, and spectinomycin than the nonrequiring strains . The decreased sensitivity to penicillin (non-PPNG strains) and tetracycline was determined by proline-requiring strains belonging to serogroup WII.

Sex Transm Dis, 1987 Jul-Sep, 14(3), 153 - 5
Single-dose treatment of uncomplicated acute gonococcal urethritis in Ethiopian men: comparison of rosoxacin, spectinomycin, penicillin, and ampicillin; Habte-Gabr E et al.; A total of 140 Ethiopian men with gonococcal urethritis were randomly assigned to treatment with aqueous procaine penicillin G (4.8 X 10(6) units intramuscularly {im} plus 1.0 g of oral probenicid); oral ampicillin (3.5 g plus 1.0 g of oral probenicid); spectinomycin (2.0 g im); or oral rosoxacin (Acrosoxacin; 300 mg) . Failure rates were 24%, 19%, zero, and 3%, respectively . Forty-four (31.4%) patients were infected with penicillinase-producing Neisseria gonorrhoeae (PPNG) and were evenly distributed in the treatment groups . All 39 PPNG strains analyzed for plasmid content possessed a 2.6-Mdalton plasmid; 28 (71.8%) had a 3.2-Mdalton beta-lactamase-encoding plasmid, ten (25.6%) had a 4.4-Mdalton plasmid (three with and seven without a 24.5-Mdalton plasmid), and one had only a 24.5-Mdalton plasmid . Two patients were infected with N . gonorrhoeae-possessing plasmids apparently capable of encoding but not producing beta-lactamase . Both spectinomycin and rosoxacin are excellent single-dose treatment regimens for gonococcal urethritis in men . All people receiving these drugs in Ethiopia should be tested serologically for syphilis, however, as eight (11.8%) of 68 men in this study also had active latent syphilis.

J Hosp Infect, 1987 Jul, 10(1), 87 - 90
Antibiotic dependence in a strain of Neisseria pharyngis; Winstanley TG et al.; A strain of Neisseria pharyngis was isolated in pure culture from a specimen of sputum . Growth was markedly enhanced by sub-lethal concentrations of rifampicin, spectinomycin, erythromycin and clindamycin . The effect was temporary with tetracycline . The possible mechanisms of this phenomenon are discussed.

Sex Transm Dis, 1987 Jul-Sep, 14(3), 147 - 52
The contraceptive sponge's protection against Chlamydia trachomatis and Neisseria gonorrhoeae; Rosenberg MJ et al.; To investigate the effect of the contraceptive sponge on the incidence of sexually transmitted diseases, we conducted a clinical trial among a high-risk population of women in Bangkok, Thailand . Two hundred fifty-five women were randomly assigned either to use the sponge or not and were evaluated weekly for gonorrhea and chlamydial infection . After adjustment by logistic regression for potentially confounding factors, women using the sponge were less likely to have contracted chlamydial infection (odds ratio {OR}, 0.6; 90% confidence interval {CI}, 0.4-1.0) and gonorrhea (OR, 0.9; CI, 0.6-1.3) as compared with women not using the sponge . These estimates probably underestimate the degree of protection because some exposure was misclassified in this pilot phase of the study . These results are consistent with other studies indicating that spermicides protect against gonorrhea and also demonstrating protection against an organism of even greater public health concern, Chlamydia trachomatis.

Mol Microbiol, 1987 Jul, 1(1), 5 - 12
Common mechanism controlling phase and antigenic variation in pathogenic neisseriae; Stern A et al.; The expression of the Neisseria gonorrhoeae opacity protein (Op, protein II), a major antigenic determinant of the outer membrane, is subject to frequent phase transitions . At least nine expression loci (opaE) are involved in the production of a large number of serologically distinct Op types . Using opa-specific oligonucleotides as probes in genomic blots, we detect Op-related gene sequences (opr) in N . meningitidis as well as in N . lactamica . DNA sequence analysis of such opr genes derived from N . meningitidis reveals distinct regions of homology with gonococcal opa E genes . As shown in the immunoblot, the proteins encoded by opa and opr are serologically related . Like the opaE genes, the 5'-coding sequences of the opr genes include a repetitive sequence composed of pentameric CTCTT units . The number of these coding repeat (CR) units is variable . This finding, together with the observation that all opr genes are constitutively transcribed, regardless of the status of protein production, suggests a translational control mechanism identical to that of the opa genes in gonococci . The related structures and control mechanisms of opa and opr genes imply a general significance of their gene products for the pathogenic character of the investigated Neisseria species.

J Clin Invest, 1987 Jul, 80(1), 78 - 87
Specificity of antibodies against Neisseria gonorrhoeae that stimulate neutrophil chemotaxis . Role of antibodies directed against lipooligosaccharides; Densen P et al.; Five strains each of Neisseria gonorrhoeae sensitive or resistant to complement (C) dependent killing by normal human serum (NHS) were examined for their ability to stimulate chemotaxis of polymorphonuclear leukocytes (PMNs) after preincubation with NHS; or IgM or IgG derived from NHS . Serum-sensitive N . gonorrhoeae stimulated C-dependent chemotaxis when opsonized with IgM, but not IgG, however, serum-resistant strains, taken as a whole, failed to promote chemotaxis when opsonized with either isotype . IgM titers in NHS against lipooligosaccharide (LOS) antigens from individual serum-sensitive, but not serum-resistant strains, correlated with the magnitude of chemotaxis generated by the corresponding opsonized strains (r = 0.99) . Western blots demonstrated that IgM and IgG from NHS recognized different antigenic determinants on LOS from serum-sensitive gonococci . IgM from NHS immunopurified against serum-sensitive LOS accounted for two-thirds of the chemotaxis promoting activity present in whole serum . IgG titers in NHS against LOS antigens from individual serum-resistant strains also correlated with magnitude of chemotaxis generated by the corresponding opsonized strains (r = 0.87), although most opsonized serum-resistant strains did not generate significantly higher magnitudes of chemotaxis than controls . In contrast, a serum-resistant isolate from a patient with disseminated gonococcal infection (DGI) stimulated chemotaxis when opsonized with IgG obtained from the patient's convalescent serum . By Western blot, convalescent IgG antibody recognized an additional determinant on serum-resistant LOS not seen by normal IgG.

Infect Immun, 1987 Jul, 55(7), 1652 - 6
Immunotype epitopes of Neisseria meningitidis lipooligosaccharide types 1 through 8; Tsai CM et al.; Lipooligosaccharides (LOS) of the eight immunotypes found in serogroup B Neisseria meningitidis were purified from their prototype strains grown in tryptic soy broth . Rabbit antisera to these LOS were prepared . Sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by silver staining revealed that most of the LOS antigens contained two major components; the larger components had apparent molecular weights (Mrs) in the range of 4,800 +/- 300, and the smaller components had an apparent Mr of 4,300 . Immunoblot analysis showed that the larger major component of an LOS, in general, was much more immunogenic because the rabbits produced antibodies exclusively or primarily to this component even though the LOS immunogen contained both large and small major components . Antibodies to the smaller 4,300-Mr components were infrequently observed but, when present, were cross-reactive with the same-size components of all heterologous LOS . Hence, the immunotype epitopes reside in the larger major components of all immunotypes except type 5, in which a smaller major component having an apparent Mr of 4,400 carries the epitope . Rabbit antisera to types 1, 5, and 6 were immunotype specific . Antisera to other types had cross-reactivities with some heterologous LOS, and the larger components, but not the 4,300-Mr components, of the LOS were primarily responsible for the cross-reactivities . This finding suggests that the larger components of cross-reactive LOS have a similar structure in addition to their type-specific sugar moieties . The LOS of N . meningitidis M986, a strain used for the production of a serotype 2a vaccine, was found to contain the immunotype 7 epitope.

Am J Med, 1987 Jun 26, 82(6B), 35 - 9
Norfloxacin in the treatment of uncomplicated gonococcal infections; Kaplowitz LG et al.; Norfloxacin, an oral fluoroquinolone antibacterial, is active in vitro against a variety of gram-positive and gram-negative pathogens, including both penicillinase-producing and non-penicillinase-producing strains of Neisseria gonorrhoeae . An earlier study demonstrated that a two-dose regimen of norfloxacin was as effective as standard therapy with spectinomycin for treating gonococcal urethritis, including infections caused by penicillinase-producing organisms . In this randomized study of treatment for uncomplicated gonococcal infection in men and women, three oral treatment regimens were compared: patients received either two doses of norfloxacin (600 mg twice daily), a single dose of norfloxacin (800 mg), or a single-dose ampicillin (3.5 g)/probenecid (1.0 g) regimen (as recommended by the Centers for Disease Control) . All three treatment regimens achieved similar cure rates . Although the number of patients treated was too small to yield statistically significant conclusions, it appears that norfloxacin may be slightly better treatment for rectal and pharyngeal gonococcal infections than ampicillin and probenecid . Additionally, norfloxacin was well tolerated in this study . Thus, based on a review of these data, norfloxacin appears to be an alternative, single-dose, oral treatment regimen for uncomplicated gonococcal infection.

Am J Med, 1987 Jun 26, 82(6B), 3 - 17
Norfloxacin, a fluoroquinolone antibacterial agent . Classification, mechanism of action, and in vitro activity; Goldstein EJ; Norfloxacin is an orally absorbed fluoroquinolone antibacterial with a fluorine at position 6 and a piperazine ring at position 7 . These changes have resulted in a marked enhancement (compared with that of the older quinolones) of in vitro antibacterial activity . Specifically, the antibacterial spectrum of norfloxacin includes Pseudomonas aeruginosa, as well as enteric pathogens . Norfloxacin is also active against both penicillin-susceptible and penicillin-resistant strains of Neisseria gonorrhoeae . Relative to its activity against gram-negative bacteria, norfloxacin is somewhat less active against gram-positive cocci . In general, the staphylococci are more susceptible to the drug than are the streptococci . As with all fluoroquinolones, norfloxacin's activity against anaerobic bacteria is poor . For urinary tract bacterial isolates, the following Bauer-Kirby disk diffusion zone-size breakpoints have been proposed: greater than or equal to 17 mm, susceptible; 13 to 16 mm, intermediate; less than or equal to 12 mm, resistant . Bacteria with minimal inhibitory concentrations (MICs) less than or equal to 16 micrograms/ml are considered susceptible; those with MICs greater than or equal to 32 micrograms/ml are considered resistant to norfloxacin . The mechanism of action of norfloxacin involves inhibition of the A subunit of the important bacterial enzyme DNA gyrase, which is essential for DNA replication . Plasmid-mediated resistance to the fluoroquinolones is not encountered . Further, although some cross-resistance within the fluoroquinolone class has occurred, there is little cross-resistance between norfloxacin and antibiotics of other classes.

J Biol Chem, 1987 Jun 5, 262(16), 7514 - 22
Fast atom bombardment mass spectrometry and tandem mass spectrometry of biologically active peptidoglycan monomers from Neisseria gonorrhoeae; Martin SA et al.; Fast atom bombardment mass spectrometry (FABMS) and tandem mass spectrometry (MS/MS) were employed to define the structures of Neisseria gonorrhoeae peptidoglycan monomers that were of interest because of their abilities to mediate diverse biological reactions ranging from arthritogenicity to somogenicity . FABMS-determined molecular weights of individual components present in several different enzymatically derived classes of gonococcal monomers revealed that each of these classes was a complex mixture of up to 13 distinct peptidoglycan fragments . These ranged from the predominant disaccharide tetrapeptides possessing reducing or nonreducing 1,6-anhydro-N-acetylmuramic acid ends to relatively minor constituents containing glycine or asparagine in addition to traditional peptidoglycan amino acids, i.e . alanine, glutamic acid, and diaminopimelic acid . FABMS of high performance liquid chromatography-purified monomers yielded some sequence information; however, analysis even of unfractionated peptidoglycan mixtures using a JEOL HX110/HX110 tandem mass spectrometer operating at 10 kV provided unambiguous primary sequence data for the peptidoglycan monomers and defined the position of glycine in four compounds as well as the location of O-acetyl substituents (present on some compounds) on C-6 of the N-acetylmuramic acid residue.

Diagn Microbiol Infect Dis, 1987 Jun, 7(2), 143 - 7
Bacteremia due to Neisseria cinerea: report of two cases; Southern PM Jr et al.; We report two cases of bacteremia due to Neisseria cinerea . One was a 2.5-yr-old boy with otitis media and pneumonia, who responded to treatment with amoxicillin . The other was a 47-yr-old man with underlying ethanol abuse who developed severe polymicrobial sepsis due to apparent intraabdominal disease . This man died despite extensive antimicrobial therapy.

J Appl Bacteriol, 1987 Jun, 62(6), 539 - 42
A note on hydrolysis of tributyrin by Branhamella and Neisseria; Riley TV; Sixty-three strains of Branhamella and Neisseria were tested by two methods for their ability to hydrolyse glycerol tributyrate . After the conventional plate test, gas liquid chromatographical (GLC) analysis of the agar medium was carried out to detect the hydrolysis product, butyric acid, and other volatile fatty acids . All strains of Branhamella catarrhalis, Neisseria caviae, N . cuniculi and N . ovis but no other Neisseria spp . gave positive results with the conventional test . With GLC, however, most strains of Branhamella and Neisseria were shown to liberate butyric acid . In addition, some strains liberated acetic and isovaleric acids . Greater amounts of butyric acid were produced by clinical strains, in particular B . catarrhalis, compared with reference strains . It was concluded that the conventional plate test for tributyrin hydrolysis differentiates B . catarrhalis, N . caviae, N . cuniculi and N . ovis from other Neisseria.

Isr J Med Sci, 1987 Jun, 23(6), 713 - 6
Mycoplasma hominis in patients with pelvic inflammatory disease; Miettinen A; The role of Mycoplasma hominis in pelvic inflammatory disease (PID) was studied among 35 patients with laparoscopically confirmed salpingitis or histopathologically confirmed plasma cell endometritis . M . hominis was isolated from the cervix of 15 patients, from the rectum of 13 patients, and from the endometrium of 5 patients . Only two of these five patients had M . hominis isolated from the endometrium in the absence of Chlamydia trachomatis or Neisseria gonorrheae, the major PID-causing organisms . None of the patients had M . hominis isolated from the fallopian tubes . Of the 35 patients, 7 demonstrated a significant change in enzyme immunoassay antibody levels to M . hominis, suggesting a recent infection with the organism . Six of the seven patients had M . hominis isolated from the cervix, and one had the organism isolated from the endometrium . Compared with patients not having M . hominis isolated from the cervix or endometrium, those who did more frequently had positive serum antibody findings for M . hominis and abnormal gas-liquid chromatographic findings of the vaginal fluid, indicative of bacterial vaginosis.

Fertil Steril, 1987 Jun, 47(6), 985 - 91
The effect of an IgA1 protease on immunoglobulins bound to the sperm surface and sperm cervical mucus penetrating ability; Bronson RA et al.; A major site of impaired fertility in men with autoimmunity to sperm rests at the level of restricted sperm entry and motion within cervical mucus . We studied the effects of a protease derived from Neisseria gonorrhoeae, whose substrate specificity is limited to human IgA1, on the ability of antibody-bound sperm to penetrate human cervical mucus in vitro . IgA on the sperm surface, but not IgG, was degraded by IgA1 protease . A correlation was seen between the levels of IgA bound relative to IgG and the improvement in sperm cervical mucus penetrating ability after IgA1 protease exposure . These results provide evidence that antisperm autoantibodies of both IgA and IgG classes impair the ability of spermatozoa to populate the female reproductive tract . They implicate the Fc region of the immunoglobulin molecule in mediating this effect and offer the potential to restore male fertility by treating antibody-bound sperm in vitro with immunoglobulin-directed bacterial proteases, before insemination.

J Exp Med, 1987 Jun 1, 165(6), 1688 - 702
Lipopolysaccharide induces recurrence of arthritis in rat joints previously injured by peptidoglycan-polysaccharide; Stimpson SA et al.; Rat ankle joints injected intraarticularly with 5 micrograms of group A streptococcal peptidoglycan-polysaccharide (PG-APS) developed an acute course of arthritis . Recurrence of arthritis was induced in 100% of these joints by intravenous injection of as little as 10 micrograms of Salmonella typhimurium lipopolysaccharide (LPS) 3 wk after intraarticular injection . This reaction was similar in athymic and euthymic rats . Buffalo rats were less susceptible than Lewis or Sprague-Dawley rats . Neisseria gonorrhoeae, Yersinia enterocolitica, and Escherichia coli LPS, and S . typhimurium Re mutant LPS, were also active . Re mutant LPS activity was greatly reduced by mixing with polymyxin B . E . coli lipid A was weakly active . An acute synovitis of much less incidence, severity, and duration was seen in contralateral joints injected initially with saline, and in ankle joints of naive, previously uninjected rats after intravenous LPS injection . The intravenous injection of the muramidase mutanolysin on day 0 or 7 after intraarticular PG-APS injection prevented LPS-induced recurrence of arthritis . These studies suggest that the phlogistic activities of lipid A and peptidoglycan might interact in an inflammatory disease process, and that LPS may play a role in recurrent episodes of rheumatoid arthritis or reactive arthritis.

Hinyokika Kiyo, 1987 Jun, 33(6), 968 - 71
{Bacteriological and clinical evaluation of norfloxacin in male gonorrheal urethritis}; Okazaki T; Thirty male patients with gonorrheal urethritis were treated with norfloxacin (NFLX) at our urological ward between May and July, 1984, and clinically evaluated . Thirty-nine strains of Neisseria gonorrhoeae isolated from the clinical specimens of these patients were bacteriologically studied . Of the 39 strains, 3 (7.7%) were PPNG strains and the other 36 strains were non-PPNG strains . The minimum inhibitory concentration (MIC) of penicillin G, PCG to the 3 PPNG strains was 6.25-25 micrograms/ml and that to the 36 non-PPNG strains was 0.05-3.13 micrograms/ml . The MIC of NFLX to the PPNG strains was 0.025-0.1 microgram/ml and that to the non-PPNG strains was less than or equal to 0.0125-0.2 microgram/ml . The patients with gonorrheal urethritis were given NFLX orally for 3 days at a daily dose of 600 mg . The clinical efficacy rate was 100%: excellent in 12 and good in 18 cases . All 3 patients with gonorrheal urethritis caused by PPNGs were cured . No subjective side effects were found.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1987 Jun, 265(1-2), 268 - 75
Sexually transmittable organisms in the urethra of males with and without urethritis; Elsner P et al.; In 589 males, 169 with and 420 without urethritis, urethral swabs were taken and assessed semiquantitatively for the sexually transmittable infectious agents Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Trichomonas vaginalis and Candida species . The organisms were isolated in patients with and without urethritis as follows: N . gonorrhoeae with urethritis 19.5%, without 0.0%; C . trachomatis with urethritis 16.0%, without 2.9%; U . urealyticum (high cfu-counts) with urethritis 27.2%, without 11.7%; M . hominis (high cfu) with 4.7%, without 2.9% . Combined infections were more frequent in males with urethritis (20.8%) than in those without (5.4%) . None of the investigated pathogenic microorganisms could be demonstrated in 37.9% of males with and in 71.2% of males without urethritis . Using loglinear analysis, a significant coincidence of infections with N . gonorrhoeae and U . urealyticum and of infections with U . urealyticum and M . hominis was found . It is concluded that an asymptomatic infection of the male urethra with sexually transmittable organisms is to be expected in partner's control examinations and in patients presenting for other STD like venereal warts or genital herpes . Therefore in these men, even if they are asymptomatic, a comprehensive microbiological examination is strongly recommended.

Rev Esp Fisiol, 1987 Jun, 43(2), 151 - 5
{Anti-phosphorylcholine response of autoimmune NZB/W mice: variations with age of serum titers and homogeneity}; Seoane R et al.; Antibody titers and avidity of sera of autoimmune NZB/W mice in responses induced by different antigens were determined . Results show an age-dependent decrease of the antibody titer in sera from female mice immunized with phosphorylcholine coupled to keyhole limpet haemocyanin . This decrease was not detected when using as immunogen an antigenic preparation of Neisseria meningitidis that naturally induces anti-phosphorylcholine antibodies, but was detected with a modification of this antigen (heat inactivation and further coupling with the hapten) . Determinations of inhibition profiles of antisera suggest that this loss of immune competence is paralleled by a decrease in avidity and homogeneity of antisera . This finding may be related to the loss of idiotypic clonal dominance recently reported to occur in these mice.

Pathol Biol (Paris), 1987 Jun, 35(5 Pt 2), 791 - 5
{Characteristics of penicillinase-producing strains of Neisseria gonorrhoeae isolated in France, 1979-1986}; Riou JY et al.; Penicillinase producing Neisseria gonorrhoeae PPNG, had been first isolated in France in 1979 . Since, they regularly increased if we considered France on the whole . From 1979 to 1986, 284 strains had been collected by a multicentric group . The frequency of isolation was strongly different in France, unknown in some region they rose 12% in specific areas in Paris . The PPNG strains were more frequently isolated from male than female (sex ratio was higher with PPNG than for non producing strain) . They were more often responsible of complicated infections in female than male at the same rate than the non producing strains . Auxotype distribution was different between producing and non producing strains . Plasmidic content from african type (Af) was almost the same than from asian type (As) . Strains with Af type associated with the conjugative plasmid were increasing.

J Antimicrob Chemother, 1987 Jun, 19(6), 761 - 5
The activity of the 4 quinolone Ro 23 6240 and the cephalosporins Ro 15 8074 and Ro 19 5247 against penicillin sensitive and resistant gonococci; Easmon CS et al.; We have compared the in-vitro activity of the 4-quinolone Ro 23 6240 and the oral cephalosporins Ro 15 8074 and Ro 19 5247 with that of penicillin, spectinomycin, cefuroxime, ceftriaxone, ciprofloxacin, ofloxacin and norfloxacin against 60 strains of Neisseria gonorrhoeae . MICs 90 against penicillinase producing N . gonorrhoeae (PPNG) and chromosomally-mediated resistant N . gonorrhoeae (CMRNG) respectively were: spectinomycin 16 and 16 mg/l, cefuroxime 0.12 and 1.0 mg/l, ceftriaxone 0.008 and 0.03 mg/l, Ro 15 8074 0.015 and 0.12 mg/l, Ro 19 5247 0.015 and 0.12 mg/l, Ro 23 6240 0.06 and 0.06 mg/l, ciprofloxacin 0.008 and 0.015 mg/l, ofloxacin 0.03 and 0.06 mg/l, norfloxacin 0.06 and 0.12 mg/l . The spectinomycin resistant and spectinomycin-sensitive strains did not differ . All three new agents show good activity against gonococci and warrant further clinical investigation . Ro 23 6240 in common with the other 4-quinolones appears to be as active against gonococcal strains exhibiting non-enzymic chromosomal resistance to penicillin as against PPNG and penicillin-sensitive isolates.

Genitourin Med, 1987 Jun, 63(3), 160 - 8
Serological ecology of Neisseria gonorrhoeae (PPNG and non-PPNG) strains: Canadian perspective; Dillon JR et al.; One hundred and thirty eight penicillinase producing Neisseria gonorrhoeae (PPNG) and 239 non-PPNG strains were characterised serologically using a panel of seven monoclonal antibodies directed against protein 1A and seven against protein 1B . An association between serovar and susceptibility to antimicrobial agents, auxotype, and plasmid content was observed . Serogroup WI strains were more sensitive to penicillin, ampicillin, tetracycline, erythromycin, cefoxitin, and cefuroxime . Sixty five (82%) of the 79 WI strains were typed as being serovar Aedgkih, and 47 (72%) of these strains required arginine, uracil, and hypoxanthine for growth (AUH-) . Seventy one (44%) of 160 WII/WIII strains were serovar Bacejk, and 42 (59%) of these required proline, citrulline, and uracil for growth (PCU-) and were plasmid free . Serovars Bcgk, Beghjk, Bacjk, and Bajk were associated with resistance to antimicrobial agents . Analysis of PPNG isolates showed a new serovar, Af, which was associated with strains imported from Malaysia and Singapore that required proline and ornithine for growth (Pro-Orn-) and carried the 24.5 megadalton transfer plasmid, the 2.6 megadalton cryptic plasmid, and the 4.5 megadalton penicillinase producing plasmid . Other associations between serovar and geographical location were noted.

Genitourin Med, 1987 Jun, 63(3), 157 - 9
Serovars, auxotypes, and plasmid contents of PPNG strains from outbreak in Amsterdam; Ansink-Schipper MC et al.; The first outbreak of penicillinase producing strains of Neisseria gonorrhoeae (PPNG) in Amsterdam in 1981-2 was caused mainly by African strains carrying the 24 megadalton transfer plasmid (Afr+) that were non-requiring (NR) and inhibited by phenylalanine (pheni), but African strains without the transfer plasmid (Afr-) that were NRpheni and Afr+ NR strains were also found . Serological classification, using two monoclonal antibody systems, showed that three main serovars (Ae/Av, Aedih/Arst, and Bacejk/Brpyust) could be distinguished in these PPNG strains, which indicated exchanges of plasmids in these serovars . The serovar Ae/Av predominated in the Afr+ and Bacejk/Brpyust in the Afr- strains.

Genitourin Med, 1987 Jun, 63(3), 153 - 6
Neisseria gonorrhoeae: subdivision of auxogroups by genetic transformation; Copley CG; Genetic transformation was used in an attempt to subdivide the most prevalent auxotypes of Neisseria gonorrhoeae in local isolates . The large proline requiring (Pro-) group could be divided into two genetic types, as could the less common arginine requiring (Arg-) group . The large arginine, hypoxanthine, and uracil requiring (Arg- Hyp- Ura-) group could not be subdivided by this method . The genetic relation between these and other auxotypes was investigated.

Eur J Epidemiol, 1987 Jun, 3(2), 206 - 8
Plasmid deoxyribonucleic acid in throat and cerebrospinal fluid isolates of Neisseria meningitidis; Facinelli B et al.; Ten strains of Neisseria meningitidis, isolated either from cerebrospinal fluid or from throat cultures, were typed and screened for the presence of plasmid DNA . Three group C strains, isolated in the same area, each harboured a plasmid of similar molecular weight (approx . 8.5 Md) . No evidence of plasmid DNA was found in the other strains (whether of the same group but isolated in another area, or of other groups).

J Bacteriol, 1987 Jun, 169(6), 2781 - 92
Genetic structure of Neisseria meningitidis populations in relation to serogroup, serotype, and outer membrane protein pattern; Caugant DA et al.; The genetic structure of populations of Neisseria meningitidis was examined by an analysis of electrophoretically demonstrable allelic variation at 15 genes encoding enzymes in 650 isolates of eight serogroups (A, B, C, W135, X, Y, Z, and 29E) and 38 nonserogroupable isolates . A total of 331 distinctive multilocus genotypes (electrophoretic types, ETs) was identified, among which mean genetic diversity per locus (H = 0.547) was greater than in Escherichia coli and other bacterial species thus far studied . The intercontinental distribution of some ETs and the recovery of organisms of identical genotype over periods of many years strongly suggest that the genetic structure of N . meningitidis is basically clonal as a consequence of low rates of recombination of chromosomal genes . Variation among strains in serogroup, serotype, and the electrophoretic pattern of the major outer membrane proteins has little relationship to the complex structure of populations revealed by enzyme electrophoresis, which involves 14 major lineages of clones diverging from one another at genetic distances greater than 0.50 . Genetic diversity among ETs of isolates of the same serogroup was, on average, 84% of that in the total sample . Clones of serogroup A were unusual in being genotypically less heterogeneous than those of other serogroups and in forming a single phylogenetic group . Isolates of the same serotype or outer membrane protein pattern were also highly heterogeneous; on average, 87 and 97%, respectively, of the total species diversity was represented by ETs of the same serotype or outer membrane protein.

Infect Immun, 1987 Jun, 55(6), 1503 - 12
Genetic relationships and clonal population structure of serotype 2 strains of Neisseria meningitidis; Caugant DA et al.; Two hundred and thirty-four strains of Neisseria meningitidis, including 94 serotype 2a, 111 serotype 2b, and 19 serotype 2c isolates, together with 10 isolates that were serotyped as 2 with polyvalent antiserum but did not react with monoclonal antibodies, were characterized by the electrophoretic mobilities of 15 metabolic enzymes . Of these enzymes, 14 were polymorphic, and 56 distinctive combinations of alleles at the enzyme loci (electrophoretic types) were identified, among which the mean genetic diversity per locus was 0.413, or about 75% of that recorded for the species N . meningitidis as a whole . Mean genetic diversity among electrophoretic types of the same serotype (2a, 2b, or 2c) was, however, on average, less than half the total species diversity, and no multilocus genotypes were shared between isolates of the different serotypes, which belong to distinctive clonal lineages . Recent temporal changes in the frequencies of recovery of pathogenic strains of serotypes 2a and 2b in South Africa and North America resulted from clone replacement in these populations rather than evolutionary modification of the serotype protein of the initially dominant clones.

Infect Immun, 1987 Jun, 55(6), 1359 - 64
Induction and repression of outer membrane proteins by anaerobic growth of Neisseria gonorrhoeae; Clark VL et al.; Neisseria gonorrhoeae is generally considered to be an obligate aerobe; it can, however, grow in the absence of oxygen by anaerobic respiration by using nitrite as a terminal electron acceptor . The outer membrane protein compositions of aerobically and anaerobically grown N . gonorrhoeae strains were compared by one- and two-dimensional polyacrylamide gel electrophoresis . Anaerobically grown strains expressed at least three proteins (Pan 1 to Pan 3) at much higher levels than did aerobically grown cells . Conversely, at least five other proteins (Pox 1 to Pox 5) were found to be expressed at significantly higher levels in aerobically grown cells . None of the Pan or Pox proteins were heat modifiable, and none of the heat-modifiable protein IIs or other major outer membrane proteins (protein I, protein III, pilin, or H-8 protein) were significantly altered in expression by anaerobic growth . There were also no apparent differences in lipopolysaccharide composition in aerobically and anaerobically grown gonococci . The regulation of protein expression by oxygen availability suggests that anaerobic growth is a physiologically significant state for this organism.

Drugs, 1987 Jun, 33(6), 577 - 609
Sulbactam/ampicillin . A review of its antibacterial activity, pharmacokinetic properties, and therapeutic use; Campoli-Richards DM et al.; Sulbactam is a semisynthetic beta-lactamase inhibitor which when combined with certain beta-lactam antibacterials extends their activity against bacteria that are normally resistant to the antibiotic due to production of beta-lactamases . In combination with ampicillin it extends the antibacterial activity of ampicillin to include beta-lactamase-producing strains which are otherwise resistant, including Bacteroides fragilis, and increases the susceptibility of many sensitive strains . Sulbactam is poorly absorbed after oral administration and sulbactam/ampicillin is therefore administered parenterally, although another linked sulbactam-ampicillin compound, sultamicillin, has been developed which is well absorbed after oral administration . The basic pharmacokinetic characteristics of sulbactam after parenteral administration are similar to those of ampicillin . Multiple-dose therapy with sulbactam/ampicillin is clinically and bacteriologically effective in infections of the urinary tract, skin and soft tissue, bones and joints, respiratory tract, ears, nose and throat, as well as intra-abdominal and obstetric and gynaecological infections and septicaemia . In addition, single intramuscular doses of sulbactam/ampicillin administered with oral probenecid are therapeutically effective in gonorrhoea, including infections due to penicillinase-producing and/or ampicillin-resistant Neisseria gonorrhoeae . In the prophylaxis of infectious complications of surgery sulbactam/ampicillin is superior to placebo and appears to be similar in efficacy to several alternative antibacterial regimens . Further studies involving larger numbers of patients are needed to clarify the comparative therapeutic and prophylactic efficacy of sulbactam/ampicillin and alternative antibacterial drugs . Nonetheless, sulbactam/ampicillin improves the therapeutic and prophylactic efficacy of an antibacterial of familiar safety, and must be seen as a worthwhile advance.

J Infect Dis, 1987 Jun, 155(6), 1276 - 81
Evidence of serum antibodies to Neisseria gonorrhoeae before gonococcal infection; Hicks CB et al.; To characterize the serum antibody response to urethral infection with Neisseria gonorrhoeae, we examined pre- and postinfection sera from 13 men experiencing their first gonococcal infection . Using western blot analysis, we found that nine of 13 patients developed new serum IgG antibodies against one or more antigens, most commonly against lipooligosaccharide, followed in order by the H.8-antigen, pili, proteins I and II, and protein III . Twelve of 13 patients had preexisting IgG to gonococcal antigens, most commonly against the H.8 antigen, followed by pili, lipooligosaccharide, protein I, and protein III . Using serum obtained from other patients before and after nasopharyngeal carriage of Neisseria meningitidis, we demonstrated that carriage resulted in serum IgG cross-reactive to N . gonorrhoeae antigens . This is likely explanation for the presence of antigen-specific antibody in preinfection sera.

Acta Pathol Microbiol Immunol Scand {B}, 1987 Jun, 95(3), 181 - 8
Comparison between serological classification and auxotyping in the analysis of Neisseria gonorrhoeae infections; Backman M et al.; Auxotyping and serological classification, using monoclonal antibodies, were performed on 730 gonococcal strains . These strains were isolated from 725 consecutive patients seen at the Venereal Outpatients Clinic at the Department of Dermatology, Sodersjukhuset, Stockholm, during one year, up to April 1983 . Strains from patients with repeated gonococcal infections were, besides auxotyping and serological classification, analysed with restriction endonuclease cleavage . The strains were distributed into 16 auxotypes, of which the eight most common accounted for 97.4% of all isolates . The same strains were distributed into 38 serovars, of which the eight most common accounted for 88.4% of all isolates . When the two methods were combined, 98 combinations of auxotypes and serovars were seen . The eight most common combinations included 60.0% of all strains . Correlations were found between auxotypes and serogroups as well as serovars . The serological classification gave a better resolution compared with auxotyping; however, when the two systems were combined the sensitivity was highly increased.

Ophthalmology, 1987 May, 94(5), 525 - 31
Neisseria gonorrhoeae keratoconjunctivitis; Ullman S et al.; Clinical and laboratory findings of 47 patients with ocular infections secondary to Neisseria gonorrhoeae during a 5 1/2-year period were reviewed . In 16 patients (34%), corneal involvement was noted . Six of these patients had a severe ulcerative keratitis resulting in permanent visual loss and five required surgery for a corneal perforation . Patients with corneal involvement were older and presented later in the course of their disease than patients with isolated conjunctival involvement (P less than 0.005) . An out-patient regimen of intramuscular antibiotics (either penicillin, cephalosporin, or spectinomycin {Trobicin}) appeared to be effective for infections limited to the conjunctiva in adults . If a topical antibiotic ointment is used in addition to parenteral antimicrobial agents, the authors' laboratory sensitivities suggest that erythromycin may be the drug of choice.

Hum Reprod, 1987 May, 2(4), 301 - 8
Influence of microbial colonization on sperm-mucus interaction in vivo and in vitro; Eggert-Kruse W et al.; Two-hundred-and-thirty-three asymptomatic couples with a mean duration of infertility of 5 years were submitted to postcoital testing (PT) and to sperm penetration meter test (SPMT) and simultaneous microbial screening . Cervical swabs and semen specimens were collected for culture of Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis, Neisseria gonorrhoeae, other potentially pathogenic and commensal aerobic and anaerobic bacteria, herpes simplex virus, vaginal swabs for Trichomonas vaginalis and yeasts . Results of microbial screening were analysed with regard to sperm penetration ability into wives' cervical mucus in vivo and in vitro, but no marked influence was revealed for most microorganisms . Samples of only one of the 233 couples proved to be completely sterile . The findings suggest that in asymptomatic patients microbial colonization is of minor importance for sperm-mucus interaction.

Ann Inst Pasteur Microbiol, 1987 May-Jun, 138(3), 333 - 42
The 70-Kd neisserial common antigen is a surface-exposed, antigenically stable peptidic structure; Lavitola A et al.; A previously described 70-Kd antigen present in all Neisseria gonorrhoeae strains tested and in most Neisseria species was characterized as a mercaptoethanol-and heat-stable protein . Using mouse polyclonal antisera specifically directed against this antigen, it was shown that it is a surface-exposed structure . The 70-Kd antigen was recovered from all gonococcal strains isolated from different anatomic sites in male and female partners, thus demonstrating its antigenic stability after in vivo transmission in humans.

Ann Inst Pasteur Microbiol, 1987 May-Jun, 138(3), 325 - 32
Indication of thioglucosidase activity in extracts of Neisseria gonorrhoeae; Goldner M et al.; The recent demonstration of a host-derived inducer of gonococcal resistance to complement-mediated killing by human serum in purified serum and red blood cell fractions, which contained small glucopeptides with cysteine as one of the constituent amino acids, prompted an investigation of Neisseria gonorrhoeae for thioglucosidase activity . This involved an examination of supernatants of sonicated gonococci for thioglucoside hydrolysis by following, spectroscopically, the hydrolysis of 6-purine beta-D-glucothiopyranoside to 6-mercaptopurine and glucose . Extracts of N . gonorrhoeae were found to hydrolyse this thioglucoside . A substantial activity was present in a fraction with the same order of molecular weight as plant thioglucosidases . This led us to suspect the presence of a thioglucosidase in N . gonorrhoeae.

Pathol Biol (Paris), 1987 May, 35(5), 517 - 20
{In vitro activities of 9 aminosides against of 250 strains of Neisseria gonorrhoeae}; Casin I et al.; We compared the in vitro activities of 9 aminoglycosides including trospectomycin sulfate against 250 selected strains of Neisseria gonorrhoeae according to their penicillin resistance (penicillinase production), streptomycin resistance, spectinomycin resistance . Trospectomycin sulfate inhibited all spectinomycin-sensible strain at a concentration of 4 mg/l but the spectinomycin-resistant strain needed 32 mg/l for its inhibition . Among the other aminoglycosides tested netilmicin had the most in vitro effectiveness . Its minimal inhibitory concentrations were comparable to that of trospectomycin sulfate: furthermore this compound demonstrated in vitro activity against the spectino-resistant strain.

Obstet Gynecol, 1987 May, 69(5), 743 - 6
The diagnosis of gonorrhea in a low-prevalence female population: enzyme immunoassay versus culture; Lieberman RW et al.; In a low-prevalence population for sexually transmitted disease, accurate methods of identifying Neisseria gonorrhoeae infections are of paramount importance . Tests with low sensitivity are of concern to each practitioner . Of no less concern, however, are the possible social and emotional consequences of a false-positive test in a family-based, rural, or military community . Several centers serving high-prevalence populations have shown that the Gonozyme Enzyme Immunoassay may provide many advantages in the rapid detection of gonococcal infection in these groups . Few studies, however, have evaluated its efficacy in low-prevalence populations . We compared the Gonozyme with Martin-Lewis culture medium in 1490 women considered at risk for infection with N gonorrhoeae at Keesler USAF Medical Center, Mississippi . Fifty-three women had culture-proved infections (3.6% disease prevalence) . The sensitivity and specificity of the Gonozyme in this population were 92.4 and 97.2%, respectively . However, the predictive value of a positive test was only 55.1%, mandating culture confirmation . It appears that in a low-prevalence female population, standard culture techniques provide a more efficient and reliable means of detecting N gonorrhoeae than does the Gonozyme Enzyme Immunoassay.

Infect Immun, 1987 May, 55(5), 1190 - 7
Probing the surface of Neisseria gonorrhoeae: simultaneous localization of protein I and H.8 antigens; Robinson EN Jr et al.; Gonococcal outer membrane protein I and the neisserial antigen H.8 are being investigated for inclusion in a gonococcal vaccine . To determine the distribution of immunoaccessible protein I and H.8 molecules on the surface of viable gonococci and to approximate the accessibility of these antigens to vaccine-elicited antibodies, immunologic probes composed of protein I- and H.8-specific antibodies linked to gold spheres were developed . When whole gonococci were exposed to the protein I and H.8 immunologic probes and examined by transmission electron microscopy, gold spheres clearly marked the surface of some of the gonococci, but not the surface of other gonococci from the same culture . The immunologic accessibility of gonococcal protein I or neisserial H.8 varied among gonococci . This diversity may affect the efficacy of a vaccine composed of these surface antigens.

Am J Med, 1987 Apr 27, 82(4A), 307 - 10
Problems in the treatment of bacterial sexually transmitted diseases; Stamm WE; Although most bacterial sexually transmitted diseases (STDs) can be effectively treated, currently available regimens are far from ideal . Increasingly widespread plasmid-mediated resistance to the penicillins limits the use of these agents in the treatment of Neisseria gonorrhoeae and Hemophilus ducreyi infections . Chromosomally mediated antimicrobial resistance to the tetracyclines, penicillins, erythromycins, and sulfonamides further limits therapeutic options in the treatment of gonorrhea, and plasmid-mediated resistance to sulfonamides and tetracyclines is frequent in H . ducreyi infections . In patients with Chlamydia trachomatis infections, effective regimens that can more easily be complied with (shorter duration, less frequent dosing) are needed, as are effective alternative regimens for use in pregnancy and in infants . In selected STDs that are polymicrobial (pelvic inflammatory disease and bacterial vaginosis, for example) or that often present simultaneously (gonorrhea-chlamydia, gonorrhea-syphilis, chancroid-syphilis), single-drug regimens that are effective against several genital pathogens would be ideal . Only limited therapeutic alternatives are available for some STDs, especially in pregnant women or in patients with penicillin allergy . Thus, antimicrobial resistance, drug toxicity, poor compliance, limited alternatives in pregnancy or allergy, and the lack of single agents possessing a broad spectrum of activity against multiple genital pathogens limit currently available therapy.

JAMA, 1987 Apr 17, 257(15), 2056 - 60
Cost-effectiveness of combined treatment for endocervical gonorrhea . Considering co-infection with Chlamydia trachomatis; Washington AE et al.; Three treatment regimens are currently recommended for penicillin-susceptible Neisseria gonorrhoeae infection of the cervix: ampicillin, tetracycline, and a combination of ampicillin and tetracycline . To evaluate the cost-effectiveness of these options, we developed a decision analysis model and analyzed the efficacy of each treatment in curing gonorrhea, as well as coexisting Chlamydia trachomatis infection, and in preventing subsequent pelvic inflammatory disease, ectopic pregnancy, and infertility . We included direct costs of medication and expenditures for management of unresolved infections and associated complications . Combination treatment is more than twice as cost-effective as tetracycline and seven times as cost-effective as ampicillin when the medical cost of managing pelvic inflammatory disease is considered . When the costs of ectopic pregnancies and infertility are included, the cost-effectiveness of combination treatment increases further.

Klin Wochenschr, 1987 Apr 15, 65(8), 387 - 90
{Recurrent meningitis in familial deficiency of the 8th component of the complement system}; Keller H et al.; An 18-year-old man suffered from recurrent bacterial meningitis . Investigation of the complement system revealed deficiency of the 8th complement component (C8) in the patient and his sister . Genetic defects of the terminal complement components C5 to C8 predispose to Neisseria infections, probably due to a lack in bacteriolytic activity . It is to be noted that 1 year ago the patient had been hospitalized for a culture-proved pneumococcal meningitis.

Am J Ophthalmol, 1987 Apr 15, 103(4), 576 - 81
Branhamella catarrhalis keratitis; Heidemann DG et al.; Branhamella catarrhalis, formerly known as Neisseria catarrhalis, has structural similarities to Neisseria gonorrhoeae, but is generally considered to be nonpathogenic . We studied the clinical and laboratory data of four previously reported cases and six additional cases of B . catarrhalis keratitis . All patients had a predisposing ocular or systemic condition, or both . There were various clinical characteristics, but in most cases the infiltrate occurred in the central or paracentral cornea . A prompt response to treatment with a cephalosporin and aminoglycoside antibiotic was noted in all cases . Two patients had corneal perforations, which probably resulted from a delay in treatment . Gram-negative diplococci from corneal scrapings may not necessarily represent N . gonorrhoeae.

Sex Transm Dis, 1987 Apr-Jun, 14(2), 75 - 8
Failure of a lottery incentive to increase compliance with return visit for test-of-cure culture for Neisseria gonorrhoeae; Chacko MR et al.; The impact of the financial incentive of playing a lottery on the rate of return for test-of-cure cultures was evaluated at a clinic for sexually transmitted diseases . All teenagers and young adults treated for gonorrhea (or as contacts of patients with gonorrhea) who were given a test-of-cure appointment were eligible to participate; in order to win, they had to keep the appointment . The return rate was documented during a baseline and a lottery phase for 519 patients . Females were significantly more likely to keep the appointment (47%) than males (27%), regardless of intervention, but there was no improvement in the return appointment rates with the lottery (baseline, 31% vs . lottery, 33%) . Although teenaged males were more likely to participate in the lottery than young adult males and all females, only young adult females who participated were significantly more likely to return (68%) . Reasons for failure of the lottery are discussed . Thus, despite the successful use of a lottery in previous studies, it is not always helpful in improving compliant behavior in certain populations.

Genitourin Med, 1987 Apr, 63(2), 119 - 21
Sexually transmitted infections in adolescent girls; Mulcahy FM et al.; Two hundred and ten adolescent girls in residential care with an age range of 12 to 16 years were screened for sexually transmitted infections . The incidences of infection with Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis were 13.7%, 16.2%, and 16.0% respectively . Pelvic inflammatory disease was identified in 16.4% of those with C trachomatis or gonococcal infection . The high morbidity from sexually transmitted disease in these adolescent girls reinforces the need for screening similar at risk teenagers.

Zentralbl Bakteriol Mikrobiol Hyg {A}, 1987 Apr, 264(1-2), 131 - 6
Supplement peptone agar--a simple carbohydrate degradation plate medium for the identification of Neisseria species; Stoakes L et al.; A carbohydrate degradation medium was developed for the detection of acid production by Neisseria species and Branhamella catarrhalis . A total of 223 clinical isolates were identified by Supplemented Peptone Agar and the results were compared with those of Cystine Trypticase Agar . Supplemented Peptone Agar and Cystine Trypticase Agar correctly identified 99.1% and 93.7% of the total strains respectively within 24 h . With Cystine Trypticase Agar method another 4% of the isolates could be identified but required an additional 24 h of incubation.

Sex Transm Dis, 1987 Apr-Jun, 14(2), 63 - 8
Endometrial damage in acute salpingitis; Tomioka ES et al.; Histologic and bacteriologic analyses of endometrium were performed before and on day 15 after minocycline treatment of 20 patients with acute salpingitis . Endometritis was diagnosed in 15 patients before and in nine after treatment . Neisseria gonorrhoeae was recovered from the cervix and endometrium of seven patients but was not isolated after treatment . Chlamydia trachomatis was recovered from the cervix of eight, and from the endometrium of three patients, two of whom had negative cervical cultures . After treatment C . trachomatis was recovered from the cervix of three patients, although two of them had taken aluminum hydroxide for gastric symptomatology during minocycline treatment . Culture of an endometrial specimen revealed no growth of C . trachomatis . The histologic study revealed plasma cell infiltrates in specimens from patients who had cultures positive for C . trachomatis . The results showed that although endometritis is an important manifestation of acute salpingitis, there is no correlation between severity of endometritis and degree of tubal damage.

Sex Transm Dis, 1987 Apr-Jun, 14(2), 113 - 5
Infections due to beta-lactamase-producing Neisseria gonorrhoeae at the University Hospital Medical Center, Kuala Lumpur, Malaysia; Ismail R; The incidence of infections due to beta-lactamase-producing Neisseria gonorrhoeae is increasing in many parts of the world . An epidemiologic survey of infections caused by beta-lactamase-producing strains of N . gonorrhoeae at the University Hospital, Kuala Lumpur, from February 1977 to December 1985 (106 months) showed that the incidence rose from 4.8% (two cases) in 1977 to 49.4% (39 cases) by the end of 1985 . The highest incidence of gonococcal infections was found to be in the group aged 20-39 years; the male-to-female ratio was 1.55:1 . The mean inhibitory concentrations of benzylpenicillin were 0.12 microgram/ml for non-beta-lactamase-producing strains and 16 micrograms/ml for isolates of N . gonorrhoeae that produce beta-lactamase.

Sex Transm Dis, 1987 Apr-Jun, 14(2), 111 - 2
Comparative in-vitro activity of enoxacin against penicillinase- and non-penicillinase-producing Neisseria gonorrhoeae; Shapiro MA et al.; The in-vitro antigonococcal activity of enoxacin was measured by a broth microdilution method . Comparisons were made with five clinically relevant marketed drugs against 23 clinical isolates of Neisseria gonorrhoeae, including several penicillinase producers as well as multiply resistant strains . Results showed that enoxacin possessed potent activity against all organisms tested, with MIC values ranging from less than or equal to 0.013 to 0.05 micrograms/ml.

Antimicrob Agents Chemother, 1987 Apr, 31(4), 535 - 8
Comparative double-blind study of 200- and 400-mg enoxacin given orally in the treatment of acute uncomplicated urethral gonorrhea in males; van der Willigen AH et al.; In a double-blind randomized study, 155 male patients with uncomplicated urethral gonorrhea were given 200 mg (one capsule with 200 mg and one capsule with placebo; n = 77) or 400 mg (two capsules with 200 mg; n = 78) of enoxacin orally . The cure rates in the 200- and 400-mg treatment groups were 90 and 92%, respectively . The enoxacin MIC for the isolated Neisseria gonorrhoeae strains ranged from 0.015 to 0.12 microgram/ml . Postgonococcal urethritis was diagnosed in 29 (42%) patients in the 200-mg treatment group and 19 (26%) patients in the 400-mg treatment group . Side effects (nausea, headache, and vomiting) occurred in 2 (3%) of the 77 patients in the 200-mg treatment group and in 3 (4%) of the 78 patients in the 400-mg treatment group.

J Clin Pathol, 1987 Apr, 40(4), 377 - 83
Chlamydial and gonococcal antibodies in sera of infertile women with tubal obstruction; Robertson JN et al.; Sera from 48 infertile women with tubal pathology and from 77 infertile women with normal fallopian tubes were tested by enzyme linked immunosorbent assay (ELISA) using Chlamydia trachomatis and Neisseria gonorrhoeae antigens . Control sera were obtained from women undergoing abortion, sterilisation, and from women practising barrier contraception . The results of ELISA for antibodies to chlamydiae were in close agreement with results published previously of an immunofluorescence test on these sera . Antibodies to C trachomatis were found in 73% of the infertile women with tubal pathology, significantly more than in any of the control groups . Only a very low prevalence (2-5%) of antibodies to gonococcal pili was found in all groups, except women undergoing abortion (16%).

Genitourin Med, 1987 Apr, 63(2), 87 - 91
Western blot analysis of gonococcal serogrouping reagents; Copley CG et al.; The W class antisera used in the coagglutination method of serogrouping Neisseria gonorrhoeae were analysed using sodium dodecyl sulphate polyacrylamide gel electrophoresis and western blot transfers . All were found to contain antibodies to the homologous protein II as well as antibodies to protein I group antigens . Examination of local isolates showed that some strains owed their reaction with coagglutination reagents to epitopes on their protein II not their protein I . How this may lead to difficulties when using coagglutination patterns to subdivide the W groups is discussed.

Infect Immun, 1987 Apr, 55(4), 931 - 6
Immunoglobulin A1 protease types of Neisseria gonorrhoeae and their relationship to auxotype and serovar; Mulks MH et al.; Immunoglobulin A1 (IgA1) proteases are extracellular bacterial proteolytic enzymes which correlate with virulence in several species of human pathogens . We report that Neisseria gonorrhoeae produced two distinct types of IgA1 protease, each of which cleaved a different peptide bond in the hinge region of human IgA1 . The type of IgA1 protease produced correlated with both nutritional auxotype and outer membrane protein I serovar in this organism . Gonococcal type 1 IgA1 protease was produced primarily by N . gonorrhoeae strains which require arginine, hypoxanthine, and uracil (AHU) and which belong to the protein IA-1 or IA-2 serovar . Most isolates of other auxotypes and serovars produced type 2 IgA1 protease . Although both the AHU auxotype and protein IA serogroup were found to be associated with disseminated gonococcal infection, there was no direct correlation of IgA1 protease type with disseminated or with uncomplicated gonorrhea.

Sex Transm Dis, 1987 Apr-Jun, 14(2), 69 - 74
Prevalence of sexually transmitted diseases in high-risk women in the Republic of Panama; Reeves WC et al.; This study enrolled 1,032 sexually active women attending social hygiene clinics in Panama City; clinic attendance is mandatory for women employed in houses of prostitution, bars, and cabarets . Women were interviewed, and endocervical specimens were obtained for culture of Neisseria gonorrhoeae, Chlamydia trachomatis, herpes simplex virus, and cytomegalovirus . Four occupational groups attended the social hygiene clinics: prostitutes, bar girls denying prostitution, cabaret entertainers, and streetwalkers detained by the police . Prevalence of sexually transmitted disease, nationality, race, contraceptive method, and self-medication varied significantly by occupation; 31% of streetwalkers had gonorrhea as did 10% of prostitutes, 5% of bar girls, and 3% of cabaret entertainers . Rates of positive serologic tests for syphilis followed the same trend: 23% in streetwalkers, 7% in prostitutes, and 3% in nonprostitutes . Rates of chlamydial infection were significantly higher in cabaret entertainers (8%) than in any other occupational group (2%) . Cytomegalovirus and herpes simplex virus infections were uncommon and were found in 5% and 1% of the women, respectively . Prevalence of N . gonorrhoeae varied with self-medication and years of "professional" experience . Only one of 160 N . gonorrhoeae isolates was resistant to penicillin and also beta-lactamase-positive.

Genitourin Med, 1987 Apr, 63(2), 116 - 8
Sexually communicable micro-organisms in human semen samples to be used for artificial insemination by donor; Tjiam KH et al.; Two hundred and thirty seven semen samples from 10 institutes for artificial insemination by donor (AID) in Belgium and the Netherlands were tested for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, herpes simplex virus, and cytomegalovirus . The incidence of these micro-organisms in the semen samples was 0%, 6.3%, 4.6%, 35.9%, 0%, and 0.4% respectively, and 47% of all samples were infected with one or more of the micro-organisms . As the ejaculates from which the samples had been taken had already been, or would be, used for AID, the exclusion of microbiological contamination with sexually communicable micro-organisms before insemination is indicated.

Infect Immun, 1987 Apr, 55(4), 1009 - 13
Distribution of specific DNA sequences among pathogenic and commensal Neisseria species; Aho EL et al.; Several traits, including pili and the outer membrane proteins P.II and H.8, have been associated with pathogenic Neisseria species . We examined several Neisseria species for DNA sequence homology to cloned pilin, P.II, and H.8 genes . Strains of Neisseria gonorrhoeae and N . meningitidis showed hybridization to all of these genes . Commensal strains showed little hybridization to any of these genes . Strains of N . lactamica and N . cinerea showed intermediate patterns of hybridization . Generally, organisms that expressed a given trait showed DNA homology to the corresponding cloned gene . However, we observed pili on some commensal strains that did not show hybridization to the cloned gonococcal pilin gene.

J Gen Microbiol, 1987 Apr, 133 ( Pt 4), 825 - 33
Localization of antibody-binding sites by sequence analysis of cloned pilin genes from Neisseria gonorrhoeae; Nicolson IJ et al.; Immunological analysis of gonococcal pilin (the protein structural subunit of pili) has demonstrated the existence of cross-reacting and type-specific epitopes . The role in adhesion of the domains represented by these epitopes remains unclear . DNA sequencing of a series of pilin-expressing (pilE) genes from a number of otherwise isogenic pilus antigenic variants combined with previous immunological analysis of the corresponding encoded pilins has allowed us to correlate certain predicted amino acid sequences with monoclonal antibody reactivities . The putative epitopes for type-specific antibodies lie predominantly in hydrophilic domains that also contain beta turns . The epitopes for type-specific monoclonal antibodies were shown to depend on amino acid changes either in three separated blocks of amino acid sequence in the semi-variable (SV) region of pilin, or in discrete regions that lie in the disulphide loop in the hypervariable (HV) region of the polypeptide . In contrast, antibody SM1, which reacts with all gonococcal pili, recognizes a poorly immunogenic region of moderate hydrophilicity but low turn potential lying in a conserved portion of the pilin molecule . Our results confirm that antibodies directed against epitopes in both the SV and HV regions are able to inhibit adhesion.

J Exp Med, 1987 Apr 1, 165(4), 1016 - 25
Gene conversion variations generate structurally distinct pilin polypeptides in Neisseria gonorrhoeae; Swanson J et al.; Pilus+ to pilus- phenotype change occurs in Neisseria gonorrhoeae through gene conversion of the gonococcus' complete, expressed pilin gene by nucleotides homologous to the pilS1 copy 5 partial pilin gene; assembly missense pilin is synthesized but pili are not . Reversion to pilus+ occurs by a subsequent recombinational event that replaces the complete pilin gene's pilS1 copy 5-like sequence with nucleotides from a different partial gene to effect expression of an orthodox (i.e., pilus producing) pilin . Sibling pilus+ revertants of common parentage can carry different sequences in their expressed pilin genes because they have undergone nonidentical gene conversion events such as recombinations with sequences from different partial genes, or recombinations with different length nucleotide stretches of the same partial gene; either can yield structurally and antigenically variant pilin polypeptides.

Am J Med, 1987 Mar 23, 82(3 Spec No), 587 - 92
Intestinal spirochetosis in homosexual men; Surawicz CM et al.; Previous studies have demonstrated intestinal spirochetosis in rectal biopsy specimens from 2 to 7 percent of heterosexual and 36 percent of homosexual patients, but the role of intestinal spirochetosis in the pathogenesis of intestinal disease remains unclear . To assess the clinical, histologic, and microbiologic correlates of intestinal spirochetosis in a high-risk group, rectal biopsy specimens from 130 homosexual men, 92 percent of whom had intestinal symptoms, were evaluated . All men were extensively evaluated for rectal and enteric pathogens . Intestinal spirochetosis was identified in rectal biopsy specimens from 39 (30 percent) men; 15 percent of biopsy specimens revealed intestinal spirochetosis on hematoxylin and eosin plus alcian blue staining, and positive results were found in 30 percent on silver staining . No rectal biopsy specimens from 79 control patients with a variety of gastrointestinal symptoms demonstrated evidence of spirochetosis on hematoxylin and eosin, alcian blue, or silver staining (p less than 0.0001) . Fifty-six percent of rectal biopsy specimens from men with intestinal spirochetosis were normal, and no specific histologic abnormality was correlated with intestinal spirochetosis . There were no differences in the presence of or type of intestinal symptoms, sigmoidoscopic appearance of the mucosa, type of sexual practice, or prior antibiotic use in men with and without spirochetosis . Other intestinal pathogens were frequent in both groups, and only rectal gonorrhea was significantly associated with intestinal spirochetosis . It is concluded that homosexual men with intestinal symptoms have an increased prevalence of spirochetosis, often in association with Neisseria gonorrhoeae . Independent association of spirochetosis with clinical or histologic findings could not be demonstrated.

Med J Aust, 1987 Mar 2, 146(5), 254 - 6
Single-dose antibiotic therapy for the treatment of uncomplicated anogenital gonorrhoea; Philpot CR et al.; Appropriate single-dose therapy will cure in excess of 95% of cases of uncomplicated anogenital gonorrhoea . Changes in the susceptibility of local isolates of Neisseria gonorrhoeae, particularly the emergence of beta-lactamase producing (and therefore penicillin-resistant) strains, have necessitated the modification of standard treatment regimens . Different patterns of antibiotic resistance have been documented in different regions of Australia and therapeutic regimens that are appropriate for use in different regions are recommended.

Dis Mon, 1987 Mar, 33(3), 121 - 79
The office approach to the sexually transmitted diseases: Part I; Levin S et al.; Sexually transmitted diseases (STDs) are diagnosed in 10 million patients per year in the United States . The infected individuals come from all walks of life and all age groups . They may present with either genital or nongenital signs and symptoms . Most individuals are treated as outpatients, but more than a quarter of a million hospital admissions for STDs are necessary each year . These numbers will rise precipitously as the number of AIDS cases increases . More than 10,000 deaths per year are caused by STDs, primarily because of AIDS, cervical carcinoma, and hepatitis B induced cirrhosis and hepatoma . Physicians must become highly skilled in the diagnosis and treatment of the common STDs caused by herpes simplex virus, Neisseria gonorrhoeae, and Chlamydia trachomatis . Simple office microscopic skills are needed for the diagnosis of vaginitis, cervicitis, and urethritis, and all physicians should be encouraged to develop these skills . Physicians will need to keep abreast of the rapidly evolving changes in the diagnosis and treatment of STDs.

J Reprod Fertil, 1987 Mar, 79(2), 517 - 21
Failure of anti-inflammatory agents to modulate infection-induced pelvic adhesive disease in rabbits; Soper DE et al.; A suspension of Neisseria gonorrhoeae was injected into rabbit uterine horns to induce pelvic adhesive disease . There was no statistical difference in the formation of adhesions between the rabbits that were given anti-inflammatory agents and those that received no therapy . This study suggests that anti-inflammatory agents will offer no benefit as adjunctive therapy for the prevention of infection-induced pelvic adhesive disease.

Infect Dis Clin North Am, 1987 Mar, 1(1), 165 - 78
Sexually transmitted diseases . Urethritis in men; Hooton TM et al.; Gonococcal and nongonococcal urethritis (NGU) are among the most common syndromes afflicting men . NGU is caused primarily by Chlamydia trachomatis and Ureaplasma urealyticum, but the cause is unknown in approximately 20 to 30 percent of cases . Evaluation of a gram-stained urethral smear is generally sufficient to distinguish between gonococcal and nongonococcal urethritis . Owing to the frequent coexistence of Neisseria gonorrhoeae and C . trachomatis in heterosexual men, treatment regimens for gonococcal urethritis should generally include an effective antichlamydial regimen . Complications of urethritis are uncommon, but the causative pathogens produce serious morbidity in women . Prevention of urethritis is based on identification of asymptomatically infected persons who serve as the major reservoir of infection with both N . gonorrhoeae and C . trachomatis.

Antimicrob Agents Chemother, 1987 Mar, 31(3), 434 - 7
Norfloxacin versus thiamphenicol for treatment of uncomplicated gonorrhea in Rwanda; Bogaerts J et al.; In an open prospective study, single oral doses of norfloxacin (800 mg) and thiamphenicol (2.5 g) were used to treat, respectively, 122 and 46 consecutive patients with uncomplicated gonorrhea . Neisseria gonorrhoeae was eradicated from 119 (97.5%) patients treated with norfloxacin and from 35 (76.0%) patients treated with thiamphenicol . Norfloxacin treatment failure was not related to drug resistance or to insufficient absorption of the drug . Thiamphenicol failure correlated with low in vitro susceptibility of the infecting strain . In a single oral dose of 800 mg, norfloxacin appeared to be an excellent alternative treatment regimen for uncomplicated gonorrhea in an area with a high prevalence of penicillin-resistant gonococci.

J Clin Microbiol, 1987 Mar, 25(3), 571 - 2
Comparison of the Gono-Pak system with the candle extinction jar for recovery of Neisseria gonorrhoeae; Devaux DL et al.; Maximum CO2 levels in the Gono-Pak system were obtained 2 h after activation, with a mean value of 1.5% . Although this is less than the 2 to 3% CO2 level obtained with the candle jar, Gono-Pak produced comparable recovery of Neisseria gonorrhoeae in 357 clinical specimens and stock cultures . Using adjustable CO2 incubators, we found the recovery at 1% CO2 to be comparable to that at 5%, whereas 10% CO2 was inhibitory.

Antimicrob Agents Chemother, 1987 Mar, 31(3), 470 - 2
In vitro activity of Ro 15-8074, Ro 19-5247, A-56268, and roxithromycin (RU 28965) against Neisseria gonorrhoeae and Chlamydia trachomatis; Bowie WR et al.; In vitro Ro 15-8074 and Ro 19-5247 (T2525), two new oral cephalosporins, were active against 410 penicillin-susceptible and -resistant isolates of Neisseria gonorrhoeae . Two new macrolides, A-56268 and to a lesser extent roxithromycin (RU 28965), were active against Chlamydia trachomatis . A-56268 had activity against N . gonorrhoeae similar to that of erythromycin.

Eur J Obstet Gynecol Reprod Biol, 1987 Mar, 24(3), 211 - 20
Salpingitis; aspects of diagnosis and etiology: a 4-year study from a Swedish capital hospital; Brihmer C et al.; 359 patients underwent laparoscopy to verify the diagnosis of salpingitis . Pelvic inflammatory disease (PID) was found in 187 (52%) cases . Laparoscopy revealed normal conditions in 136 (37%) cases . Other diseases were diagnosed in 36 (10%) cases . Bacteriological cultures from the fimbrial lumen were positive in 24% of the PID cases . Chlamydia trachomatis (CT) was detected in 12%, Bacteroides species (BS) in 5%, Actinomyces israelii (AI) in 3%, Gardnerella vaginalis (GV) in 2%, Neisseria gonorrhoeae (NG) in 1%, and Ureaplasma urealyticum (UU) in 1% . Cervical cultures were positive for NG and/or CT in 71% of the PID cases but only in 19% of the non-PID cases . From these no positive intra-abdominal cultures were detected . Serological tests for CT were carried out . A positive acute titre of greater than or equal to 1/64 was noted in 37%, a seroconversion (X4) 2-3 weeks later was found in 14% . Positive serology despite a negative culture was registered in 19%.

J Gen Microbiol, 1987 Mar, 133 ( Pt 3), 553 - 61
Genetic analysis of variant pilin genes from Neisseria gonorrhoeae P9 cloned in Escherichia coli: physical and immunological properties of encoded pilins; Nicolson IJ et al.; A series of genomic DNA fragments that encode gonococcal pilins from four well-characterized pilus variants of Neisseria gonorrhoeae strain P9 have been cloned in Escherichia coli K12 . At least nine classes of cloned P9 pilin genes have been identified on the basis of restriction mapping of cloned pilin-encoding DNA and physical and immunological analysis of expressed pilin proteins . Each antigenic variant of strain P9 possesses many genomic segments of pilin gene information, although our results suggest that strain P9 contains only a single pilin-expressing (pilE) locus.

Obstet Gynecol, 1987 Mar, 69(3 Pt 1), 350 - 3
Enzyme immunoassay for detection of Neisseria gonorrhoeae from urogenital samples; Grubin L et al.; A solid-phase enzyme immunoassay (Gonozyme) was used to detect Neisseria gonorrhoeae; the results were compared with the results of cultures taken simultaneously from 201 patients from sexually transmitted disease clinics or family planning clinics . Cultures were positive in 32 of 201 consecutive patients seen in the clinics, while the Gonozyme was positive in 28 of these patients . Overall, five positive cultures were not detected by the Gonozyme, and one positive Gonozyme was not confirmed by culture in the 201 patients tested . The overall sensitivity of the enzyme immunoassay was 84.4% and the specificity 99.4% . The predictive values of a positive and negative Gonozyme result were 96.4 and 97.1%, respectively.

Brain Res, 1987 Feb 17, 403(2), 249 - 57
Bacterial peptidoglycans as modulators of sleep . I . Anhydro forms of muramyl peptides enhance somnogenic potency; Krueger JM et al.; Chemically defined muramyl peptides (MPs), derived primarily from enzymatic digests of Neisseria gonorrhoeae peptidoglycan, were used to define the structural determinants of MP-mediated somnogenic activity . One of these, i.e . N-acetylglucosaminyl-N-acetyl-1,6-anhydro-N-acetylmuramyl-alanyl-glutamy l- diaminopimelyl-alanine, was structurally identical to the major naturally occurring MP previously detected in mammalian brain and urine . The somnogenic potency of this MP was similar to that of the corresponding disaccharide pentapeptide containing an additional alanine at the C-terminus and the analogous anhydro-muramic acid-containing monosaccharide tetrapeptide lacking the glucosamine moiety . Infusion of as little as 1 pmol of these highly active MPs increased significantly the percentage of slow-wave sleep in experimental animals . In fact, each of 5 anhydro-muramyl disaccharide peptides tested was somnogenic at a dose of 10 pmol or less and, as far as tested, the activity was affected only slightly by the length or composition of the peptide side chain . However, none of a matched set of analogous MPs, differing only in replacement of the anhydro-muramyl end by a hydrated muramic acid residue, was somnogenic at this dose . A modified form of the hydrated muramyl tripeptide containing a free amide on the diaminopimelic acid residue was completely inactive in amounts up to 1000 pmol . Together, the current data suggested: that the anhydro-muramic acid end (but not the glucosamine moiety) is essential for maximal somnogenic potency; and that amidation of carboxyl groups on the peptide-side chain may block MP-mediated somnogenic activity.

Genitourin Med, 1987 Feb, 63(1), 16 - 8
Prevalence of chlamydial infection in acute epididymo-orchitis; Mulcahy FM et al.; The prevalence of sexually transmitted infection was studied in 40 men presenting with acute epididymo-orchitis in Leeds . Chlamydia trachomatis infection was identified in 13 of 29 men (45%) aged under 35 years . Neisseria gonorrhoeae was isolated from four of these 13 men with chlamydial urethritis . C trachomatis was isolated from the urethra of only one of 11 men (9%) aged over 35 . Appreciable bacteriuria was found in six of these 11 men (55%) . Noting details of sexual history and screening for sexually acquired pathogens is advocated in younger men with acute epidiymo-orchitis.

Immunol Lett, 1987 Feb, 14(3), 175 - 81
Inherited deficiencies of complement components in man; Alper CA; Isolated inherited deficiency states of almost every complement protein have been recognized . Almost all are autosomal recessive traits . Deficiency of the early-acting components C1, C4 and C2 is associated with increased risk of immune complex disease, particularly systemic lupus erythematosus . Patients with deficiency of C3, factor I or factor H have increased susceptibility to infection by pyogenic bacteria, whereas those with deficiencies of properdin, C5, C6, C7 or C8 are prone to systemic neisserial infection . Inherited deficiency of C1 inhibitor is transmitted as an autosomal dominant trait, is genetically heterogeneous, and is associated with attacks of angioedema and consumption of C4 and C2 . There is evidence that a plasmin-modified fragment of C2 is responsible for the angioedema in this disorder . Administration of androgens tends to correct the biochemical abnormalities of hereditary angioedema and to prevent attacks.

Arzneimittelforschung, 1987 Feb, 37(2), 135 - 8
Morphological changes in Neisseria gonorrhoeae induced by various subinhibitory concentrations of cefotiam; Korting HC et al.; A wide variety of morphological changes is induced in gonococci exposed to subinhibitory concentrations of cefotiam . The spectrum reaches from phenomena like enlargement or lysis of cells which can already be seen on the light microscopic level to others which can only be detected by ultrastructural analysis . Most of the changes rarely also occur during the life cycle of gonococci not exposed to an antibiotic . Yet they are more frequent and also more distinct even in the presence of rather low concentrations of cefotiam . The development of mixed (layered and tubular) and even further disorganized mesosomes, however, seems to be characteristic of antibiotic interference.

Antimicrob Agents Chemother, 1987 Feb, 31(2), 178 - 82
Alterations in peptidoglycan of Neisseria gonorrhoeae induced by sub-MICs of beta-lactam antibiotics; Garcia-Bustos JF et al.; Exposure of Neisseria gonorrhoeae to sub-MICs of selected beta-lactam antibiotics caused distortion of normal cell morphology . Analysis of the peptidoglycan indicated that the cells were accumulating increased quantities of disaccharide pentapeptide in their cell walls . The O-acetylated form of the disaccharide pentapeptide was not detected among the major peaks . The correlation of antibiotic binding to gonococcal penicillin-binding protein 2 and accumulation of non-O-acetylated disaccharide pentapeptide suggested an explanation for the previously observed relationship of penicillin-binding protein 2 and O-acetylation of peptidoglycan.

Acta Pathol Microbiol Immunol Scand {B}, 1987 Feb, 95(1), 1 - 4
Protein I serotype of serum-resistant versus serum-sensitive Neisseria gonorrhoeae strains; Odum L et al.; In order to characterize serum-resistant and serum-sensitive strains of N . gonorrhoeae, the protein I serotype, auxotype, and penicillin susceptibility of 128 strains were tested . Sensitivity to the complement-dependent bactericidal activity of normal human serum was highly associated with protein I serotype (p less than 0.001) . Thus 85% of serotype 1-3 strains were serum-resistant, whereas 86% of serotype 8 strains and all strains with serotypes 8 + 9 or 9 were serum-sensitive . Serum-resistance or sensitivity for a given serotype was independent of auxotype . The susceptibility to penicillin within the serotypes 1-3 was significantly associated with auxotype (p = 0.0016); all AHU- (requirement for arginine, hypoxanthine and uracil) strains had MICs of penicillin of 0.04 microgram/ml or less and were serotypes 1-3 . Among the non-AHU-strains, serotype 9 was significantly more penicillin susceptible than the other serotypes (p less than 0.003).

Genitourin Med, 1987 Feb, 63(1), 6 - 12
Identification of penicillinase producing Neisseria gonorrhoeae in Chile during clinical and microbiological study of gonococcal susceptibility to antimicrobial agents; Garcia Moreno J et al.; The first penicillinase producing isolates of Neisseria gonorrhoeae (PPNG) identified in Chile were discovered during a clinical and microbiological study to compare the efficacy of penicillin (4.8 MIU aqueous procaine penicillin G plus 1 g oral probenecid) and tetracycline (1.5 g followed by 500 mg four times daily for four days) treatment regimens for acute uncomplicated gonorrhoea . Penicillin treatment was effective in 93.1% (282) of 303 patients, whereas tetracycline was effective in 98.3% (233) of 237 patients . Six of the penicillin treatment failures were attributable to PPNG strains . In all, 21 PPNG strains were identified during the study . They were genetically identical, having a wild type auxotype, a WII/III serotype (serovar Bajk), and carrying cryptic and transfer plasmids and an Asian type penicillinase producing plasmid . In addition, 674 non-PPNG isolates were tested for their susceptibility to eight antimicrobials . Over 95% were sensitivie to 1 mg/l of penicillin, ampicillin, cefotaxime, cefuroxime, and erythromycin, over 90% were sensitive to 1 mg/l of tetracycline and 2 mg/l of thiamphenicol, and all were sensitive to spectinomycin . Of 226 non-PPNG isolates characterised for plasmid content and auxotype, 90% (205) were either wild type or proline requiring, 67% (153) carried only the cryptic plasmid, and a further 31% (71) carried both cryptic and transfer plasmids . Unusually, three of four isolates lacking the cryptic plasmid carried only the transfer plasmid.

J Med Chem, 1987 Feb, 30(2), 348 - 56
2,4-Diamino-5-benzylpyrimidines as antibacterial agents . 7 . Analysis of the effect of 3,5-dialkyl substituent size and shape on binding to four different dihydrofolate reductase enzymes; Roth B et al.; A group of trimethoprim (TMP) analogues containing 3,5-dialkyl(or halo)-4-alkoxy, -hydroxy, or -amino substitution were analyzed in terms of their inhibitory activities against four dihydrofolate reductase (DHFR) isozymes . Although selectivities were lower than with TMP, the activities against vertebrate DHFR were usually at least 2 orders of magnitude less than against enzymes from microbial sources . However, the profiles of activity were remarkably similar for rat, Neisseria gonorrhoeae, and Plasmodium berghei enzymes in all three series, although somewhat different for Escherichia coli DHFR, leading to the conclusion that the hydrophobic pockets are similar for the first three isozymes . Optimal substitution was reached with 3,5-di-n-propyl or 3-ethyl-5-n-propyl groups . Branching of chains at the alpha-carbon, which resulted in increased substituent thickness, was detrimental to E . coli DHFR inhibition in particular . MR is an inadequate parameter for use in correlating such substituent effects . Conformational changes of the more bulky inhibitors can be invoked to explain some differences in inhibitory pattern . Although log P explains simple substituent effects with the vertebrate DHFRs very well, it is insufficient in the more complex cases described here, where shape is clearly involved as well . Solvent-accessible surface areas were measured for TMP in E . coli and chicken DHFRs, where the coordinates are now known . The environment is more hydrophobic in the latter case; this can also be postulated for rat DHFR, which has a very similar activity profile . As with the mammalian isozymes, N . gonorrhoeae DHFR contains an active site phenylalanine replacing Leu-28 of E . coli DHFR, thus creating a more hydrophobic pocket . A similar replacement may also occur in the P.berghei isozyme . Selectivity for bacterial DHFR is dependent on the nature of the 4-substituent, being low for polar 4-hydroxy compounds but high for polar 4-amino analogues, possibly as a result of solvation differences . With complex substituents, the environment of each atom in the active site must be taken into account to adequately explain structure-activity relationships.

J Pediatr, 1987 Feb, 110(2), 314 - 21
Microflora of the urethra in adolescent boys: relationships to sexual activity and nongonococcal urethritis; Chambers CV et al.; Urethral cultures were obtained from 90 adolescent youth, 16 of whom denied previous sexual activity . Among the sexually active boys was a group of 32 with clinically significant pyuria, consistent with the diagnosis of urethritis, on a first-part urinalysis (FPU) specimen . To relate differences in urethral microflora to sexual activity, 42 sexually active patients with a negative FPU were compared with the never sexually active group . The profile of anaerobic, but not aerobic, bacteria isolated from the urethra was related to the presence or absence of previous sexual activity . Mycoplasma species and Ureaplasma urealyticum were isolated from sexually active patients only, and may be markers of sexual activity in adolescent boys . Of the 32 patients with FPU evidence of urethritis, 22 (69%) had cultures positive for Chlamydia trachomatis, and an additional three (9%) had cultures positive for Neisseria gonorrhoeae . The findings in sexually active patients with a positive FPU were otherwise similar to those of sexually active patients without evidence of urethritis . C . trachomatis appears to be the most important agent of urethritis among adolescent boys with a positive FPU.

J Bacteriol, 1987 Feb, 169(2), 790 - 5
Cloning of the recA gene of Neisseria gonorrhoeae and construction of gonococcal recA mutants; Koomey JM et al.; Interspecific complementation of an Escherichia coli recA mutant was used to identify recombinant plasmids within a genomic cosmid library derived from Neisseria gonorrhoeae that carry the gonococcal recA gene . These plasmids complement the E . coli recA mutation in both homologous recombination functions and resistance to DNA damaging agents . Subcloning, deletion mapping, and transposon Tn5 mutagenesis were used to localize the gonococcal gene responsible for suppression of the E . coli RecA- phenotype . Defined mutations in and near the cloned gonococcal recA gene were constructed in vitro and concurrently associated with a selectable genetic marker for N . gonorrhoeae and the mutated alleles were then reintroduced into the gonococcal chromosome by transformation-mediated marker rescue . This work resulted in the construction of two isogenic strains of N . gonorrhoeae, one of which expresses a reduced proficiency in homologous recombination activity and DNA repair function while the other displays an absolute deficiency in these capacities . These gonococcal mutants behaved similarly to recA mutants of other procaryotic species and displayed phenotypes consistent with the data obtained by heterospecific complementation in an E . coli recA host . The functional activities of the recA gene products of N . gonorrhoeae and E . coli appear to be highly conserved.

Acta Pathol Microbiol Immunol Scand {B}, 1987 Feb, 95(1), 13 - 21
Molecular characterization and comparison of plasmid content in seven different strains of Neisseria gonorrhoeae; Aalen RB et al.; The plasmid content of one penicillin sensitive and six penicillin resistant strains of Neisseria gonorrhoeae has been examined . All strains harbour a small, phenotypically cryptic plasmid of 4.1 kilo base pairs (kb) . Four of the penicillin resistant strains carry a beta-lactamase-producing plasmid of 7.3 kb . One of these also carries a large plasmid of about 40 kb . The two remaining penicillin resistant strains harbour a smaller beta-lactamase-producing plasmid of 5.5 kb . The plasmids have been subjected to digestion with a number of restriction endonucleases, and their restriction maps have been compared . Judging by the maps, the cryptic (C-) plasmids show great similarities . Except that two of them have 54 additional base-pairs (bp), and two have a HpaII site instead of a DdeI site, no differences were found . The larger beta-lactamase-producing (B-) plasmids have identical maps . The smaller seem to be homologous with the larger, except for a deletion of 1.8 kb . There is no correlation between the variant of C-plasmid and type of B-plasmid harboured in the penicillin resistant strains . The evolutionary implications suggested by this finding are discussed.

Am J Obstet Gynecol, 1987 Feb, 156(2), 507 - 12
Ampicillin/sulbactam versus metronidazole-gentamicin in the treatment of soft tissue pelvic infections; Crombleholme WR et al.; The clinical efficacy and safety of ampicillin/sulbactam versus metronidazole-gentamicin were evaluated in a comparative, randomized, prospective study . Forty-four patients were enrolled: 22 received the ampicillin/sulbactam regimen, and 22 received the metronidazole-gentamicin combination . There were 33 cases of severe acute pelvic inflammatory disease, two tuboovarian abscesses, five cases of endomyometritis, and two cases of posthysterectomy pelvic cellulitis . Aerobic and anaerobic cultures from the infection sites yielded 447 microorganisms from 44 patients (an average of 10 bacteria per infection; 6.4 anaerobes and 3.7 aerobes) . The most frequent isolates were Bacteroides sp., 54; Bacteroides bivius, 17; black-pigmented Bacteroides, 12; Bacteroides disiens, 11; Fusobacterium, 13; Peptostreptococcus anaerobius, 24; Peptostreptococcus asaccharolyticus, 21; anaerobic gram-positive cocci, 34; Gardnerella vaginalis, 29; Neisseria gonorrhoeae, 17; alpha-hemolytic streptococci, 15; and Escherichia coli, five . Clinical cure was noted in 19 of 20 patients treated with ampicillin/sulbactam and 18 of 21 patients treated with metronidazole-gentamicin . One treatment failure occurred in the ampicillin/sulbactam group in a patient who required antichlamydial therapy and had a complex left adnexal mass consistent with an abscess . The cases of metronidazole-gentamicin failure included two patients initially diagnosed as having tuboovarian abscesses who required a change in antibiotic therapy to control the infections . The third patient had postabortion endomyometritis that did not respond to metronidazole-gentamicin therapy within 48 hours, and required a change of medication . No adverse hematologic, renal, or hepatic effects were noted in either group of patients.

Genitourin Med, 1987 Feb, 63(1), 1 - 5
Plasmid profile of Neisseria gonorrhoeae in Nigeria and efficacy of spectinomycin in treating gonorrhoea; Osoba AO et al.; The prevalence of penicillinase producing Neisseria gonorrhoeae (PPNG) strains has been steadily rising in Nigeria since 1979, and now about 80% of the strains of gonococci isolated in Ibadan are found to produce penicillinase . Spectinomycin has consequently become widely used in treating these infections . To ascertain the emergence of spectinomycin resistance, this study was undertaken to assess the in vivo susceptibilities of gonococcal strains to spectinomycin and other common antibiotics . Five hundred and twenty seven isolates were tested, of which 452 (85.5%) were PPNG strains . None of the strains were found to be resistant to 100 micrograms spectinomycin discs in vitro, whereas all 370 patients treated with the antibiotic were bacteriologically cured . Plasmid analysis shows that both "Asian" and "African" PPNG types are circulating in Nigeria . For the moment spectinomycin remains highly effective in treating gonococcal infections in west Africa.

Nature, 1987 Jan 29-Feb 4, 325(6103), 458 - 62
Gene structure and extracellular secretion of Neisseria gonorrhoeae IgA protease; Pohlner J et al.; Several human bacterial pathogens, including the Gram-negative diplococcus Neisseria gonorrhoeae, produce extracellular proteases that are specific for human immunoglobulin IgA1 . Immunoglobulin A (IgA) proteases have been studied extensively and the genes of some species cloned in Escherichia coli, but their role in pathogenesis remains unclear . Recently we derived a DNA fragment of 5 kilobases (kb) from N . gonorrhoeae MS11 directing extracellular active enzyme in E . coli . Although the mature enzyme of strain MS11 was shown to have a relative molecular mass of 106,000 (Mr 106K) in gels, the DNA sequence of this cloned fragment reveals a single gene coding for a 169K precursor of IgA protease . The precursor contains three functional domains, the amino-terminal leader which is assumed to initiate the inner membrane transport of the precursor, the protease, and a carboxyl-terminal 'helper' domain apparently required for extracellular secretion (excretion) . Based on the structural features of the precursor, we propose a model in which the helper serves as a pore for excretion of the protease domain through the outer membrane . IgA protease acquires an active conformation as its extracellular transport proceeds and is released as a proform from the membrane-bound helper by autoproteolysis . The soluble proform further matures into the 106 K IgA protease and a small stable alpha-protein.

Am J Med, 1987 Jan, 82(1), 163 - 4
Infective endocarditis caused by Neisseria flavescens; Sinave CP et al.; Neisseria flavescens is a rare cause of human disease . This is the first reported case of endocarditis caused by N . flavescens . The organism produced beta-lactamase, and penicillin therapy failed to cure the infection . Therapy with cefotaxime, to which the organism was highly sensitive, led to a complete and uneventful recovery.

Pediatrie, 1987, 42(1), 41 - 3
{Epidemiological and prognostic aspects of purpura fulminans in children . Regional survey}; Frappat P; A regional survey (Rhone-Alpes region) about fulminans purpura has been performed in the pediatric services and the pediatric intensive care units . Between January 1982 and July 1986, 101 cases have been observed . 93.5% (72/77) of the bacteriologically documented cases were due to Neisseria meningitidis . Fatality rate is 34.6%, 58.6% in infants younger than 1 year to 14.3% in children older than 2 years . Between 1982 and 1985 fatality rate was reduced from 54.5% to 27.6% . This study confirms the interest of the severity score established by the French Pediatric Intensive Care Club.

Ann Fr Anesth Reanim, 1987, 6(1), 50 - 1
{Purpura fulminans associated with a C7 deficiency}; Vigouroux C et al.; A patient suffering from purpura fulminans was found to have a hereditary deficiency of the C7 component of complement . The homozygous deficiency of late acting complement components increases the risk of neisserial infection . CH50 titration will detect those patients suffering from a homozygous deficiency, who should be vaccinated against Neisseria meningitidis types.

Sex Transm Dis, 1987 Jan-Mar, 14(1), 23 - 5
Colonization of sexually abused children with genital mycoplasmas; Hammerschlag MR et al.; Although sexually abused children are usually evaluated only for the presence of infections with Neisseria gonorrhoeae and Treponema pallidum, they are also at risk for acquiring other sexually transmitted organisms prevalent in the adult population . Accordingly, we examined pharyngeal, anorectal and genital specimens from 50 children who had been sexually abused and from 40 healthy children who served as controls; these specimens were cultured for Mycoplasma hominis and Ureaplasma urealyticum . M . hominis was isolated from the anorectal and vaginal cultures of 11 (23%) and 16 (34%), respectively, of 47 abused girls as compared with three (8%) and six (17%), respectively, of 36 controls . U . urealyticum was isolated from the anorectal and vaginal cultures of nine (19%) and 14 (30%), respectively, of the abused girls as compared with one (3%) and three (8%), respectively, of 36 controls . Colonization with genital mycoplasmas was not associated with any symptoms.

Hautarzt, 1987 Jan, 38(1), 26 - 30
{Condylomata acuminata-associated STD infections of the urethra of the male . A comparative epidemiologic study}; Elsner P et al.; Urethral swabs from 322 men without urethritis, 73 of whom had venereal warts (condylomata acuminata, CA) and 249 who had none, were investigated between 1981 and 1984 by microscope and culture for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma species, Trichomonas vaginalis, Garderella vaginalis, B streptococci, aerobic pathogenic bacteria and Candida species . The isolation frequencies in patients with and without CA were as follows: N . gonorrhoea: with CA 0%, without 0.4%; C . trachomatis: with CA 6%, without 4.4%; U . urealyticum in high CFU: with CA 15%, without 17.7%; Mycoplasma spp . in high CFU: with CA 6%, without 4%; T . vaginalis: with CA 0%, without 0.4%; G . vaginalis: with CA 4%, without 5%; B streptococci: with CA 4%, without 6%; Candida spp . only in low CFU: with CA 3%, without 2.4%.--The results indicate that as far as the isolation frequencies of sexually transmittable pathogens in the urethra are concerned, there are no significant differences between patients with CA and asymptomatic patients presenting to an STD department . However, N . gonorrhoeae was significantly less frequently isolated and C . trachomatis and U . urealyticum significantly more frequently isolated in our patients than has been reported in previous studies.

Rev Fr Gynecol Obstet, 1987 Jan, 82(1), 9 - 15
{Prospective randomized study comparing the efficacy and tolerance of clindamycin-gentamycin versus metronidazole-gentamycin in acute utero-adnexal infections in hospitalized patients}; Lebceuf D et al.; The efficacy and safety of two antibiotic combination (clindamycin + gentamycin {C + G} versus metronidazole + gentamycin {M + G}) have been compared in 45 in-patients suffering from pelvic inflammatory disease in a clinical prospective randomized trial . The rates of clinical and bacteriological recovery reached respectively 85.7% and 71.4% for C + G group compared to 83.3% and 78.6% for M + G group (no significant differences) . Side effects (vomiting, gastralgia and vaginal mycosis) developed in four occasions in each group . The most frequently isolated organisms were chlamydiae, E . coli and Neisseria gonorrheae (around 50% of overall isolated organisms) . Due to the lack of significant differences between the two antibiotic combinations, the final choice will depend on potential risks generated by these products.

Clin Pharm, 1987 Jan, 6(1), 25 - 36
Recognition and treatment of chlamydial infections; Lisby SM et al.; The microbiology, laboratory diagnosis, clinical features, and treatment of infectious diseases caused by Chlamydia trachomatis and Chlamydia psittaci are reviewed . Chlamydial genital infection is the most common sexually transmitted disease in the United States . C . trachomatis plays an important role in nongonococcal urethritis, postgonococcal urethritis, cervicitis, pelvic inflammatory disease, and possibly proctitis . Proper treatment of genital infections caused by C . trachomatis is important to prevent severe sequelae such as epididymitis and pelvic inflammatory disease, both of which may lead to sterility . Infected pregnant women should be treated to prevent transmission of chlamydial infections to their infants . Chlamydial conjunctivitis is the most common eye infection in the first month of life . C . trachomatis also causes pneumonia in infants . Lymphogranuloma venereum and trachoma are important diseases in developing countries . C . psittaci, transmitted by birds, causes psittacosis in humans; this disease is rare in the United States . Diagnosis is a problem because chlamydial genital infection can be asymptomatic and because the organism is difficult to isolate . Culture remains the diagnostic method of choice, but recently marketed direct-detection assays provide qualitative results within hours after specimen collection . Tetracyclines and erythromycin are the drugs of choice for treating chlamydial infections in adults . An antimicrobial with activity against both C . trachomatis and Neisseria gonorrhoeae is preferred because both organisms are often present concurrently in patients with sexually transmitted disease . Chlamydial infections in pediatric patients often respond to systemic erythromycin therapy; tetracyclines are equally effective but are contraindicated for children less than nine years of age . Adequate diagnosis and treatment of sexually transmitted chlamydial infections in patients and their contacts is important to limit the spread of disease.

Antonie Van Leeuwenhoek, 1987, 53(6), 537 - 43
Enteric immunization reveals a T cell network for IgA responses and suggests that humans possess a common mucosal immune system; McGhee JR et al.; The local IgA response is a result of two related events, the induction of sensitized T and B cells in gut- or bronchial-associated lymphoreticular tissues (GALT or BALT) and the final differentiation of IgA plasma cells in mucosal tissues where IgA is produced and transported to become secretory IgA (S-IgA) antibodies into external secretions . Oral administration of various types of antigens/vaccines may result in two types of response, i.e., S-IgA antibodies at mucosa and systemic unresponsiveness to antigen, a state termed oral tolerance . Regulatory T cells in GALT help account for both S-IgA responses and oral tolerance and thus serve to fine tune responses to orally encountered antigens . Studies in animal models and humans have shown that oral administration of antigens sensitize lymphoid cells in GALT which subsequently home to mucosa and result in S-IgA responses in several external secretions . The significant promise of oral vaccines for prevention of microbial diseases including neisserial diseases is discussed.

Drugs, 1987, 34 Suppl 1, 107 - 10
Single doses of ofloxacin in uncomplicated gonorrhoea; Aznar J et al.; The clinical efficacies of 2 different single-dose oral treatments of ofloxacin were evaluated in a double-blind, randomised study of 60 males with gonococcal urethritis . 30 patients received a single dose of ofloxacin 100mg and 30 received a single dose of ofloxacin 200mg . The minimal inhibitory concentrations of ofloxacin against all isolates were less than or equal to 0.25 mg/L . Neisseria gonorrhoeae was eradicated from all 50 patients evaluated and clinical cure was achieved in 84% . In total, 8 patients developed post-gonococcal urethritis, although there was a significantly (p less than 0.05) lower rate of post-gonococcal urethritis in the group treated with ofloxacin 200mg . In conclusion, a single oral dose of ofloxacin 100mg could be an alternative treatment for uncomplicated gonorrhoea.

Arch Gynecol Obstet, 1987, 241(3), 133 - 43
Bacterial synergy in pelvic inflammatory disease; Brook I; Polymicrobial aerobic and anaerobic flora are responsible for pelvic inflammatory disease (PID) . The most frequent pathogens appear to be Neisseria gonorrhoea and anaerobic bacteria (most commonly anaerobic cocci and Bacteroides sp.) . Recent studies have demonstrated the recovery of Chlamydia trachomatis in up to a third of these infections . Although N . gonorrhoea is frequently recovered from cervical cultures, it is less commonly recovered from intra-abdominal sites . Recent studies have demonstrated the in-vivo synergistic relationship between N . gonorrhoeae and Bacteroides fragilis . The growth of each component of the mixed infection was enhanced when these were present together in an abscess . Furthermore, the emergence of encapsulated strains was enhanced in these infections . This synergy enables the organisms to cause more severe local and systemic damage to the host . Therapeutic intervention should include the use of antimicrobial agents effective against both the aerobic and anaerobic components of the mixed infection . Unless such therapy is given, the infection may persist . It is also recommended to use antimicrobials that possess synergy between them against the bacterial pathogens . Agents effective against the anaerobic pathogens are metronidazole, clindamycin and cefoxitin . Antimicrobials effective against the Gram-positive aerobic pathogens and N . gonorrhoeae are spiramycin and penicillins . Aminoglycosides or third generation cephalosporins are effective against Gram-negative enterics . The combination of metronidazole and spiramycin has shown to be synergistic against mixed infections of Bacteroides sp . and N . gonorrhoeae.

Drugs Exp Clin Res, 1987, 13(3), 137 - 43
Enzymatic modification of aminoglycoside antibiotics by Branhamella catarrhalis carrying an R factor; Robledano L et al.; Fifteen out of 89 clinical strains of Branhamella catarrhalis isolated from patients at the University Hospital of Zaragoza were resistant to aminoglycosides and other antimicrobials . In two strains, B . catarrhalis 220 and B . catarrhalis 115, the resistance to aminoglycosides was associated with synthesis of aminoglycoside-modifying enzymes, namely 3"-O-phosphotransferase {APH(3")} and 3'-O-phosphotransferase {APH(3')} . B . catarrhalis 115 was resistant to ampicillin, streptomycin, kanamycin, neomycin, butirosin, lividomycin, ribostamycin, paromomycin and trimethoprim-sulfamethoxazole and harboured a 32 megadalton (Md) plasmid . The resistance determinants of the latter were transferred to Neisseria subflava by conjugation and to Escherichia coli by transformation . The transconjugant strain presented an antibiotic resistance pattern similar to the donor strain and carried the same plasmid . The transformant strain acquired the 32 Md plasmid but presented, besides the resistance pattern already mentioned, resistance to tetracycline, gentamicin and tobramycin . Resistance to gentamicin and tobramycin was mediated by the synthesis of a 3-N-acetyltransferase . This resistance and the related enzyme were expressed neither in the donor B . catarrhalis strain nor in the transconjugant N . subflava strain.

Antonie Van Leeuwenhoek, 1987, 53(6), 565 - 74
Mechanisms of stable serum resistance of Neisseria gonorrhoeae; Rice PA et al.; Neisseria gonorrhoeae that resist complement-dependent killing by normal human serum (NHS) are sometimes killed by immune convalescent sera from patients recovering from disseminated gonococcal infection (DGI) . In these studies, killing by immune serum was prevented or blocked by immunoglobulin G (IgG) or F(ab')2 isolated from NHS . Purified human IgG antibodies directed against gonococcal protein III, contained most of the blocking activity in IgG . In addition, immune convalescent DGI serum, which did not exhibit bactericidal activity, was restored to killing by selective immunodepletion of protein III antibodies . Blocking IgG or F(ab')2 prepared from IgG, partially inhibited binding of bactericidal antibody to N . gonorrhoeae . Also, binding of a monoclonal antibody recognizing N . gonorrhoeae outer membrane protein PIII was almost completely inhibited by blocking F(ab')2 . Presensitization of N . gonorrhoeae with increasing concentrations of blocking IgG or F(ab')2 before incubation with bactericidal antibody and an antibody free source of complement, increased consumption and deposition of the third component of human complement (C3) and the ninth component of complement (C9) but inhibited killing in dose-related fashion.

Antonie Van Leeuwenhoek, 1987, 53(6), 551 - 5
Gonococci in vivo and in vitro . Further studies on the host and bacterial determinants of gonococcal resistance to killing by human serum, and by phagocytes; Parsons NJ et al.; A small M, heat and acid labile, host inducer(s) of gonococcal resistance to complement mediated killing by fresh human serum (-FHS), being purified from red blood cell (RBC) extracts, produced changed in lipopolysaccharide (LPS) structure, surface antigens and proteins; and acquirement of resistance related to loss of a target antigen for bactericidal IgM, possibly LPS components . A 20 kDalt . lipoprotein with a high content of glutamic acid isolated from outer membranes of a gonococcal strain selected in vivo is a determinant of gonococcal resistance to killing by human phagocytes . Sonic extracts of gonococci may contain a cytotoxin for human phagocytes . At the 4th International Pathogenic Neisseriae Conference, we reported (Parsons et al . 1985) that conditions in vivo induced phenotypic change leading to gonococcal resistance to complement-mediated killing by human serum; and, also, selected gonococcal types which showed a greater resistance to intracellular killing by human phagocytes than laboratory strains . Furthermore, evidence was presented that not only was resistance to complement mediated killing important in gonococcal pathogenesis, but also resistance to phagocytic defences . This paper describes the continuance of our studies on the determinants of induced serum resistance and of resistance to killing by phagocytes including toxicity to these cells . Each section begins by summarising previous work that was referenced in Parsons et al . (1985).

Antonie Van Leeuwenhoek, 1987, 53(6), 545 - 50
Metabolic responses of Neisseria gonorrhoeae to human serum and myeloid cells . Adaptation to host defenses?
Cohen MS, Britigan BE.
The interaction of gonococci with host defenses including serum and phagocytic cells has been extensively studied . We have shown that a small molecular weight factor in serum stimulates gonococcal metabolism . This factor has now been isolated by column chromatography and may be released from mammalian cells including phagocytes . Exposure of gonococci to serum decreases membrane fluidity as demonstrated by EPR, seems to reduce OMP shedding, and reduces uptake by PMNS . Serum stimulated gonococci consume O2 to an extent adequate to interfere with PMN formation of reactive oxygen intermediates . We propose that all of these responses are adaptive and favor survival of this pathogen.

Antonie Van Leeuwenhoek, 1987, 53(6), 485 - 91
Development of a tissue culture model for gonococcal invasion; Shaw JH et al.; Neisseria gonorrhoeae invasion of the human endometrial cell line HecIB was monitored by electron microscopy . Within six hours postinfection, the gonococci have attached to the surface of some HecIB cells and are embraced by microvilli . Gonococci subsequently enter the HecIB cells in membrane bound vesicles but by eight hours, gonococci can be seen free in the cytoplasm . At twelve hours post-infection some HecIB cells are observed containing hundreds of internalized bacteria . At twenty-four hours gonococci appear in large clusters embedded in a matrix of cellular debris, which are possibly the remains of lysed infected cells . In contrast, N . lactamica is adherent to the monolayer but noninvasive.

Antonie Van Leeuwenhoek, 1987, 53(6), 479 - 84
Neisseria gonorrhoeae IgA protease . Secretion and implications for pathogenesis; Pohlner J et al.; A cloned 5 kb DNA fragment from Neisseria gonorrhoeae strain MS11 promotes expression and excretion of IgA protease in E . coli and other Gram-negative hosts . DNA sequencing reveals a large open reading frame coding for a precursor molecule of 169 kd . The 106 kd mature IgA protease is released from the bacteria in conjunction with a 15 kd soluble precursor segment, the alpha-protein . In contrast, the carboxy terminal portion of the precursor, the beta-protein (45 kd), remains associated with the outer bacterial membrane . The three proteins result form autoproteolytic cleavage at sites in the precursor which are similar to the target site in IgA1 . Consensus sequences of the specific cleavage sites are found in a number of relevant human proteins . IgA protease may therefore have other natural substrates besides IgA1 . The soluble alpha-protein as well as the membrane bound beta-protein, both associated with IgA protease, may confer additional virulence functions to the gonococcus.

Antonie Van Leeuwenhoek, 1987, 53(6), 435 - 40
The control mechanism of opacity protein expression in the pathogenic Neisseriae; Muralidharan K et al.; The expression of Neisseria gonorrhoeae opacity protein shows frequent phase transitions . The genome contains at least twelve copies of the opa gene . Each copy is complete and different from most of the others in certain hypervariable regions . All opa genes are constitutively transcribed . Part of the leader peptide of all Op's is encoded by repetitive CTTCT pentameric units, the so-called coding repeat (CR) . The number of repeat units found in the genes and mRNA is subject to frequent and precise changes . Such changes affect the expression of individual opa genes at the translational level . This control mechanism is common also to the class 5 proteins of N . meningitidis and the Op-related proteins of N . lactamica.

Antonie Van Leeuwenhoek, 1987, 53(6), 381 - 8
A clonal analysis of Neisseria meningitidis serogroup A; Crowe BA et al.; A typing scheme has recently been developed for Neisseria meningitidis serogroup A based on the clonal population structure of these bacteria . An international strain collection consisting of 423 group A strains isolated from 23 epidemics or outbreaks since 1963, as well as from older epidemics and numerous non-epidemic situations was used in the analysis . Strains were first segregated into electrophoretic types, depending on the combined score for the electrophoretic mobilities of 7 cytoplasmic isoenzymes resolved by starch gel electrophoresis and of 2 outer membrane proteins resolved by sodium dodecyl sulphate polyacrylamide gel electrophoresis . The bacteria were subsequently assigned to one of 21 clones after numerical analysis of their electrophoretic types . The epidemiological value of the typing scheme was assessed by examining case and carrier strains isolated during (1982-83) and subsequent to (1984-85) an epidemic in the Gambia, West Africa . The case isolates, all of which were serogroup A, were of a single clonal type . All serogroup A carrier isolates were also of this clone, while carrier strains of other serogroups showed greater clonal diversity . These results indicate that case strains during an epidemic show little clonal diversity and thus that the typing scheme is of value in distinguishing the etiology of epidemics . A retrospective epidemiological analysis of the strains in the international collection showed that most serogroup A epidemics were associated with a single or predominant clone, although some epidemics were of mixed etiology.(ABSTRACT TRUNCATED AT 250 WORDS)

Antonie Van Leeuwenhoek, 1987, 53(6), 375 - 80
Serological classification of Neisseria gonorrhoeae . Clinical and epidemiological applications; Sandstrom E et al.; The development of gonococcal serovar determination and the different nomenclatures are presented . The current prospects for the application of typing to clinical, epidemiological and theoretical studies are reviewed . Future prospects are discussed with special reference to the need for standardization.

Med Cutan Ibero Lat Am, 1987, 15(6), 517 - 22
{Mucopurulent cervicitis at a clinic for sexually transmitted diseases}; Perez Bernal AM et al.; In a series of 1,011 women seen in the Diagnosis Center of Sexually Transmitted Diseases of the Faculty of Medicine of Seville, we study the prevalence of cervical infections caused by Neisseria gonorrhoeae and/or Chlamydia trachomatis and also mucopurulent cervicitis (CMP), these last diagnosed by the presence of more than 10 polymorphonuclear leukocytes x 1,000 magnification in Gram stain of secretion or endocervical mucopus . We calculate the predictive value that the diagnosis of the CMP had in detecting cervical infection by chlamydia and gonococcus . N . gonorrhoeae was isolated in 56 patients (5.5%), C . trachomatis in 83 (8.2%) and both in 15 (1.5%) . In all, 154 women presented cervical infections, which correlates to a prevalence of 15.2% . CMP was diagnosed in 267 patients and, of these, 43.4% had cervical infection accused by N . gonorrhoeae and/or C . trachomatis . The diagnosis criteria of CMP used as predictors of cervical infection, had a sensibility of 0.75 and a specificity of 0.82, with a positive predictive value of 0.42.

Trans R Soc Trop Med Hyg, 1987, 81(3), 378 - 80
Ophthalmia neonatorum in a semi-rural African community; Frost E et al.; The incidence and aetiology of ophthalmia neonatorum have been estimated over a 7-month period in Franceville, a semi-rural community in south-eastern Gabon . Chlamydia trachomatis was the most frequently observed pathogen, being isolated from 17 babies (2.7% of births), and Neisseria gonorrhoeae was recovered from 12 (1.6% of births) . 5 of 17 cases of chlamydial conjunctivitis were in infants less than 5 d old as opposed to 9 in the typical 5 to 10-days-old group . As expected, most cases of gonococcal ophthalmia neonatorum occurred in the first 5 d of life with cases in older infants often not accompanied by a granulocytic response . Chlamydial conjunctivitis was usually unilateral whereas other cases were most frequently bilateral.

J Mol Evol, 1987, 25(3), 261 - 9
An analysis of the organization and evolution of type 4 fimbrial (MePhe) subunit proteins; Dalrymple B et al.; We have analyzed and compared the amino acid sequences of the type 4 fimbrial subunits from Pseudomonas aeruginosa . Moraxella bovis, M . nonliquefaciens, Bacteroides nodosus, Neisseria gonorrhoeae, and N . meningitidis . We propose a consensus sequence for the highly conserved amino-terminal regions of these proteins . In the variable regions, a domain corresponding to an epitope common to N . gonorrhoeae and N . meningitidis fimbriae is conserved, both in sequence and in environment, in fimbrial subunits from B . nodosus . The subunits from M . bovis and P . aeruginosa do not show any homologies to this sequence . In all of the subunits, the carboxy-terminal half of the molecule consists of a series of fairly hydrophobic domains . The last three domains, two of which include the cysteines of the disulfide bridge in N . gonorrhoeae, P . aeruginosa, and M . bovis, are more or less conserved in sequence in all of the proteins including that of B . nodosus . We propose that these conserved hydrophobic regions, which have the potential to form a series of beta-sheets, form a structural framework around which more variable hydrophilic sequences determining immunological profile are arranged . The evolutionary relationships of the contemporary proteins and the distribution of type 4 fimbriae are also discussed.

J Gen Microbiol, 1987 Jan, 133 ( Pt 1), 155 - 62
Cleavage of the protein III and major iron-regulated protein of Neisseria gonorrhoeae by lysosomal cathepsin G; Shafer WM et al.; Incubation of either 125I-labelled or unlabelled Neisseria gonorrhoeae with enzymically active preparations of human polymorphonuclear leucocyte lysosomal cathepsin G revealed that surface-exposed outer-membrane proteins were susceptible to proteolytic modification . Electroimmunoblotting experiments confirmed that outer-membrane protein III (PIII) and the major iron-regulated protein (MIRP), two conserved gonococcal proteins, were cleaved by cathepsin G . A direct relationship was observed between susceptibility to the antibacterial properties of cathepsin G and cleavage of PIII among isogenic strains differing in their level of resistance to the bactericidal activity of cathepsin G . Although the antibacterial property of cathepsin G is known to be independent of serine-esterase activity, the data suggest that gonococcal outer-membrane proteins are involved in the binding of cathepsin G, and that variation in the level of resistance reflects the degree to which target outer-membrane proteins such as PIII are exposed.

Bull Soc Pathol Exot Filiales, 1987, 80(1), 38 - 44
{Auxotypes, plasmid content and serovars of 3 strains of Neisseria gonorrhoeae isolated in Bordeaux in 1955}; Dutilh B et al.; Penicillinase-producing gonococci are isolated with increasing frequency . Epidemiologic markers, auxotypes, serovars, plasmids have been studied for three strains isolated in Bordeaux, responsible for therapeutic failure . For two of them, the source of contamination could be identified as endemic countries.

Sex Transm Dis, 1987 Jan-Mar, 14(1), 26 - 32
Epidemiology of gonorrhea: distribution and temporal changes in auxotype/serovar classes of Neisseria gonorrhoeae; Knapp JS et al.; The auxotype/serovar (A/S) class of 489 isolates of Neisseria gonorrhoeae were determined and 425 isolates from 390 consecutive patients with gonorrhea who attended the Sexually Transmitted Diseases Clinic at Harborview Medical Center in Seattle during the first three months of 1985 were analyzed . Patients included 123 women, 187 heterosexual men, and 80 homosexual men . A total of 57 A/S classes of N . gonorrhoeae were identified during this study . For the first eight weeks, between three and seven new A/S classes were identified each week . The number of new A/S classes encountered in this community declined subsequently, and leveled off at about zero to two new A/S classes introduced per week . Two A/S classes were limited almost solely to homosexual men, one group of related classes was limited to heterosexual patients, and one class was initially limited largely to heterosexual men, possibly because of spread from a prostitute . The results show that the A/S classification system can be used in combination with epidemiologic data for tracing the introduction and spread of gonoccocal strains and their eventual elimination from a community . A/S classification can be used to study the clinical epidemiology of gonorrhea and may facilitate evaluation of strategies for control of gonorrhea.

Infect Immun, 1987 Jan, 55(1), 273 - 6
Characterization of protein I from serum-sensitive and serum-resistant transformants of Neisseria gonorrhoeae; Judd RC et al.; The protein IAs of serum-sensitive (FA635) and serum-resistant (FA638) transformants of Neisseria gonorrhoeae, which have identical pedigrees, have been shown to be different by the use of a monoclonal antibody and were also shown to be different by proteinase K cleavage and primary structural and surface peptide mapping . The difference in structure is within the surface-exposed region of the molecule . The only other difference observed between the two strains was a very slight difference in lipooligosaccharide silver staining in sodium dodecyl sulfate-polyacrylamide gel electrophoresis . These data suggest that protein I alone or in combination with lipooligosaccharide may significantly contribute to serum resistance.

Infect Immun, 1987 Jan, 55(1), 141 - 7
Chemical characterization of binding properties of opacity-associated protein II from Neisseria gonorrhoeae; Bessen D et al.; Binding of an opacity-associated protein II (PIIop) from Neisseria gonorrhoeae to eucaryotic macromolecules was studied . HeLa cell extracts were subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis and transferred to nitrocellulose, and purified PIIop bound to approximately 50 distinct molecular species . The binding of PIIop to HeLa cell components was stable in high salt and nonionic detergent and was not inhibited by a variety of monosaccharides and polyionic substances . PIIop binding behavior was compared with that of two model carbohydrate-binding proteins, wheat germ agglutinin (WGA) and concanavalin A (ConA) . Model glycoproteins (ovomucoid, fetuin, mucin, ovalbumin) inhibited binding by PIIop, WGA, and ConA to various degrees . HeLa cell glycopeptides, generated by pronase digestion of chloroform-methanol-extracted cells, were tested for their ability to inhibit binding by PIIop to Western blots of HeLa cell macromolecules . HeLa cell extracts inhibited PIIop binding before pronase treatment, but inhibitory activity was lost as a result of pronase digestion . Direct binding to defined glycosylated and nonglycosylated proteins revealed that ConA and WGA bound only glycoproteins, whereas PIIop bound to proteins lacking carbohydrate as well . PIIop binding to human and bovine serum albumins was of high affinity and required partial unfolding of albumin; native albumin was not bound by PIIop; however, both the denatured, reduced form of albumin and the compact, nonreduced form of carboxymethylated albumin were bound strongly by PIIop . Albumin-PIIop interaction did not involve covalent bond formation through sulfhydryl groups . The predominant binding interactions of PIIop found in this study were with protein rather than carbohydrate, and the chemical nature of the interactions is more complex than involvement of purely ionic or hydrophobic forces.

Infect Immun, 1987 Jan, 55(1), 253 - 7
Induction of mucosal immunoglobulin A immune response by preparations of Neisseria gonorrhoeae porin proteins; Jeurissen SH et al.; The aim of this study was to develop an immunization scheme appropriate for the induction of an immunoglobulin A (IgA) response against Neisseria gonorrhoeae at the mucosae . For several reasons, the major outer membrane protein of N . gonorrhoeae (gonococcal PI) is attractive as a component of a gonococcal vaccine . Purified PI obtained from strain B2 was used in Zwittergent 3-14 for immunization . Rats received the antigen subcutaneously, intraintestinally, or directly in Peyer's patches with or without the adjuvant N-acetylmuramyl dipeptide (MDP) or AlPO4 . The immune response was studied in situ by a newly developed antigen-specific three-step immunoperoxidase method, whereas specific antibodies in the serum were measured by an enzyme-linked immunosorbent assay procedure . Subcutaneous immunizations triggered peripheral lymphoid organs, whereas intraintestinal and intra-Peyer's patch immunizations triggered mucosa-associated lymphoid organs . This was reflected not only in the lymph nodes involved, popliteal versus mandibular and mesenteric lymph nodes, but also in the isotypes of the produced anti-PI antibodies, IgG versus IgA . The adjuvants AlPO4 and MDP appeared to act differently during subcutaneous and intraintestinal immunizations . AlPO4 augmented subcutaneous immune responses, whereas MDP had no effects . In contrast, intraintestinal immune responses increased most with the adjuvant MDP . In summary, we concluded that PI is capable of inducing a mucosa-associated IgA response when administered intraintestinally and that this response can be augmented by the adjuvant MDP.

Ann Dermatol Venereol, 1987, 114(8), 941 - 6
{Re-evaluation of single-dose treatment with thiamphenicol and spectinomycin of uncomplicated male gonococcal urethritis}; Lassau F et al.; Gonococcal urethritis being highly contagious, the ideal treatment should be effective, well tolerated and relatively cheap . Among antibiotics fulfilling these conditions, thiamphenicol and spectinomycin are widely used throughout the world and particularly in France . However, the ever increasing incidence of infections caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) strains, the growing number of strains with low sensitivity to penicillin and/or other antibiotics and the recent emergence of strains that are highly resistant to penicillin make it necessary from time to time to re-evaluate the main therapeutic approaches to gonococcal urethritis . In this study thiamphenicol and spectinomycin were compared for effectiveness as single-dose treatments of uncomplicated gonococcal urethritis in 207 male patients who consulted at the Clinical and Biological Centre for Sexually Transmitted Diseases, Saint-Louis Hospital, Paris, during April and May, 1985 . Prior to the trial the patients had not received antibiotics for at least 2 weeks . They were allocated at random to two therapeutic groups: 89 patients received a single 2.5 g dose of thiamphenicol orally, and 84 patients received a single 2 g dose of spectinomycin by intramuscular injection . In every case the gonococcal origin of the urethritis had been confirmed by culture . The patients were examined 3 to 7 days after treatment for clinical and bacteriological evaluation . Specimens were cultivated on agar-blood medium, and N . gonorrhoeae was also identified by biochemical and antigenic reactions . The minimum inhibitory concentrations (MIC) of the two antibiotics were determined by the agar plate dilution method, using an agar nutrient medium . The possible production of beta-lactamase and the auxotypic and plasmidic profiles of the PPNG strains were investigated.(ABSTRACT TRUNCATED AT 250 WORDS)

Hinyokika Kiyo, 1987 Jan, 33(1), 157 - 68
{Epidemiological and therapeutic studies on gonococcal infections--one shot therapy by spectinomycin--{Sapporo Clinical Research Group for STD}}; Sakai S et al.; From January through March of 1985, the Sapporo Clinical Research Group for STD treated 69 cases of gonococcal infections (61 cases of male gonococcal urethritis and 8 cases of female gonococcal cervicitis) at its facilities in Sapporo City . The therapeutic efficacy of one shot therapy of Spectinomycin (SPCM) was investigated, and an epidemiological study on the cases and bacteriological studies on the isolated strains of Neisseria gonorrhoeae were made . The male patients were between 19 and 55 years old, with a peak age distribution in the younger half of the twenties . The female patients were between 18 and 40 years old . The major source of infections was a so-called special massage parlor which accounted for 36.1% of male cases . The isolation rate of PPNG were 16.7% (11/66) . The MIC (inoculum size; 10(6) CFU/ml) of SPCM ranged from 3.13 to 25 micrograms/ml regardless of beta-lactamase production . In male patients, the eradication rate (efficacy rate) of N . gonorrhoeae by SPCM was 94.7% on the first day, 93.6% on the third day and 100% on the seventh day after 2 g one shot therapy . In female patients, the rate was 100% on the third and seventh day after 2 g one shot therapy, and 75% on the first day, 66.7% on third day and 100% on seventh day after 4 g one shot therapy . We considered that one shot therapy of SPCM was effective for gonococcal infection also in the present time . Especially SPCM was effective for infections by PPNG, since it was not resolved by beta-lactamase of N . gonorrhoeae . Positive rate of Chlamydia trachomatis was 16.3% in male gonococcal urethritis, and the serous discharge tended to remain longer in the positive patients than in the negative patients . There was only one side effect (1.4%), therefore SPCM was recognized to be a safely administrated antimicrobial agent.

Antonie Van Leeuwenhoek, 1987, 53(6), 471 - 8
Restriction site polymorphism in genes encoding type 2 but not type 1 gonococcal IgA1 proteases; Mulks MH et al.; Neisseria gonorrhoeae produces two phenotypically distinct types of IgA1 proteases, each of which cleaves a specific peptide bond in the hinge region of the human IgA1 heavy chain . The genes encoding IgA1 protease from twenty-eight different strains of N . gonorrhoeae, including twelve which produce type 1 enzyme, thirteen which produce type 2 enzyme, and three which are protease negative, were analyzed . Nine restriction site patterns were found in the iga genes . All twelve type 1 strains showed identical restriction maps of the iga gene, which differed from all the iga-2 variants . The three protease negative strains each contained DNA homologous to the probe . While strain to strain variation in restriction maps of specific genes is not unique and has been reported in N . gonorrhoeae previously, the existence of such restriction site polymorphism among iga-2 genes contrasts strongly with the lack of such variation among iga-1 genes . The basis for this lack of diversity among the iga-1 genes is under further investigation.

Antonie Van Leeuwenhoek, 1987, 53(6), 431 - 4
Molecular principles of antigenic variation in Neisseria gonorrhoeae; Haas R et al.; The genome of Neisseria gonorrhoeae harbours many gene loci for the production of variant pili . Strain MS11 has two expression genes (pilE) with promoter and complete coding sequences . The remaining genes are silent (pilS) lacking the promoter and the conservative amino terminals coding sequences of pilin . The pilus genes consist of six variable minicassettes (mc's), that are flancked by strictly conserved sequences . Upon phase (P+ to P+) and antigenic (P+ to P-, or vice versa) transitions minicassettes from silent loci are transferred from silent pilus gene copies to the expression gene by gene conversion . P- variants resulting from such rearrangements still produce pilin mRNA as well as pilin, but only a few are found on the surface of those gonococci.

Antonie Van Leeuwenhoek, 1987, 53(6), 425 - 30
Pilin independent binding of Neisseria gonorrhoeae to immobilized glycolipids; Deal CD et al.; The adherence process in pathogenesis involves the attachment of bacteria to structures present on eukaryotic cell surfaces . To investigate components necessary for this interaction, we have characterized the binding of N . gonorrhoeae to eukaryotic glycolipids immobilized on thin layer chromatograms . The gonococci specifically bind to a subset of glycolipids consisting of lactosylceramide, gangliotriosylceramide, and gangliotetraosylceramide . This binding was identified in both piliated and nonpiliated cells, and is postulated to be mediated by a nonpilin lectin-like adhesin protein.

Arch Microbiol, 1987, 149(2), 87 - 94
Enzymic arrangement and allosteric regulation of the aromatic amino acid pathway in Neisseria gonorrhoeae; Berry A et al.; The pathway construction and allosteric regulation of phenylalanine and tyrosine biosynthesis was examined in Neisseria gonorrhoeae . A single 3-deoxy-D-arabino-heptulosonate 7-phosphate (DAHP) synthase enzyme sensitive to feedback inhibition by L-phenylalanine was found . Chorismate mutase and prephenate dehydratase appear to co-exist as catalytic components of a bifunctional enzyme, known to be present in related genera . The latter enzyme activities were both feedback inhibited by L-phenylalanine . Prephenate dehydratase was strongly activated by L-tyrosine . NAD+-linked prephenate dehydrogenase and arogenate dehydrogenase activities coeluted following ion-exchange chromatography, suggesting their identity as catalytic properties of a single broad-specificity cyclohexadienyl dehydrogenase . Each dehydrogenase activity was inhibited by 4-hydroxyphenylpyruvate, but not by L-tyrosine . Two aromatic aminotransferases were resolved, one preferring the L-phenylalanine:2-ketoglutarate substrate combination and the other preferring the L-tyrosine: 2-ketoglutarate substrate combination . Each aminotransferase was also able to transaminate prephenate . The overall picture of regulation is one in which L-tyrosine modulates L-phenylalanine synthesis via activation of prephenate dehydratase . L-Phenylalanine in turn regulates early-pathway flow through inhibition of DAHP synthase . The recent phylogenetic positioning of N . gonorrhoeae makes it a key reference organism for emerging interpretations about aromatic-pathway evolution.

Gene, 1987, 60(1), 85 - 92
Structural analysis of the pilE region of Neisseria gonorrhoeae P9; Perry AC et al.; We have determined the nucleotide sequence of an expressed structural pilus gene (pilE) derived from Neisseria gonorrhoeae strain P9-2 . Detailed analysis of nucleotide sequences upstream from pilE revealed a silent, truncated pilin gene segment that was linked to families of DNA elements (RS1 and RS3) that have previously been identified at the major silent pilin gene locus (pilS1) and at pilE of the independently isolated N . gonorrhoeae strain MS11ms . A nucleotide sequence downstream from pilE was reminiscent of the recognition sequences of several recombinases, including Tn3 tnpR product (resolvase), suggesting a possible role for site-specific events in the recombinational modulation of pilus expression.

J Bacteriol, 1987 Jan, 169(1), 33 - 41
Morphogenetic expression of Bacteroides nodosus fimbriae in Pseudomonas aeruginosa; Mattick JS et al.; Type 4 fimbriae are found in a range of pathogenic bacteria, including Bacteroides nodosus, Moraxella bovis, Neisseria gonorrhoeae, and Pseudomonas aeruginosa . The structural subunits of these fimbriae all contain a highly conserved hydrophobic amino-terminal sequence preceding a variable hydrophilic carboxy-terminal region . We show here that recombinant P . aeruginosa cells containing the B . nodosus fimbrial subunit gene under the control of a strong promoter (pL, from bacteriophage lambda) produced large amounts of fimbriae that were structurally and antigenically indistinguishable from those produced by B . nodosus . This was demonstrated by fimbrial isolation and purification, electrophoretic and Western transfer analyses, and immunogold labeling and electron microscopy . These results suggest that type 4 fimbriated bacteria use a common mechanism for fimbrial assembly and that the structural subunits are interchangeable, thereby providing a basis for the development of multivalent vaccines.

Antonie Van Leeuwenhoek, 1987, 53(6), 501 - 7
The immunochemistry of neisserial LOS; Griffiss JM et al.; The outer membrane glycolipids of Neisseria lack long polysaccharides and are properly termed lipooligosaccharides (LOS) . A Neisseria strain makes from two to six LOS of Mr 3150-7100 . Different species commonly make LOS of identical Mr and epitope content . Oligosaccharide (OS) differences account for physical heterogeneity . OS consist of a conserved triantenary basal oligosaccharide, two linear segments of (n) hexose residues that determine OS mass, and terminal sequences similar to those of glycosphyngolipids . Epitope expression is linked to physical heterogeneity and conditioned by the molecular environment of the outer membrane . Serotype epitopes are expressed on Mr-restricted LOS . LOS regulate complement activation onto the bacterial surface and, hence, immune lysis.

Med Microbiol Immunol (Berl), 1987, 176(6), 289 - 303
Immunoresponses to Neisseria meningitidis epitopes: in vivo analysis of immunocompetent cells involved in suppression of secondary response to phosphorylcholine; Faro J et al.; The immune response to phosphorylcholine (PC) antigens has been extensively studied in recent years . Neisseria meningitidis serogroup B M986 (NMB) was recently reported to induce a PC-specific plaque-forming cell (PFC) immuno-response in mice, a characteristic useful for the study of immunomodulating properties of N . meningitidis . With this technique, priming mice with low doses of NMB has been shown greatly to impair their ability, one month after priming, to mount an anti-PC response induced by NMB; this suppression is permanent, does not involve switching from IgM to another immunoglobulin class, transiently affects the T15 idiotype expression and is carrier specific . We report, based on an analysis of spleen cells from NMB-primed mice in an adoptive transfer model, that this suppression does not appear to be mediated by B lymphocytes nor does it seem to be under the direct control of T lymphocytes; rather, it involves radio-resistant cells . Additionally, our results show that NMB modulates the idiotype composition of the anti-phosphorylcholine response, probably by enhancing the expression of so called hapten-augmentable PFC . These results demonstrate that NMB can interfere effectively with the immune response in a variety of ways.

Hautarzt, 1987 Jan, 38(1), 4 - 9
{Serotyping Neisseria gonorrhoeae}; Kohl PK et al.; To control gonorrhea an understanding of pathogenesis and epidemiology is necessary . To achieve this goal a serologic typing system recognizing antigenic variants of the gonococcus is needed . The serotyping systems proposed in past years are described and their clinical relevance discussed . At the moment two typing systems based on protein I and monoclonal antibodies are available . Protein I serotypes are correlated with the killing of Neisseria gonorrhoeae by bactericidal antibodies and may play a role in the future development of a gonococcal vaccine . The serovar system permits precise analysis of gonococcal populations and can be used especially for epidemiologic studies . The possibility of discriminating between reinfection and therapy failure can be of importance in therapeutic studies . A microepidemiologic analysis for partner identification is possible by combined determination of serovar and auxotype . Both monoclonal typing systems represent standardized monospecific reagents which, besides serotyping, will be used for the diagnosis of gonococcal disease as well.

Nucleic Acids Res, 1986 Dec 22, 14(24), 10027 - 44
Selective enrichment of specific DNA, cDNA and RNA sequences using biotinylated probes, avidin and copper-chelate agarose; Welcher AA et al.; We have developed a general procedure for the rapid and efficient enrichment of specific DNA, RNA or cDNA sequences . Biotinylated DNA or RNA is used as a hybridization probe in solution, avidin is then added to label both the probe and hybrid molecules, and the hybridization mixture chromatographed over cupric-iminodiacetic acid agarose beads . Avidin-probe and avidin-hybrid molecules are selectively retained on the column; non-hybridized sequences are contained in the flow-through fraction . Sequences retained on the column are recovered in high yield by the addition of ethylenediamine tetracetic acid in the buffer . The method can be used in both subtractive enrichment and positive selection protocols . Here we report its application to the isolation of Neisseria gonorrhoeae specific genomic DNA clones and the purification of a cDNA subpopulation representing mRNA sequences that are over-expressed in murine Friend cells after dimethylsulfoxide induction.

Eur J Biochem, 1986 Dec 15, 161(3), 519 - 24
In-vivo-modified gonococcal plasmid pJD1 . A model system for analysis of restriction enzyme sensitivity to DNA modifications; Korch C et al.; The 4207-bp cryptic plasmid (pJD1) of Neisseria gonorrhoeae has 5-methylcytosine bases present at several positions in the DNA sequence . Fortuitously, these modified bases lie in the recognition sequences of many restriction enzymes . This feature makes the cryptic plasmid a model system for assaying the effect of these modified cytosines on the activities of the following restriction endonucleases and their isoschizomers: R X AvaII, R X BamHI, R X BglI, R X Fnu4HI, R X HaeII, R X HaeIII, R X HhaI, R X HpaII, R X KpnI, R X MspI, R X NaeI, R X NarI, R X NciI, R X NgoI, R X NgoII, and R X Sau96I . Of particular interest was the finding that methylation of one of the external cytosines of the palindrome 5'-CCGG-3' prevented its cleavage by R X MspI, but not by R X HpaII as had been suggested by Walder et al . {J . Biol . Chem . (1983) 258, 1235-1241}.

Can J Microbiol, 1986 Dec, 32(12), 909 - 11
Structure of the exocellular D-glucan produced by Neisseria polysaccharea; Riou JY et al.; Neisseria polysaccharea (LNP 462, NCTC 11858), proposed as a prototype strain constituting a new taxon in the genus Neisseria, produces copious amounts of polysaccharide when grown on agar containing 1-5% sucrose . Plate-grown cells produced an exocellular polysaccharide which was composed of D-glucose, had {alpha}D +222 degrees (water), and was shown from composition, specific optical rotation, methylation, enzymic hydrolysis, and 13C nuclear magnetic resonance studies to have an amylopectinlike structure containing mainly 1,4-linked alpha-D-glucopyranosyl residues, but also containing ca . 6% 4,6-di-O-substituted alpha-D-glucopyranosyl branch points.

Genitourin Med, 1986 Dec, 62(6), 380 - 3
Resistance of Gardnerella vaginalis to bactericidal activity of human serum; Boustouller YL et al.; To assess the sensitivity of Gardnerella vaginalis to the complement mediated bactericidal activity of serum, six laboratory strains were incubated with normal human serum and two strains freshly isolated from women with non-specific vaginitis (NSV) were each incubated with homologous patient serum . There was no significant difference between the number of organisms recovered from unheated or heat inactivated serum after incubation at 37 degrees C for one hour with any of the strains tested . A suspension of G vaginalis incubated at 37 degrees C for one hour in heat inactivated homologous mouse antiserum with unheated normal human serum as a source of complement did not show any less viability than the control mixture using heat inactivated human serum . In contrast, a serum resistant strain of Neisseria gonorrhoeae incubated in heat inactivated homologous mouse antiserum with unheated normal human serum showed noticeably less viability than the control . G vaginalis therefore seems to be resistant to the bactericidal activity of both normal and immune serum.

J Gen Microbiol, 1986 Dec, 132 ( Pt 12), 3289 - 302
Physiology and virulence determinants of Neisseria gonorrhoeae grown in glucose-, oxygen- or cystine-limited continuous culture; Keevil CW et al.; Piliated Neisseria gonorrhoeae forming small, transparent colonies (P+O-) on clear typing agar have been grown in prolonged continuous culture to ascertain how different growth environments might affect gonococcal physiology and the expression of virulence determinants . Virulence of the penicillin-sensitive P9-2 and the penicillin-resistant KW1 strains was assessed by their ability to survive in polypropylene chambers implanted into the flanks of guinea pigs . Initial continuous culture experiments in the defined medium of Manchee et al . (FEMS Microbiology Letters 7, 115-118, 1980) indicated that growth was actually cystine-limited, rather than the anticipated glucose-limited . Surprisingly, cysteine was not completely metabolized and ammonium salts remained in excess . The molar growth yield on glucose (YGlc) was 65 g dry wt mol-1 and 45% of the glucose carbon metabolized was converted to biomass . Gonococci, whilst retaining the P+O- phenotype for over 100 generations of growth, did not survive in the subcutaneous chambers when inoculated at a variety of doses . When the cystine and glucose concentrations were increased and decreased respectively, growth became glucose-limited, the YGlc increased to 108 g mol-1 for strain KW1 and 75% of the metabolized glucose carbon was converted to biomass . After 17 generations of growth, however, only 2% of the gonococci retained the P+O- phenotype and P-O- bacteria predominated . Nevertheless, these bacteria were virulent in the chamber model, as was strain P9-2, which also retained only 2% of the P+O- phenotype during glucose-limited continuous culture . By contrast, the P+O- phenotype was retained during prolonged cystine- or oxygen-limited growth but only the latter was virulent . SDS-PAGE of membrane extracts confirmed that opaque colonies (O+) selected from the glucose-limited cultures contained a heat-modifiable protein (protein II) whereas transparent colony types lacked such proteins . The initial phenotype of virulent gonococci recovered from the subcutaneous chambers was P+O- but opaque variants dominated after several days . A 40 kDa outer-membrane protein was apparently induced during oxygen-limited continuous culture whereas a 44 kDa protein was absent during cystine-limited growth.

Drug Intell Clin Pharm, 1986 Dec, 20(12), 943 - 8
Topical mupirocin in the treatment of bacterial skin infections; Rumsfield J et al.; Mupirocin is an investigational topical antibiotic used for treatment and prophylaxis of bacterial skin infections . Mupirocin differs from other antibiotics in its synthesis, structure, and mechanism of action . In vitro, mupirocin possesses antimicrobial activity against staphylococci, streptococci, Hemophilus influenzae, and Neisseria gonorrhoeae . Few studies comparing mupirocin to other topical antibiotics are available . Initial studies comparing mupirocin to inactive vehicle in the treatment of impetigo indicate an overall 92 percent pathogen eradication rate with active drug and 58 percent eradication rate with vehicle . Overall response to treatment of secondary skin infections was favorable in 91 percent of patients treated with mupirocin and 77 percent of those treated with vehicle . Although incidence is not greater than placebo, adverse effects have included pruritus, burning, dry skin, and erythema . Additional trials and clinical use should further help determine the role of mupirocin in the treatment of minor, primary, and secondary skin infections.

Antimicrob Agents Chemother, 1986 Dec, 30(6), 856 - 60
Genetics of resistance in a non-beta-lactamase-producing gonococcus with relatively high-level penicillin resistance; Faruki H et al.; A penicillin-resistant (Penr) non-penicillinase-producing Neisseria gonorrhoeae strain responsible for an outbreak affecting 199 persons in Durham, N.C., in 1983 was studied to determine the genetic basis of its unusually high-level (MIC, 2.0 micrograms/ml) Penr . Plasmid screening of the strain revealed no plasmids other than the 2.6-megadalton cryptic plasmid . Penr was found to be partially due to mutations genotypically and phenotypically similar to the previously characterized chromosomal loci penA, mtr, and penB . Resistance loci from the epidemic donor strain were transformed into susceptible recipients FA19 and F62 in a stepwise fashion; the combination of the three loci resulted in moderate levels of penicillin resistance (MIC, 0.5 micrograms/ml), but donor levels of resistance were not obtainable in either recipient, for uncertain reasons . Occurrence of an antibiotic-susceptible (env) mutation in a clinical isolate of the Penr epidemic strain also was documented.

Aviat Space Environ Med, 1986 Dec, 57(12 Pt 1), 1170 - 5
Prevalence of penicillinase-producing Neisseria gonorrheae in Korea; Berliner DS et al.; An almost two-fold increase in the monthly reported case rate for sexually transmitted disease (STD) in U.S . military members assigned in the Republic of Korea in April 1981 prompted an epidemiologic assessment of that population . Inasmuch as previously nonexistent treatment failures for Neisseria gonorrheae were also being reported, a demographic slice of 253 symptomatic military members was surveyed in June and July, 1981, for gonorrhea prevalence and the proportion of this that could be attributed to penicillinase-producing Neisseria gonorrheae (PPNG) . Using standard and accepted methods, the gonorrhea prevalence rate in symptomatic military members was found to be 100% while the proportion that could be attributed to PPNG was 43% . In order to compare this to the contact population of local prostitutes, 116 asymptomatic women who presented to local STD clinics for routine, often legally-mandated examinations, were surveyed . The expected lower gonorrhea prevalence rate was 13.9% but the proportion attributed to PPNG was 27.6% . This data was similar to the sudden increase in PPNG experienced by U.S . military forces at Subic Bay in the Philippines in 1979 and reflected the slow but steady migration of this resistance throughout Asia . The long-accepted norm for gonorrhea treatment using penicillin was changed to spectinomycin in the U.S . military population and was being considered for implementation by the Korean official health community . Further organism resistance can be expected, and close monitoring is taking place.

J Clin Microbiol, 1986 Dec, 24(6), 1111 - 2
Comparative evaluation of New York City and modified Thayer-Martin media for isolation of Neisseria gonorrhoeae; Greenwood JR et al.; Commercially manufactured New York City (NYC) medium and modified Thayer-Martin (MTM) medium were compared for their ability to isolate Neisseria gonorrhoeae from clinical specimens . Twenty-seven public health laboratories throughout California evaluated 4,802 specimens collected from patients attending either sexually transmitted disease or family planning clinics . Total of 726 and 737 N . gonorrhoeae isolates were recovered from NYC and MTM medium, respectively . Although less contamination was noted on NYC medium, MTM medium was equivalent to commercially prepared NYC medium for the isolation of N . gonorrhoeae from clinical specimens.

J Clin Microbiol, 1986 Dec, 24(6), 1109 - 10
Effect of holding temperature on isolation of Neisseria gonorrhoeae; Evans KD et al.; The effect of holding temperature on the recovery of Neisseria gonorrhoeae was studied . From 300 specimens tested, Thayer-Martin medium plates inoculated and incubated in the presence of CO2 at 35, 22, and 4 degrees C for 24 h before incubation at 35 degrees C yielded 100, 96, and 95% of all isolates ultimately recovered from 82 positive specimens . Although there was a decrease in the quantity of organisms recovered, initial incubation of specimens under refrigeration or at room temperature yielded greater than or equal to 95% of the positive specimens.

Infect Immun, 1986 Dec, 54(3), 841 - 5
Surface-exposed antigenic cleavage fragments of Neisseria gonorrhoeae proteins 1A and IB; Schmitt S et al.; Whole bacteria, isolated outer membranes, and purified protein I (PI) from one transparent (O-) and two different opaque (O+) phenotype gonococcal strains (serogroups I, II, and III; PI serotypes 1, 5, and 9b) were each treated with tolylsulfonyl phenylalanyl chloromethyl ketone-trypsin, alpha-chymotrypsin, and proteinase K . Protein IA (PIA) of strain 7122 (O-, serotype 1, serogroup I) was resistant to proteolysis by tolysulfonyl phenylalanyl chloromethyl ketone-trypsin and alpha-chymotrypsin and only slightly affected by proteinase K, as long as it was associated with intact bacteria or isolated outer membranes . Purified PIA however was cleaved by these enzymes, resulting in two to five fragments . In contrast, all preparations of strains 5766 opaque phenotype (O+, serotype 7, serogroup II) and 1955 (O+, serotype 9b, serogroup III) were accessible to proteolysis, resulting in cleavage fragments of PIB compatible to those described previously by O . Barrera and J . Swanson (Infect . Immun . 44:565-568, 1984), M . S . Blake et al . (Infect . Immun . 33:212-222, 1981), and Blake (in G . K . Schoolnik, ed., The Pathogenic Neisseriae, 1985) . Our data indicated that the purified PIB fraction was more accessible to proteases than the PIBs of whole bacteria or outer membranes . The fragmentation pattern of PIA cleavage products were quite different from PIB fragments, consistent with the different structure of these two groups of PI molecules . Time-dependent cleavage experiments with proteases, i.e., alpha-chymotrypsin, indicated that PIA was subsequently cleaved into smaller fragments . Highly reactive monoclonal antibodies, each specific for a surface-exposed epitope of PIA of strain 7122 or PIB of strains 5766 and 1955, as assessed by coagglutination, Western blot, and immunofluorescence, were reacted with PIA and PIB cleavage fragments in Western blot experiments . All cleavage fragments of the purified PIA and PIB preparations with molecular weights of greater than or equal to 14,200 showed immune reaction in Western blotting, whereas whole cell and outer membrane PIB fragments were less reactive with the specific monoclonal antibodies.

Genitourin Med, 1986 Dec, 62(6), 373 - 6
In vitro activity of selected antimicrobial agents against penicillinase producing Neisseria gonorrhoeae (PPNG) and non-PPNG strains; Waghorn DJ et al.; One hundred and twelve penicillinase producing Neisseria gonorrhoeae (PPNG) isolates and the same number of non-PPNG isolates were obtained from patients attending the genitourinary department of this hospital . Susceptibilities to six beta lactam antibiotics--ceftriaxone, cefotaxime, cefuroxime, ceftazidime, amoxycillin, and temocillin--to the combined formulation of amoxycillin and clavulanic acid, Augmentin, and to the aminocyclitol, spectinomycin, were compared by assessing their minimum inhibitory concentrations (MICs) . Results showed that all the cephalosporins used in this study had good in vitro activity against both PPNG and non-PPNG strains, and ceftriaxone had the lowest MICs . Temocillin and Augmentin also showed good activity against both types of strain . Spectinomycin resistance was shown in about 4% of the PPNG isolates but was not found in any non-PPNG strains.

J Gen Microbiol, 1986 Dec, 132 ( Pt 12), 3277 - 87
A determinant of resistance of Neisseria gonorrhoeae to killing by human phagocytes: an outer membrane lipoprotein of about 20 kDa with a high content of glutamic acid; Parsons NJ et al.; A protein of about 20 kDa was extracted by sodium cholate (1%, w/v) from outer membranes of a strain of Neisseria gonorrhoeae, BS4 (agar), which is resistant to killing by human phagocytes . When the protein was purified by repeated fractionation on Sephadex G75, contamination with other outer-membrane proteins and lipopolysaccharide was negligible . The protein contained a full complement of amino acids, with high levels of glutamic acid . Carbohydrate, detected by the anthrone method and by sugar and hexosamine analysis, was present, but at very low levels . There was a significant content of fatty acids (about 5.7% of the protein), indicating a lipoprotein . The 20 kDa lipoprotein: (1) neutralized the ability of antiserum against whole organisms of BS4 (agar) to reduce the resistance of this strain to phagocyte killing; (2) evoked in mice an antiserum which reduced this resistance and immunoblotted only with 20 kDa lipoprotein in the cholate extract of outer membranes; and (3) promoted resistance to intracellular killing of an otherwise phagocyte susceptible gonococcal strain (BSSH) . This is strong evidence that it is a determinant of gonococcal resistance to phagocyte killing.

Infect Immun, 1986 Dec, 54(3), 924 - 7
Stability of expression of Neisseria gonorrhoeae lipooligosaccharides; Schneider H et al.; We compared multiple lipooligosaccharide (LOS) extracts from individual strains of Neisseria gonorrhoeae . Each of the extracts was prepared from single mass cultures grown on solid media under similar conditions but separated by time . We found only subtle variations in the number, electrophoretic mobility, and concentration of components of the LOSs from individual strains . We found no variation in the expression of a 3.6-kilodalton LOS component that carries the L8 LOS epitope . A significant variation in the 3-deoxy-D-manno-octulosonic acid content was found among different extracts from the same strain, but this variation appeared to be unrelated to the other LOS characteristics studied.

N Engl J Med, 1986 Nov 27, 315(22), 1382 - 5
Single-dose therapy of gonococcal ophthalmia neonatorum with ceftriaxone; Laga M et al.; We conducted a randomized clinical trial comparing a single intramuscular dose of 125 mg of ceftriaxone with a single intramuscular dose of 75 mg of kanamycin followed by topical gentamicin for seven days, and with a single intramuscular dose of 75 mg of kanamycin followed by topical tetracycline for seven days, in the treatment of gonococcal ophthalmia neonatorum in Nairobi, Kenya . Of 122 newborns with culture-proved gonococcal ophthalmia neonatorum, 105 returned for follow-up . Sixty-one infants (54 percent) received ceftriaxone, 32 received kanamycin plus topical gentamicin, and 29 received kanamycin plus topical tetracycline . Sixty-six (54 percent) of the Neisseria gonorrhoeae isolates were penicillinase producing . All 55 newborns who received ceftriaxone and returned for follow-up were clinically and microbiologically cured . One of 26 returning newborns who received kanamycin plus tetracycline and 2 of 24 returning newborns who received kanamycin plus gentamicin had persistent or recurrent gonococcal conjunctivitis . Ceftriaxone also eradicated oropharyngeal gonococcal infection in 18 newborns, whereas oropharyngeal infection persisted in 2 of 8 newborns who had received kanamycin (P not significant) . We conclude that 125 mg of ceftriaxone as a single intramuscular dose is very effective therapy for gonococcal ophthalmia neonatorum, with marked efficacy against extraocular infection and without the need for concomitant topical antimicrobial therapy.

Am J Ophthalmol, 1986 Nov 15, 102(5), 575 - 83
The clinical characteristics and course of adult gonococcal conjunctivitis; Wan WL et al.; We studied 21 cases of adult conjunctivitis caused by Neisseria gonorrhoeae, confirmed by either Gram's stain or culture, that were seen between 1972 and 1986 . The patients, typically young men, had irritation or pain, a copious purulent discharge, and marked conjunctival inflammation . Keratitis, anterior chamber inflammation, periocular edema and tenderness, gaze restriction, and preauricular lymphadenopathy were common . All patients were hospitalized and treated with high doses of parenterally administered antibiotics . Two patients had severe ulcerative keratitis at initial examination, which ultimately resulted in light-perception visual acuity, despite antibiotic therapy and keratoplasty . In the remainder of the patients, corneal involvement was milder and transient, and treatment with parenteral penicillin and topical antibiotics was uniformly effective in reversing the course of the infection and preventing significant visual loss . Careful ophthalmologic and microbiologic monitoring is suggested to prevent possible complications caused by penicillin-resistant strains.

Carbohydr Res, 1986 Nov 15, 156, 123 - 35
Analysis of the chain length of oligomers and polymers of sialic acid isolated from Neisseria meningitidis group B and C and Escherichia coli K1 and K92; Lifely MR et al.; A series of (2----8)-alpha-, (2----9)-alpha-, and alternate (2----8)-alpha- and (2----9)-alpha-linked oligomers of sialic acid (N-acetylneuraminic acid, NeuNAc) was prepared by digestion with bacteriophage or by partial hydrolysis at pH 7.0 and 100 degrees of polymers of sialic acid produced by Neisseria meningitidis and Escherichia coli . The oligosaccharides were purified by gel filtration or by anion-exchange chromatography, and their chain lengths were determined by colorimetric measurement of the formaldehyde released from the non-reducing end residue after periodate oxidation, radiolabelling of the reducing end residue by reduction with borotritiide, and determination of the ratio of the non-reducing end and internal residues by g.l.c . of the trimethylsilyl derivatives of the methyl ester methyl beta-ketosides . 1H-N.m.r . spectroscopy was used to confirm the chain length of two oligosaccharides . These methods were used to determine the average chain-length of the sialic acid polysaccharides produced by N . meningitidis and E . coli and the percentage of chains with covalently bound lipid moieties at the reducing end.

Lancet, 1986 Nov 15, 2(8516), 1145 - 9
Epidemiology of ophthalmia neonatorum in Kenya; Laga M et al.; In a Nairobi hospital where ocular prophylaxis against ophthalmia neonatorum has been discontinued, 1,019 women were screened for Neisseria gonorrhoeae and Chlamydia trachomatis during labour and 7 and 28 days postpartum . The prevalence of gonococcal infection was 7% and that of chlamydial was 29% . 52.4% of gonococcal isolates produced penicillinase . The incidence of ophthalmia neonatorum was 23.2 per 100 live births, and incidences of gonococcal and chlamydial ophthalmia were 3.6 and 8.1 per 100 live births, respectively . Of 181 cases of neonatal conjunctivitis, 31% were caused by C trachomatis, 12% by N gonorrhoeae, and 3% by both . In 67 babies exposed to maternal gonococcal infection and 201 exposed to maternal chlamydial infection, rates of transmission to the eye were 42% and 31%, respectively, and to the throat were 7% and 2% . Gonococcal transmission rate was higher in mothers with concomitant chlamydial infection (68%; p = 0.01) . Postpartum endometritis was associated with ophthalmia neonatorum (p less than 0.001) . Ocular prophylaxis at birth for gonococcal ophthalmia should be reintroduced.

J Antimicrob Chemother, 1986 Nov, 18 Suppl D, 129 - 32
Ciprofloxacin in the treatment of gonorrhoea and non-gonococcal urethritis; Oriel JD; The treatment of gonococcal infections by quinolones is reviewed . Acrosoxacin is effective, but side effects are relatively common . Ciprofloxacin is effective in single dosage against urogenital gonococcal infections, and probably also against rectal and pharyngeal infections . It is effective against infections by penicillinase-producing Neisseria gonorrhoeae . In vitro, ciprofloxacin is active against Chlamydia trachomatis, and preliminary results indicate that this drug may be of value in the treatment of non-gonococcal urethritis and chlamydial infection . No major side effects of ciprofloxacin therapy in patients with these infections have been reported.

J Adolesc Health Care, 1986 Nov, 7(6), 401 - 4
Chlamydia trachomatis detection in adolescents . A comparison of direct specimen and tissue culture methods; Jaffe LR et al.; We compared tissue cell culture isolation with the Microtrak fluorescent monoclonal antibody direct specimen test for detection of endocervical Chlamydia trachomatis in an inner-city population of sexually active Black and Hispanic adolescent girls . Of the 95 patients screened, C . trachomatis was identified in 26.3% . The sensitivity of the direct specimen test was 91.7%, and its specificity was 98.6% . The positive predictive value was 95.6%, and the negative predictive value was 97.2% . No significant difference was found between Blacks (28.6%) and Hispanics (24.1%) in the incidence of endocervical C . trachomatis, nor was the use of an oral contraceptive significantly associated with the diagnosis of C . trachomatis (p greater than 0.10) . Neisseria gonorrhoeae was isolated in 8.4% of the patients . The direct specimen test appears to be an accurate and convenient method of screening sexually active adolescent girls for genital C . trachomatis . Further study is needed to determine if an oral contraceptive increases the risk of Chlamydia infection in adolescents.

Antimicrob Agents Chemother, 1986 Nov, 30(5), 664 - 70
High-level tetracycline resistance in Neisseria gonorrhoeae is result of acquisition of streptococcal tetM determinant; Morse SA et al.; Recently, strains of Neisseria gonorrhoeae have been isolated which are highly resistant to tetracycline (MICs of 16 to 64 micrograms/ml) . This resistance was due to the acquisition of the resistance determinant tetM, a transposon-borne determinant initially found in the genus Streptococcus and more recently in Mycoplasma hominis, Ureaplasma urealyticum, and Gardnerella vaginalis . In N . gonorrhoeae, the tetM determinant was located on a 25.2-megadalton plasmid . This plasmid arose from the insertion of tetM into the 24.5-megadalton gonococcal conjugative plasmid . The tetM determinant could be transferred to suitable recipient strains of N . gonorrhoeae by both genetic transformation and conjugation.

Antimicrob Agents Chemother, 1986 Nov, 30(5), 649 - 52
Genetic analysis and penicillin-binding protein alterations in Neisseria gonorrhoeae with chromosomally mediated resistance; Dougherty TJ; Eight recent isolates of Neisseria gonorrhoeae with high-level non-beta-lactamase-mediated penicillin resistance were investigated . The penicillin-binding proteins of these strains were found to have reduced affinity for radiolabeled penicillin . Testing for known resistance genes showed that these were present in the resistant isolates . Genetic transformation was used to construct strains with increasing levels of antibiotic resistance . Modification of the transformation protocol made it possible to isolate transformants at the highest (penicillin-resistant DNA donor) level of resistance . These transformants unexpectedly yielded two distinct penicillin-binding protein patterns when tested.

J Bacteriol, 1986 Nov, 168(2), 756 - 61
Linearization of donor DNA during plasmid transformation in Neisseria gonorrhoeae; Biswas GD et al.; We examined the fate of plasmid DNA after uptake during transformation in Neisseria gonorrhoeae . An 11.5-kilobase plasmid, pFA10, was processed to linear double-stranded DNA during uptake by competent cells, but cleavage of pFA10 was not site specific . A minority of pFA10 entered as open circles . A 42-kilobase plasmid, pFA14, was degraded into small fragments during uptake; no intracellular circular forms of pFA14 were evident . Since pFA10 DNA linearized by a restriction enzyme was not further cut during uptake, the endonucleolytic activity associated with entry of plasmid DNA appeared to act preferentially on circular DNA . Although linear plasmid DNA was taken up into a DNase-resistant state as efficiently as circular DNA, linear plasmid DNA transformed much less efficiently than circular plasmid DNA . These data suggest that during entry transforming plasmid DNA often is processed to double-stranded linear molecules; transformants may arise when some molecules are repaired to form circles . Occasional molecules which enter as intact circles may also lead to transformants.

J Exp Med, 1986 Nov 1, 164(5), 1735 - 48
Immunoglobulin G antibodies directed against protein III block killing of serum-resistant Neisseria gonorrhoeae by immune serum; Rice PA et al.; Neisseria gonorrhoeae that resist complement-dependent killing by normal human serum (NHS) are sometimes killed by immune convalescent serum from patients recovering from disseminated gonococcal infection (DGI) . In these studies, killing by immune serum was prevented or blocked by IgG isolated from NHS . Purified human IgG antibodies directed against gonococcal protein III, an antigenically conserved outer membrane protein, contained most of the blocking activity in IgG . Antibodies specific for gonococcal porin (protein I), the major outer membrane protein, displayed no blocking function . In separate experiments, immune convalescent DGI serum which did not exhibit bactericidal activity was restored to killing by selective depletion of protein III antibodies by immunoabsorption . These studies indicate that protein III antibodies in normal and immune human serum play a role in serum resistance of N . gonorrhoeae.

Infect Immun, 1986 Nov, 54(2), 408 - 14
Evidence for N-terminal exposure of the protein IA subclass of Neisseria gonorrhoeae protein I; Judd RC; The JS3 and FA638 strains of Neisseria gonorrhoeae bear a protein IA subclass of protein I (P.I) . The purified P.Is of surface-labeled strains JS3 and FA638 were cleaved with the N-terminal degradation enzyme leucine amino peptidase (LAP), and the resultant fragments were separated in sodium dodecyl sulfate-polyacrylamide gels . Autoradiography demonstrated that the surface radiolabel was absent in a LAP-generated P.I peptide that was about 1,900 daltons lower in apparent molecular mass than the native P.I in both strains . Moreover, the 4G5 monoclonal epitope, known to be located on the surface of the organism, was also absent in the LAP-generated P.I peptide that was about 1,900 daltons less in apparent molecular mass than the original P.I of strain FA638 . These data strongly suggest that the N terminus of the P.IA subclass is exposed on the surface of the bacterium and that this region represents about 5%, or 15 to 20 amino acids, of the total protein.

Infect Immun, 1986 Nov, 54(2), 333 - 8
Immunogenic activity of gonococcal protein I in mice with three different lipoidal adjuvants delivered in liposomes and in complexes; Jiskoot W et al.; For several reasons the major outer membrane protein from Neisseria gonorrhoeae (gonococcal protein {PI}) is an attractive component for a gonococcal vaccine . This paper describes the influence of two different physical forms of PI on its immunogenic activity . To this end PI was delivered in liposomes and in protein-detergent complexes . In both forms PI was present in a multimeric form . The liposomes were composed of phosphatidylcholine and cholesterol . The effect of dicetylphosphate as a negatively charged amphiphile and three lipoidal adjuvants was investigated . Two lipoidal adjuvants (Avridine and dimethyldioctadecylammoniumbromide) were positively charged amphiphiles, whereas the third one (tridecyl N-acetylmuramyl-L-alanyl-D-isoglutaminate) was neutral . The protein-detergent complexes were also tested in the presence of the lipoidal adjuvants and in an AlPO4-adsorbed form . The liposome preparations were characterized for their size, charge, and residual amount of detergent . The immunogenic activity of PI in all forms was tested in mice . The results of the antibody assays showed that PI in the liposomes was more immunogenic than PI in the complexes . A second dose with liposomes induced only a small booster effect, whereas such a dose with the complexes produced pronounced booster effects . The incorporation of the positively charged lipoidal adjuvants in the liposomes resulted in enhanced booster effects . The highest immunogenic activity of PI after two injections, however, was observed in the complexed form adsorbed to AlPO4.

Clin Pediatr (Phila), 1986 Nov, 25(11), 566 - 8
Isolation of Neisseria gonorrhea from the urethra of asymptomatic adolescent males; Smith JA et al.; Symptomatic infection with Neisseria gonorrhea (NG) has become a major health problem in the adolescent population . While sexually active adults, who carry Neisseria gonorrhea may serve as a reservoir of infection even when asymptomatic, there are few data documenting the frequency of the asymptomatic carrier state in adolescent males . The purpose of this study was to determine the frequency of NG isolates in a sample of asymptomatic adolescent males (ages 13-18 years) . Urethral cultures and gram stains were performed on 249 males (95% black) from a lower socioeconomic background presenting to an adolescent clinic for routine health care . Of the 249 males cultured, 177 were without symptoms or signs of urethritis . NG were isolated from four (2.26%) patients (Z = 2.03, p less than or equal to 0.043) . They were also isolated from 65 (90.3%) of the remaining 72 who had either symptoms or signs of urethritis . Although 26% of the patients had documented gonococcal disease, only 8% offered a genitourinary complaint at the time of initial evaluation . Our data indicate a low but statistically significant incidence of NG colonization comparable to that found in adult males in this population of asymptomatic adolescent males.

Rev Infect Dis, 1986 Nov-Dec, 8 Suppl 5, S599 - 603
Treatment of infections due to multiresistant Neisseria gonorrhoeae with sulbactam/ampicillin; Kim JH et al.; Between January and April 1984, 229 of 448 male patients with urethritis at the Choong-Ku Venereal Disease Clinic in Seoul had positive urethral cultures: 66 for penicillinase-producing Neisseria gonorrhoeae (PPNG) and 163 for non-penicillinase-producing N . gonorrhoeae (non-PPNG) . Forty-five men with PPNG urethritis were enrolled in a study of the efficacy of treatment with sulbactam/ampicillin plus probenecid . Diagnosis and evaluation of cure were based on culture results . The agar-plate dilution method was used for susceptibility testing, and the chromogenic cephalosporin test was used for detection of beta-lactamases . MICs of various antibiotics for the isolates were high . MICs of sulbactam/ampicillin were 0.25-4 micrograms/ml, with an MIC90 of 4 micrograms/ml, a value 16-fold lower than that for ampicillin alone (MIC90 greater than 32 micrograms/ml) . Patients were treated with 1 g of probenecid orally and either one vial of sodium sulbactam/ampicillin or two vials intramuscularly . Each vial contained 0.5 g of sodium sulbactam and 1 g of sodium ampicillin . Patients were followed up for three to five days . All patients but one were cured, and no remarkable adverse reactions were noted . The two regimens of sulbactam/ampicillin were equally effective in the treatment of uncomplicated PPNG in men.

Infect Immun, 1986 Nov, 54(2), 465 - 71
Inability of pyrogenic, purified Bordetella pertussis lipid A to induce interleukin-1 release by human monocytes; Caroff M et al.; Free lipid A of Bordetella pertussis, Neisseria meningitidis, and Escherichia coli lipopolysaccharide (LPS) was prepared by hydrolysis in acetate buffer (pH 4.5); in addition, lipid A from B . pertussis and E . coli was prepared by hydrolysis in mineral acid (HCl) . The precipitates obtained were purified by extraction methods in toluene-methanol and are referred to as crude lipid A . Purified lipid A from N . meningitidis and B . pertussis was obtained by extraction in a mixture of chloroform-methanol-water-triethylamine . The different preparations were tested for their pyrogenicity (endogenous pyrogen; EP) and their capacity to trigger the release of interleukin-1 (IL-1; previously known as lymphocyte-activating factor; LAF) by human monocytes . Crude lipid A from E . coli and N . meningitidis were both IL-1 inducers . Crude B . pertussis lipid A (acetate buffer; pH 4.5), which contains a beta-1-6-linked D-glucosamine disaccharide, two phosphoryl groups, and five fatty acids, was pyrogenic and an IL-1 inducer (EP+/LAF+); but crude B . pertussis lipid A (0.25 N HCl), which lacked the glycosidic phosphoryl group, was 1,000-fold less pyrogenic than the diphosphorylated lipid A, yet it retained its IL-1-inducing capacity (EP-/LAF+) . Purified N . meningitidis lipid A was not an inducer of IL-1 release and purified B . pertussis lipid A exhibited identical pyrogenicity as the parent LPS but was devoid of any IL-1-release inducing capacity (EP+/LAF-) . These results demonstrate that for some endotoxins, purified lipid A is unable to induce IL-1 release by human monocytes; however, it is pyrogenic, supporting the hypothesis that IL-1 and EP are induced by different determinants on the LPS molecule.

Wien Klin Wochenschr, 1986 Oct 24, 98(20), 679 - 83
{Chlamydia trachomatis in patients with genital contact infections in Austria--studies of 3,367 patients}; Stary A et al.; In order to evaluate the epidemiological importance of Chlamydia trachomatis (C . trachomatis) as a genital microorganism, data were obtained from 3,367 patients with sexually transmitted diseases in Vienna and analyzed by computer-assisted methods . C . trachomatis was cultured in 26.1% of 2,594 patients investigated for the first time . The microorganism was found more often in male patients (31.3%) than in female patients (21%) . 32.2% of positive Chlamydia cultures were obtained from patients with non-gonococcal urethritis (NGU) and 64% from postgonococcal urethritis (PGU) patients . A high coincidence with Neisseria gonorrhoeae (N . gonorrhoeae) was detected in males (31.2%) and females (43.5%) . Data on Mycoplasma hominis (M . hominis), and Ureaplasma urealyticum (U . urealyticum) show that, in contrast to the low incidence of M . hominis and U . urealyticum in males, the organisms were found predominantly in females.

Cell, 1986 Oct 24, 47(2), 267 - 76
Gene conversion involving the pilin structural gene correlates with pilus+ in equilibrium with pilus- changes in Neisseria gonorrhoeae; Swanson J et al.; Gonococci (Gc) exhibit pilus+----pilus- "phase transitions" at high frequency, but only some of the pilus- Gc can revert to pilus+ phenotype . We examined reversible phase transitions between pilus+ Gc and a particular pilus- variant (P-rp+ phenotype) whose pilin mRNA carries a unique block of nucleotides encoding an "assembly missense" pilin polypeptide . The results show that Gc pilus+ in equilibrium with P-rp+ transitions can result from intragenic recombination in which there is nonreciprocal exchange of partially homologous DNA sequences from a partial pilin gene (in silent, storage form) into the expression locus' complete pilin gene . Hence Gc pilus phase variation, like pilus antigenic variation, can occur by gene conversion of the pilin structural gene expression locus.

Cell, 1986 Oct 10, 47(1), 61 - 71
Opacity genes in Neisseria gonorrhoeae: control of phase and antigenic variation; Stern A et al.; The chromosome of N . gonorrhoeae contains several complete expression genes coding for variant opacity proteins . DNA sequence analysis of two opacity genes derived from the same locus (opaE1) of two isogenic gonococcal variants reveals common and variable regions in these genes . Genomic blotting experiments using synthetic probes suggest gene conversion as a principle for the assembly of variant sequence information in opacity genes . The 5' region of opacity genes is composed of identical pentameric pyrimidine units (CTCTT) encoding the hydrophobic portion of the opacity leader peptide . This coding repeat is variable in a given locus with respect of the number of pentameric units . While all expression loci in a single cell are constitutively transcribed, the production of opacity proteins is determined by the coding repeat sequence on the translational level.

Genitourin Med, 1986 Oct, 62(5), 333 - 41
Aetiology of urinary symptoms in sexually active women; Feldman RG et al.; Two hundred and fifty six unselected women, 50 of whom had urinary symptoms (frequency of urination or dysuria, or both), and who were attending a department of genitourinary medicine, were investigated . The urinary symptoms were associated both with pyuria and the isolation of undoubted pathogens from midstream urine (MSU) specimens . No associations were found between urinary symptoms and the isolation of Neisseria gonorrhoeae or Chlamydia trachomatis from the urethra or cervix; the recovery of Mycoplasma hominis from the urethra, cervix, or MSU; the recovery of Trichomonas vaginalis or Candida albicans from the vagina; or the presence of bacterial vaginosis . Urethral leucocytosis was associated with the isolation of T vaginalis but not with the recovery of N gonorrhoeae, C trachomatis, C albicans, or urinary pathogens . Pyuria was associated with the isolation of urinary pathogens and with the presence of trichomoniasis; it was not associated with the recovery of C trachomatis or M hominis.

Genitourin Med, 1986 Oct, 62(5), 313 - 7
Comparison of oral treatment of uncomplicated urogenital and rectal gonorrhoea with cefuroxime axetil ester or clavulanic acid potentiated amoxycillin (Augmentin); Schift R et al.; In a randomised study of two drugs for the oral treatment of uncomplicated urogenital and rectal gonorrhoea the therapeutic effect of cefuroxime axetil ester (CAE) and amoxycillin plus clavulanic acid (A + C) was compared . Cefuroxime axetil ester 1.5 g was given to 129 men and 118 women . Amoxycillin 3.0 g and clavulanic acid 0.25 g was given to 131 men and 122 women . Both treatments were combined with probenecid 1.0 g and administered in a single oral dose . Of the 500 patients thus treated, 376 were assessable . In the group taking CAE, failure rates were 0.9% for the men and 0% for the women; and the overall failure rate was 0.5% . In the group taking A + C the equivalent failure rates were 4.6%, 1.2%, and 3.1% . The differences were not significant . Penicillinase producing Neisseria gonorrhoeae (PPNG) was isolated from 5.6% of the assessable patients . All 10 PPNG infections in the group taking CAE and four of 11 PPNG infections in the group taking A + C were cured . These numbers were too small to draw a definite conclusion about the efficacy of both drugs in this type of infection . Postgonococcal urethritis was observed in 35% of the men in the group taking CAE and in 32% of those in the group taking A + C . Side effects were noted in 38% of the group taking CAE and 28% of the group taking A + C . Nausea and vomiting were more commonly observed in the group taking CAE; and diarrhoea was more commonly observed in the group taking A + C.

Jpn J Antibiot, 1986 Oct, 39(10), 2685 - 9
{Bacteriological and clinical study of ciprofloxacin in gonococcal urethritis}; Okazaki T et al.; The purpose of this study was to determine the susceptibility of Neisseria gonorrhoeae to ciprofloxacin (CPFX) . The MIC's of CPFX against 50 clinical isolates of N . gonorrhoeae was examined and they were between less than or equal to 0.003 microgram/ml and 0.006 microgram/ml including 8 beta-lactamase producing strains . The CPFX was administered orally to 3 groups of 10 cases with gonococcal urethritis, groups being determined by 3 dose levels: a group with 200 mg b.i.d . for 3 days (a total of 1,200 mg), another with 400 mg b.i.d . (a total of 800 mg) and the final group with single administration of 400 mg . The effect of CPFX in the 1,200 mg-administered group was excellent in 3 and good in 7 . The effect of the drug in the 800 mg-administered group was excellent in 2 and good in 8 . The effect in the 400 mg-administered group was all good . Therefore, the overall cure rate was 100% including 5 patients with beta-lactamase producing gonococcic infection . Side effects were not observed in the 30 cases.

J Antimicrob Chemother, 1986 Oct, 18 Suppl C, 199 - 205
Epidemiology of resistance in Neisseria gonorrhoeae; Jephcott AE; In the face of almost unique selective pressures many strains of gonococci have become increasingly resistant to antibiotics . Both chromosomal mutation and acquisition of plasmids are involved . However, whereas there have probably been multiple selections of many mutation events determining chromosomal resistance, evidence suggests that a very limited number of plasmid acquisitions has occurred, with subsequent spread within members of the species.

Antimicrob Agents Chemother, 1986 Oct, 30(4), 590 - 3
In vitro activity of difloxacin hydrochloride (A-56619), A-56620, and cefixime (CL 284,635; FK 027) against selected genital pathogens; Bowie WR et al.; Management of sexually transmitted diseases is facilitated by having antimicrobial agents with activity against all of the major genital pathogens . Newer quinolones show promise of being active against Neisseria gonorrhoeae and Chlamydia trachomatis . Two quinolones, difloxacin (A-56619) and A-56620, and an oral cephalosporin, cefixime (CL 284,635; FK 027), were evaluated in vitro . All three were highly active against 400 isolates of N . gonorrhoeae, including penicillinase-producing N . gonorrhoeae, N . gonorrhoeae with chromosomally mediated resistance, and isolates with penicillin MICs of less than 1 microgram/ml . Susceptibilities to one antimicrobial agent were usually strongly correlated with susceptibilities to the other antimicrobial agents evaluated, but isolates with increasing resistance to beta-lactams were least likely to show increasing resistance to quinolones . Difloxacin and, to a lesser extent, A-56620 were active against all 10 strains of C . trachomatis, and both had moderate activity against over 200 strains of Gardnerella vaginalis . Based on in vitro activity, difloxacin and A-56620 merit in vivo assessment for management of both C . trachomatis and N . gonorrhoeae infections, and cefixime shows considerable promise for treatment of N . gonorrhoeae infections.

J Clin Pathol, 1986 Oct, 39(10), 1119 - 23
Homology of cryptic plasmid of Neisseria gonorrhoeae with plasmids from Neisseria meningitidis and Neisseria lactamica; Ison CA et al.; DNA probe hybridisation was used to examine the relation between the cryptic plasmid from Neisseria gonorrhoeae and plasmids carried by pharyngeal isolates of Neisseria meningitidis and Neisseria lactamica . The complete gonococcal cryptic plasmid and HinfI derived digestion fragments subcloned into Escherichia coli were used to probe Southern blots of plasmid extracts . Homology was found to a plasmid of approximate molecular weight 4.5 kilobase pairs (Kb) but not to plasmids of less than 3.2 Kb or 6.5 Kb . Eleven of 16 strains of N meningitidis and two of six strains of N lactamica carried plasmids that showed strong hybridisation with the 4.2 Kb gonococcal plasmid . Hybridisation of plasmids from non-gonococcal species of neisseria with the gonococcal cryptic plasmid indicates that caution should be taken when using the cryptic plasmid as a diagnostic probe for gonorrhoea.

Eur J Clin Microbiol, 1986 Oct, 5(5), 498 - 501
In vitro activity of the two new 4-quinolones A56619 and A56620 against Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum and Gardnerella vaginalis; Tjiam KH et al.; The in vitro activity of tetracycline, ciprofloxacin and two recently developed 1-aryl-fluoroquinolones, A56610 and A56620, was tested against 65 beta-lactamase-negative and 35 beta-lactamase-positive Neisseria gonorrhoeae strains, 12 Chlamydia trachomatis, 50 Mycoplasma hominis, 28 Ureaplasma urealyticum and 50 Gardnerella vaginalis strains . In the case of Chlamydia trachomatis and Mycoplasma hominis both the MIC and the MBC were determined . The MIC90 of ciprofloxacin for Neisseria gonorrhoeae was 0.008 microgram/ml and of A56619 and A56620 less than or equal to 0.03 microgram/ml . No difference was observed between the activity against beta-lactamase-negative and beta-lactamase-positive strains . The MIC90 values of of ciprofloxacin and A56620 for Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum were identical, the values being 2 micrograms/ml, 1 micrograms/ml and 4 micrograms/ml respectively . The MIC90 of A56619 for Chlamydia trachomatis and Ureaplasma urealyticum was 0.5 micrograms/ml and 1 microgram/ml respectively . The MBC90 values of the three quinolones for Chlamydia trachomatis and Mycoplasma hominis were less than or equal to 2 micrograms/ml . The activity of the quinolones against Gardnerella vaginalis was rather low, the MIC90 being greater than or equal to 4 micrograms/ml . It is concluded that A56619 and A56620 might be useful for single-dose therapy of gonococcal infections.

Genitourin Med, 1986 Oct, 62(5), 318 - 20
Treatment of uncomplicated gonorrhoea with single dose aztreonam; Evans DT et al.; Infection with Neisseria gonorrhoeae was cleared in 61 men and 26 women at all sites (except in the pharynx of one male bisexual patient with urethral and pharyngeal gonorrhoea) after treatment with aztreonam as a single 1 g intramuscular injection . Aztreonam was well tolerated with no adverse effects . This monobactam antibiotic was effective against both penicillin sensitive and resistant strains.

Genitourin Med, 1986 Oct, 62(5), 302 - 7
Penicillinase producing gonococci: a spent force?
Ison CA, Gedney J, Harris JR, Easmon CS.
Though the incidence of gonorrhoea caused by penicillinase producing Neisseria gonorrhoeae (PPNG) strains at St Mary's Hospital rose rapidly from 1980 to reach 6.2% in 1982, it declined in 1983 (8.6%) and in 1984 (6.5%), a trend that has continued in 1985 . The use of penicillinase stable antibiotics or more effective contact tracing are unlikely to be responsible for this recent decline . We have always isolated very few PPNG strains from homosexual men, and the possible effects of the acquired immune deficiency syndrome (AIDS) on sexual behaviour in this group is therefore unlikely to be relevant . We have seen a steady increase in the proportion of PPNG strains carrying the 4.4 megadalton penicillinase plasmid (67% of PPNG strains in 1984) . Strains carrying both the 4.4 megadalton plasmid and the 24.5 megadalton conjugal plasmid were very common in 1982, but since then have declined in importance . PPNG strains carrying the 3.2 megadalton plasmid have become less common, and the presence of the 24.5 megadalton plasmid in these strains has not apparently led to their wider dissemination in the community . Whereas the basic pattern of PPNG auxotypes has changed little, since 1982 we have isolated an increasing number of mixed auxotypes with nutritional requirements other than just proline . PPNG strains carrying the 4.4 megadalton plasmid seem to be more resistant to erythromycin, tetracycline, and streptomycin than those carrying the 3.2 megadalton plasmid . Spectinomycin resistance has only occurred in strains carrying the 4.4 megadalton plasmid.

Infect Immun, 1986 Oct, 54(1), 184 - 8
Antigonococcal activity of human neutrophil cathepsin G; Shafer WM et al.; We have shown that lysosomal cathepsin G, prepared from acid extracts of granules derived from human polymorphonuclear granulocytes, exhibits potent in vitro antimicrobial activity against Neisseria gonorrhoeae . An isolated isozyme of cathepsin G was found to exhibit antigonococcal activity by a nonenzymatic mechanism in a time-dependent manner . Moreover, we observed that the antigonococcal activity of cathepsin G was relatively independent of pH and evident over a pH range resembling that invoked for maturing phagolysosomes . Using a number of isogenic strains, we determined that certain mutations known to alter cell envelope structure rendered gonococci more susceptible to cathepsin G . This suggests that the susceptibility of gonococci to cathepsin G, and possibly other antimicrobial proteins derived from PMN granules, is genetically determined and possibly related to the structure of the gonococcal cell envelope.

Antimicrob Agents Chemother, 1986 Oct, 30(4), 619 - 21
Comparative study of cefoperazone and spectinomycin for treatment of uncomplicated gonorrhea in men; Hook EW 3rd et al.; Beta-lactamase-negative Neisseria gonorrhoeae infections were treated with single-dose cefoperazone (0.5 or 1.0 g) or spectinomycin (2.0 g) . Anogenital infections were cured in 36 (83%) of 43 volunteers given 0.5 g of cefoperazone, 61 of 61 volunteers given 1.0 g of cefoperazone, and 99 of 100 volunteers given spectinomycin . The cefoperazone geometric mean MIC for 242 isolates was 0.028 microgram/ml . Cefoperazone (1.0 g) and spectinomycin (2.0 g) are comparable for the therapy of anogenital gonorrhea in men.

Hautarzt, 1986 Oct, 37(10), 547 - 53
{Pathogen-host relations in sexually transmitted diseases}; Korting HC et al.; The host-parasite relationship between the major causative agents of sexually transmitted diseases, e.g . Neisseria gonorrhoeae, Treponema pallidum and Trichomonas vaginalis, and their target cells in the urogenital tract can generally be studied in suitable cell and organ cultures . Experience with N . gonorrhoeae predominantly gained from fallopian-tube organ cultures shows that there are several prerequisites for adherence as the first step of pathogenesis . They range from the type of bacterial pili to the type of epithelial cell . Later the function of these cells is damaged by subcellular toxins of a lipopolysaccharide nature . The cocci are phagocytosed, which eventually leads to definite (ultra-) structural alterations . These processes are not only described in detail but also compared with those found with other bacterial species and target cells . Possible predisposing factors in the host are also taken into account . Finally the need for investigating the effect of antibiotics on the host-parasite relationship is stressed.

Infect Immun, 1986 Oct, 54(1), 154 - 60
Interactions of gonococci with HeLa cells: attachment, detachment, replication, penetration, and the role of protein II; Bessen D et al.; Colony variants of Neisseria gonorrhoeae differ in their interactions with eucaryotic cells . When gonococci were cultivated with HeLa cell monolayers, the opacity phenotype (Op) became increasingly dominant in the subpopulation of organisms which adhered to the HeLa cells . Once bound, Op organisms displayed very low levels of detachment . Adherent Op gonococci exhibited generation times up to threefold greater than cultures containing gonococci in the absence of HeLa cells . In addition, the progeny of adherent Op organisms remained bound to the HeLa cell monolayer . Both piliated (P+) and transparent (Tr) colony types attached to HeLa cells, but their progeny were retained less efficiently . Gonococci bound to HeLa cells were subjected to the bactericidal action of fresh rat serum and approximately 0.5 to 2.5% survived, irrespective of their opacity or piliation phenotype . Incubation with gentamicin resulted in a 10- to 50-fold further reduction in viability . Pretreatment of HeLa cell monolayers with the microfilament-disrupting agent cytochalasin b diminished gonococcal survival in either serum or gentamicin by up to eightfold . In contrast, cytochalasin b treatment did not decrease survival of the commensal organism N . sicca . The data suggest that very few gonococci are completely interiorized and a small proportion of adherent gonococci are partially protected from the soluble-phase environment by HeLa cells.

Infect Immun, 1986 Oct, 54(1), 63 - 9
Antigenic and physical diversity of Neisseria gonorrhoeae lipooligosaccharides; Mandrell R et al.; We used mouse monoclonal antibodies (MAbs) to characterize Neisseria gonorrhoeae lipooligosaccharide (LOS) . LOSs that bound two or more MAbs in a solid-phase radioimmunoassay usually bound them to different LOS components, as separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE); strains with multiple LOS components on SDS-PAGE usually bound more than one MAb . However, the LOS of some strains bound the same MAb to two LOS components with different relative molecular weights, and some individual LOS components bound more than one MAb . LOSs from different strains bound different amounts of the same MAb at saturation, reflecting differences in the quantitative expression of individual LOS components . Not all components recognized by MAbs were stained by silver after periodate oxidation . Treatment with NaOH variously affected epitopes defined by different MAbs . MAb 3F11 completely inhibited and MAb 2-1-L8 partially inhibited the binding of 125I-labeled 06B4 MAb to WR220 LOS and WR220 outer membranes in competitive binding studies . Other MAbs did not compete with the binding of 125I-labeled 06B4 to either antigen . We conclude that a strain of N . gonorrhoeae elaborates multiple LOSs that can be separated by SDS-PAGE and that are antigenically distinct . Epitope expression within these glycolipids is complex.

J Med Chem, 1986 Sep, 29(9), 1792 - 5
Amino-substituted p-benzoquinones; Mathew AE et al.; Based on the observation of outstanding antineoplastic activity of a number of amino-substituted anthraquinones, thioxanthones, and N-(aminoethyl)-substituted naphthalimides, four types of amino-substituted p-benzoquinones were designed, synthesized, and their biological activity evaluated . Although none of these compounds exhibited inhibitory activity against P388 leukemia, 2,5-bis{{4-{(dimethylamino)methyl}phenyl}amino}-3,6-dibromo-1,4- benzoquinone and the corresponding dichloro compound demonstrated good inhibitory activity against the proliferating human colon adenocarcinoma in vitro . The dichloro compound was also found to be active against the leukemia L1210 screening in vitro . 2,5-Bis{{2-(dimethylamino)ethyl}amino}-1,4-benzoquinone possessed inhibitory activity against Neisseria catarrhali.

Antimicrob Agents Chemother, 1986 Sep, 30(3), 508 - 9
Characterization of a beta-lactamase-specifying plasmid isolated from Eikenella corrodens and its relationship to a commensal Neisseria plasmid; Rotger R et al.; A 9.4-kilobase plasmid encoding penicillin, streptomycin, and sulfonamide resistance was isolated from a beta-lactamase-producing Eikenella corrodens strain . This plasmid appears to be identical to a resistance plasmid common to saprophytic Neisseria strains.

Diagn Microbiol Infect Dis, 1986 Sep, 5(3), 225 - 34
Rapid detection of Chlamydia trachomatis by an enzyme immunoassay method; Ryan RW et al.; Chlamydia trachomatis has been shown to be a major cause of sexually transmitted diseases in the United States . An enzyme immunoassay (Abbot Laboratories) has been developed that detects chlamydial antigen directly in the urogenital specimens of patients . We have evaluated specimens from 1,074 patients belonging to one of three risk groups . Three swabs were collected from each patient--one each for Neisseria gonorrhoeae, chlamydia cell culture, and enzyme immunoassay . When compared with cell culture, the sensitivity and specificity of the enzyme immunoassay for symptomatic males and females attending a sexually transmitted disease clinic was 82% and 100%, and 91.3% and 95.0%, respectively . A moderate risk group, consisting of female patients seen at either urology or gynecology clinics for genitourinary symptoms was also evaluated . The sensitivity and specificity of the test on this group was 96% and 96.7% . A population of females at low risk were also screened for chlamydial infection . In this group, the sensitivity and specificity of the enzyme immunoassay was 89.3% and 93.2%, respectively . This rapid test is a highly specific and sensitive procedure for the detection of chlamydial antigen in genital specimens from high risk female patients as well as symptomatic males.

Ann Inst Pasteur Microbiol, 1986 Sep-Oct, 137B(2), 177 - 85
Deoxyribonucleic acid relatedness among Neisseria gonorrhoeae, N . meningitidis, N . lactamica, N . cinerea and "Neisseria polysaccharea"; Guibourdenche M et al.; Deoxyribonucleic acid relatedness studies (S1 nuclease method with DE-81 filters method) indicated that Neisseria gonorrhoeae, N . meningitidis, N . lactamica and "N . polysaccharea" form a single genospecies, in which four subspecies can be delineated . However, from a clinical and practical viewpoint, it seems desirable to maintain N . gonorrhoeae, N . meningitidis, N . lactamica and "N . polysaccharea" as separate species . N . cinerea is a valid species, closely related to N . gonorrhoeae, N . meningitidis, N . lactamica and "N . polysaccharea" . These five species were O to 46% related to the other known species of the genus Neisseria.

J Gen Microbiol, 1986 Sep, 132 ( Pt 9), 2413 - 20
O-acetylation of peptidoglycan in Neisseria gonorrhoeae . Investigation of lipid-linked intermediates and glycan chains newly incorporated into the cell wall; Lear AL et al.; Radioactive labelling of the amino sugars in gonococcal peptidoglycan was followed by treatment with Chalaropsis muramidase and TLC separation of the products . Even after very brief periods of labelling (0.5 min) the peptidoglycan was already cross-linked to some 80% of the final value and little change occurred within 2 min . The remaining cross-linking was achieved only over a period of about one generation time . Streptomycete endopeptidase was used to show the extent to which new chains were cross-linked to old . Even at the earliest times many cross-linked units contained new material in both moieties and by 3 min there was little distinction in relative labelling, indicating that in Neisseria gonorrhoeae most newly synthesized glycan chains are cross-linked to other new chains rather than to pre-existing peptidoglycan . A model is proposed in which newly polymerized monomer units are predestined either towards dimer formation with other new chains, which are then rapidly O-acetylated and not further cross-linked, or towards the formation of trimers and higher oligomers, the latter being a slower process . Although significant O-acetylation of peptidoglycan was detectable even at the earliest times, efforts to detect O-acetylated lipid intermediates were unsuccessful . The chief lipid intermediate found was apparently the disaccharide-peptide unit linked to undecaprenol.

Eur J Epidemiol, 1986 Sep, 2(3), 191 - 6
Plasmid profile of penicillinase-producing Neisseria gonorrhoeae in Greece; Sima A et al.; Four plasmid patterns were detected in thirteen strains of beta-lactamase-producing Neisseria gonorrhoeae isolated in Greece . Nine strains harbored the 4.5 Mdal penicillin-resistance plasmid with or without a 24.5 Mdal conjugative plasmid, two strains carried the 3.2 Mdal penicillin-resistance plasmid and two strains the new combination of the 3.2 Mdal penicillin-resistance plasmid and the conjugative plasmid (24.5 Mdal) . Conjugal transfer experiments between Neisseria gonorrhoeae and E . coli revealed that beta-lactamase activity was acquired by recipient E . coli . The 4.5 and 3.2 Mdal penicillin-resistance plasmids were detected in the transconjugants by agarose gel electrophoresis, but co-transfer of the conjugative plasmid did not occur . The auxotypes and plasmid profiles were also compared.

Antimicrob Agents Chemother, 1986 Sep, 30(3), 514 - 5
Norfloxacin in the therapy of uncomplicated gonorrhea; Romanowski B et al.; In an open study, 70 patients with uncomplicated anogenital Neisseria gonorrhoeae infection were evaluated to determine the efficacy and safety of a single oral dose of norfloxacin (800 mg) . Norfloxacin cured all 31 male urethral and 25 endocervical infections . All 63 isolates of N . gonorrhoeae tested were inhibited by 0.05 microgram of norfloxacin per ml.

J Infect, 1986 Sep, 13(2), 147 - 9
A rare case of meningitis due to Neisseria meningitidis group 29E; Kerr D et al.; We report a case of meningitis due to Neisseria meningitidis group 29E . The organism was serum-sensitive and therefore not expected to be encountered in an immunologically competent young man . Trauma sustained in a road traffic accident 18 months earlier had affected the tympanic membrane and middle ear, allowing direct infection of the meninges . Myringoplasty was performed to prevent recurrent infection.

J Exp Med, 1986 Sep 1, 164(3), 868 - 81
Cloning of the structural genes of three H8 antigens and of protein III of Neisseria gonorrhoeae; Gotschlich EC et al.; A bank of gonococcal DNA was constructed in the lambda gt11 expression vector . immunological screening of the bank resulted in the isolation of a clone that contains the structural gene of protein III . In addition, several clones reactive with mAbs specific for the H8 antigen were isolated . DNA hybridization studies revealed that these H8-reactive clones were derived from three different gonococcal genes . When the products produced by these clones were used to absorb antibodies from a rabbit antiserum, and the eluted antibodies were used in immunological studies, it could be shown that the parent gonococcus expressed the product of two of these H8 genes, and in strain R10, these had Mr of approximately 19,700 21,200 respectively . The larger form has not been recognized hitherto because the epitope reactive with the H8 mAb may be masked in this product.

J Bacteriol, 1986 Sep, 167(3), 1009 - 15
A 26-base-pair repetitive sequence specific for Neisseria gonorrhoeae and Neisseria meningitidis genomic DNA; Correia FF et al.; Two-dimensional heteroduplex mapping of Neisseria gonorrhoeae genomic DNA revealed a number of spots, indicating the existence of repetitive sequences . When one of the spots was extracted and used as a probe for Southern blot analysis, two HindIII bands (11.0 and 3.6 kilobases {kb}) of the genomic digest hybridized with approximately equal intensity . The 3.6-kb fragment was cloned and found to contain two different types of repeated sequence . One type was approximately 1.1 kb in length and was found at least twice in the entire genome . The other consisted of a 26-base-pair family GT(C/A)C(Py)G(Pu)TTTTTGTTAAT(Py)C(Pu)CTATA (Py, pyrimidine; Pu, purine) that was repeated at least 20 times in the entire genome . This repetitive sequence was found also in Neisseria meningitidis but not in various other gram-negative bacteria.

CMAJ, 1986 Sep 1, 135(5), 489 - 93
In-vitro susceptibility of 400 isolates of Neisseria gonorrhoeae in Vancouver, 1982-84; Bowie WR et al.; Consecutive isolates of Neisseria gonorrhoeae obtained at a sexually transmitted disease clinic in Vancouver between June 1982 and June 1984 were tested for in-vitro susceptibility to eight antimicrobial agents . Of the 400 isolates 6 (1.5%) were penicillinase-producing N . gonorrhoeae, and for 25 (6.2%) the minimum inhibitory concentrations (MICs) of penicillin were 1.0 to 4.0 micrograms/ml . Ceftriaxone sodium was the most active agent . The MICs were higher than those reported in a Canadian study in 1973-74, except for tetracycline hydrochloride . The patterns of susceptibility of the isolates to one antimicrobial agent correlated significantly with those to each other agent, although the relation was weakest for trimethoprim-sulfamethoxazole and spectinomycin . The results reinforce the need to evaluate local in-vitro susceptibility patterns, especially since the proportion of isolates with relative and absolute resistance to penicillin is increasing.

Am J Obstet Gynecol, 1986 Sep, 155(3), 602 - 7
Lower genital tract infection with Chlamydia trachomatis and Neisseria gonorrhoeae in Icelandic women with salpingitis; Magnusson SS et al.; In a study of 225 women with acute salpingitis verified by laparoscopy or laparotomy we investigated the prevalence of gonococcal and chlamydial infection in the lower genital tract . Neisseria gonorrhoeae was isolated from 18.9% of the women and Chlamydia trachomatis from 38.5% . Women with positive cultures were significantly younger (p less than 0.01) than those with negative cultures . A trend toward more severe inflammatory changes of the tubes was found in women with positive cultures compared with those with negative cultures . The majority of women with positive cultures stated they had only one sexual partner during the preceding 6 months . Single women had more partners (mean 1.9) than those cohabiting (mean 1.2) . The ratio of single/multiple partners for women with Chlamydia was 2.5:1, and for those with gonorrhea 1:1 (p less than 0.05) . Of the men, 60% could be examined and about 50% had positive cultures . Microbiologic investigation of both partners is necessary in order to prevent reinfection of the woman.

J Biol Chem, 1986 Aug 15, 261(23), 10624 - 31
Characterization of a structural series of lipid A obtained from the lipopolysaccharides of Neisseria gonorrhoeae . Combined laser desorption and fast atom bombardment mass spectral analysis of high performance liquid chromatography-purified dimethyl derivatives; Takayama K et al.; Monophosphoryl lipid A (MLA) obtained from the lipopolysaccharides of serum-sensitive strains of Neisseria gonorrhoeae was fractionated on a silicic acid column to yield the hexaacyl and pentaacyl MLAs . The dimethyl derivative of the hexaacyl MLA was analyzed by proton nuclear magnetic resonance spectroscopy . The dimethyl esters of hexaacyl and pentaacyl MLAs were further purified by reverse-phase high performance liquid chromatography, and all of the peaks were analyzed by laser desorption mass spectrometry . Considerable structural information was obtained by laser desorption mass spectrometry due to three kinds of specific fragmentations of the sugar at the reducing end . Two major fractions were also analyzed by positive ion fast atom bombardment mass spectrometry . High performance liquid chromatography was able to separate the dimethyl MLA according to number, nature, and position of the fatty acyl groups . Since almost no structural information is available, the mass spectra of the samples were interpreted on the basis of the established structure of a model lipid A (hexaacyl MLA derived from Salmonella minnesota) . Thirteen different structures of dimethyl MLA were identified . The four prominent dimethyl MLAs found in the fractionated samples were M1 (Mr = 1463), M2 (Mr = 1479), M3 (Mr = 1661), and M4 (Mr = 1677) . These MLAs appear to have a 1'----6 linked glucosamine disaccharide backbone . The most prominent hexaacyl MLA was M3 . We propose that it contains hydroxylaurate at the 3- and 3'-positions in ester linkage and lauroxymyristate at the 2- and 2'-positions in amide linkage of the glucosamine disaccharide . The most abundant pentacyl MLA was M2 . We propose that it contains hydroxylaurate at the 3- and 3'-positions in ester linkage, lauroxymyristate at the 2'-position in amide linkage, and hydroxymyristate at the 2-position in amide linkage of the disaccharide . The lipid A of N . gonorrhoeae appeared to differ from that of the Salmonella strains by the presence of shorter-chain fatty acids and by the normal fatty acid distribution in the reducing and distal subunits.

Genitourin Med, 1986 Aug, 62(4), 267 - 9
Incidence of sexually transmitted diseases in rape victims during 1984; Forster GE et al.; During 1984, 46 women attended the sexually transmitted disease (STD) clinic at St Mary's Hospital alleging that they had been raped . At presentation, 31 (67%) were asymptomatic . Evidence of STD was found in 14 (30%) women, mixed infections occurring in four . Chlamydia trachomatis and Trichomonas vaginalis were each detected in six (13%) patients and Neisseria gonorrhoeae in three (6%) . The source of the infection could not confidently be traced to the alleged rapist . Two patients were found to have cervical cytological abnormalities suggestive of cervical intraepithelial neoplasia of grades II or III . One woman became pregnant as a consequence of the sexual assault . Investigations may unveil infection or other abnormalities, which are incidental to the rape but nevertheless require further investigation and treatment.

J Pediatr, 1986 Aug, 109(2), 260 - 4
Movement disorders in bacterial meningitis; Burstein L et al.; Movement disorders developed in five children, ages 6 to 21 months, during the course of bacterial meningitis caused by Hemophilus influenzae (one), Streptococcus pneumoniae (one), Neisseria meningitidis (one), or Mycobacterium tuberculosis (two) . Athetosis, choreoathetosis, and hemiballismus occurred, ranging in duration from hours to months . Cranial computed tomography, performed in four cases, showed no lesion of the basal ganglia . The movements were of such abrupt onset and severity that in four cases they were initially misinterpreted as seizures, and anticonvulsant therapy was contemplated . It is important to recognize the potential development of movement disorders during the acute phase of bacterial meningitis to preclude the inappropriate administration of anticonvulsant medication.

Genitourin Med, 1986 Aug, 62(4), 221 - 3
Oral cefuroxime axetil compared with oral ampicillin in treating acute uncomplicated gonorrhoea; Wanas TM et al.; The efficacy and tolerance of single oral doses of cefuroxime axetil (1.5 g) were compared with oral ampicillin (3 g) for treating acute gonococcal urethritis in 110 men and 30 women . Each dose was given with 1 g probenecid . Of the 62 assessable patients who received ampicillin, two failed to respond to treatment . Of 67 assessable patients who received cefuroxime axetil, one failed to respond . Pencillinase producing strains of Neisseria gonorrhoeae were isolated from five patients; one received ampicillin and failed to respond, whereas the other four received cefuroxime axetil and three were cured . A single oral dose of 1.5 g cefuroxime axetil with 1 g probenecid seemed to be an effective treatment for acute gonococcal urethritis, especially for penicillin resistant strains.

Pediatr Ann, 1986 Aug, 15(8), 588 - 9, 592-601, 604-5
Vulvar disorders in the prepubertal female; Williams TS et al.; Inspection of the vulva should be a routine part of well child care . Detection of poor perineal hygiene permits the establishment of good hygiene practices, which may prevent development of vulvovaginitis . Condylomata acuminata, molluscum contagiosum, herpetic vulvitis, and vulvovaginitis secondary to Neisseria gonorrhoeae, Gardnerella vaginalis, Chlamydia trachomatis, and Trichomonas vaginalis arouse suspicion of child sexual abuse, which must be addressed . Atopic dermatitis, psoriasis, lichen planus, and lichen sclerosis et atrophicus are often chronic and early diagnosis with appropriate treatment and follow-up contributes to the acceptance of the disease by parent and child . Early detection of the rare neoplasms of the vulva is essential to improved survival.

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