Neisseria

Surg Gynecol Obstet, 1986 Aug, 163(2), 156 - 62
A comparison of piperacillin and clindamycin plus gentamicin in women with pelvic infections; Gunning JE; The efficacy and safety of piperacillin were compared with those of clindamycin plus gentamicin in 74 women with obstetric or gynecologic infections (such as endometritis, salpingitis and septic abortion) . Thirty-five of the patients in the group treated with piperacillin and 33 of the patients in the group treated with clindamycin plus gentamicin were clinically cured . Clinical failure occurred in two patients in the group treated with piperacillin (salpingitis in one and endometritis in the other patient) and relapse of salpingitis occurred in one . Three patients who were given clindamycin plus gentamicin (all with salpingitis) did not respond to therapy . The most frequently isolated organisms were Neisseria gonorrhea and Bacteroides species . Adverse clinical experiences and the results of laboratory tests were fewer in the group treated with piperacillin than in the patients who received the combination regimen; in neither instance was treatment discontinued because of these effects . Thus, piperacillin was as safe and effective as a combination of clindamycin plus gentamicin.

Antimicrob Agents Chemother, 1986 Aug, 30(2), 267 - 9
Comparative trial of single-dose ciprofloxacin and ampicillin plus probenecid for treatment of gonococcal urethritis in men; Roddy RE et al.; In a double-blind comparative trial, 100 men with uncomplicated gonorrhea caused by beta-lactamase-negative Neisseria gonorrhoeae were treated with a single 0.25-g dose of ciprofloxacin administered orally or with 3.5 g of ampicillin plus 1.0 g of probenecid administered orally . Urethral infection was eradicated in all 49 men treated with ciprofloxacin and in 47 (92%) of 51 men treated with ampicillin-probenecid (P = 0.12) . The geometric mean MICs for pretreatment isolates were 0.008 microgram of ciprofloxacin per ml, 0.09 microgram of penicillin G per ml, 0.52 microgram of tetracycline per ml, and 23.5 micrograms of spectinomycin per ml . Chlamydia trachomatis infection persisted in 10 of 11 men treated with ciprofloxacin and in 11 of 14 men treated with ampicillin-probenecid . A single 0.25-g dose of ciprofloxacin was effective for treatment of uncomplicated urethral gonorrhea in men, but it did not eradicate coinfection with C . trachomatis.

Eur J Clin Microbiol, 1986 Aug, 5(4), 395 - 8
Treatment of uncomplicated urogenital gonorrhoea in women with a single dose of enoxacin; Tegelberg-Stassen MJ et al.; One hundred and twenty-three female patients suffering from uncomplicated urogenital gonorrhoea were treated in a double blind randomised trial with either 200 mg enoxacin (one capsule of 200 mg, one of placebo) or 400 mg enoxacin (two capsules of 200 mg) . The cure rate in the 46 evaluable patients in the 400 mg group was 100%, and in the 40 evaluable patients in the 200 mg group 98.7% . Minor side effects such as nausea, headache and skin rash occurred in three of 109 evaluable patients (2.8%) . The minimum inhibitory concentration of enoxacin for the Neisseria gonorrhoeae strains isolated varied between 0.03 and 0.12 mcg/ml . Enoxacin would seem to be a very effective drug in the treatment of uncomplicated urogenital gonorrhoea in female patients.

Am J Obstet Gynecol, 1986 Aug, 155(2), 424 - 9
Induction of subcutaneous and intraperitoneal abscesses in mice by Neisseria gonorrhoeae and Bacteroides species; Brook I; The pathogenicity in relation to encapsulation and potential for synergy between Neisseria gonorrhoeae and Bacteroides spp . was studied by subcutaneous and intraperitoneal inoculation of single organisms or mixtures of these organisms into mice . Ten isolates of N . gonorrhoeae and 12 isolates of Bacteroides spp . were studied . When injected alone, only heavily encapsulated organisms induced subcutaneous and intraperitoneal abscesses . However, N . gonorrhoeae did not induce intraperitoneal abscesses and did not survive in intraperitoneal abscesses even when inoculated with Bacteroides spp . Abscesses developed after subcutaneous inoculation of mixtures of heavily encapsulated Bacteroides and heavily or slightly encapsulated N . gonorrhoeae or of slightly encapsulated Bacteroides and heavily encapsulated N . gonorrhoeae . Heavily encapsulated N . gonorrhoeae did not survive in subcutaneous abscesses longer than 3 days after being inoculated alone and survived no longer than 7 days after inoculation with heavily encapsulated Bacteroides spp . An increase in the colony-forming units of Bacteroides spp . per abscess was observed when they were inoculated with N . gonorrhoeae . When mixed with heavily encapsulated isolates, slightly encapsulated N . gonorrhoeae or Bacteroides isolates became heavily encapsulated . These data demonstrate the effect of encapsulation on the relationship between N . gonorrhoeae and Bacteroides spp . and the potential for synergy between these organisms.

Obstet Gynecol, 1986 Aug, 68(2), 290 - 1
Successful therapy of penicillinase-producing Neisseria gonorrhoeae pharyngeal infection during pregnancy; Soper DE et al.; The relative frequency of pharyngeal gonococcal infection may be increased in certain prenatal populations . Therapy of penicillin-sensitive strains of Neisseria gonorrhoeae is associated with acceptable cure rates using aqueous procaine penicillin with probenecid . Infection of the oropharynx of pregnant women with penicillinase-producing strains is more problematic . The antibiotics normally used for the therapy of uncomplicated penicillinase-producing N gonorrhoeae infections, spectinomycin or cefoxitin, are not effective in the therapy of pharyngeal infection . Reported is the first case of penicillinase-producing N gonorrhoeae oropharyngeal infection during pregnancy . The patient was successfully treated with trimethoprim/sulfamethoxazole, and no maternal or neonatal morbidity was noted.

J Med Microbiol, 1986 Aug, 22(1), 63 - 7
Role of endotoxin in the pathogenicity of Neisseria gonorrhoeae colonial types 1, 4 and 5 determined by chicken embryo model; Hafiz S; The pathogenicity of Neisseria gonorrhoeae is a subject of considerable interest . It is believed that N . gonorrhoeae of colonial type 1 are pathogenic while those of type 4 are not . This is based on experimentation in human volunteers . The object of this study was to determine the reasons for the differences of susceptibility of chicken embryos to N . gonorrhoeae strains of colonial types 1, 4, 5 and 1R (a type-1 revertant from a non-pathogenic type 4 strain originally tested in human volunteers) . Colonial types 1, 5, 1R and 4 caused mortality rates of 80, 70, 85 and 20% respectively . This variation in lethality appeared to depend upon the availability of free extra-cellular endotoxin and this was confirmed by chicken-embryo inoculation results and electronmicroscopy of normal and heated colonial types 1, 4 and 5 . Similar results were obtained by inoculating purified endotoxins from these types into chicken embryos . The results of this study suggest that endotoxins play a major role in the pathogenicity of N . gonorrhoeae and that the variations in virulence of the colonial types depends on the stability of their cell walls.

J Bacteriol, 1986 Aug, 167(2), 685 - 94
Construction of isogenic gonococcal strains varying in the presence of a 4.2-kilobase cryptic plasmid; Biswas GD et al.; A 4.2-kilobase (kb) cryptic plasmid is present in 96% of isolates of Neisseria gonorrhoeae . An inability to construct isogenic derivatives which vary in the presence of the 4.2-kb plasmid has prevented the study of its function . We report a method to deliver an intact 4.2-kb plasmid into plasmidless gonococcal strains . The method involved transformation with novel 15.7-kb hybrid penicillinase-producing (Pcr) plasmids, which were cointegrates containing two copies of the 4.2-kb plasmid arranged in tandem direct repeat plus one copy of the 7.2-kb Pcr plasmid pFA3 . When the 15.7-kb hybrid Pcr plasmids were introduced into a gonococcal recipient lacking evident plasmids, they dissociated at a relatively high frequency into plasmids identical to their parents: the 4.2-kb cryptic plasmid and pFA10 (a stable 11.5-kb plasmid containing one copy of each of the 7.2-kb Pcr plasmid pFA3 and the 4.2-kb cryptic plasmid pFA1) . Curing strains of their Pcr plasmids resulted in isogenic strains which varied only in the presence of the 4.2-kb plasmid . The presence of the autonomously replicating 4.2-kb plasmid did not affect a number of tested phenotypes, including auxotype, antibiotic sensitivity, and frequencies of variation of outer membrane protein II . The interpretation of the functional significance of the 4.2-kb plasmid was complicated, however, by the additional finding that each of three tested plasmid-free strains contained a chromosomal fragment of about 1.6 kb that hybridized under moderate stringency with a 1.65-kb HinfI fragment of the 4.2-kb plasmid.

Genitourin Med, 1986 Aug, 62(4), 230 - 4
Comparison of clinical and epidemiological characteristics of pelvic inflammatory disease classified by endocervical cultures of Neisseria gonorrhoeae and Chlamydia trachomatis; Judson FN et al.; We compared the clinical and epidemiological characteristics of 89 women with pelvic inflammatory disease (PID) seen at a clinic for sexually transmitted diseases during 1982 and 1983 . Patients were classified into four groups by having endocervical cultures positive for Neisseria gonorrhoeae only (24), Chlamydia trachomatis only (16), both organisms (14), or neither organism (35) . More women with cultures positive for N gonorrhoeae were black (p less than 0.005), had a sexual partner with gonorrhoea (p less than 0.005), and had a purulent vaginal discharge (p less than 0.05) . No other significant differences were found between groups regarding age, exposure to a sexual partner with non-gonococcal urethritis, history of trichomoniasis, parity, use of antibiotics, contraceptive history, duration of abdominal pain, relation of pain to the phase of the menstrual cycle, abdominal rebound tenderness, reproductive tract signs, or febrility . In women presenting to outpatient clinics, PID tends to be mild and the diagnosis unreliable . Though C trachomatis is emerging as an important aetiological agent, we found no clinical indicators that could distinguish chlamydial from gonococcal PID.

Genitourin Med, 1986 Aug, 62(4), 224 - 7
Single dose cefoxitin in treating uncomplicated gonorrhoea caused by penicillinase producing Neisseria gonorrhoeae (PPNG) and non-PPNG strains; Lim KB et al.; A total of 136 patients with uncomplicated gonorrhoea were treated with intramuscular cefoxitin 2 g (25 patients) or 1 g (111 patients) and oral probenecid 1 g . Cefoxitin 1 g cured 95% (42 out of 45 men and all of 14 women) with infections caused by penicillinase producing Neisseria gonorrhoeae (PPNG) strains and 98% (all of 38 men and 13 out of 14 women) with non-PPNG infections, giving an overall cure rate of 96% . The rate of postgonococcal urethritis (PGU) in men treated with 1 g cefoxitin was 28% . No serious side effects of treatment were observed in patients treated with either dose . The failure rate of 7% in men infected with PPNG strains who were treated with the 1 g dose is, however, disturbing . We therefore recommend that intramuscular cefoxitin 2 g and oral probenecid 1 g may be used to treat uncomplicated gonorrhoea, especially in areas where PPNG strains are common.

J Infect Dis, 1986 Aug, 154(2), 225 - 30
Auxotypes, penicillin susceptibility, and serogroups of Neisseria gonorrhoeae from disseminated and uncomplicated infections; Bohnhoff M et al.; We examined auxotypes, penicillin susceptibility, and outer membrane serogroups of 137 strains of Neisseria gonorrhoeae isolated from patients with disseminated gonococcal infection (DGI) and 137 control strains from patients with uncomplicated gonorrhea . We analyzed separately the data for strains isolated from systemic sites in patients with DGI and for strains from local sites in patients with the clinical syndrome of DGI (SDGI) who had negative systemic cultures . We found the nutritional requirement for arginine, hypoxanthine, and uracil (AHU auxotype) significantly more often among DGI strains than among SDGI strains . By using commercially available serogrouping reagents to detect outer membrane protein antigens, we found that regardless of strain auxotype, dissemination correlated best with the presence of protein IA antigens . We did not find that gonococci isolated from DGI are highly susceptible to penicillin . Susceptibility to low concentrations of penicillin correlated only with the AHU requirement, not with serogroup or isolation from a patient with DGI or SDGI.

Genitourin Med, 1986 Aug, 62(4), 217 - 20
In vitro antimicrobial sensitivity of Neisseria gonorrhoeae from Rwanda; Bogaerts J et al.; The in vitro sensitivity of 104 isolates of Neisseria gonorrhoeae to six antimicrobial agents was tested . More than 50% of the isolates produced penicillinase . Of those that did not produce penicillinase, 26% were resistant (minimum inhibitory concentration (MIC)) greater than or equal to 0.5 mg/l), and 68% showed a decreased sensitivity for penicillin G (0.06 less than or equal to MIC less than or equal to 0.25 mg/l) . Twenty six per cent and 50% of the strains, respectively, showed a decreased sensitivity to thiamphenicol (MIC greater than or equal to 1 mg/l) and tetracycline (MIC greater than or equal to 2 mg/l) . All isolates were sensitive to spectinomycin, kanamycin, and norfloxacin . Of 20 penicillinase producing N gonorrhoeae (PPNG) isolates examined, seven contained the 3.4 megadalton R-plasmid, another seven contained both the 3.4 megadalton and 22.5 megadalton plasmids, five the 4.3 megadalton and 22.5 megadalton plasmids, and one isolate harboured both the 3.4 and 4.3 R-plasmids, together with the 22.5 megadalton plasmid . A disturbing increase in resistance to penicillin has been observed since the publication of earlier surveys, and the clinical implications of these findings are discussed.

Sex Transm Dis, 1986 Jul-Sep, 13(3), 172 - 3
Postgonococcal conjunctivitis due to Chlamydia trachomatis; Scott BD et al.; We describe a case in which Chlamydia trachomatis was the etiologic agent of postgonococcal conjunctivitis in an adolescent female . This case report demonstrates the need for considering C . trachomatis as the cause of persistent or recurrent conjunctivitis in a sexually active patient . Clinicians should be aware of the possibility of concurrent infections with Neisseria gonorrhoeae and C . trachomatis and should treat the patient accordingly.

Sex Transm Dis, 1986 Jul-Sep, 13(3), 169 - 71
Comparative clinical efficacy of two different single-dose ciprofloxacin treatments for uncomplicated gonorrhea; Aznar J et al.; The clinical efficacies of two different single-dose, oral treatments with ciprofloxacin were evaluated in a double-blind randomized study of 50 men with gonococcal urethritis . Two groups of patients were studied . The 25 patients in group A (age, 18-32 years; mean = 26.2) received a single dose of 250 mg of ciprofloxacin; the 25 in group B (age, 16-42 years; mean = 26.3) received a single dose of 100 mg of ciprofloxacin . The minimal inhibitory concentrations of ciprofloxacin for all the isolates were less than or equal to 0.0015 microgram/ml . Neisseria gonorrhoeae was eradicated from all 50 patients; 80% of them were clinically cured, and 20% developed postgonococcal urethritis . There was no significant difference between the two treatments evaluated . We conclude that a single oral dose of 100 mg of ciprofloxacin could be an alternative treatment for uncomplicated gonorrhea in men . Neither treatment prevented the development of postgonococcal urethritis.

Sex Transm Dis, 1986 Jul-Sep, 13(3), 123 - 6
Sexually transmitted diseases in sexually abused children; De Jong AR; To determine the prevalence and pattern of sexually transmitted diseases among sexually abused children, we evaluated 532 victims under 14 years of age for the presence of Neisseria gonorrhoeae and Treponema pallidum . Twenty-five girls with vaginal discharge and six children with perineal skin lesions underwent more detailed microbiologic examination . Thirty-four infections were identified in 33 children . Gonorrhea was present in 25 (4.7%) of the 532 children, and other sexually transmitted diseases were identified in nine children . Rates of gonococcal infection were higher for children with multiple episodes of abuse (8.1%), delayed reporting (7.4%), and for children evaluated for "suspicion of abuse" without a specific history (28%) . Eight gonococcal infections (32%) were discovered at sites not involved in the abuse, according to the child's history . Eleven (44%) infected children were asymptomatic . Routine cultures of oropharyngeal and anogenital sites detected clinically unsuspected cases of oral, vaginal, and rectal gonorrhea . These data suggest that routine cultures are indicated for sexually abused children.

Sex Transm Dis, 1986 Jul-Sep, 13(3 Suppl), 192 - 8
Pelvic inflammatory disease; Sweet RL; Acute pelvic inflammatory disease (PID) is a major public health problem . An estimated 1 million cases occur annually in the United States . PID is a major cause of infertility and ectopic pregnancy . Prevention of the significant medical and economic sequelae of acute PID relies on the institution of appropriate treatment regimens that are based on the true microbiologic etiology of acute PID and take cognizance of the polymicrobic nature of this etiology . The clinician must maintain a high index of suspicion for acute PID so that early diagnosis can be made and treatment begun . Hospitalization and utilization of parenteral antimicrobial therapy will be of greatest benefit to the patient . This therapy should include combination agents that provide coverage for Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobes (including Bacteroids and anaerobic cocci), gram-negative aerobic rods, and gram-positive aerobes (including group B Streptococcus) . Finally, to prevent repeated infection, it is crucial to locate the sexual partners of women with acute PID and to screen and treat them for sexually transmitted diseases . In this way, the recurrent infections, which lead to a poor prognosis for fertility, can be avoided.

Geburtshilfe Frauenheilkd, 1986 Jul, 46(7), 462 - 6
{Bacteriologic findings and therapeutic consequences in adnexitis}; Mendling W et al.; After laparoscopic confirmation of adnexitis, a bacteriological examination was made of specimens taken from the small pelvis of 63 patients, with an average age of 26.4 years, at the Rheinischen Landesfrauenklinik (Gynecological Hospital) in Wuppertal . To this end, various aerobic and anaerobic optimal and selective culture media were used . The cultured germs were identified with API systems, other conventional methods, and by using gas chromatography . All bacilli were tested for their sensitivity to mezlocillin and metronidazole . In 40 cases (63.5%), it was possible to determine 1-10 bacilli from the inner genital tract . In most cases there was an aerobic/anaerobic mixed infection, with participation of streptococci, staphylococci, enteric bacteria, as well as peptococci, peptostreptococci and bacteroid types . Neisseria gonorrhoeae was only identified three times . In 23 cases (36.5%), it was not possible to determine bacilli in spite of definite inflammatory symptoms . Since, according to international literature, Chlamydia trachomatis was to be found on the inflamed tubes of roughly one third of cases of adnexitis, the presence of this bacillus is suspected even in the many bacteriologically negative cases in the author's own study . Only in one case of a monoinfection by Staphylococcus aureus did the combination of mezlocillin and metronidazole prove to be unsuitable . In 25% of the cases where the presence of bacilli was proved, metronidazole was even necessary, since bacilli of the Bacteroides fragilis and Bacteroides bivius and disiens groups were involved, all of which are capable of inactivating penicillins and cephalosporins by formation of a beta-lactamase.(ABSTRACT TRUNCATED AT 250 WORDS)

Sex Transm Dis, 1986 Jul-Sep, 13(3), 159 - 62
Gardnerella vaginalis-associated balanoposthitis; Burdge DR et al.; The clinical features, microbiologic investigation, and response to therapy of three patients with Gardnerella vaginalis-associated balanoposthitis were studied . Each man presented with a similar syndrome of diffuse erythema and pruritis of the glans meatus and coronal sulcus, irritation of the prepuce, and minimal urethral discharge . A characteristic fishy odor was present in the urethral discharge of all three patients . G . vaginalis was isolated from the glans of all three, and clue cells were present in two . In all cases, cultures for Candida albicans, herpes simplex virus, Neisseria gonorrhoeae, Chlamydia trachomatis, and Ureaplasma urealyticum were negative . All three patients responded to oral therapy with metronidazole and concurrent treatment of the partner . Two patients subsequently relapsed but ultimately responded to clindamycin therapy . These men presented with a distinctive clinical syndrome of balanoposthitis associated with G . vaginalis, which is in many respects similar to the syndrome of bacterial vaginosis in women . Our data indicate that balanoposthitis may have a polymicrobial and synergistic etiology involving G . vaginalis and anaerobic bacteria in the male lower genital tract; such an etiology is analogous to that of bacterial vaginosis.

Ann Inst Pasteur Microbiol, 1986 Jul-Aug, 137B(1), 37 - 45
Evaluation of hydrophobicity and adherence of Neisseria meningitidis strains and a study of their correlation by analysis of alterations induced by antibiotics; Ferreiros CM et al.; Surface hydrophobicity and adherence to human buccal epithelial cells were evaluated in four Neisseria meningitidis strains . Hydrophobicity was measured by partition into p-xylene in the presence or absence of ammonium sulphate, whereas radioactivity-labelled bacteria were used to estimate the ability to adhere to buccal cells by liquid scintillation techniques . Eight antibiotics were employed to induce modifications in the two parameters in order to estimate their possible relationship . The presence of ammonium sulphate enhanced the partition into p-xylene and hence the hydrophobicity values obtained . There was no correlation between adherence and hydrophobicity (no matter what the method employed to evaluate the latter) . The effect of the antibiotics varied as a function of the strain, method and/or parameter tested.

Sex Transm Dis, 1986 Jul-Sep, 13(3 Suppl), 203 - 6
Treatment of gonorrhea with first- and second-generation cephalosporins and other new beta-lactam antibiotics; Mills J et al.; Aqueous procaine penicillin, ampicillin, and amoxicillin have been used successfully in treatment of gonococcal infections for many years . Many of the new beta-lactam antimicrobial agents subsequently have proved effective for treating these infections as well . First-generation cephalosporins are less active (by weight) than second-generation cephalosporins, which, in turn, are less active than third-generation drugs . Single-dose therapy of uncomplicated mucosal gonococcal infections with first-generation cephalosporins has resulted in generally unacceptably low cure rates of less than 90% in most studies, whereas parenterally and orally administered second-generation cephalosporins show good clinical efficacy . Both second- and third-generation cephalosporins are active against beta-lactamase-producing Neisseria gonorrhoeae . The extended-spectrum and ureido-penicillins are active in vitro against non-beta-lactamase-producing N . gonorrhoeae and have parallel activity in vivo . Single doses of aztreonam, the first monobactam studied in humans, have also shown excellent clinical efficacy.

Sex Transm Dis, 1986 Jul-Sep, 13(3 Suppl), 199 - 202
Treatment of uncomplicated gonorrhea with ceftriaxone: a review; Judson FN; Of the currently recommended regimens for treatment of uncomplicated gonorrhea, only aqueous procaine penicillin G is effective against infections of all sites . However, this agent is not effective against penicillinase-producing Neisseria gonorrhoeae and suffers from poor patient acceptability owing to the 10-ml volume of injection and to allergic and toxic reactions to procaine . Ceftriaxone is a new, extended-spectrum cephalosporin with a long serum half-life and is many times more active than penicillin G against both beta-lactamase-positive and -negative strains of N . gonorrhoeae . In clinical trials ceftriaxone, in a single intramuscular dose of 125 or 250 mg, has proved as effective as any other regimen in the treatment of uncomplicated gonococcal infections of the pharynx, anorectum, cervix, and urethra . Thus, ceftriaxone (125 mg) should be considered a drug of choice for uncomplicated gonorrhea, particularly where homosexual men are treated and penicillinase-producing N . gonorrhoeae and/or chromosomally mediated resistance is prevalent.

Sex Transm Dis, 1986 Jul-Sep, 13(3), 156 - 8
Treatment of infection due to penicillinase-producing Neisseria gonorrhoeae with oral thiamphenicol and with oral lymecycline; Latif AS et al.; Seventy-five men with gonococcal urethritis were treated with a single oral dose of thiamphenicol, and 88 men with this infection were treated with two 1.5-g oral doses of lymecycline taken 12 hr apart . Of the 75 subjects treated with thiamphenicol, 72 (96%) were cured, as compared with 80 (91%) treated with lymecycline . Sixty subjects (37%) were infected with penicillinase-producing Neisseria gonorrhoeae . In this group, 28 (97%) of 29 subjects treated with thiamphenicol were cured, as compared with 29 (94%) of 31 subjects treated with lymecycline . Patient compliance with the two-dose regimen was excellent, and no adverse effects occurred with either drug . Lymecycline may therefore be an effective alternative to thiamphenicol in those countries where strains of N . gonorrhoeae remain sensitive to the tetracyclines.

Am J Clin Pathol, 1986 Jul, 86(1), 71 - 8
Multicenter clinical trial and laboratory utilization of an enzymatic detection method for gonococcal antigens; Thomas JG et al.; Seven institutions participated in a comparative study evaluating standard culture method and a new enzyme immunoassay (EIA, Gonozyme, Abbott Diagnostics) for the detection of Neisseria gonorrhoeae . Five hundred twenty-three patients were entered from hospitals of various sizes representing different population densities, ethnic and economic sectors, and gonococcal prevalence . Statistical analysis showed sensitivity, specificity, and positive and negative predictive values of 80.3%, 94.6%, 66.2%, and 97.3% for the total population tested . For the high-prevalence (greater than 15%) population the respective values were as follows: 78.6%, 91.5%, 68.8%, and 94.7% . Specimens from females had a lower sensitivity than those from males . In the low-prevalence population (less than 10%) results were as follows: 100%, 97.8%, 50%, and 100% . A cost comparison emphasized the benefit of the Gram's stain and culture . It also indicated that, unless batched or assayed at high volume, Gonozyme is not cost competitive for laboratories using standard culture methods . The impact of the EIA method, in general, and Gonozyme, specifically, on the microbiology section also was investigated . Integration would require altering of established work patterns and loss of flexibility and freedom of standard plating technics . The fact that Gonozyme is a "presumptive" test limits it to being a complementary assay, not an alternative . The authors conclude that Gonozyme is optimally suited to a high-volume laboratory, screening a low-prevalence female outpatient population, where specimen transport is a problem and gonococcal resistance to penicillin has not been demonstrated . This would include sexually transmitted disease clinics, reference laboratories, and state health departments.

J Clin Microbiol, 1986 Jul, 24(1), 96 - 8
Evaluation of the GO Slide (Roche) growth transport system for isolation of Neisseria gonorrhoeae from clinical specimens; Anand CM et al.; A new growth transport system for the isolation of Neisseria gonorrhoeae from clinical specimens was evaluated . The system, GO Slide (Roche) of F . Hoffmann-La Roche & Co., Basel, Switzerland, showed 88% sensitivity for male urethral specimens and 59% sensitivity for endocervical specimens compared with transport in the Amies transport medium combined with culturing on modified Thayer-Martin medium . The media used appear not to support growth of certain strains of N . gonorrhoeae . recovery and growth-supporting capabilities of this system need to be improved before the system can be used routinely.

J Clin Microbiol . 1986 Jul;24(1):145.
Increased detection of prolylaminopeptidase in Neisseria meningitidis by Identicult-Neisseria; Sperry JF et al.; Identicult-Neisseria (Scott Laboratories, Inc., Fiskeville, R.I.), a rapid enzymatic method with chromogenic substrates, was tested in our laboratories for the identification of Neisseria gonorrhoea, Neisseria meningitidis, and Neisseria lactamica . The test correlated very highly in its identification of pathogenic Neisseria spp . with modified New York City fermentation medium . Identicult-Neisseria appeared to be more sensitive in its detection of prolylaminopeptidase activity in N . meningitidis than most of the currently available systems.

J Clin Microbiol, 1986 Jul, 24(1), 141 - 2
Preliminary evaluation of a rapid colorimetric method for identification of pathogenic Neisseria; Hosmer ME et al.; A rapid colorimetric method for the identification of pathogenic Neisseria (Identicult-Neisseria; Scott Laboratories, Inc.) based on beta-galactosidase, gamma-glutamylaminopeptidase, and gamma-prolylaminopeptidase is described . All 82 clinical isolates of Neisseria gonorrhoeae, 9 clinical isolates of N . meningitidis, and 5 clinical isolates of N . lactamica were correctly determined to the species level, as were 4 isolates of Branhamella catarrhalis . Reactions were prompt and easily interpreted . The system should be extremely useful in clinical laboratories.

J Bacteriol, 1986 Jul, 167(1), 231 - 7
Intragenic variation by site-specific recombination in the cryptic plasmid of Neisseria gonorrhoeae; Hagblom P et al.; Cryptic plasmid DNA of Neisseria gonorrhoeae was found integrated into the gonococcal chromosome in both plasmid-bearing strains and plasmid-free strains . At several chromosomal locations only segments of the plasmid were found . However, in at least two strains an intact copy of the plasmid seemed to be present with the joints between the plasmid and the chromosomal DNA being located within the cppB gene of the cryptic plasmid . The cppB gene was shown to undergo a sequence-specific intragenic deletion . The deletion removed 54 base pairs, representing 18 amino acids, and did not affect the reading frame . It is proposed that the cryptic plasmid integrates into the chromosome and other gonococcal plasmids within this site-specific deletion region . Models for the site-specific recombination are presented.

J Bacteriol, 1986 Jul, 167(1), 186 - 90
Genetic transformation of genes for protein II in Neisseria gonorrhoeae; Schwalbe RS et al.; The protein II (PII) outer membrane proteins of Neisseria gonorrhoeae are a family of heat-modifiable proteins that are subject to phase variation, in which the synthesis of different PII species is turned on and off at a high frequency . Transformation of PII genes from a donor gonococcal strain into a recipient strain was detected with monoclonal antibodies specific for the PII proteins of the donor . Individual PII protein-expressing transformants generally bound only one donor-specific PII monoclonal antibody . Recovery of transformants expressing a donor-specific PII protein depended on the PII protein expression state of the donor: the transformed population bound only monoclonal antibodies specific for PII proteins that were expressed in the donor . Colony variants with an altered frequency of switching of PII protein expression were isolated, but the altered switch phenotype did not cotransform with the PII structural gene . These results provide genetic evidence that PII proteins are the products of different genes and that expressed and unexpressed forms of the PII gene are different from each other.

Med J Aust, 1986 Jun 9, 144(12), 651 - 2
Penicillin-sensitive spectinomycin-resistant Neisseria gonorrhoeae; Gollow MM et al.; The first identification in Australia of a penicillin-sensitive spectinomycin-resistant Neisseria gonorrhoeae organism is reported . The method of identification is detailed . Caution is recommended in the use of spectinomycin for the primary treatment of gonorrhoea.

Pathol Biol (Paris), 1986 Jun, 34(5 Pt 2), 604 - 7
{Sensitivity of Kingella kingae to antibiotics}; Prere MF et al.; Kingella kingae is a small Gram negative rod of the Neisseriaceae family, formerly called Moraxella kingae . This microorganism is found occasionally in the oral cavity and is capable of causing infections . We report three cases of septic arthritis in children due to K . kingae . In vitro susceptibility of the recovered strains was tested using determination of MICs in agar . The strains were susceptible to penicillin, ampicillin, ticarcillin, cephalothin, cefotaxime, gentamicin, chloramphenicol, tetracycline, trimethoprim-sulfamethoxazole, and pefloxacin, less susceptible to erythromycin and resistant to lincomycin (MIC 32 mg/l).

Genitourin Med, 1986 Jun, 62(3), 163 - 5
Antimicrobial activity of seven metallic compounds against penicillinase producing and non-penicillinase producing strains of Neisseria gonorrhoeae; Peeters M et al.; The in vitro activity of seven metallic compounds was tested against penicillinase (beta lactamase) producing strains of Neisseria gonorrhoeae (PPNG) and non-PPNG strains . On a weight basis, the mercurials showed the greatest in vitro activity . Phenylmercuric borate, thiomersal, and mercuric chloride inhibited 90% of all strains at concentrations of 5 mg/l, 5 mg/l, and 20 mg/l respectively . Silver nitrate inhibited 90% of the strains at 80 mg/l and the MIC90 for mild silver protein was 200 mg/l . Copper and selenium salts had lower in vitro activities, inhibiting 90% of all the strains at 320 mg/l and 640 mg/l respectively . Silver nitrate and the six other compounds tested showed equal activities against PPNG and non-PPNG strains . This finding supports the recommendation for prophylaxis of gonococcal conjunctivitis of the newborn with 1% silver nitrate eye drops.

Genitourin Med, 1986 Jun, 62(3), 158 - 62
Incidence of gonorrhoea due to penicillinase producing Neisseria gonorrhoeae in Japan 1981-3 and treatment using a new antibiotic combination, BRL25000 (amoxycillin and clavulanic acid); Osato K et al.; During the three years 1981-3, 134 (9.1%) of 1473 patients presenting at our clinics were found to be infected with penicillinase producing strains of Neisseria gonorrhoeae (PPNG) . Minimum inhibitory concentrations (MICs) of benzylpenicillin and ampicillin against these PPNG strains were 8 mg/l or more, whereas against non-PPNG strains they were consistently 4 mg/l or less . In contrast, the MIC of BRL25000 (two parts amoxycillin and one part clavulanic acid, the beta lactamase inhibitor) was 4 mg/l or less even against PPNG strains . MICs of a number of other drugs commonly used to treat gonorrhoea, such as cephaloridine, cefoxitin, tetracycline, doxycycline, minocycline, kanamycin, and spectinomycin, showed no appreciable differences between non-PPNG and PPNG strains and the MIC of cephaloridine in particular was relatively high . BRL25000 proved to be very effective in the treatment of PPNG infection and cured all of 121 patients treated . A daily dose of 2.25g, cured 105 patients in two days, 11 patients in three days, four patients in four days, and one patient in five days . A new rapid diagnostic method for detecting PPNG strains, capable of application at an outpatient clinic and providing a result on the following day, is described.

Genitourin Med, 1986 Jun, 62(3), 151 - 7
Molecular and epidemiological analysis of penicillinase producing strains of Neisseria gonorrhoeae isolated in Canada 1976-84: evolution of new auxotypes and beta lactamase encoding plasmids; Dillon JR et al.; Though the number of penicillinase producing Neisseria gonorrhoeae (PPNG) strains isolated in Canada comprises under 1% of all gonococcal isolates, it continues to increase appreciably each year . Most strains are imported from areas of endemic infection with PPNG strains . Two local outbreaks in 1984, however, were notable for the number of patients infected and for the distinctive phenotypes of the strains . One outbreak was caused by a wild type strain, of serovar BACJK with a new 3.05 megadalton penicillinase encoding plasmid, whereas the other was caused by strains with the Asia+ plasmid type, serovar AE and with a proline and ornithine requiring auxotype . Five plasmid patterns (Africa+, Africa-, Asia+, Asia-, and Toronto+) were observed among the PPNG strains . The association between plasmid content and specific auxotype (such as Asia plasmid with proline requiring auxotype or Africa plasmid with wild type auxotype) and inhibition by phenylalanine continues to be unexplained.

Genitourin Med, 1986 Jun, 62(3), 145 - 50
Epidemiological analysis of Neisseria gonorrhoeae in the Federal Republic of Germany by auxotyping and serological classification using monoclonal antibodies; Kohl PK et al.; We evaluated a new serological classification system for Neisseria gonorrhoeae based on monoclonal antibodies directed against epitopes on the outer membrane protein I, in conjunction with auxotyping, to analyse gonococci from two cities in the Federal Republic of Germany . Isolates of N gonorrhoeae were collected during 1976-8 and 1980-2 in Lubeck, and during 1980-2 in Heidelberg . Between the two study periods in Lubeck, we observed an appreciable decrease in strains of the auxotype that requires arginine, hypoxanthine, and uracil (AHU-) and with serovar class PrIA-1 and the emergence of strains with the proline requiring auxotype and PrIB-1 serovar class . Serovar PrIA-1 accounted for 89 (97%) of 92 strains with the AHU- auxotype as opposed to 12 (4%) of 297 strains with other auxotypes (p less than 0.0001) . Disseminated gonococcal infection was associated with AHU-/PrIA-1 strains . Penicillinase producing N gonorrhoeae (PPNG) strains belonged to eight different auxotype and serovar classes, which indicated that different strains had been imported . Classification of strains of N gonorrhoeae by auxotype and serovar class permits analysis of temporal changes in gonococcal populations, and of migrations of gonococci between different geographical areas . Typing N gonorrhoeae, together with assessing antibiotic susceptibilities, may prove useful for further studies of the epidemiology and control of gonorrhoea.

Antimicrob Agents Chemother, 1986 Jun, 29(6), 1095 - 7
Previously undescribed 6.6-kilobase R plasmid in penicillinase-producing Neisseria gonorrhoeae; Gouby A et al.; A penicillin-resistant Neisseria gonorrhoeae strain was isolated . The resistance was due to the production of TEM-1 beta-lactamase encoded by a plasmid . This 6.6-kilobase plasmid was compared with the previously known 7.4- and 5.3-kilobase penicillin R plasmids of N . gonorrhoeae.

Infect Immun, 1986 Jun, 52(3), 657 - 63
Effects of human serum on bacterial competition with neutrophils for molecular oxygen; Britigan BE et al.; A dialyzable factor(s) in human serum is known to stimulate gonococcal oxygen consumption . Its effect on other human pathogens was investigated . A 10% serum solution increased peak O2 consumption for Escherichia coli and Staphylococcus aureus to 157% (P less than 0.05) and 199% (P less than 0.02), respectively, of their O2 consumption when suspended in Hanks balanced salt solution, compared with a 356% increase for Neisseria gonorrhoeae with serum . Dialyzed serum lacked stimulatory capacity . Bacteria, serum, and neutrophils are often incubated to evaluate neutrophil bactericidal activity . Samples of 10(8) N . gonorrhoeae, S . aureus, and E . coli turned resazurin colorless (anaerobic conditions, Eh less than -42 mV) after 7.4, 13.3, and 15.1 min, respectively . Because neutrophil formation of reactive oxygen intermediates requires ambient O2, the effect of live bacteria and serum on this process was explored . After 5 min of incubation of 10(8) N . gonorrhoeae or S . aureus in 10% normal or dialyzed serum, 10(5) neutrophils were added . Phorbol myristate acetate was then added to assure neutrophil stimulation, and luminol-dependent luminescence was measured . N . gonorrhoeae and S . aureus incubation in normal serum decreased peak LDL 91.7 and 88.6%, respectively, relative to incubation in dialyzed serum . A sample of 10(8) E . coli totally eliminated LDL . A sample of 10(8) E . coli incubated in Hanks balanced salt solution for 5 min also eliminated phorbol myristate acetate induced neutrophil H2O2 production . LDL inhibition increased in proportion to bacterial concentration and time of incubation and was prevented by inclusion of KCN . Increasing the concentration of neutrophils to 10(8) (1:1 particle-to-cell ratio) only partially reversed LDL inhibition . Re-aeration of the system allowed brief LDL which persisted only if KCN was added . Addition of KCN after bacterial incubation also permitted LDL, arguing against depletion of other factors from the media or accumulation of bacterially derived inhibitory substances . A dynamic competition for O2 occurs between bacteria and neutrophils . Serum stimulation of bacterial O2 utilization may contribute to virulence by increasing bacterial capacity to inhibit neutrophil function.

Genitourin Med, 1986 Jun, 62(3), 170 - 4
Evaluation of ciprofloxacin 500 mg twice daily for one week in treating uncomplicated gonococcal chlamydial, and non-specific urethritis in men; Arya OP et al.; Ciprofloxacin, a quinolone antibacterial, was evaluated in the treatment of gonococcal, chlamydial, gonococcal and chlamydial, and non-gonococcal non-chlamydial urethritis . The dosage regimen used was 500 mg orally twice a day for seven days . Of the 56 patients evaluated 22 had gonococcal infection only, 13 were infected with Chlamydia trachomatis only, seven had combined infection, and 14 were harbouring neither of these organisms . Neisseria gonorrhoeae was cleared in all the 29 patients with or without chlamydial infection . Of those who denied having sexual intercourse during the follow-up period, post gonococcal urethritis (PGU) developed in 12 (63%) out of 19, C trachomatis was isolated again from 11 (78%) out of 14, and urethritis recurred in five (55%) out of nine patients with non-gonococcal non-chlamydial infection . There was also evidence that the dosage regimen used was only partially effective against Ureaplasma urealyticum.

Immunology, 1986 Jun, 58(2), 329 - 34
Effects of antigen and internal environment on anti-phosphorylcholine immune responses of autoimmune aged NZB/W F1 mice; Seoane R et al.; The idiotypic profile of anti-phosphorylcholine plaque-forming cell responses and their evolution with ageing were studied in (NZB X NZW) F1 mice . Our results showed that the anti-phosphorylcholine plaque-forming cell response induced by phosphorylcholine coupled to keyhole limpet haemocyanin and, paralleling, the T15 idiotype clonal dominance declined with ageing . This loss of immune competence was also observed with another thymus-dependent (phosphorylcholine coupled to egg globulin) as well as thymus-independent (capsular polysaccharide of Streptococcus pneumoniae strain R36a) antigens . In contrast, old mice challenged with an antigenic preparation of Neisseria meningitidis showed an immune response not significantly different from that elicited by the same antigen in young mice . The hapten-augmentable plaque-forming cells were assayed to determine whether a putative auto-antiidiotypic regulation underlies this loss of immune competence . Only minimal numbers and non-significant differences between young and old mice immunized with any antigen could be detected . Further studies using an adoptive transfer system demonstrated that cells from aged mice were able to support a normal anti-phosphorylcholine response when transferred into lethally irradiated young recipients . Our results suggest that no permanent cellular defects, but rather internal environment or/and radioresistant suppressor cells, are involved in this loss of immune competence . The role played by these factors and their effect on distinct subpopulations of B cells are discussed.

Proc Natl Acad Sci U S A, 1986 Jun, 83(11), 3890 - 4
Piliation control mechanisms in Neisseria gonorrhoeae; Bergstrom S et al.; Gonococci (Gc) undergo pilus+ to pilus- "phase transitions" readily in vitro . In the present study we sequenced pilin mRNA from reverting, pilus- Gc by oligonucleotide primer extension and compared these pilin mRNA sequences with those expressed by their pilus+ predecessors and pilus+ revertants . The results suggest that genetic rearrangement within the pilin structural gene can generate defective pilin gene products, resulting in a pilus- phenotype . These pilus- Gc give rise to pilus+ revertants upon reconstitution of their modified pilin gene.

J Gen Microbiol, 1986 Jun, 132 ( Pt 6), 1611 - 20
Monoclonal antibodies to gonococcal outer membrane protein I: location of a conserved epitope on protein IB; Fletcher JN et al.; Hybrid cell lines have been derived which produce monoclonal antibodies reacting with outer membrane protein I from Neisseria gonorrhoeae strain P9 . The antibodies obtained showed variable reactivity with other strains but one antibody recognized an epitope present on all of the strains tested which expressed the protease sensitive protein IB . Purified IgG labelled with 125I was used in competitive radioimmunoassays with unlabelled antibody to investigate the spacial distribution of the epitopes recognized . Each pair of antibodies showed some degree of inhibition . The relative magnitude of inhibition suggested that the conserved epitope lies within a variable region containing other epitopes which determine the antigenic specificity of the protein . Western blotting of peptides derived by proteolytic digestion of protein IB revealed that the conserved epitope is located close to the chymotrypsin cleavage site within a 7000 Mr surface exposed region of the molecule.

Arch Intern Med, 1986 May, 146(5), 890 - 3
Branhamella catarrhalis as a lower respiratory tract pathogen in patients with chronic lung disease; Nicotra B et al.; To determine the possible role of Branhamella (formerly Neisseria) catarrhalis as a respiratory pathogen, we screened quality sputa (defined by cellular criteria) that showed numerous gram-negative cocci on Gram's stain for the presence of B catarrhalis . In an eight-month period, 52 isolates of B catarrhalis were identified in adults attending a hospital for chest diseases . During this period B catarrhalis was the third most common potential pathogen isolated from sputa . Twenty-two patients (42%) had associated patchy bronchopneumonic or lobar infiltrates . All had negative blood cultures and a generally mild clinical course . The majority of strains (73%) of B catarrhalis produced beta-lactamase and were resistant to penicillin and ampicillin . Isolates (including beta-lactamase-producing strains) were susceptible to erythromycin, tetracycline, and trimethoprim-sulfamethoxazole . These studies demonstrate that in patients with chronic lung disease, the presence of B catarrhalis in sputum can be suspected on the basis of a Gram's stain and may be associated with the development of new pneumonic infiltrates . Since these organisms frequently produce beta-lactamase, empiric antimicrobial therapy should include agents other than the penicillins.

Diagn Microbiol Infect Dis, 1986 May, 5(1), 81 - 5
Manifestations of Kingella kingae infections in adults: resemblance to neisserial infections; Toshniwal R et al.; Kingella kingae is a rare human pathogen . Most reported infections are in children and involve endocardium, vascular space, and skeletal tissues . We report herein two cases of K . kingae infection recently seen in adults . Kingella kingae caused acute meningitis in a patient with sickle cell anemia and in the second patient with alcoholic liver disease, sepsis with a petechial rash . The clinical presentation due to K . kingae closely resembled that caused by related Neisseria genus.

Pathol Biol (Paris), 1986 May, 34(5), 502 - 4
{Treatment with ofloxacin (RU 43280) of uncomplicated bacterial urethritis in males}; Morel P et al.; Ofloxacin is a new fluoroquinolone with in vitro activity against the three main urethritis-causing pathogens: i.e . Neisseria gonorrhoeae, Chlamydia trachomatis and Ureaplasma urealyticum . 18 adult males with acute uncomplicated urethritis took 200 mg ofloxacin by mouth twice daily for 7 (non-chlamydial urethritis) or 14 (chlamydial urethritis) days . 12 patients had N . gonorrhoeae; 2 had H . parainfluenzae, 1 had E . coli and 5 had C . trachomatis . Urethral cultures were obtained before treatment and on day 7 (non-chlamydial urethritis) or 28 (chlamydial urethritis) . Clinical and microbiological cure was achieved in 17 of the 18 patients . Clinical manifestations failed to resolve in one patient due to the presence of Trichomonas vaginalis recognized on day 7 . No side effects were observed . According to these results, ofloxacin is effective and safe against gonococcal and chlamydial urethritis.

J Pediatr, 1986 May, 108(5 Pt 1), 779 - 83
Evaluation of fluorescein-conjugated monoclonal antibody test to detect Chlamydia trachomatis endocervical infections in adolescent girls; Shafer MA et al.; We evaluated the fluorescein-conjugated monoclonal antibody (FA) test for screening for Chlamydia trachomatis endocervical infection in a general adolescent clinic . Three hundred sixty-three consecutive adolescent girls, ages 13 to 20 years (mean 17.3 years) were examined . Forty-five (12%) FA smears had insufficient cells . Reason for visit included non-lower genital tract-related disorders in 241 (76%) girls, and lower genital tract-related disorders in 77 (24%) . C . trachomatis was isolated by tissue culture in 46 (14%) patients, and Neisseria gonorrhoeae by culture in 22 (7%), and Trichomonas vaginalis was identified by wet mount in 13 (5%) . Compared with our tissue culture technique, the performance of the FA test was as follows: sensitivity 61% (28 of 46), specificity 97% (264 of 272), positive predictive value 78% (28 of 36), and negative predictive value 94% (264 of 282) . There was no significant difference in test performance by race, although the sensitivity rate (64%) of the test in blacks was twice that (30%) in nonblacks . This apparent difference in test performance by race may actually represent variations in group characteristics, including exposure rate, susceptibility, and number of inclusion forming units available for tissue culture of Chlamydia in blacks compared with nonblacks . In our adolescent clinic, the tissue culture is superior to FA in detecting Chlamydia . We recommend that the FA test be used where tissue culture isolation for Chlamydia is not readily available, where known or predicted chlamydial infection rates are high, and where known or predicted numbers of inclusion forming units of Chlamydia in tissue culture are high.

Emerg Med Clin North Am, 1986 May, 4(2), 281 - 97
Cerebral spinal fluid; Dougherty JM et al.; The advent of very sensitive and rapid agglutination tests has been a major advance in facilitating the rapid diagnosis of bacterial meningitis (Table 3) . Future investigations will focus on the use of monoclonal antibodies that have been found to be more sensitive and specific than polyclonal antiserums . Modifications of enzyme immunoassays of bacterial antigens to improve speed and technical reliability are in progress . The day may come with the present advances in technology that within 1 hour of receiving a CSF specimen, both the identity and antimicrobial sensitivity of the invading pathogen will be known to the physician . In addition, through quantitation of bacterial antigen, a reliable prognosis as to the outcome of the treated meningitis will also be possible . Finally, the continued refinement of reliable antiserums to group B Neisseria meningitidis, as well as other bacteria responsible for meningitis, particularly in the immunocompromised host will occur.

Ann Inst Pasteur Microbiol, 1986 May-Jun, 137A(3), 279 - 85
Presence of a capsule in Neisseria lactamica, antigenically similar to the capsule of N . meningitidis; Martin PV et al.; Three of thirteen strains of Neisseria lactamica, a species closely related to N . meningitidis, were selected on the basis of their ability to be strongly agglutinated by serogroup B antimeningococcal serum . The presence of a capsule was demonstrated using Alcian blue as a stain for acidic polysaccharide . When reacted with serogroup B antimeningococcal sera, 2 out of 3 N . lactamica B-coagglutanating strains exhibited an extracellular material comparable in size, antigenicity and staining properties to the capsule of serogroup B N . meningitidis.

J Gen Microbiol, 1986 May, 132 ( Pt 5), 1407 - 13
Lipopolysaccharide alteration is associated with induced resistance of Neisseria gonorrhoeae to killing by human serum; Tan EL et al.; On SDS-PAGE, solubilized and proteinase K treated preparations of Neisseria gonorrhoeae strain BS4 (agar) showed differences in silver stained lipopolysaccharide (LPS) patterns, before and after induction to resistance to serum killing by incubation for 3 h at 37 degrees C with low Mr fractions from lysates of guinea pig red blood cells . Preparations from the original serum susceptible gonococci and LPS purified from such bacteria showed two components, but the preparations from the serum resistant gonococci were deficient in the higher Mr component . Furthermore, on immunoblotting with fresh human serum (FHS), the two LPS components of the susceptible gonococci reacted strongly with IgM . With preparations from the serum resistant gonococci there was no reaction in the area corresponding to the higher Mr component and a weaker reaction with the component of low Mr . Purified LPS from the susceptible gonococci neutralized the bactericidal activity of FHS against N . gonorrhoeae strain BS4 (agar) probably by reacting with the relevant antibody, since heated FHS was no longer bactericidal when mixed with a source of complement (human placental serum) after prior reaction with the LPS . These neutralization tests coupled with the results of immunoblotting strongly suggest that increased serum resistance is due to the lack of the high Mr LPS moiety.

Andrologia, 1986 May-Jun, 18(3), 323 - 5
Risk of transmission of sexually transmitted diseases by cryopreserved semen; Glander HJ et al.; The increasing incidence of sexually transmitted diseases (STD) involves the risk of the transmission of these diseases by the artificial insemination . Therefore the cryotolerance of several microorganisms causing STD and the efficiency of penicillin of the cryoprotective medium (CMP) against Neisseria gonorrhoeae (N.g.) were investigated . The results have shown that penicillinase-producing N.g . (PPNG), genital mycoplasmas and Candida species survive the cryopreservation . Trichomonas vaginalis could not be recultivated after our temperature-time-regimen of the cryopreserving process . CPM with penicillin was unable to prevent a transmission of penicillin-sensitive N.g.

Scand J Prim Health Care, 1986 May, 4(2), 75 - 80
Microbiology of vaginal discharge in general practice; Schmidt H et al.; Three groups of women were examined by culture for Gardnerella vaginalis and Candida . Group I consisted of 427 women, who complained spontaneously of vaginal discharge, group II of 311 women who did not complain of vaginal discharge until questioned prior to gynaecological examination, and group III of 100 women who denied vaginal discharge . Groups I and II also had cultures made for Trichomonas vaginalis and Neisseria gonorrhoica . In group I with spontaneous complaints the one-year prevalence rate of vaginal discharge was 3.4% . Candida, Trichomonas vaginalis and Neisseria gonorrhoica were cultured in 24%, 8% and 1% respectively . Gardnerella vaginalis was cultured in half of the women in all groups . A characteristic discharge or a positive microscopic finding was related to high concentration of Gardnerella vaginalis . A characteristic discharge even without spontaneous complaints of vaginal discharge was related to a high prevalence of Gardnerella vaginalis . Women complaining from discharge had higher concentrations of Gardnerella vaginalis than non-complaining . This leads to the conclusion that clinical disease may not be present unless concentrations of Gardnerella vaginalis have risen above some minimum level . The Gardnerella vaginalis syndrome defined by positive culture, clinical finding and microscopy was found in 20% of symptomatic women.

Am J Clin Pathol, 1986 May, 85(5), 618 - 22
Detection of L-forms of Neisseria gonorrhoeae in pure and mixed culture suspensions by an enzyme immunoassay; Bae BH et al.; An enzyme immunoassay (EIA) (Gonozyme, Abbott Laboratories, Chicago, IL) was evaluated for its ability to detect L-forms of Neisseria gonorrhoeae in pure and mixed culture suspensions . A total of 15 L-form strains that were induced from fresh clinical isolates of N . gonorrhoeae on an L-form medium were tested by EIA at antigen levels equivalent to those found in 2 X 10(5), 3 X 10(4), and 2 X 10(3) parental cells per milliliter . The results showed the sensitivity of the EIA for L-forms and parental cells to be the same, exhibiting positive results in all pure culture suspensions of parental cells at 2 X 10(5) and 3 X 10(4) cells per milliliter and their corresponding L-form preparations . At 2 X 10(3) cells per milliliter, three parental and two of their respective L-form preparations yielded positive EIA results . Incorporation of a mixture of heterologous organisms that can be found in the normal human genital flora, each at a concentration of 1 X 10(7) cells per milliliter into the L-form preparations, did not affect the sensitivity of the EIA for detection of L-forms . The results of the present study indicate that the EIA is an equally sensitive method for detecting gonococcal L-forms and parental cells . A further study, however, is needed to ascertain its usefulness under actual clinical conditions.

J Infect Dis, 1986 May, 153(5), 910 - 7
A spontaneous mutant of Neisseria gonorrhoeae with decreased resistance to neutrophil granule proteins; Shafer WM et al.; We examined the resistance of Neisseria gonorrhoeae to proteins prepared from the granules of human polymorphonuclear neutrophils (PMNs) . We found that nearly isogenic strains differing in lipopolysaccharide subunit molecular weight also differed in levels of resistance to crude granule extracts . N . gonorrhoeae strain WS1 was at least 10-fold less resistant than the parental strain FA 102 to granule extracts . Surprisingly, strain WS1 did not differ from FA 102 in resistance to two isolated antimicrobial proteins obtained previously from extracts of human PMN granules . We used strain WS1 in assays that detected antimicrobial proteins in granule extracts, and we obtained at least two proteins with apparent molecular masses of 24-25.5 kilodaltons that exerted potent in vitro antigonococcal activity . We found that the ED50 (concentration of protein required to kill 50% of gonococci) against the strain WS1 was approximately 0.006 microgram of protein/ml, whereas the ED50 against the parental strain (FA 102) was approximately 0.4 microgram of protein/ml . Accordingly, alterations in lipopolysaccharide structure apparently caused a 66-fold decrease in gonococcal resistance to granule proteins . Our data suggest that gonococcal resistance to oxygen-independent antimicrobial systems of human PMNs may, in part, depend on the availability of certain lipopolysaccharide domains involved in recognition of the antimicrobial granule proteins described in this report.

J Infect Dis, 1986 May, 153(5), 888 - 92
Potential value of rectal-screening cultures for Chlamydia trachomatis in homosexual men; Rompalo AM et al.; We compared the potential value of rectal-screening cultures for Chlamydia trachomatis and Neisseria gonorrhoeae among homosexual men attending a sexually transmitted disease clinic and also assessed the relation of either infection to patient age, symptoms, history of previous infection, and likelihood of early treatment . Of 1,429 homosexual men cultured over a six-month period, 118 (8%) had gonococcal rectal infection, 72 (5%) had chlamydial rectal infection, and 15 (1%) had both . The prevalence of rectal chlamydial infection was strongly related to age, with the highest occurrence in adolescents . C . trachomatis was isolated more often from men infected with N . gonorrhoeae (11%) than from men not infected with N . gonorrhoeae (5%; P = .01), and simultaneous urethral infection in patients with positive rectal cultures occurred more frequently in men infected with N . gonorrhoeae than in men infected with C . trachomatis (27% vs . 14%, respectively; P = .05) . The majority of rectal infections with N . gonorrhoeae and C . trachomatis in this population were asymptomatic . Although 80% of the patients who had rectal infection with N . gonorrhoeae were appropriately treated on the initial clinic visit, only 18% of those with rectal chlamydial infections received proper treatment (P less than .0001) . The yield of patients who were newly identified and brought to treatment was 4.8 patients per 100 screening cultures for C . trachomatis vs . 1.9 patients per 100 screening cultures for N . gonorrhoeae.

J Infect Dis, 1986 May, 153(5), 862 - 9
Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis; Fransen L et al.; Among 149 consecutive infants with ophthalmia neonatorum in Nairobi, Neisseria gonorrhoeae was recovered from 43%, Chlamydia trachomatis from 13%, and both microorganisms from 4% . Three of five isolates of C . trachomatis belonged to trachoma serovars . The sensitivity and specificity of a gram-stained smear for the diagnosis of gonococcal conjunctivitis were 86% and 90%, respectively . Patients with gonococcal conjunctivitis had more purulent discharge, a higher clinical severity score, and a younger age at onset of disease . Corneal epithelial edema with superficial keratitis was present in four (16%) of 25 patients with gonococcal conjunctivitis but in none of 22 other patients (P = .07) . N . gonorrhoeae or C . trachomatis was isolated from the pharynx in 11 (15%) and six (23%) cases, respectively . Oropharyngeal gonococcal infection was associated with coughing (P = .007).

Infect Immun, 1986 May, 52(2), 600 - 8
Arthropathic properties of gonococcal peptidoglycan fragments: implications for the pathogenesis of disseminated gonococcal disease; Fleming TJ et al.; We examined the arthropathic activity of purified peptidoglycan (PG) fragments derived from (i) lysozyme-resistant, extensively O-acetylated PG from Neisseria gonorrhoeae FA19 (O-PG), and (ii) lysozyme-sensitive, O-acetyl-deficient PG from N . gonorrhoeae RD5 (non-O-PG) . Male Lewis rats were injected intradermally in the tail with 200 micrograms of PG emulsified in mineral oil and water (1:1) or with the oil and water emulsion alone (controls) . Quantitation of hind paw size indicated that macromolecular PG of various chemical and physical forms induced paw swelling (P versus controls, less than 0.01) that was evident at about day 14 and that reached a maximum at about day 24 . PG-mediated paw swelling was accompanied by intense synovitis with some cartilage and bone involvement . The minimal arthropathic dose of soluble macromolecular PG was 20 micrograms per rat . Of particular interest was that macromolecular O-PGs from strain FA19 caused considerably more extensive swelling than did either their RD5 non-O-PG counterparts or the homologous FA19 PG that had been de-O-acetylated by mild alkali treatment . This suggested that the persistence of hydrolase-resistant high-molecular-weight fragments, afforded by extensive O-acetylation, may be important for optimal expression of arthropathic activity . However, oligomeric PG was not an absolute requirement, since even low-molecular-weight fragments, including the anhydro-muramyl-containing disaccharide peptide monomer released by growing gonococci, were also arthritogenic . Experiments employing purified gonococcal lipopolysaccharide indicated that the arthropathic activity of PG preparations was not due to contaminating lipopolysaccharide . Based on the arthritogenicity of gonococcal PG in this model system, we suggest that PG may play a role in the pathogenesis of gonococcal arthritis, and that such an activity might be potentiated by the persistence of hydrolase-resistant O-PG.

Obstet Gynecol, 1986 May, 67(5), 657 - 62
Treatment of acute pelvic inflammatory disease with aztreonam, a new monocyclic beta-lactam antibiotic, and clindamycin; Dodson MG et al.; Forty-two patients with acute pelvic inflammatory disease were treated using aztreonam, a monobactam, and clindamycin . Sixty-four percent of protocol patients were culture positive for Neisseria gonorrhoeae, and 26% had positive endometrial cultures for other organisms . Fifty-one percent of patients had ultrasound findings consistent with a pelvic abscess . One patient with a tuboovarian abscess palpable to the umbilicus became afebrile and improved on treatment, but ultimately was treated surgically . All other protocol patients responded rapidly to the aztreonam-clindamycin regime, giving a 97.7% cure rate.

Infect Immun, 1986 May, 52(2), 384 - 9
Neisseria gonorrhoeae survive intraleukocytic oxygen-independent antimicrobial capacities of anaerobic and aerobic granulocytes in the presence of pyocin lethal for extracellular gonococci; Casey SG et al.; The resistance of a piliated, transparent variant of Neisseria gonorrhoeae FA19 to intraleukocytic killing by human polymorphonuclear neutrophils (PMN) was examined . In both aerobic and anaerobic PMN monolayers, approximately 2% of the intracellular gonococci survived for as long as 165 min . Anaerobic PMN were as effective as aerobic PMN in the intracellular killing of gonococci . Hence, O2-independent antimicrobial systems of PMN performed a significant role in the intraleukocytic killing of gonococci were intracellular was supported by the elimination of extracellular bacteria by the addition of pyocin 103 and confirmed by the fluorescent antibody staining of intact gonococci after the PMN were permeabilized to antibody with a Formalin-acetone treatment of PMN monolayers . Our data indicate that while the majority of ingested gonococci are killed by O2-independent antimicrobial systems, a small number (about 2%), survive even when care is taken to eliminate extracellular bacteria.

JAMA, 1986 Apr 18, 255(15), 2062 - 4
The occurrence of chlamydial and gonococcal salpingitis during the menstrual cycle; Sweet RL et al.; We evaluated 104 women hospitalized with a diagnosis of acute salpingitis to compare the relationship between the menstrual cycle and onset of acute chlamydial and/or gonococcal salpingitis and acute salpingitis associated with other facultative aerobic and anaerobic bacteria . Neisseria gonorrhoeae was recovered from 42 women (40%), Chlamydia trachomatis from 28 (27%), and nongonococcal, nonchlamydial organisms only from the upper genital tract in 48 (46%) . Among 37 cases with symptoms of acute salpingitis within seven days of onset of menses, 30 (81%) had chlamydial and/or gonococcal infection . Of 35 cases with onset after 14 days postmenses, 23 (66%) had nongonococcal, nonchlamydial organisms only . Of the 28 women with chlamydial infection, 17 (57%) had the onset of disease within one week from the first day of their last menstrual period . Similarly, 23 (55%) of gonococcal infections had onset of symptoms within one week from onset of menses . However, only seven (14%) of the women with nongonococcal, nonchlamydial salpingitis reported onset of symptoms within one week . The temporal pattern of onset of chlamydial or gonococcal acute salpingitis showed significant differences when compared with the time of onset for nongonococcal, nonchlamydial acute salpingitis.

Am J Obstet Gynecol, 1986 Apr, 154(4), 855 - 64
Focal vulvitis: a characteristic syndrome and cause of dyspareunia . Features, natural history, and management; Peckham BM et al.; Based on the study of 67 affected women during a period of 15 years, we report the clinical features and natural history of focal vulvitis, a unique syndrome characterized by severe and persistent superficial dyspareunia and the presence of one to 11 (median three) minute, exquisitely tender areas of focal inflammation or ulceration on the mucosa of the vestibule . Three fourths of all lesions occur around the Bartholin gland ducts or between them posteriorly . Histopathologic study of tissues from seven patients has not shown a characteristic pattern of inflammation and fails to confirm a reported association between these lesions and the minor vestibular glands . These histologic studies and an in-depth clinical and epidemiologic investigation in nine patients, including microbiologic studies to identify infection by herpes simplex virus . Neisseria gonorrhoeae, Staphylococcus aureus, beta-hemolytic streptococci, Chlamydia trachomatis, mycoplasmas, Candida sp., trichomonads, or Mycobacterium sp., have not established an infectious etiology for this syndrome or evidence that it represents an unusual form of an autoimmune disease or Behcet's syndrome . Treatment with topical antimicrobial or corticosteroid creams, antibiotics given systemically, or cryotherapy has not been of demonstrable benefit . Approximately one half of patients eventually experience spontaneous remission but many appear to remain symptomatic indefinitely . Surgical excision of the hymenal ring and contiguous mucosa of the vestibule has brought relief and permitted resumption of sexual activity in seven of eight treated patients . While promising, operation should be reserved for patients who have experienced unremitting dyspareunia associated with the characteristic focal inflammatory lesions for at least 6 months.

Acta Pathol Microbiol Immunol Scand {B}, 1986 Apr, 94(2), 89 - 95
Branhamella catarrhalis: significance in pulmonary infections and bacteriological features; Christensen JJ et al.; A three-month survey revealed 29 patients at our hospital with symptoms of acute pulmonary infection, from whom Branhamella catarrhalis was isolated from lower respiratory tract specimens, in 18 cases in pure culture . Approximately 2% of all respiratory tract specimens examined during the period yielded growth of B . catarrhalis . All except one patient suffered from chronic pulmonary disease, notably chronic bronchitis . A phenotypic comparison was made between 55 strains of B . catarrhalis, of which 50 were recent isolates from lower respiratory tract specimens, and 23 Neisseria strains representing Neisseria meningitidis, Neisseria gonorrhoeae, Neisseria cinerea, Neisseria flavescens, Neisseria mucosa, Neisseria pharyngis, and Neisseria lactamica . The morphology of B . catarrhalis colonies is very characteristic, and when the diagnosis is suspected, testing for the ability to hydrolyze tributyrin may confirm it within hours . Ability to produce deoxyribonuclease is another property which differentiates B . catarrhalis from the Neisseria species . Otherwise, the combination of nitrate reduction and failure to produce acid from glucose, maltose, and sucrose establishes the diagnosis.

Genitourin Med, 1986 Apr, 62(2), 88 - 92
Prevalence of Chlamydia trachomatis and other micro-organisms in women seeking abortions in Pittsburgh, Pennsylvania, United States of America; Amortegul AJ et al.; The prevalence of Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, group B streptococcus, herpes simplex virus, and Neisseria gonorrhoeae from cervical cultures obtained from 210 women seeking abortion in Pittsburgh, Pennsylvania, United States of America was 9.3%, 72.9%, 25.2%, 4.3%, 0.9%, and 0.9% respectively . Cultures from 40/203 (19.7%) patients failed to produce any of these organisms . C trachomatis isolation was not associated with age, race, marital status, average family income, number of sexual partners, history of gonorrhoea or syphilis, or previous pregnancies, live births, or abortions, and 82.4% of women with chlamydial infections had had no urogenital symptoms in the preceding six months . The highest concentration of U urealyticum was 10(5) colour changing units (ccu)/ml, and about half of the positive ureaplasma cultures produced less than 10(3) ccu/ml of this organism . Screening for C trachomatis, is encouraged to prevent neonatal morbidity and the common complication of pelvic inflammatory disease after abortion.

Genitourin Med, 1986 Apr, 62(2), 82 - 5
Three regimens of procaine penicillin G, Augmentin, and probenecid compared for treating acute gonorrhoea in men; Lim KB et al.; The efficacy of three penicillin regimens in treating uncomplicated gonorrhoea in men was evaluated . The regimens consisted of: Augmentin 3.25 g plus probenecid 1 g orally: aqueous procaine penicillin G 4.5 MIU intramuscularly and probenecid 1 g plus one tablet of Augmentin 375 mg orally; or aqueous procaine penicillin G 4.5 MIU intramuscularly and probenecid 1 g plus two tablets of Augmentin 375 mg orally . Cure rates for infections caused by penicillinase (beta lactamase) producing Neisseria gonorrhoeae (PPNG) were 87% (20/23) for regimen 1, 97% (28/29) for regimen 2, and 95% (19/20) for regimen 3 . Thus the addition of one or two tablets of Augmentin 375 mg to aqueous procaine penicillin G and probenecid cured 96% (47/49) of infections caused by PPNG strains . All three regimens were 100% effective in eradicating infections caused by non-PPNG strains . Post gonococcal urethritis occurred in 24% of cases treated with regimen 1, 14% of cases treated with regimen 2, and 15% of cases treated with regimen 3 . The geometric minimum inhibitory concentrations (MIC90) of Augmentin for 72 PPNG and 162 non-PPNG isolates of N gonorrhoeae obtained before treatment were 1.98 and 0.55 mg/l, respectively . Regimen 2, besides being effective against infections caused by PPNG or non-PPNG strains, has the advantage of cost effectiveness and low toxicity . This regimen may be useful in treating gonorrhoea in areas of high prevalence of PPNG strains, such as South East Asia and Africa.

Genitourin Med, 1986 Apr, 62(2), 78 - 81
Randomised observer blind comparative trial of ceftriaxone and penicillin in treating uncomplicated gonorrhoea in men and women; Dixon CA et al.; Ceftriaxone is a third generation cephalosporin with a prolonged half life . It was used in doses of 500 mg intramuscularly in 27 men (group 1) and 23 women (group 2) and 250 mg in 48 men (group 3) and 45 women (group 4) with uncomplicated urogenital gonorrhoea . Similar numbers of patients in each group were treated with 2 MIU intramuscular Bicillin (procaine penicillin 1.5 g plus benzylpenicillin 300 mg (Brocades, Weybridge, Surrey, England) . Success of treatment was measured as one or two negative cultures after three or more days . The success rate for ceftriaxone was 100% in 19 evaluable men and 19 women treated with 500 mg and in 38 men and 31 women treated with 250 mg, including one infection due to penicillinase producing Neisseria gonorrhoeae (PPNG) . Success rates for Bicillin were 90% (19/21) evaluable patients cured in group 1, 100% (19/19) in group 2, 95% (37/39) in group 3, and 92% (33/36) in group 4 . Both drugs were well tolerated . Each isolate of N gonorrhoeae isolated was sensitive to 0.05 mg/l or less of ceftriaxone.

Zh Mikrobiol Epidemiol Immunobiol, 1986 Apr, (4), 37 - 40
{Modelling of an association of Chlamydia trachomatis and Neisseria gonorrhoeae in in ovo experiments}; Shcherbakova NI et al.; In experiments in ovo mixed chlamydial and gonococcal infection has been obtained by the successive infection of developing chick embryos with C . trachomatis and N . gonorrhoeae into the yolk sack . The competitive interrelations between the associated microorganisms with respect to their pathogenicity characteristics for chick embryos have not been established . This simulator is intended for use in the primary selection of etiotropic chemical preparations capable of producing combined effect on C . trachomatis and N . gonorrhoeae.

Sex Transm Dis, 1986 Apr-Jun, 13(2), 71 - 5
Approximate molecular weight of envelope protein 1 and colony opacity of Neisseria gonorrhoeae strains isolated from patients with disseminated or localized infection; Martin D et al.; The patterns of electrophoretic (SDS-PAGE) migration of the major outer membrane protein I of 35 strains of Neisseria gonorrhoeae causing disseminated gonococcal infections (DGI) were compared, and the proportion of colonies expressing the transparent phenotype on a solid medium was determined . Thirty-one of these DGI strains had a protein I of very similar apparent molecular weight (approximately 36,000 daltons), and at least 75% of their colonies on a translucid medium expressed the transparent phenotype . Strains responsible for localized infections and isolated from patients in the same geographic area (Montreal) showed a greater heterogeneity in both apparent molecular weight of protein I and colonial opacity than did strains from patients with DGI . In particular, most prototrophic strains obtained from patients with localized infection had proteins I with molecular weights varying from 35,000 to 38,000 daltons and gave predominantly opaque colonies.

Sex Transm Dis, 1986 Apr-Jun, 13(2), 108 - 10
Comparison of Thayer-Martin, Transgrow, and Gonozyme for detection of Neisseria gonorrhoeae in a low-risk population; Martin R et al.; The Gonozyme test (Abbott Laboratories, North Chicago, IL) an enzyme-linked immunosorbent assay procedure, on-site Thayer-Martin cultures, and Transgrow cultures were compared for sensitivity and specificity in detecting gonorrhea . For these comparisons triplicate genital swab specimens were obtained from women for the diagnosis of infection with Neisseria gonorrhoeae . Both the Transgrow and the Gonozyme specimens were mailed to a public health laboratory . The population under study was considered to be low-risk . When sensitivity and specificity were calculated on the basis of results of Thayer-Martin cultures, Transgrow had a sensitivity of 57% and a specificity of 100% . Gonozyme had a sensitivity of 80% and a specificity of 99% . In a low-risk population, the predictive value of a positive Transgrow culture was 100%, whereas the predictive value of a positive Gonozyme test was 57% . The predictive value of a negative Transgrow result was 99.7%, and that of a negative Gonozyme test was 99.8% . It is concluded that the use of the Gonozyme procedure for screening of low-risk populations needs further evaluation.

Antimicrob Agents Chemother, 1986 Apr, 29(4), 687 - 95
Vancomycin hypersusceptibility in Neisseria gonorrhoeae isolated from patients involves diverse mutations; Koelbl JA et al.; We investigated the genetic determinants of hypersusceptibility to vancomycin and erythromycin found in Neisseria gonorrhoeae strains isolated from patients . In terms of resistance (highest concentration of antibiotic permitting growth), the levels of vancomycin resistance of six strains ranged from 0.2 to 1.0 microgram/ml, and the level of erythromycin resistance of these strains was 0.02 or 0.05 micrograms/ml . DNA from these strains was used to introduce their hypersusceptibility determinants into partially isogenic derivatives of N . gonorrhoeae 89 which initially had wild-type levels of resistance to vancomycin (greater than or equal to 3.0 micrograms/ml) and erythromycin (greater than or equal to 0.1 microgram/ml) . The recombination frequencies found in reciprocal transformation tests of six isogenic strains indicated that the mutations responsible for vancomycin hypersusceptibility were located at different sites . The transformants selected for increased resistance to vancomycin were also resistant to erythromycin . This evidence, together with DNA concentration-response curves, indicated that the mutations affected either one gene locus or closely linked loci . The recombination indices obtained in crosses between our hypersusceptible strains and DNAs from reference strains carrying the envelope mutations env-1, env-2, env-3, and env-10 showed that the mutation (designated env-12) responsible for erythromycin hypersusceptibility in one strain (89-954) was located in close proximity to env-2 . The determinant of vancomycin hypersusceptibility in strain 89-954 was distinct from env-12, but the two were linked . In the other five isogenic strains, the hypersusceptibilities to both vancomycin and erythromycin could be annulled by spontaneous mutations in a locus provisionally designated vel because of its likely effects on the envelope . Vel+ mutants obtained by selection with either vancomycin alone or erythromycin alone gained increased resistance to both antibiotics.

South Med J, 1986 Apr, 79(4), 420 - 3
Outbreak of penicillinase-producing Neisseria gonorrhoeae with an African connection; Greaves WL et al.; Previous outbreaks of penicillinase-producing gonococcal infection in the United States have generally been attributed to importation of Southeast Asian strains . During July 1982 through July 1983, 110 cases of gonorrhea caused by penicillinase-producing strains were reported in metropolitan Atlanta, Georgia . Among the 53 infected women, 14 (26%) had pelvic inflammatory disease (PID) . Compared to other infected women, those with PID experienced a greater delay from the time of last sexual exposure (19.1 vs 8.1 days) to receipt of appropriate antibiotic therapy (P less than .01) . At least 22 prostitutes were involved in the outbreak . Sixteen (76%) of 21 isolates tested were serogroup 1A; 15 required arginine and proline for growth; and 17 (81%) possessed a 3.2 megadalton plasmid . Our data suggest that this outbreak was associated with both African and Southeast Asian strains.

Pediatrics, 1986 Apr, 77(4), 488 - 94
Sexually transmissible infectious agents in sexually active and virginal asymptomatic adolescent girls; Bump RC et al.; Sixty-eight sexually active and 52 virginal adolescent girls were evaluated for six sexually transmissible infectious agents: Gardnerella vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Chlamydia trachomatis, Trichomonas vaginalis, and Neisseria gonorrhoeae . There were significant differences between sexually active and virginal girls with respect to the prevalence of isolation of U urealyticum (75% v 33%, P less than .005), M hominis (27% v 10%, P less than .05), and C trachomatis (19% v 2%, P less than .025) but not for G vaginalis (34% v 17%, P = .09) . N gonorrhoeae and T vaginalis were isolated exclusively from sexually active girls, but their low prevalence (6% and 9%, respectively) made the difference statistically insignificant (P = .2 and .06, respectively) . Race, current v previous sexual activity, multiple sexual partners, oral contraceptive use, and concurrent isolation of another organism did not identify those at increased risk for chlamydial isolation . Such girls were significantly more likely to have inflammatory Papanicolaou smears (36% v 10%, P less than .05) and excessive WBC in their vaginal secretions (50% v 19%, P = .05) . The data support the contention that C trachomatis, N gonorrhoeae, and T vaginalis are organisms that are predominantly acquired via sexual routes . Significant nonsexual modes of transmission are supported by the data for the genital mycoplasmas and G vaginalis . Finally, a history of sexual activity in an adolescent female warrants specific diagnostic testing for Chlamydia.

Sex Transm Dis, 1986 Apr-Jun, 13(2), 105 - 7
Prevalence of genital pathogens among female prostitutes in New York City and in Rotterdam; Nayyar KC et al.; The authors studied the prevalence of genital microorganisms among 300 female prostitutes in brothels in New York City and 60 female prostitutes attending a sexually transmitted diseases clinic in Rotterdam, The Netherlands . Rates of isolation of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum in the two cities were 9.3% and 8.3%, 25.3% and 16.6%, 57.3% and 74.9%, and 73% and 79%, respectively . Trichomonas vaginalis was detected in 3.6% of New York prostitutes and in 16.6% of those in Rotterdam . Nonspecific vaginitis was found in 33% of prostitutes examined in New York . In New York, Asian prostitutes were more likely to be infected with C . trachomatis (33 of 102; 32.3%) than were prostitutes of other ethnic backgrounds (44 of 194; 21.5%; P less than .05.

Genitourin Med, 1986 Apr, 62(2), 86 - 7
Ciprofloxacin for treating urethral gonorrhoea in men; Shahmanesh M et al.; The effectiveness of a single oral dose of ciprofloxacin in eradicating urethral gonorrhoea was assessed in 18 men who received 250 mg and 26 men who were given 100 mg . All patients, including two infected with beta lactamase (penicillinase) producing strains of Neisseria gonorrhoeae (PPNG), were cured . The drug had no effect on infection with Chlamydia trachomatis or on the incidence of post gonococcal urethritis . Ciprofloxacin may be useful in patients hypersensitive to penicillins and cephalosporins, and the drug may also be useful in urethral gonorrhoea caused by PPNG strains.

Sex Transm Dis, 1986 Apr-Jun, 13(2), 97 - 101
Anorectal gonorrhea in women . Is it more difficult to cure?
Davidson AJ, Judson FN.
It is unclear whether anorectal gonorrhea in women is more difficult to cure than endocervical gonorrhea or whether anorectal test-of-cure cultures are always indicated . Using endocervical and anorectal test-of-cure cultures, the authors evaluated 1,124 women treated for culture-positive endocervical gonorrhea with a recommended regimen of ampicillin (n = 868), procaine penicillin G (n = 78), spectinomycin (n = 45), or tetracycline (n = 133) . There were 35 failures (3.1%) among women with anogenital gonorrhea, including 11 (1.0%) among those with anorectal infection . Only eight failures (0.7%) were detected by anorectal culture alone . Although anorectal isolates of Neisseria gonorrhoeae obtained before treatment from women were significantly (P less than .05) less susceptible to tetracycline than were endocervical isolates (geometric mean MIC, 0.35 micrograms/ml vs . 0.21 micrograms/ml), there were no failures of treatment of anorectal infection when tetracycline was used . The authors conclude that anorectal infection in women is not more difficult to treat than endocervical infection . Because of the very high cost-per-case ratio, anorectal test-of-cure cultures in women should be accorded a low priority in a gonorrhea control program.

Proc Natl Acad Sci U S A, 1986 Apr, 83(7), 2177 - 81
Antigenic variation of gonococcal pilus involves assembly of separated silent gene segments; Segal E et al.; The pilus is a major outer-membrane protein of Neisseria gonorrhoeae that undergoes phase and antigenic variation . In strain MS11 pilus expression is regulated at two expression loci on the chromosome, pilE1 and pilE2, although many other regions contain silent pilin information . A comparison of variant pilin sequences has revealed that the gene can be divided into a constant, a semivariable, and a hypervariable region . We report here that complete pilin genes are found only at the expression loci . Silent constant and variable region pilin gene segments are located on separate and distinct restriction fragments, and the generation of a complete pilin gene within the expression loci is the result of multiple recombination events . Conserved sequences within and flanking the pilin gene are proposed to act as recombination sites during the gene conversion events needed to produce a functional pilin gene.

Mol Immunol, 1986 Apr, 23(4), 385 - 91
A molecular model of artificial glycoprotein with predetermined multiple immunodeterminants for gram-positive and gram-negative encapsulated bacteria; Porro M et al.; An artificial molecule was synthesized by covalently linking the oligosaccharide haptens derived frm Streptococcus pneumoniae type 6A and Neisseria meningitidis group C capsular polysaccharides to the non-toxic mutant protein CRM197, serologically related to diphtheria toxin . Immunochemical analysis using polyclonal and monoclonal antibodies showed in the glycoprotein the presence of specific immunodeterminants of the native polysaccharides and of the carrier protein . The immunological activity of this hybrid molecule tested in two animal models gave evidence for anamnestic induction of serum antibodies specifically directed to the three distinct native molecules . They neutralized the toxicity of diphtheria toxin, recognized the polysaccharide capsule of S . pneumoniae type 6A and 6B (group 6) strain and killed the N . meningitidis group C bacteria by complement-mediated bacterial lysis . These findings support the possibility of using in humans a multivalent antigen with immunogenic activity for several epidemiologically significant Gram-positive and Gram-negative encapsulated bacterial strains.

Nucleic Acids Res, 1986 Mar 11, 14(5), 1991 - 9
Two unique restriction endonucleases from Neisseria lactamica; Qiang BQ et al.; Two new site-specific endonucleases, N1a III and N1a IV, have been isolated from Neisseria lactamica . N1a III recognizes the sequence, CATG, and cleaves 3' of the sequence to produce a four base 3' extension . N1a IV recognizes the sequence, GGNNCC, and cleaves between the two N's to produce blunt ended fragments.

Minerva Med, 1986 Mar 10, 77(9-10), 283 - 7
{Sexually transmitted infections in patients with condylomata acuminata}; Lodi A et al.; 42 patients (26 males, 16 females) with genital and perianal warts were submitted to serological testing for HBV markers, anti HSV antibodies and syphilis . Specimens were also collected for microscopic and cultural examination for Neisseria gonorrhoeae, Chlamydia Trachomatis, Trichomonas vaginalis, Candida albicans and other pathogenic bacteria from urethra in men and from urethra, vagina and cervix in women . Women had also cytologic examination from cervix with Papanicolau method . We have found an high incidence of urethral and vaginal asymptomatic infections, of positivity for HBV markers and some positivities of tests for syphilis . Importance of these screening examinations in the management of patients with genital warts is then discussed.

J Clin Microbiol, 1986 Mar, 23(3), 452 - 5
Simplified lysed-blood culture technique; Zierdt CH; A blood culture system was developed in which a lysing agent (either Tween 20, one of several other polyoxyethylene adducts, digitonin, or Triton X-100) is added to the blood culture medium . Of 33 Triton compounds, 9 lysed human blood, as did 7 of 21 polyoxyethylene compounds and digitonin, all at a concentration of 0.05% . Under the specific test conditions, three of the hemolytic polyoxyethylene compounds and digitonin had no inhibitory effect . All of the Triton compounds had at least some inhibitory effect on the most sensitive of the pathogenic bacteria that were tested, Streptococcus pneumoniae and Neisseria meningitidis . Because of results from previous studies, Triton X-100 was tested further, despite evidence in this study of its inhibition of bacteria . Of the 55 lysing agents tested, digitonin, Triton X-100, Brij 96, and Tween 20 were selected for further testing as additions to conventional culture broth . Comparative culture studies with bacteremic blood from infected rabbits were performed with the conventional blood culture, the Isolator system (Du Pont Co., Wilmington, Del.), and the new lysing medium . The new system has the advantages of lysis filtration and lysis centrifugation without the associated added cost and processing complexity.

J Clin Microbiol, 1986 Mar, 23(3), 425 - 30
Detection by gas chromatography of 3-deoxy-D-manno-2-octulosonic acid and L-glycero-D-manno-heptose in whole cells of Neisseria elongata; Guerrant GO et al.; Lipopolysaccharide components 3-deoxy-D-manno-2-octulosonic acid and L-glycero-D-manno-heptose were detected in hydrolysates from whole cells of Neisseria elongata by gas-liquid chromatography . Cells from a single plate were hydrolyzed, and carbohydrate components were converted to aldononitrile and O-methyloxime acetate derivatives for subsequent analyses by gas-liquid chromatography . 3-Deoxy-D-manno-2-octulosonic acid was well separated from other cell components as the O-methyloxime acetate derivative . With both derivatives, L-glycero-D-manno-heptose was readily identified by their different retention times . The procedure requires only a relatively small number of cells, and detection is accomplished without prior isolation of the lipopolysaccharide.

Eur J Epidemiol, 1986 Mar, 2(1), 48 - 51
Penicillinase producing Neisseria gonorrhoeae in the United Kingdom; Shahmanesh M et al.; Following the isolation of the first penicillinase-producing gonococcus in 1976 the number of such isolates rose rapidly in the United Kingdom until 1982 . There was a smaller increase in 1983 . At St . Thomas' Hospital, the largest clinic serving the population of South London, there was a parallel rise with stabilisation from 1982 to 1984 . While for some years relatively more infections diagnosed at St Thomas' Hospital appeared to originate abroad than in the country as a whole, this proportion has gradually declined to approximately the national figure . With a gradual decline in the total numbers of gonococcal infections in the United Kingdom the proportion of infections by PPNG has continued to rise . It is important to monitor this closely, to review therapy recommendations where indicated and to maintain a vigilant watch for local epidemics.

Am J Clin Pathol, 1986 Mar, 85(3), 357 - 9
Quality control testing of anti-sera with glutaraldehyde-treated antigens; Charsha-May DE et al.; Glutaraldehyde-treated bacterial cells were used as the quality control organisms in agglutination and fluorescent antibody tests for group A Streptococcus; Salmonella groups A, B, and D; Shigella groups B, C, and D; and Neisseria gonorrhoeae . The antigen preparations were serologically reactive over a period of five months.

Zh Mikrobiol Epidemiol Immunobiol, 1986 Mar, (3), 28 - 30
{Use of an experimental model of mixed chlamydial-gonococcal infection in ovo for evaluating the etiotropic action of chemopreparations}; Nurusheva SM et al.; The detection of the differentiated chemotherapeutic activity of tetracyclin and penicillin has been used as an example for demonstrating the possibility of using the experimental in ovo model of mixed chlamydial and gonococcal infection for the detection and primary selection of effective etiotropic preparations, simultaneously affecting Chlamydia trachomatis and Neisseria gonorrhoeae.

Diagn Microbiol Infect Dis, 1986 Mar, 4(3 Suppl), 93S - 99S
Diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis infections using antigen detection methods; Stamm WE; Rapid antigen detection methods have great potential value in managing sexually transmitted gonococcal and chlamydial infections . Ideally, such tests should be rapid, technically simple, inexpensive, accurate, and applicable to all sites of infection commonly sampled (cervix, urethra, pharynx) . For gonorrhea, the Gram stain fulfills these criteria in men with symptomatic urethritis, but lacks sensitivity when used at other sites or in asymptomatic patients . Antigen detection for gonorrhea would thus be of greatest value in 1) the diagnosis of gonococcal cervical infections in women with mucopurulent cervicitis or pelvic inflammatory disease, 2) the diagnosis of gonococcal proctitis in homosexual men, and 3) in situations requiring lengthy specimen transport . Because culture confirmation of Chlamydia trachomatis infections is not widely available, antigen detection tests could be of great value in management of these infections . Major uses include 1) confirming infection in women with cervicitis, endometritis, and pelvic inflammatory disease; 2) screening for asymptomatic infections in high risk groups of women; and 3) confirmation of Chlamydia trachomatis infections in infants and in adult males . The currently available methods for diagnosis of gonococcal and chlamydial infection by antigen detection are reviewed herein . Continued experience with antigen detection tests in well defined populations having high and low risk of gonococcal and chlamydial infection is needed to more fully determine how best to utilize these assays.

S Afr Med J, 1986 Mar 1, 69(5), 307 - 8
Beta-lactamase-producing isolates of Neisseria gonorrhoeae in Cape Town; Simpson JA et al.; Isolates of Neisseria gonorrhoeae from patients attending the sexually transmitted disease clinics of the Cape Town Municipal Health Department were examined for beta-lactamase (penicillinase) production by a chromogenic cephalosporin test . Of the 208 isolates, 4 (less than 2%) produced beta-lactamase . When grown on chocolate blood agar plates 3 isolates showed no inhibition of growth around a penicillin disc; the 4th had a markedly reduced zone of inhibition . The minimum inhibitory concentrations of penicillin for these 4 strains were from 1 to 4 micrograms/ml.

J Infect Dis, 1986 Mar, 153(3), 520 - 6
Bactericidal antibody response of normal human serum to the lipooligosaccharide of Neisseria gonorrhoeae; Apicella MA et al.; Human antibody to lipooligosaccharide (LOS) from pooled normal human serum (NHS) and human immunne serum globulin (HISG) was isolated by affinity chromatography from a Sepharose column to which Escherichia coli strain J-5 LOS had been conjugated . Fractionated antibody was tested for bactericidal activity against serum-resistant Neisseria gonorrhoeae strains JW31, WR220, or 838 or serum-sensitive strains JW31R or 1074 . By enzyme-linked immunosorbent assay the eluate of antibody to LOS contained IgM, IgA, and IgG antibodies to both JW31 and JW31R LOS . The IgM fraction from NHS was bactericidal at 30 min for strains JW31R and 1074 but failed to kill strains JW31 and 838 . An IgG fraction from HISG was bactericidal for strains JW31 and WR220 yet failed to kill strain JW31R . The IgA fraction from NHS did not kill either strain JW31 or JW31R . Blocking experiments indicated that IgA or IgG failed to prevent IgM-mediated killing of strain JW31R, whereas IgA blocked the IgG-mediated killing of strain JW31.

Clin Pediatr (Phila), 1986 Mar, 25(3), 160 - 3
Neisseria gonorrhoeae in asymptomatic prepubertal household contacts of children with gonococcal infection; Nair P et al.; This report describes the occurrence of gonococcal infection among prepubertal household contacts of children younger than 12 years of age . The records of 14 index cases (12 females and 2 males) reported during the period January 1979 and June 1983 were reviewed . Among 31 asymptomatic contacts of 10 index cases, nine (29%) had positive cultures (5 females and 4 males) . Three were siblings of the index cases, and six were other children in the index households . The predominant site of positive cultures was the throat (7/9).This high recovery rate of gonococci among young asymptomatic household contacts makes clear the need for aggressive surveillance of prepubertal household contacts of children with gonococcal infection, and the importance of culturing all three sites, e.g., vagina/urethra, rectum, and throat.

J Gen Microbiol, 1986 Mar, 132 ( Pt 3), 641 - 52
Multilocus genotypes determined by enzyme electrophoresis of Neisseria meningitidis isolated from patients with systemic disease and from healthy carriers; Caugant DA et al.; Variation in nine enzymes in 152 isolates of Neisseria meningitidis from Norway (118 from blood or cerebrospinal fluid of patients with systemic disease and 34 from the pharynx of healthy carriers) was analysed by starch-gel electrophoresis . All nine enzymes were polymorphic and the number of allozymes (electromorphs) identified per locus ranged from 3 to 12, with a mean of 6.1 . Among the 152 isolates, 55 unique combinations of electromorphs (electrophoretic types, ETs) were distinguished . Twenty ETs were represented among the carrier isolates and 37 among the systemic isolates; hence, only two ETs were found in both groups of isolates . ET-5 was identified 67 times among the 118 systemic isolates (58%), indicating an association of this ET with invasiveness; ET-5 was also the most common type among the carrier isolates (18%) . Genetic similarity between ETs was analysed by pairwise comparison of all 55 ETs with respect to the number of electromorphs by which they differed . No evidence of a general genetic difference between carrier and case isolates was found . Two well-defined clusters of ETs were observed, each including one of the two most common ETs identified among the systemic isolates (ET-5 and ET-37), together with isolates differing from them only at one or two loci . All isolates of ET-5 and ET-37, as well as their closely related variants defined by the similarity matrix, were resistant to sulphonamide, independent of their antigenic characteristics and isolation site . The extensive allozyme variation among isolates of the same serogroup demonstrated the limited value of serogrouping as an epidemiological tool . All but one isolate of serotype 15:P1.16 were electrophoretically similar, as were all the 2a:P1.2 isolates . The 15:P1.15 isolates, however, were genetically heterogeneous . The distribution of alleles in genotypes identified among the systemic isolates indicated that genetic recombination may occur in natural populations of N . meningitidis.

Med Lett Drugs Ther, 1986 Feb 28, 28(708), 23 - 8
Treatment of sexually transmitted diseases; Superoxide dismutase and oxygen toxicity defenses in the genus Neisseria; Among aerotolerant cells, Neisseria gonorrhoeae is very unusual because despite its obligately aerobic lifestyle and frequent isolation from purulent exudates containing polymorphonuclear leukocytes vigorously evolving O2- and H2O2, it contains no superoxide dismutase (SOD) . Strains (14) of N . gonorrhoeae were compared with each other and with strains of Neisseria meningitidis, Neisseria mucosa, and Neisseria subflava under identical growth conditions for their contents of the oxy-protective enzymes catalase, peroxidase, and SOD, as well as respiratory chain proteins and activity . The absence of SOD from N . gonorrhoeae strains was demonstrated under a variety of oxygen-stress conditions . The neisserial species showed very different SOD, catalase, and peroxidase profiles . These profiles correlated well with the tolerance of the species to various intra- and extracellular oxygen insults . The high tolerance of N . gonorrhoeae for extracellular O2- and H2O2 appeared to be due to very high constitutive levels of peroxidase and catalase activity combined with a cell envelope impervious to O2- . Nevertheless, N . gonorrhoeae 19424 was much more sensitive to an intracellular flux of O2- than were the other (SOD-containing) neisserial species . The responses of N . gonorrhoeae and N . meningitidis respiratory and oxy-protective enzymes to growth under high and low oxygen tensions were followed, and a novel response, the apparent repression of the respiratory chain intermediates, respiration, and SOD, peroxidase, and catalase activity, was observed . The gonococcal catalase was partially purified and characterized . The results suggest that the very active terminal oxidase, low pO2 natural habitat, O2-stable catalase, and possibly the high glutathione content of the organism explain its aerobic survival in the absence of SOD.

J S C Med Assoc, 1986 Feb, 82(2), 79 - 83
Prevalence of Chlamydia trachomatis in women attending a family planning clinic: the need for a screening service; Tschanz DW et al.; PIP: This study was aimed at assessing the prevalence of Chlamydia trachomatis infections among women enrolled in a county health department family planning program in Lancaster, South Carolina . Cervical specimens were collected from 187 women with a mean age of 22.7 years; 103 of these women were black . C trachomatis was isolated from 31 (16.6%) of these women . Black women had a 21.3% isolation rate compared with a 10.7% rate among whites--a nonsignificant difference . Neisseria gonorrhoeae was isolated from 4.7% of the women cultured for this organism, and 6 of these women had comcomitant chlamydial infection . The 2 women identified as having secondary syphilis had simultaneous gonococcal and chlamydial infections . At presentation to the clinic, only 4 (2.1%) women had specific gynecologic complaints suggestive of chlamydial infection; the remaining 183 were asymptomatic . These findings document the pervasiveness of chlamydial infection among the sexually active population . Of particular concern is the finding that 87.5% of women with gonococcal infection had concurrent chlamydial infection . Because of the potentially serious consequences of untreated chlamydial infection and the high degree of inapparent infection, changes are recommended in the screening and management of women at risk for exposure to this agent . Specifically recommended is routine chlamydial screening in the population of reproductive age at the time of the annual or biannual gynecologic examination . Moreover, given the high occurrence of concomitant gonococcal and chlamydial infection, gonococcal pelvic inflammatory disease treatment should be followed with an antichlamydial treatment .

Microb Pathog, 1986 Feb, 1(1), 101 - 5
Antibodies to the capsular polysaccharide of Neisseria meningitidis group B or E . coli K1 bind to the brains of infant rats in vitro but not in vivo; Saukkonen K et al.; The binding of monoclonal and polyclonal IgG antibodies specific to the capsular polysaccharide of Neisseria meningitidis group B and E . coli K1 was tested to the cross-reacting polysialosyl structures previously shown to be present in the brain of infant rats (Lancet 1983; ii: 355-7) . Strong immunofluorescence was obtained after in vitro incubation of the brains of 1 to 13 days old rats with the antibodies whereas the brains of adult rats remained negative . The number of antibody-binding structures decreased as a function of age, being highest at the age of 1 to 5 days . However, when the same antibodies were injected intraperitoneally into the infant rat, or into the mother rat 2 days before parturition, no binding of antibodies to the infant rat brain tissue was observed.

Aust N Z J Ophthalmol, 1986 Feb, 14(1), 49 - 53
Penicillinase-producing Neisseria gonorrhoea as a cause of neonatal and adult ophthalmia; Lockie P et al.; A retrospective analysis of 80 cases of gonococcal ophthalmia revealed six (7.5%) to be due to penicillinase-producing Neisseria gonorrhoeae (PPNG), five neonatal cases and one adult . All six cases were finally cured, but best results were obtained with topical chloramphenicol and single-dose spectinomycin (40 mg/kg) given intramuscularly . All gonococcal isolates should be tested promptly for penicillinase production, and if this is present systemic treatment, modified to spectinomycin or penicillinase-stable cephalosporin, should be given as single-dose treatment.

Genitourin Med, 1986 Feb, 62(1), 9 - 14
Some phenotypic and genotypic characteristics of prevailing gonococcal strains in northern Norway; Falk ES et al.; Ninety two non-penicillinase producing Neisseria gonorrhoeae (non-PPNG) strains were investigated by the restriction enzyme technique with Hind III enzyme . Serogrouping by coenzyme . A with monoclonal antibodies and testing susceptibility to doxycycline were also performed by an agar dilution method . Fifteen different restriction enzyme patterns were shown, of which three represented 50% (46/92) of all strains . One band, representing a deoxyribonucleic acid (DNA) fragment of 1.45 kilobase pairs, was shared by all the strains investigated . Serogroup WI dominated, representing 57 isolates (62%) with four serovars, one of which was found in 82% (47/57) of the WI serogroups . Eight serovars were found among WII and WIII serogroups, but no one serovar dominated, as happened among WI serogroups . Identical serovars and restriction enzyme patterns were found in eight patients who were epidemiologically linked . All strains were highly or moderately sensitive to doxycycline, and the strains belonging to serogroup WI were more sensitive than those in the WII or WIII serogroups.

J Infect Dis, 1986 Feb, 153(2), 340 - 5
Chromosomally mediated resistance in Neisseria gonorrhoeae in the United States: results of surveillance and reporting, 1983-1984; Rice RJ et al.; Between January 1983 and October 1984, 446 cases of infection due to chromosomally mediated resistance in Neisseria gonorrhoeae (CMRNG) were reported in 23 states . Eighty percent were detected as primary penicillin or ampicillin treatment failures . Gonococcal isolates were submitted from 175 (40%) for confirmation of resistance, susceptibility testing, gonococcal strain typing using monoclonal antibodies specific for outer membrane Protein I, and auxotyping . All were typed as Protein I serogroup IB (WII/WIII), and the majority were proline or prototrophic auxotypes . All were resistant in vitro to less than 1 microgram/ml of either penicillin or tetracycline . Comparing CMRNG with penicillinase-producing Neisseria gonorrhoeae (PPNG), we found that CMRNG were significantly more resistant to tetracycline and erythromycin, but PPNG were more resistant to penicillin (P less than .01) . Because of increasing reports of gonococcal resistance in the United States, improved surveillance of clinical and laboratory resistance is needed in support of control and treatment recommendations for gonorrhea.

Ann Intern Med, 1986 Feb, 104(2), 187 - 93
Microbial causes of proven pelvic inflammatory disease and efficacy of clindamycin and tobramycin; Wasserheit JN et al.; Thirty-six women with suspected pelvic inflammatory disease were examined by laparoscopy and endometrial biopsy . Acute salpingitis was diagnosed by laparoscopy in 22 . Among women with evaluable biopsy samples, plasma cell endometritis was present in 14 of 20 with acute salpingitis and in 1 of 13 without acute salpingitis (p less than 0.001) . Chlamydia trachomatis, Neisseria gonorrhoeae, or both were identified in the endometrium or fallopian tubes in 11 of 14 women with both salpingitis and endometritis, in 2 of 9 with salpingitis or endometritis alone, and in 0 of 13 without salpingitis or endometritis (p less than 0.0001) . Anaerobic or facultative bacteria or mycoplasmas were isolated from tubes or peritoneum from 9 of 14 women with both salpingitis and endometritis, 2 of 9 with salpingitis or endometritis alone, and 3 of 13 without salpingitis or endometritis . Therapy with clindamycin plus tobramycin produced an adequate short-term clinical response in 16 of 19 patients, although patients with severe salpingitis at laparoscopy responded slowly.

J Gen Microbiol, 1986 Feb, 132 ( Pt 2), 503 - 12
The effect of protein II and pili on the interaction of Neisseria gonorrhoeae with human polymorphonuclear leucocytes; Virji M et al.; Colonial variants of Neisseria gonorrhoeae strain P9 expressing different pili and/or outer membrane protein II (P.II) were investigated with respect to their interaction with human polymorphonuclear leucocytes (PMN) . Two assay systems were used . A phagocytic killing assay measured the intracellular survival of gonococci, and PMN chemiluminescence (CL) was used to determine the initial surface interactions . All variants expressing P.II were killed effectively by PMN and also greatly stimulated PMN CL . The P.II- variants, on the other hand, were resistant to phagocytic killing and stimulated a much lower CL response . The presence of different P.II species was associated with different CL profiles and therefore different modes of interaction with the PMN membrane . A P.II-specific monoclonal IgG was opsonic and greatly increased PMN CL in contrast to F(ab')2 prepared from the same antibody, which inhibited it, thus confirming the role of P.II in the PMN interaction . Phagocytic killing assays revealed that with the loss of P.II, gonococcal variants acquired resistance to killing . Comparison of piliated and non-piliated pairs of variants with the same P.II profile showed that PMN-gonococcal interactions are dominated by the nature of the P.II species present whereas pili have little effect.

Can J Microbiol, 1986 Feb, 32(2), 83 - 8
Changes in host cell membrane activities in response to adhesion of Neisseria gonorrhoeae; Wiseman GM et al.; Physiological changes in host cell model membranes (intact human erythrocytes and ghosts) as a consequence of bacterial adhesion were studied with special reference to Neisseria gonorrhoeae . Membrane activities examined were transport of K+, Cl- ions, pyruvate kinase, Na-K-dependent ATPase, and cAMP . We found that K+ and Cl- transport were affected, more so in membranes with attached pilated (P+) organisms than in those with apilated (P-) isogenic strains . In N . gonorrhoeae and in several other species of gram-negative bacteria studied, hemagglutination titres were directly correlated with effects on anion transport, suggesting that perturbations in anion transport are an immediate result of adhesion . Of three P+ gonococcus strains tested, two depressed Na-K-ATPase activity in the membrane, indicating a possible effect on the Na-K pump . Pyruvate kinase activity associated with the membrane appeared to be stimulated by attached gonococci, again by P+ strains to higher levels than P- organisms . Clearly, some enzyme properties of host membranes are intrinsically affected by bacterial adhesion . Human polymorphonuclear neutrophils were also investigated, and with some exceptions, changes observed in leukocyte enzyme activities tended to parallel those in erythrocytes . Since hypochlorous acid production is considered to be an important microbicidal mechanism in neutrophils, interference with Cl- transport could jeopardize their role in host defense.

Schweiz Med Wochenschr, 1986 Jan 25, 116(4), 119 - 22
{Acute Neisseria subflava endocarditis}; Guelpa G et al.; A 50-year-old woman who developed acute endocarditis on a mitral Starr valve due to Neisseria subflava is reported . This microorganism, which belongs to the normal flora of the upper respiratory tract, is a very rare cause of endocarditis since only 9 cases have been described . The patient developed various complications including right hemiplegia . Cure was obtained by medical therapy alone due to the high susceptibility of the bacteria to a third generation cephalosporin (moxalactam) . This is the third time a neurological complication of this kind is reported during N . subflava endocarditis . A high frequency of neurological and systemic embolic complications appears to be an important feature of endocarditis due to N . subflava and other saprophytic Neisseria.

Cell, 1986 Jan 17, 44(1), 107 - 15
The repertoire of silent pilus genes in Neisseria gonorrhoeae: evidence for gene conversion; Haas R et al.; To investigate the significance of silent gene loci for pilus antigenic variation in N . gonorrhoeae, we determined the nucleotide sequence of the major silent locus, pilS1 . The pilS1 locus contains six tandem pilus gene copies linked by a 39 bp repeat sequence also present in the expression loci . All silent copies lack the common N-terminal coding sequence of pilin, containing instead variant sequence information that constitutes a semivariable (SV) and a hypervariable (HV) domain . The SV and HV domains are interspersed with short, strictly conserved (C) regions flanking small cassettes of variable sequence information . It appears that such minicassettes from silent copies can be duplicated and transferred to other silent or expression genes by means of gene conversion.

CMAJ, 1986 Jan 15, 134(2), 121 - 4, 146
Validity and cost-effectiveness of the Gonozyme test in the diagnosis of gonorrhea; Thomas E et al.; Although bacterial culture is considered to provide the most definitive diagnosis of gonorrhea, it has limitations when specimens must be transported long distances . A study was carried out to evaluate the validity and cost-effectiveness of an alternative method of diagnosing gonorrhea, the Gonozyme test, a commercially available enzyme immunoassay . Urogenital specimens from 100 men and 100 women with symptoms suggestive of or a history of exposure to gonorrhea were tested for the presence of Neisseria gonorrhoeae by means of bacterial culture and for gonococcal antigen with the Gonozyme test . The specimens from the men were also examined by means of microscopy of Gram-stained smears . The sensitivity and specificity of the Gonozyme test with reference to culture results were 95.6% and 97.4% respectively in the men and 84.2% and 98.7% in the women . The predictive value of a positive result was 91.6% in the men and 94.1% in the women, and the predictive value of a negative result 98.6% in the men and 96.3% in the women . The cost-effectiveness of the Gonozyme test was higher than that of bacterial culture in this population, which had a high prevalence rate of gonorrhea (23% in the men and 19% in the women) . The Gonozyme test would be an adequate alternative to culture for the diagnosis of gonorrhea and contact tracing in areas far from diagnostic laboratories.

S Afr Med J, 1986 Jan 4, 69(1), 32 - 4
Prevalence of Neisseria gonorrhoeae infection in patients attending an antenatal clinic; Welgemoed NC et al.; Neisseria gonorrhoeae infection was diagnosed by culture using a selective medium (Thayer-Martin) in 140 (11.7%) of 1 200 pregnant black women attending an antenatal clinic in 1981 . The study confirmed the need for specimens from three sites (endocervix, urethra and rectum)--endocervical cultures were positive in only 75.9% of infected women, in the remainder only the urethral and/or rectal cultures were positive . Rectal cultures were positive in 41.6% . Cultures of throat swabs from 200 women were all negative for N . gonorrhoeae . In comparison with endocervical specimens directly plated, high vaginal swab specimens placed in Stuart's transport medium before plating gave a lower yield of positive cultures . No penicillinase-producing N . gonorrhoeae strains were detected.

Infect Immun, 1986 Jan, 51(1), 60 - 8
Distribution of an antigenically related iron-regulated protein among the Neisseria spp; Mietzner TA et al.; Several iron-regulated proteins of Neisseria gonorrhoeae have been reported . One of these, a 37,000-molecular-weight protein (37K protein), appears to be common to all gonococcal isolates . Recently, the occurrence of a similar protein has also been noted in N . meningitidis . The gonococcal 37K protein has been purified and used to produce both rabbit monospecific antiserum and murine monoclonal antibodies . Using these antibody reagents, we analyzed 57 strains from nine species of Neisseria and the closely related organism Branhamella catarrhalis for the presence of proteins antigenically related to the gonococcal 37K protein . Strains grown on medium with low iron content were probed for antigenic reactivity by Western blot techniques and an enzyme-linked immunosorbent assay . Proteins which cross-reacted with the rabbit monospecific antiserum were designated as AgR-37K proteins . The data indicated that the AgR-37K proteins were conserved among the 40 strains of N . gonorrhoeae, N . meningitidis, N . lactamica, and N . cinerea tested . Seventeen strains from other species of Neisseria and Branhamella did not express AgR-37K proteins with the exception of one N . subflava isolate . All AgR-37K proteins appeared to be regulated by the amount of available iron in the growth medium . Murine monoclonal antibodies were used to probe the antigenic heterogeneity of the AgR-37K proteins from different Neisseria spp . Two of seven monoclonal antibodies were broadly cross-reactive, recognizing the AgR-37K proteins from all species examined . The remaining five monoclonal antibodies were more discriminating, recognizing the AgR-37K proteins from certain species . The antigenic conservation of these AgR-37K proteins, particularly among the pathogenic members of the genus Neisseria, may imply that these proteins serve a common function in pathogenicity.

Infect Immun, 1986 Jan, 51(1), 348 - 51
Salivary immunoglobulin A and serum antibodies to Streptococcus mutans ribosomal preparations in dental caries-free and caries-susceptible human subjects; Gregory RL et al.; Caries-free subjects or individuals with low caries susceptibility exhibited significantly higher (P less than 0.001) levels of naturally occurring salivary immunoglobulin A (IgA) and serum IgG, IgA, and IgM antibodies to a Streptococcus mutans ribosomal preparation than subjects with high caries susceptibility . Absorption of saliva and serum samples with S . mutans ribosomal preparations, but not with other S . mutans antigens or with Escherichia coli and Neisseria gonorrhoeae ribosomal preparations, removed the antibody activity . Absorption with Streptococcus sanguis ribosomes and NH4Cl-washed S . mutans ribosomes partially removed the anti-S . mutans ribosome antibody activity . These results provide evidence that naturally occurring salivary and serum antibodies to the S . mutans ribosomal preparation correlate with susceptibility to dental caries.

Clin Ther, 1986, 9 Suppl A, 3 - 5
A retrospective study of doxycycline in the treatment of genitourinary infections; Portnoy D; A retrospective study was conducted to assess the prevalence of Chlamydia trachomatis, Ureaplasma ureolyticum, and Mycoplasma sp in patients with suspected genital infection, and to assess the efficacy of doxycycline and other current antibiotic therapies . Over a three-year period, 1,048 records of patients (64% female; 36% male) were reviewed . C trachomatis, U ureolyticum, or Mycoplasma hominis was found in 39% of the men and 49% of the women . Other pathogens included Gardnerella vaginalis (in 21%), Candida albicans (in 12%), Neisseria gonorrhoeae (in 4%), and Trichomonas vaginalis (in 1%) . Doxycycline eradicated C trachomatis in 88% of patients, U ureolyticum in 87%, and M hominis in 95% . Eradication rates with erythromycin were 91%, 71%, and 100% and with tetracycline, 88%, 92%, and 80%, respectively.

Infection, 1986, 14 Suppl 4, S314 - 5
Single dose ofloxacin in treatment of uncomplicated gonorrhoea; Chan AS et al.; 78 patients (66 male and 12 female) suffering from uncomplicated gonorrhoea were randomly selected to receive a single oral dose of either 400 mg or 600 mg ofloxacin . Of the 59 patients completely followed up penicillinase-producing Neisseria gonorrhoeae strains were cultured in 15 (25.4%) and the overall cure rate was 100% . Both groups showed excellent clinical effectiveness in over 80% and adverse reactions were uncommon and transient . We conclude that a single oral dose of ofloxacin in the studied dosage regimens was highly effective and safe in the treatment of uncomplicated gonorrhoea.

Infection, 1986, 14 Suppl 4, S311 - 3
Efficacy of ofloxacin in uncomplicated gonorrhoea; Ariyarit C et al.; A randomised double blind trial comparing single oral dose therapy with 200 mg and 400 mg of ofloxacin, respectively was conducted at the Bangrak Hospital, Bangkok during the period December 6, 1985 to January 24, 1986 . We treated 234 male patients diagnosed as having uncomplicated gonococcal urethritis with ofloxacin . Ofloxacin, at a single dose of 200 mg or 400 mg, was given to each of them . Fourteen patients were excluded for efficacy assessment . There were 223 patients left for safety assessment . The cure rates were 100% in both groups . Among 233 isolates tested, 48.5% were penicillinase producing Neisseria gonorrhoeae . The range of minimum inhibitory concentrations of ofloxacin was 0.008 to 0.063 mg/l . No adverse drug experiences were reported.

Infection, 1986, 14 Suppl 4, S309 - 10
Clinical experience with ofloxacin in sexually transmitted disease; Judson FN et al.; Experience with ofloxacin in the United States in the treatment of sexually transmitted diseases is reviewed . In one study, a single oral dose of either 400 mg or 600 mg eradicated Neisseria gonorrhoeae in all 43 evaluable patients . In another multicenter study a seven-day course of ofloxacin 300 mg b.i.d . was as effective as a seven-day course of doxycycline 100 mg b.i.d . in eradicating N . gonorrhoeae, Chlamydia trachomatis and, in men, Ureaplasma urealyticum . Because of increasing problems with antimicrobial resistance, particularly among strains of N . gonorrhoeae, ofloxacin, with its unique mechanism of action, and its broad spectrum activity against pathogens, may prove useful in the treatment of sexually transmitted diseases.

Exp Biol, 1986, 45(4), 323 - 34
Adherence of gram-positive and gram-negative bacterial strains to human lung fibroblasts in vitro; Martin D et al.; The adherence to eukaryotic cells of Escherichia coli, Neisseria gonorrhoeae, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis and the yeast Candida albicans was studied by light microscopy with an in vitro micromethod involving different cell lines . The method is inexpensive, consumes little time and material, and is reproducible . It was used to show that the gram-positive Cowan I strain of S . aureus, which naturally forms protein A on its surface, adheres in much larger numbers to human lung fibroblasts than the protein A-free Wood 46 strain, the strain of S . epidermidis, and the encapsulated Smith strain . The presence of a capsule on the latter strain apparently prevented its attachment to the fibroblasts . Among the gram-negative species studied, a piliated clinical isolate of N . gonorrhoeae, displaying the opaque colonial phenotype, adhered in larger numbers than another isolate lacking pili and displaying the transparent phenotype . E . coli K12 attached slightly to the cell line, whereas P . aeruginosa adhered to it moderately . One strain of C . albicans tested did not attach in any detectable numbers . No clear correlation between bacterial cell surface hydrophobicity, as evaluated by the hexadecane assay, and adherence to eukaryotic cells could be demonstrated for these microorganisms . With our method, bacterial attachment proceeded best at 37 degrees C and did not require more than 1 h of contact with the cell monolayer . The method described revealed differences in the adherence to eukaryotic cells, not only among species, but also between strains of the same species.

Am J Obstet Gynecol, 1986 Jan, 154(1), 98 - 103
Adjunctive erythromycin treatment for idiopathic preterm labor: results of a randomized, double-blinded, placebo-controlled trial; McGregor JA et al.; Pathogenesis and optimal treatment and prevention of preterm labor remain incompletely understood . Entry of cervical/vaginal microorganisms into lower uterine tissues has been implicated in preterm labor and may be amenable to specific therapy . Fifty-eight women with less than 34 completed weeks of gestation and without other obstetric complications, who were receiving intravenous tocolytics because of uterine contractions and who had cervical alteration (less than 5 cm dilated), were enrolled in a prospective randomized, double-blinded evaluation of 7 days of adjunctive therapy with enteric-coated erythromycin base (333 mg three times daily by mouth) versus placebo . Microbiologic examination included cultures for Neisseria gonorrhoeae, Chlamydia trachomatis, and group B streptococcus . Fifty-eight women with singleton pregnancies (29 erythromycin; 29 placebo) completed the protocol . Among women with cervical dilatation greater than or equal to 1 cm at the beginning of treatment, mean time until delivery was 32.5 days with erythromycin and 22.4 days with placebo treatment (p = 0.027) . Of the erythromycin-treated women, seven of eight were delivered at greater than or equal to 37 weeks and only three of nine placebo-treated women were delivered at greater than or equal to 37 weeks (p = 0.035) . Orally administered enteric-coated erythromycin as adjunctive treatment of pregnant women in labor less than or equal to 34 weeks is well tolerated . Adjunctive erythromycin given to women treated for preterm labor less than or equal to 34 weeks is associated with prolongation of pregnancy and delivery at 37 weeks only in women with cervical dilatation at the beginning of treatment.

Infection, 1986, 14 Suppl 4, S321 - 3
Ofloxacin, a new quinolone in the treatment of genitourinary and enteric infections; Tanphaichitra D et al.; During 1984 to 1986, 121 patients with gonorrhoea were treated with ofloxacin . This report is to summarize the results of our trial in patients treated with three different dose regimens of ofloxacin: A) a single 800 mg dose of ofloxacin (32 patients); B) a single 400 mg dose of ofloxacin (55 patients) or C) a twice a day dose of 600 mg ofloxacin (34 patients) . In addition, 19 patients with urinary tract infection and eight patients with enteric fever were treated with 400 mg ofloxacin twice a day for seven to ten days . Out of 121 patients with gonococcal urethritis, only 107 patients were evaluable . Cure was obtained in 96.5%; 93.2% and 94.5% of the patients in groups A, B and C respectively . 16 out of 17 patients with urinary tract infection achieved clinical cure or improvement . The 16 patients were bacteriologically accessible; pathogens were eradicated in all of them . Ofloxacin was also effective in the treatment of enteric fever, in which eradication was achieved in all seven patients . 28% of Neisseria gonorrhoea and 29% of Salmonella spp . isolated in our community were beta-lactamase-positive.

Dermatologica, 1986, 173(5), 237 - 44
Evaluation of cefotetan in uncomplicated gonorrhea; Korting HC et al.; Cefotetan is a newly developed cephamycin especially resistant to bacterial beta-lactamase . Therefore both its in vitro activity against Neisseria gonorrhoeae and its clinical efficacy in uncomplicated gonorrhea are investigated . The minimal inhibitory concentrations (MIC) lie in the range of 0.016-2 micrograms/ml, 90% of the strains being inhibited by 0.5 microgram/ml . Of 52 finally evaluable patients who were treated by a single intramuscular injection of 1 g, 48 (92.3%) were cured bacteriologically . Thus the present treatment protocol may prove useful in individual cases . It should, however, not be advocated for gonorrhea treatment in general.

Microbiol Immunol, 1986, 30(8), 737 - 42
Conjugal transfer of beta-lactamase-producing plasmids of Neisseria gonorrhoeae to Neisseria meningitidis; Ikeda F et al.; Twenty clinical isolates of beta-lactamase-producing Neisseria gonorrhoeae from Japanese sources were studied to define their ability to serve as donors for their plasmids in conjugation with Neisseria meningitidis . These twenty strains of N . gonorrhoeae harbored the 4.5-megadalton (Mdal) beta-lactamase-producing plasmids and the 24.5-Mdal conjugative plasmids . We found that only three of twenty N . gonorrhoeae strains showed a detectable conjugation frequency (greater than 10(-5)) with N . meningitidis as the recipient although all strains were capable of mobilizing beta-lactamase-producing plasmids to N . gonorrhoeae and to Escherichia coli . The 4.5-Mdal beta-lactamase-producing plasmid was maintained in N . meningitidis, but the large 24.5-Mdal conjugative plasmid has not been found in N . meningitidis transconjugants.

Scand J Infect Dis Suppl, 1986, 48, 40 - 5
Norfloxacin in the therapy of gonococcal infections; Romanowski B; Norfloxacin is a quinolone derivative with demonstrated activity against Neisseria gonorrhoeae . The MIC90 against penicillinase- and non-penicillinase producing N . gonorrhoeae is 0.06 mg/l and 0.015 mg/l respectively . The drug is rapidly absorbed with a single oral dose of 800 mg producing peak serum levels of 2.45 mg/l . In this open, uncontrolled study, 70 patients with laboratory confirmed, uncomplicated infections with N . gonorrhoeae were entered to determine the efficacy and safety of a single oral dose of norfloxacin 800 mg . Thirty-one males and 27 females were evaluated for efficacy with 34 males and 25 females evaluated for safety . Norfloxacin cured all 31 urethral and two pharyngeal infections in men . All 25 females with endocervical infections and six with rectal involvement were also cured . The single treatment failure occurred in a woman who had persistent pharyngeal infection . All isolates of N . gonorrhoeae were inhibited by 0.05 mg/l of norfloxacin . The incidence of adverse effects was 23.7% but all were mild, required no specific therapy and cleared without sequelae . In this study, norfloxacin proved to be an effective agent in the therapy of uncomplicated gonococcal infection in males and females . It has previously been proven to be useful in the therapy of gonococcal infections due to penicillinase-producing N . gonorrhoeae and the value of this drug as a first line choice in the treatment of gonococcal infections is discussed.

Zentralbl Gynakol, 1986, 108(13), 805 - 12
{Infections with penicillinase-producing Neisseria gonorrhoeae in females . Report on 24 cases}; Baumann L et al.; Between the last few weeks of 1980 and March 1985 the susceptibilities of 881 strains of Neisseria gonorrhoeae to penicillin were tested by a simple screening method (disc diffusion test) . 76.6% of the isolates were good susceptible, 17.7% moderately susceptible and 5.7% resistant to 3 units of penicillin G . Penicillinase-producing Neisseria gonorrhoeae (PPNG) could be detected in 24 cases (2.7%), most of them between July 1983 and January 1984 (n = 18) . 23 patients have been treated successfully with oxytetracycline . All infections had been acquired in the GDR, however, the sources of infection could be firmly traced in 6 cases only . On the basis of the results some clinical and microbiological aspects of infections with penicillin resistant gonococci are discussed.

Exp Biol, 1986, 45(4), 317 - 21
Delayed clearance from the murine uterus of gonococci enclosed in an artificial polysaccharide matrix; Jacques M et al.; The fate of Neisseria gonorrhoeae in the murine uterus and adjacent oviduct following an intrauterine inoculation was investigated . We compared also the rate of clearance of gonococci that were and that were not enclosed in an artificial polysaccharide matrix made of agar . Gonococci suspended in phosphate buffered saline were rapidly eliminated from the murine uterus and few viable cells were recovered 24 h after inoculation . The clearance of agar-enclosed gonococci was markedly delayed and viable cells were recovered 5 days after inoculation . Our data suggest that the presence of an artificial polysaccharide matrix around gonococci enable them to persist much longer in the murine genital tract.

Arch Androl, 1986, 16(1), 19 - 23
Enhancing detection of gonococcus in ejaculates of adult males using sperm dilution; Vicari E et al.; Specific cultures were used to detect growth of Neisseria Gonorrhoeae (NG) in 90 ejaculates of partners of childless marriages . Although no gonococcal growth was observed in undiluted semen, 9 out of 68 subjects with silent infection presented growth of NG in seminal plasma after dilution 1:2 with saline . It is concluded that semen dilution increases the chances of detection of NG in semen samples of asymptomatic gonococci carriers.

Trans Ophthalmol Soc U K, 1986, 105 ( Pt 1), 41 - 2
A fresh look at ophthalmia neonatorum; Ridgway GL; Recent surveys have stressed the importance of Chlamydia trachomatis as a cause of ophthalmia neonatorum . Advances in diagnostic techniques should enable this organism to be readily identified . Precise identification of the aetiological agent is important because of the differing antibacterial sensitivities of the pathogens . Neisseria gonorrhoeae and C . trachomatis require systemic therapy . Investigation and treatment of both parents is necessary to prevent recurrence in subsequent pregnancies.

Microbios, 1986, 45(183), 113 - 29
Proteases of the pathogenic neisseriae: possible role in infection; O'Reilly TM et al.; Proteolytic enzymes are produced by animal as well as human pathogens . Several micro-organisms including Neisseriae produce IgA1 specific proteases . This protease specifically hydrolyses IgA1 protein . IgA1-specific protease(s) synthesized by Neisseria species are briefly reviewed with particular reference to their role in infection.

Chemotherapy, 1986, 32(3), 260 - 9
Bactericidal activity of cefotiam and ceftizoxime against Neisseria gonorrhoeae in an in vitro model simulating plasma and cantharidal blister fluid levels after the single intramuscular application of one gram; Korting HC et al.; Two gonococcal strains with differing susceptibility to cefotiam and ceftizoxime, as expressed by the minimum inhibitory concentration (MIC), are exposed to continuously changing concentrations of these antibiotics as they are found in plasma and skin cantharidal blister fluid (CBF) after a single intramuscular application of 1 g . Under the conditions of the plasma level profiles, bacterial density is always greatly but not totally reduced, already during the first 1-1.5 h it declines by 99% . The effect is the more marked the quicker and higher the levels increase . In this respect, facing the less favorable CBF level profiles, a 99% reduction of gonococci takes much longer . While the degree of bacterial susceptibility plays no major role as long as the MIC is highly exceeded, as during invasion, it becomes important when the actual levels come more or less close to the MIC . Then the decline of bacterial density can slow down and even the maximum relative reduction can be affected . Under the condition of equivalent in vitro activity, the superior plasma kinetics of cefotiam leads to better antimicrobial activity, an effect no longer found facing similar CBF kinetics . This demonstrates the need for the inclusion of tissue level data, in so far as infection sites other than blood are simulated . The high degree of antigonococcal activity of the drug concentration time curves for plasma and CBF after cefotiam and ceftizoxime (1 g) allow the expected high cure rates in uncomplicated gonorrhoea.

Chemotherapy, 1986, 32(3), 247 - 54
The susceptibility of Neisseria gonorrhoeae strains to different cephalosporins and penicillin G depends on the auxotype; Korting HC et al.; The relatively broad range of minimum inhibitory concentrations (MICs) of different cephalosporins and penicillin G with Neisseria gonorrhoeae results from the differing susceptibility of various subsets, i.e . auxotypes . While prototrophic and proline-dependent strains are especially resistant (p less than or equal to 0.001), AHU strains are especially susceptible . The bimodality of MIC values with penicillin G and the older cephalosporins, cephalothin and cefazoline, results from quite a big subset of relatively resistant prototrophic strains . As the newer cephalosporins from generation (e.g . cefotiam) to generation (e.g . cefmenoxime and ceftizoxime) tend to have less special problems with these strains, the general distribution of MIC values changes to monomodality.

Ann Biol Clin (Paris), 1986, 44(1), 39 - 42
{In vitro bactericidal activity of polyvinylpyrrolidone iodine on Neisseria gonorrhoeae}; Benoit M et al.; A standardized methodology was used to study the in vitro behavior of different strains of Neisseria gonorrhoeae when treated with povidone-iodine . The bactericidal activity of the antiseptic was appraised using the dilution-neutralization technique on four gonococcal strains, two of which produced a beta-lactamase . Bactericidal activity in aqueous medium was observed down to a dilution of 1/128 . This result specifies the conditions under which this antiseptic is active against Neisseria gonorrhoeae.

Sex Transm Dis, 1986 Jan-Mar, 13(1), 53 - 5
Single-dose ceftriaxone therapy of gonococcal ophthalmia neonatorum; Haase DA et al.; Ceftriaxone (125 mg) given as a single intramuscular dose without topical therapy was evaluated in seven infants with smear-positive gonococcal ophthalmia neonatorum . Neisseria gonorrhoeae was isolated from the eyes of six infants, and four of these isolates were penicillinase-producing N . gonorrhoeae . Two infants had concomitant ocular infection with Chlamydia trachomatis . All seven infants, when seen at follow-up, showed marked clinical improvement . Conjunctivitis resolved completely in four infants . One infant was lost to subsequent follow-up, while two infants had persistent ophthalmia due to C . trachomatis . Follow-up eye cultures for N . gonorrhoeae were all negative.

Sex Transm Dis, 1986 Jan-Mar, 13(1), 50 - 2
Isolation of Chlamydia trachomatis from men with urethritis: relative value of one vs . two swabs and influence of concomitant gonococcal infection; Singal SS et al.; Two successive urethral swabs were used to obtain specimens for culture of Neisseria gonorrhoeae and Chlamydia trachomatis from 136 heterosexual men with urethritis . The first swab was used to culture N . gonorrhoeae and then C . trachomatis; the second was used to culture C . trachomatis only . C . trachomatis cultures from the second swab were positive more often (30 of 31 pairs) than were cultures from the first swab (22 of 31 pairs) (P less than .05) . In addition, cultures from swab 2 had greater numbers of inclusions per coverslip more frequently (23 of 31 pairs) than did cultures from the first swab (six of 31 pairs) (P = .003) . Numbers of chlamydial inclusions per coverslip were lower in specimens positive for both C . trachomatis and N . gonorrhoeae than in specimens positive for C . trachomatis only (P less than .02) . In addition, the presence of N . gonorrhoeae in a specimen adversely affected the quality of the McCoy cell monolayer . In 17 of 21 instances of monolayer toxicity, cultures for N . gonorrhoeae were positive (P less than .01) . These results demonstrate that when specimens from men with urethritis are cultured for N . gonorrhoeae and C . trachomatis, use of a second swab will improve rates of recovery of C . trachomatis . Material present in specimens that contain N . gonorrhoeae may adversely affect rates of isolation of C . trachomatis.

Sex Transm Dis, 1986 Jan-Mar, 13(1), 5 - 8
Prevalence of nonspecific vaginitis and other cervicovaginal infections during the third trimester of pregnancy; Paavonen J et al.; Nonspecific vaginitis (NSV) is a clinical syndrome characterized by a decreased concentration of normal acidophilic Doderlein flora in the vagina and increased concentration of nonacidophilic microorganisms, such as Gardnerella vaginalis, anaerobic bacteria, and mycoplasmas . Since several NSV-associated organisms are associated with complications of pregnancy, we studied the prevalence of NSV among 104 consecutive women during the third trimester of pregnancy . Overall, 14 women (14%) had NSV by clinical and/or biochemical criteria, two women had Chlamydia trachomatis isolated from the cervix, and 24 women (23%) had yeast isolated from the vagina . None had Neisseria gonorrhoeae or Trichomonas vaginalis isolated . There was a correlation between an abnormal succinate to lactate ratio (on gas-liquid chromatography) and cytologic atypia detected by cervicovaginal Papanicolaou smears . More extensive studies are needed to correlate NSV with prematurity.

Sex Transm Dis, 1986 Jan-Mar, 13(1), 29 - 39
Characteristics of Neisseria gonorrhoeae strains isolated on selective and nonselective media; Pace PJ et al.; The possible inhibition of Neisseria gonorrhoeae on modified Thayer-Martin (VCNT) medium was investigated by inoculation of multiple media with specimens from 3,490 patients . N . gonorrhoeae was recovered from 461 patients, and in 24 cases (5.2%) it was isolated on drug-free medium only; 18% of the recoveries were on VCNT medium only . The minimal inhibitory concentration (MIC) of benzylpenicillin was determined for 411 of the strains, and 175 were examined for responses to 12 other antibiotics and for auxotype . Of the 24 strains isolated on drug-free medium only, one was inhibited by trimethoprim at a concentration of 2.0 micrograms/ml and four others had MICs of vancomycin of less than or equal to 2.0 micrograms/ml . The remainder were resistant to vancomycin, trimethoprim, and colistin at the concentrations present in VCNT medium . Unexpectedly, four strains isolated on both VCNT and drug-free medium had MICs of vancomycin of less than or equal to 3.0 micrograms/ml and were defined as hypersusceptible . Genetic tests showed that gonococci resistant to less than or equal to 0.5 microgram of vancomycin/ml differed genotypically from those resistant to 1.0 microgram/ml . The eight strains hypersusceptible to vancomycin were highly susceptible to various other antibiotics . Their nutritional requirements included hypoxanthine (Hyx-) and uracil (Ura-), and all but one also required arginine (Arg-), which for two strains could not be replaced by ornithine (Arg0-) . Pro-,Arg0-,Ura- (5.7%) and Arg0-,Ura- (1.1%) auxotypes were found at this time but not in earlier studies of gonococci isolated in the same clinic.

Sex Transm Dis, 1986 Jan-Mar, 13(1), 24 - 8
Epidemiologic and clinical characteristics of pelvic inflammatory disease associated with Mycoplasma hominis, Chlamydia trachomatis, and Neisseria gonorrhoeae; Miettinen A et al.; We studied selected epidemiologic, clinical, serologic, and microbiologic findings and their interrelationships among 57 women with acute pelvic inflammatory disease (PID) . Cervical cultures positive for Neisseria gonorrhoeae alone and for both N . gonorrhoeae and Chlamydia trachomatis were associated with young age, nulliparity, and use of birth-control pills . Positive serologic findings for C . trachomatis were associated with the isolation of C . trachomatis and/or N . gonorrhoeae from the cervix and predicted the presence of a pelvic mass . High levels of antibody to Mycoplasma hominis were associated with increasing age and parity, and predicted a low concentration of C-reactive protein (CRP), a long hospital stay, and a high convalescent-phase erythrocyte sedimentation rate (ESR) . Women with recurrent PID had higher titers of antibody to C . trachomatis than those with primary PID . The use of an intrauterine contraceptive device predicted high CRP, high acute-phase ESR, long hospital stay, and was frequently associated with positive serologic tests for M . hominis . These results demonstrate that the clinical picture of PID depends not only on the microorganisms involved but also on many epidemiologic factors such as age, contraceptive method, and parity.

Sex Transm Dis, 1986 Jan-Mar, 13(1), 19 - 23
Auxotypes of Neisseria gonorrhoeae isolated from heterosexual men, homosexual men, and heterosexual women; Givan KF et al.; During 1979-1984 we auxotyped 1822 strains of Neisseria gonorrhoeae and recorded the site of isolation and sexual orientation of the patients . Auxotypes were determined by the growth requirements of strains for proline (Pro-), uracil (Ura-), hypoxanthine (Hyx-), citrulline (Cit-), or citrulline replaceable by ornithine (Orn-) . Of all isolates from homosexual men, 96% belonged to three auxotypes: nonrequiring (NR), Pro-, or Orn-, and only 1.5% belonged to the Pro-, Cit-, Ura- and Orn-, Ura-, Hyx- auxotypes . Of the isolates from women, 49.9% belonged to these latter two auxotypes . Of the strains isolated from male homosexuals, 19.5% were resistant to 1.0 microgram of erythromycin/ml, whereas only 9.6% of strains from other men and 2.6% of strains from women were resistant to this concentration . We suggest that strains of N . gonorrhoeae infecting homosexual men tend to be less demanding in their nutritional requirements and more resistant to erythromycin than strains infecting heterosexual men and women.

Sex Transm Dis, 1986 Jan-Mar, 13(1), 1 - 4
Experience with a modified solid-phase enzyme immunoassay for detection of gonorrhea in prostitutes; van Ulsen J et al.; The modified Gonozyme Test (Abbott Laboratories; Chicago, IL), a new enzyme immunoassay for detection of Neisseria gonorrhoeae, was evaluated in testing of 266 prostitutes . When the enzyme immunoassay was used with material from the cervix, the prevalence of gonorrhea was 8.4% . As compared with culture results, this rate represents a sensitivity of 88% and a specificity of 99.2% . A sensitivity of 71% and a specificity of 98.9% were registered for tests of urethral material . In a comparison of the two tests without accepting either one as standard, the sensitivity of the enzyme immunoassay was 90% for material from the cervix and the specificity was 100% . There are several possible causes for discordance between results of culture and of enzyme immunoassay . The high predictive value of a negative enzyme immunoassay in screening urogenital samples from prostitutes makes this test very suitable for rapid elimination of gonorrhea from this pool of patients.

J Adolesc Health Care, 1986 Jan, 7(1), 60 - 1
Hemorrhagic Neisseria gonorrhoeae conjunctivitis in an adolescent female; Buchta RM; Gonococcal conjunctivitis in adults is rare; however, over the past two years there have been reports of cases from the military and an outbreak of ten cases in Miami, where urine was used as therapy for hemorrhagic conjunctivitis . Reported here is the case of a sixteen-year-old female who developed hemorrhagic conjunctivitis that grew Neisseria gonorrhoeae . With the increase in sexual activity at younger ages, gonococcal conjunctivitis may become more prevalent in this age group.

Drugs, 1986, 31 Suppl 2, 11 - 3
Sulbactam/ampicillin versus metronidazole/gentamicin in the treatment of severe pelvic infections; Crombleholme W et al.; The clinical efficacy and safety of sulbactam/ampicillin versus metronidazole/gentamicin were compared in 39 patients with severe pelvic infections . 30 patients had severe acute pelvic inflammatory disease with peritonitis, 3 tubo-ovarian abscesses, 4 endomyometritis, and 2 posthysterectomy pelvic cellulitis . Aerobic and anaerobic cultures from the sites of infection yielded 259 micro-organisms from 38 patients; an average of 6.8 bacteria per infection (3.9 anaerobes and 2.9 aerobes) . The most frequent isolates were Bacteroides spp . (21), B . bivius (13), B . disiens (8), Fusobacterium spp . (9), Peptostreptococcus anaerobius (15), P . asaccharolyticus (8), anaerobic Gram-positive cocci (17), Gardnerella vaginalis (24), Neisseria gonorrhoeae (14), alpha-haemolytic streptococci (6) and Escherichia coli (3) . Clinical cure was noted in 19 of 20 patients treated with sulbactam/ampicillin and 16 of 19 treated with metronidazole/gentamicin . The sulbactam/ampicillin failure was a patient with pelvic inflammatory disease with a positive Chlamydia trachomatis culture who required antichlamydial therapy . The metronidazole/gentamicin failures included a patient with a tubo-ovarian abscess requiring surgical drainage and 2 patients with pelvic inflammatory disease requiring antichlamydial treatment . No adverse haematological, renal, or hepatic effects were noted with either regimen.

Annu Rev Med, 1986, 37, 333 - 46
Inherited complement component abnormalities; Schur PH; Inherited deficiencies of early complement components are frequently associated with immune/rheumatic disorders and recurrent (Neisserial) infection with deficiency of late complement components . The genetic complexity of complement components is further demonstrated by electrophoretic allotypy and analysis of DNA restriction fragment length polymorphisms.

Bull Soc Pathol Exot Filiales, 1986, 79(1), 130 - 9
{Epidemiological aspects and prevalence of Neisseria gonorrhoeae in genital infections in Abidjan: analysis of 1742 samples}; Dosso M et al.; The authors report a study about the investigations of N . gonorrhoeae in 1 742 samples from genital . Epidemiological aspects and the prevalence of gonococcal infections are precised: 10% in vulvovaginitis; 73% in acute anterior urethritis.

Sex Transm Dis, 1986 Jan-Mar, 13(1), 47 - 9
An unusual case of penicillinase-producing Neisseria gonorrhoeae resistant to spectinomycin in California; Pon E et al.; We report a case of gonorrhea due to a penicillinase-producing strain of Neisseria gonorrhoeae resistant to spectinomycin in a 26-year-old man who had not been out of the United States for a year-and-a-half . His sexual contact also had no recent travel out of the United States . The genital and oropharyngeal infections were successfully treated with cefoxitin (1 g im) plus probenecid (1 g orally) and trimethoprim-sulfamethoxazole (80 mg of trimethoprim and 400 mg of sulfamethoxazole) . The patient took nine of the latter tablets daily for five days . The organism was a serovar IB-3, proline-requiring auxotype . The patient's isolate contained both 2.6-megadalton and 4.4-megadalton plasmids . Measurement of minimal inhibitory concentrations (MICs) of antibiotics for the isolate confirmed the penicillin resistance and showed an MIC of spectinomycin of greater than 256 micrograms/ml . The epidemiologic investigation suggested that the source of the infection was a male contact with unusual clinical features, including bloody urethral discharge and a possible incubation period of 28 days.

Presse Med, 1985 Dec 21, 14(45), 2287 - 9
{Homozygotic C5 deficiency disclosed by purulent Neisseria meningitidis meningitis}; Cesbron JY et al.; The complement system functions to protect the individual against infectious agents . Deficiencies of the late-acting complement proteins C5-C8 are associated with an increased susceptibility to Neisseria infection . This paper describes a deficiency in C5 in a Caucasoid family from the north of France that was revealed by the occurrence of a N . meningitidis meningitis in the homozygous C5-deficient propositus.

Eur J Epidemiol, 1985 Dec, 1(4), 294 - 300
Evaluation of plasmids in tetracycline resistant strains of Neisseria gonorrhoeae and Ureaplasma urealyticum in a case of severe urethritis; Jahn G et al.; A young man who acquired gonococcal urethritis in the Far East was not cured by repeated i.v . treatment with a broad-spectrum penicillin . Cultures of pre- and post-treatment urethral specimens grew tetracycline-resistant penicillinase-producing Neisseria gonorrhoeae (PPNG) and tetracycline-resistant Ureaplasma urealyticum . The patient was successfully treated with erythromycin, to which both isolates were sensitive . The strain of N . gonorrhoeae carried a novel plasmid of 10.5 Md molecular mass in addition to plasmids previously observed in this organism . The strain of U . urealyticum carried two distinct plasmids, one with mass 4.9 Md and the other one with mass 8.1 Md . This report demonstrates that ureaplasmas can contain plasmids and raises the question if tetracycline resistance is controlled by plasmids or by the chromosome.

J Gen Microbiol, 1985 Dec, 131 ( Pt 12), 3397 - 400
The peptidoglycan of Neisseria gonorrhoeae, with or without O-acetyl groups, contains anhydro-muramyl residues; Blundell JK et al.; Muramidase digests of alkali-treated SDS-insoluble peptidoglycan from two strains of Neisseria gonorrhoeae were examined . Both strains contained disaccharide peptide monomers that had intramolecular 1,6-anhydro-muramyl ends . In contrast to strain 1L260, in which 50% of the monomer fraction is O-acetylated, the monomer fraction from strain RD5 was completely devoid of O-acetyl groups, as shown by HPLC . Penicillin decreased the O-acetylation of peptidoglycan but did not affect the proportion of anhydro-muramyl residues.

Zh Mikrobiol Epidemiol Immunobiol, 1985 Dec, (12), 19 - 21
{Cultivation of Neisseria gonorrhoeae in an L-929 cell culture}; Nurusheva SM et al.; N . gonorrhoeae strain b has been found to be capable of retaining its viability in medium 199 with 10% of inactivated cattle serum added and in monolayer cell culture L-929 in the above medium . The characteristics obtained in the present investigation permit simulating the mixed association of gonococci and chlamydiae in the culture system used in this work.

Genitourin Med, 1985 Dec, 61(6), 376 - 8
Chlamydial proctitis?
Munday PE, Carder JM, Taylor-Robinson D.
Chlamydia trachomatis was isolated from 21 (7%) of 309 specimens obtained in October 1982 from the rectum of homosexual men undergoing proctoscopy . During the same period Neisseria gonorrhoeae was isolated from 12 (3%) of 454 specimens obtained similarly . The clinical features of patients infected with each of these micro-organisms were compared with those of an uninfected group of homosexual men . No characteristic diagnostic features were noted in the infected men.

Genitourin Med, 1985 Dec, 61(6), 367 - 70
Incidence of penicillinase producing Neisseria gonorrhoeae (PPNG) strains and susceptibility of gonococcal isolates to antibiotics in Benin City, Nigeria; Obaseiki-Ebor EE et al.; Of 53 strains of Neisseria gonorrhoeae isolated in Benin City, Nigeria, in February 1983 to October 1984, 46 (87%) produced penicillinase . The minimum inhibitory concentrations (MICs) of penicillin G and ampicillin for these isolates were between 1 mg/l and and 50 mg/l . About 48% (22/46) of the penicillinase producing strains were also resistant to streptomycin, cotrimoxazole, and ampicillin and cloxacillin . All 53 isolates were sensitive to tetracycline, erythromycin, amoxycillin and clavulanic acid, nalidixic acid, spectinomycin, and the penicillinase stable cephalosporins . The high incidence of resistance may have been the result of indiscriminate and unsupervised use of antibiotics before patients presented for proper treatment in clinics and hospitals.

Genitourin Med, 1985 Dec, 61(6), 363 - 6
Comparison of Neisseria gonorrhoeae isolates from homosexual and heterosexual men; Fagan D; The gene locus known as mtr confers resistance to hydrophobic dyes, detergents, and antibiotics . It has been suggested previously that the host environment is important in the selection of gonococcal strains with this outer membrane phenotype, and thus that strains with mtr gene loci should predominate in environments high in hydrophobic molecules . Furthermore, resistance to hydrophobic molecules has been related to a sevenfold increase in a minor outer membrane protein . To test these suggestions the outer membrane phenotypes of 61 strains of Neisseria gonorrhoeae were identified using 27 rectal isolates from homosexual men and 34 urethral isolates from heterosexual men who were matched for age . The cell envelope phenotype of each strain was identified on the basis of resistance to various hydrophobic compounds . The results were compared with the protein profiles of these strains on sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE); no significant correlation was found.

J Med Microbiol, 1985 Dec, 20(3), 379 - 86
Correlation of cell-envelope phenotypes of Neisseria gonorrhoeae with site of infection and serogroup; Reid KG et al.; The envelope phenotypes and coagglutination (CoA) W serogroups of 301 unselected clinical isolates of Neisseria gonorrhoeae were studied . Of the 287 isolates from infections acquired in the Edinburgh area, 252 (88%) were of the wild-type phenotype, 17 (6%) were of Env phenotype with increased permeability of the cell envelope, and 18 (6%) were of Mtr phenotype with reduced permeability of the cell envelope . Mtr strains were isolated significantly more often from homosexual men than from heterosexual men and women (p less than 0.001) . Of the isolates from homosexual men there were considerably fewer Mtr phenotypes among rectal isolates than among urethral and throat isolates . All isolates from homosexual men, 57% from heterosexual men and 52% from women were of CoA serogroup WII (including WII/WIII) . Although the Mtr phenotype was strongly associated with serogroup-WII isolates from homosexual men, there was no such correlation between the Mtr phenotype and serogroup-WII isolates from heterosexual patients . It is suggested that hydrophobic compounds in the rectal environment are not the major factor in selecting serogroup-WII strains of Mtr phenotype associated with homosexually acquired infection . The hypothesis that the Mtr phenotype and serogroup WII are selected independently as a result of a more general selective pressure such as antibiotic usage, common to all infected sites, is discussed.

Infect Immun, 1985 Dec, 50(3), 738 - 44
Effects of human serum on the growth and metabolism of Neisseria gonorrhoeae: an alternative view of serum; Britigan BE et al.; Humans are the sole reservoir of Neisseria gonorrhoeae, an organism which undergoes a marked increase in metabolic rate after exposure to a low-molecular-weight, heat-stable component(s) of human serum . Further studies on the effect of serum on gonococcal metabolism were undertaken . Gonococcal broth (GCB) is commonly used for in vitro cultivation of gonococci . Gonococci suspended in GCB plus 10% serum exhibited oxygen consumption rates of 139% (P less than 0.01) and 456% (P less than 0.01) of those suspended in GCB or Hanks balanced salt solution, respectively . A twofold increase in growth rate also resulted from the addition of 10% serum to GCB . Gonococcal 14C-labeled adenine incorporation increased threefold with 10% serum supplementation of Hanks balanced salt solution . Dialysis of serum in 1,000-molecular-weight exclusion tubing removed the stimulatory factor(s) . Neither correction of anion-cation concentrations altered by dialysis nor addition of substances of known importance to the metabolism of gonococci (i.e., lactate, pyruvate, cysteine, ATP, AMP, NADPH, amino acids, malate, and glutathione) to dialyzed serum reconstituted stimulatory capacity . The effect of serum on gonococcal glucose-catabolic pathways was measured by modified radiospirometry . An apparent threefold increase in Entner-Doudoroff and pentose phosphate pathway activities was induced by 10% serum, as was the increased shunting of glucose-derived glyceraldehyde-3-phosphate into these pathways . These metabolic changes did not allow specific identification of the serum stimulatory factor(s) . Acetate, the major by-product of gonococcal glucose catabolism, inhibited gonococcal oxygen consumption as previously reported . A high-molecular-weight serum component, probably albumin, reversed acetate-mediated inhibition of gonococcal oxygen consumption, identifying a second mechanism by which serum increases gonococcal metabolism . These results suggest that supplementation of growth media with serum should be considered to provide N . gonorrhoeae with conditions more consistent with its normal environment.

Infect Immun, 1985 Dec, 50(3), 672 - 7
Elaboration of a 3.6-kilodalton lipooligosaccharide, antibody against which is absent from human sera, is associated with serum resistance of Neisseria gonorrhoeae; Schneider H et al.; Neisseria gonorrhoeae strains that resist lysis by normal human sera (NHS) do so, in part, because NHS contain immunoglobulin M (IgM) specific for lipooligosaccharide (LOS) antigens of serum-sensitive strains, but lack antibodies for LOS antigens that can serve as loci for immune lysis of serum-resistant (serr) strains . We used a monoclonal antibody (McAb), specific for an epitope within a 3.6-kilodalton (kDa) component of Neisseria meningitidis L8 LOS, that binds a 3.6-kDa gonococcal LOS component so that we could explore further serr gonococcal strains . The McAb bound to the LOS of 6 of 7 serr of strains but not to the LOS of 0 of 14 serum-sensitive and serum-intermediate gonococcal strains of diverse origin . We studied three serr strains further . Strain 7134 does not elaborate the 3.6-kDa LOS component and does not bind the McAb; strains WR220 and WR302 do elaborate the 3.6-kDa LOS component . The titer (log2) at which the McAb, diluted in NHS, lysed strain WR220 was 7.7; for WR302 it was 3.7, and for 7134 it was 0 . Addition of McAb to NHS caused increased classical and alternative-pathway C3 deposition onto strain WR220, but only classical-pathway-activated C3 deposition onto strain WR302 . The difference in lytic effectiveness of the McAb for the two strains, therefore, may result from differences in alternative-pathway augmentation of McAb-dependent classical-pathway activation on their surfaces . None of 40 randomly selected normal young adults had serum antibody that could compete with the McAb for binding to WR220 LOS in a solid-phase RIA . We conclude that the 3.6-kDa LOS component is commonly expressed by serr strains of N . gonorrhoeae and that antibody to it would be lytic if present in human serum, but that it is infrequently, if ever, present . As a result, strains elaborating this LOS are resistant to lysis by NHS.

Acta Pathol Microbiol Immunol Scand {B}, 1985 Dec, 93(6), 389 - 94
Identification of Eikenella corrodens and Cardiobacterium hominis by genetic transformation; Tonjum T et al.; Genetic transformation was employed to attain exact identification of Eikenella corrodens and Cardiobacterium hominis . The two species appeared both homogeneous and without genetic affinity to each other or to species of Kingella, Neisseria, and Moraxella, as tested for by rather sensitive procedures with streptomycin- and spectinomycin-resistance markers.

Hautarzt, 1985 Dec, 36(12), 675 - 81
{Detection of the gonococcal antigen with an enzyme immunoassay (Gonozyme) . Results of the original and modified test procedure}; Hofmann H et al.; Urogenital specimens of 2,485 patients were examined by an enzymeimmunoassay for the detection of Neisseria gonorrhoeae antigen (Gonozyme, Abbott) . The results of the original test (Gonozyme A) and a modified version (Gonozyme B) were compared to bacterial culture . Three different groups were examined by Gonozyme A: 526 men and 464 women from the clinic for sexually transmitted diseases (STD) and 548 registered prostitutes . Sensitivity in men was 98%, in women from the STD clinic 89%, and in prostitutes 81% . Specificity in men was 99.5%, in women from the STD clinic 94%, and in prostitutes 88% . One of the reasons for the decreased specificity in women could be cross reacting bacteria from the genital secretions of the women . The assay was modified by optimizing the antigonococcal antibody and increased incubation times . These modifications improved the specificity of Gonozyme B by reducing the number of cross reactions with other bacterial antigens . Four different groups were examined by Gonozyme B: 261 men and 220 women from the STD clinic, 121 women from an infertility clinic, and 345 registered prostitutes . Sensitivity in men was 100%, in women from the infertility clinic 100%, in women from the STD clinic 94%, and in prostitutes 77% . Specificity in men was 99%, in women from the infertility clinic 100%, in women from the STD clinic 99%, and in prostitutes 96.5% . Analysis of the Gonozyme-positive/culture-negative test results suggested that most patients (85%) did not have gonorrhoea . In 15% of these specimens it is possible that patients had pretreated gonorrhoea which was only detected by Gonozyme.(ABSTRACT TRUNCATED AT 250 WORDS)

J Exp Med, 1985 Dec 1, 162(6), 2017 - 34
Analyses of gonococcal H8 antigen . Surface location, inter- and intrastrain electrophoretic heterogeneity, and unusual two-dimensional electrophoretic characteristics; Hitchcock PJ et al.; The H8 protein is a surface-exposed antigen that is found, among members of the Neisseria genus, primarily on pathogenic species . In this study, the surface exposure of H8 was reassessed by four techniques . Results of slide agglutination, indirect fluorescent antibody binding, absorption of sera with whole gonococci, and immune electron microscopy all confirmed the presence of H8 in the outer membrane . The degree to which protein A-gold-labeled monoclonal antibodies bound to H8 was marked, and suggested that this antigen was present in abundant amounts in the outer membrane . Also in this study, the electrophoretic heterogeneity of this common surface antigen was examined . Because H8 stains poorly, electrophoretic mobility was assessed using polyclonal antibodies and a monoclonal antibody that recognizes a common H8 epitope . H8 was analyzed with respect to protein I, lipopolysaccharide (LPS), and pilus and opacity phenotypic variation; results confirmed that heterogeneity of Mr was the rule among strains (21 were examined), however, the variability in Mr was independent of protein I or LPS Mr . In one strain (FA1090), the heterogeneity of H8 was examined among 10 piliation/opacity variants; the H8 (and LPS) Mr was identical in all variants; similar data were generated in strains JS3 and JS1 . The electrophoretic mobility of H8 was altered in serum-resistant and neutrophil enzyme-resistant gonococci compared to the sensitive gonococci . Some of the unusual electrophoretic migration characteristics of the antigen were also examined . H8 formed a unique mushroom-shaped band in one-dimensional gels; in a two-dimensional electrophoresis system, the antigen migrated aberrantly, very similarly to LPS . Also seen in the two-dimensional electrophoresis profile were multimers of the H8 antigen; in strain JS3 (Mr 23,500), these migrated at 43,600, 86,000, and greater than 150,000 . In other strains, the Mr of the multimers differed depending upon the Mr of the monomer . The two-dimensional migration characteristics (as measured by antigenicity) were completely destroyed by proteinase K digestion . Activity of H8 polyclonal antibodies to the antigens in two-dimensional gels was completely removed by adsorption of formalin-fixed whole cells, but was not affected by adsorption with LPS . These electrophoretic characteristics may reflect the close association of some nonprotein constituent, perhaps lipid or carbohydrate or both.

Am J Med, 1985 Nov 29, 79(5B), 13 - 24
Antibacterial activity of ticarcillin in the presence of clavulanate potassium; Sutherland R et al.; The antibacterial effects produced by ticarcillin disodium plus clavulanate potassium, a combination of the broad-spectrum penicillin ticarcillin, and the beta-lactamase inhibitor clavulanic acid as the potassium salt, have been measured in vitro and in experimental infection studies . The presence of clavulanic acid resulted in a significant enhancement of the activity of ticarcillin against a wide range of beta-lactamase-producing bacteria . These included ticarcillin-resistant strains of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, P . vulgaris, Yersinia enterocolitica, and the anaerobe Bacteroides fragilis . In addition, beta-lactamase-producing isolates of Hemophilus influenzae, Branhamella catarrhalis, Neisseria gonorrhoeae, and Staphylococcus aureus were susceptible to ticarcillin and clavulanate . Clavulanic acid did not influence the activity of ticarcillin against ticarcillin-susceptible bacteria . The bactericidal effects of the antibiotic combination were measured in an in vitro kinetic model in which the drug concentrations were varied to simulate those measured in humans after intravenous dosing with ticarcillin (3.0 g) and clavulanate potassium (100 mg clavulanic acid) . In these tests, ticarcillin plus clavulanic acid had pronounced bactericidal activity against ticarcillin-resistant bacteria . The protection of ticarcillin by clavulanic acid from inactivation by bacterial beta-lactamases in vivo was demonstrated in experimental infection models in which the efficacy of the ticarcillin plus clavulanic acid combination against infections caused by beta-lactamase-producing bacteria was correlated with the presence of effective concentrations of both antibiotic and inhibitor at the site of infection.

Eur J Biochem, 1985 Nov 4, 152(3), 663 - 8
Structure of the capsular antigen of Neisseria meningitidis serogroup K; Van der Kaaden A et al.; The capsular antigen isolated from the culture liquid of a Neisseria meningitidis serogroup K(1811) fermentation consists of the 2-acetamido-2-deoxymannuronic acid disaccharide repeating unit as follows: ----3)-beta-D-ManpNAcA-(1----4)-beta-D-ManpNAcA-(1---- The polysaccharide is O-acetylated at the non-glycosylated C-4 . Structural evidence has been obtained from sugar analysis, methylation analysis, as well as 1H and 13C NMR spectroscopy.

J Gen Microbiol, 1985 Nov, 131 ( Pt 11), 3105 - 15
Genetic relationships among Neisseria species assessed by comparative enzyme electrophoresis; Chun PK et al.; The electrophoretic mobilities of 12 enzymes from 19 Neisseria species (including 6 strains of N . perflava), Gemella haemolysans, Escherichia coli and Branhamella catarrhalis were characterized by polyacrylamide slab gel electrophoresis . All strains and species tested exhibited qualitatively different zymogram patterns . Species and strain relationships were quantified by pairwise comparisons of all 12 enzyme systems to obtain similarity indices; these data were subjected to numerical clustering methods to obtain groups and a phenogram . The electrophoretic classification compared favourably with those obtained by other criteria . In addition, the quantitative clustering data indicated that N . ovis and N . caviae are sufficiently different from the other Neisseria species to warrant their separation into a distinct group . These two species also lacked the characteristic NADPH-diaphorase zymogram pattern found in all the other Neisseria species . Intra-species similarity indices were generally greater than the inter-species index values . However, certain species such as N . meningitidis and N . gonorrhoeae had similarity index values in the range of inter-strain index values.

Zh Mikrobiol Epidemiol Immunobiol, 1985 Nov, (11), 6 - 10
{Cultivation of Neisseria meningitidis serogroups A, B and C in a synthetic nutrient broth}; Karabak VI et al.; The processes of the cultivation of N . meningitidis, serogroups A, B and C, in a liquid synthetic culture medium have been studied . Strictly group-specific biomass has been obtained . The maximum productivity at all stages of the batch cultivation of N . meningitidis strains 125 and 133 in this medium does not differ from that at similar stages of cultivation in modified Cohen-Wheller semisynthetic medium . In the serotype antigen preparations obtained from N . meningitidis strain 125 grown in the above-mentioned liquid synthetic culture medium basic polypeptides with a molecular weight of 33000, 36000 and 41000 D have been detected . Their presence in N . meningitidis cells is linked with the growth phase of the population.

Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi, 1985 Nov, 18(4), 264 - 73
Protective effect of normal guinea pig serum on the bactericidal activity of normal human serum for Neisseria gonorrhoeae; Ding MJ et al.; Normal human serum (NHS) killed Neisseria gonorrhoeae (GC) strain F62 after incubation at 37 degrees C . In contrast, the bactericidal effect of normal guinea pig serum (NGPS) under similar conditions was not obvious . When NHS was mixed with NGPS or heated NGPS and a suspension of strain F62, the bacteria were protected from killing by NHS . When strain F62 was incubated first with NGPS for 30 min at 37 degrees C, washed and then treated with NHS, the strain was significantly protected . Depletion of complement (C) of NGPS by zymosan treatment or by heating at 56 degrees C for 30 min decreased the protective activity of NGPS . These data suggest that protection of GC by NGPS occurred on the surface of GC and C may be involved . However, when strain F62 was incubated first with heated NGPS for 30 min at 37 degrees C, washed and then treated with NHS, the strain was significantly killed . This suggests that protection of GC by heated NGPS did not occur on the surface of GC . In addition to the protective effect of NGPS on the bactericidal activity of NHS for GC, NGPS adsorbed with strain F62 also had the ability to kill the GC.

Z Hautkr, 1985 Nov 1, 60(21), 1665 - 6, 1671-4, 1679-81
{Critical remarks on gonorrhea therapy: netilmicin}; Soltz-Szots J et al.; Several failures of gonorrhea treatment due to neisseria producing penicillinase (PPNG), resistance against other antibiotics, side effects like allergies, gastrointestinal problems, and other factors are the reasons for continuing trials with new drugs in the treatment of gonorrhea . With regard to modern aminoglycosides, the development of early resistance has not been observed so far . Especially with Netilmicin, no such disadvantages have been reported in the literature . Therefore a single dose schedule was introduced with Netilmicin given to 600 patients suffering from uncomplicated gonorrhea in order to evaluate the efficacy and safety of the drug . 300 mg Netilmicin were administered intramuscularly in a one shot therapy . With all patients, the diagnosis had been confirmed by culture . The efficacy of therapy was controlled by a second culture, which proved to be negative in all 600 cases . Gonorrhea was also clinically cured in all patients.

J Clin Invest, 1985 Nov, 76(5), 1765 - 72
Mechanism of action of blocking immunoglobulin G for Neisseria gonorrhoeae; Joiner KA et al.; Blocking immunoglobulin G (IgG) inhibits complement-mediated killing of serum-resistant Neisseria gonorrhoeae (GC) in immune human serum . We examined the mechanism of action of blocking IgG . Presensitization of GC with increasing concentrations of blocking IgG or F(ab')2 before incubation with bactericidal antibody and absorbed pooled normal human serum increased consumption and deposition of the third component of human complement (C3) and the ninth component of human complement (C9) but inhibited killing in dose-related fashion . We next showed that blocking IgG or F(ab')2 partially inhibited binding of bactericidal IgG to GC . Also, binding of a monoclonal antibody recognizing GC outer membrane protein PIII was almost completely inhibited by blocking F(ab')2, confirming other work (Rice, P . A., M . R . Tam, and M . S . Blake, manuscript submitted for publication) showing that PIII is a target for blocking antibody . Studies of the C3 deposition site showed that one quarter of the C3 deposited on GC in the presence of blocking IgG bound covalently to the antibody molecule . Finally, 125I-GC constituents with covalently bound C3 were affinity purified on Sepharose bearing antibodies to C3 and identified by sodium dodecyl sulfate polyacrylamide gel electrophoresis . C3 deposition on a 40,000-mol wt surface protein was enhanced six- to ninefold by blocking IgG, which indicates that the site of complement deposition was altered by blocking antibody . These studies show that blocking IgG competes with bactericidal antibody for binding to GC, but enhances rather than blocks complement activation, and leads to complement deposition at new sites that do not result in serum killing.

J Clin Microbiol, 1985 Nov, 22(5), 731 - 4
Difficulties in differentiating Neisseria cinerea from Neisseria gonorrhoeae in rapid systems used for identifying pathogenic Neisseria species; Boyce JM et al.; Neisseria cinerea and Neisseria gonorrhoeae may occur at the same body sites and may have similar colony morphologies . Ideally, systems used for rapid identification of N . gonorrhoeae should be able to differentiate N . cinerea from gonococci . We tested seven N . cinerea strains using the Gonochek II (Du Pont Diagnostics), Minitek (BBL Microbiology Systems), RapID-NH (Innovative Diagnostics, Inc.), RIM-N (American Microscan), and Phadebact (Pharmacia Diagnostics) systems . We found that the reactions produced by N . cinerea in Gonochek II, Minitek, and RapID-NH kits could be confused with the results produced by some strains of N . gonorrhoeae . The susceptibility of N . cinerea to colistin, its ability to grow on tryptic soy or Mueller-Hinton agar, and its inability to grow on modified Thayer-Martin medium help differentiate it from gonococci.

Rev Infect Dis, 1985 Nov-Dec, 7 Suppl 4, S696 - 702
The polymicrobial etiology of acute pelvic inflammatory disease and treatment regimens; Dodson MG et al.; Continued research on acute pelvic inflammatory disease (PID) has demonstrated that PID has a rather remarkably varied etiology, the pathogens responsible including Neisseria gonorrhoeae, Chlamydia trachomatis, aerobic and anaerobic gram-positive and gram-negative organisms, and possibly mycoplasmas . There is clearly no single antimicrobial agent that is effective against all of the organisms implicated in the etiology of acute PID . The aminoglycosides, generally in combination with an antibiotic such as clindamycin, are commonly used in the treatment of patients with acute PID . The combination of a new monocyclic beta-lactam antibiotic, aztreonam, and clindamycin may be less toxic and equally or more effective for the treatment of acute PID.

Z Hautkr, 1985 Nov 1, 60(21), 1655 - 62
{Detection of Gardnerella vaginalis in the pathogen spectrum of sexually transmissible diseases in vulvovaginitis}; Elsner P et al.; Gardnerella vaginalis, a sexually transmittable organism, is regarded as the indicator of the so-called "non-specific vaginitis" . The isolation rate of G . vaginalis from 72 women attending our out-patient department during one year because of urogenital complaints was higher in pretreated than in untreated patients . In genital swabs taken from untreated patients, G . vaginalis could be isolated only in 17%, whereas this was observed in 38% of the specimens from women pretreated with various antimicrobial agents . In 9% of the women without vaginal discharge G . vaginalis was isolated . In specimens obtained from 53% of the women positive for G . vaginalis further organisms such as Chlamydia trachomatis, Trichomonas vaginalis, Candida albicans, Ureaplasma urealyticum, Mycoplasma spp . and B-Streptococci could be isolated . Asymptomatic infections with Neisseria gonorrhoeae (1) and C . trachomatis (4) were also observed . The present study clearly demonstrates that a broad microbiological examination is essential for specific therapy in vaginitis . Even if unspecific vaginitis is diagnosed by the presence of clue-cells, increased vaginal pH and fishy odour, a combined infection by further sexually transmittable organisms, especially N . gonorrhoeae, is to be excluded.

Plasmid, 1985 Nov, 14(3), 209 - 16
Polypeptides encoded by cryptic plasmids from Neisseria gonorrhoeae; Aalen RB et al.; Almost all clinical isolates of Neisseria gonorrhoeae harbor a small, phenotypically cryptic plasmid of approximately 4.1 kb . In this study several polypeptides encoded by two variants of such plasmids, one (pSB01C) having a deletion of approximately 50 bp as compared to the other (p31788C), have been identified, and the position of the genes for two of the proteins determined . The cryptic plasmids were cloned into the HindIII site of the vectors pBR322 and pACYC184 . The resulting recombinant plasmids were transformed into the Escherichia coli minicell producing strain DS410 (minA, minB) and the plasmid-encoded proteins analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis . The pSB01C derivatives express two distinct proteins of 22 and 16 kDa and p31788C two other proteins of 24 and 18.5 kDa . Additionally, both plasmids express common proteins of 32.5, 9, and 7.5 kDa . The genes coding for the 24- and the 7.5 kDa proteins have been mapped by restriction enzyme analysis of Tn5 insertions suppressing the expression . The additional 50 bp in p31788C are localized to the coding region of the 24-kDa protein, and the 22-kDa protein of pSB01C is possibly a shortened form of the former due to the lacking 50 bp.

J Infect Dis, 1985 Nov, 152(5), 990 - 1001
Antibody-antigen specificity in the immune response to infection with Neisseria gonorrhoeae; Lammel CJ et al.; This study was done to define antigens important in the immune response to infection with Neisseria gonorrhoeae . Sera were obtained from men and women with uncomplicated gonorrhea (UGC), women with disseminated gonococcal infection, and women with gonococcal pelvic inflammatory disease (PID); sera were also obtained from uninfected controls . Vaginal fluids were taken from 15 patients with UCG or PID . The sera and vaginal fluids were tested against gonococcal isolates from the same patients to examine homologous antibody-antigen interactions by use of the western blot technique . Antibodies in the serum reacted with more gonococcal antigens compared with antibodies in the vaginal fluid . IgG in serum and vaginal fluid reacted with more antigens than did IgA in the same specimens . The predominant antigens reactive with IgG in serum were pili, protein II, a broad 23-33-kDa band of antigen, and presumptive lipopolysaccharide; and for IgA, protein II and a 46-48-kDa protein . The control sera also reacted with the 46-48-kDa protein . The predominant antigens reactive with IgG in vaginal fluid were protein I, protein II, pili, and the 46-48-kDa protein; and for IgA, protein I, protein II, and pili . Immunoglobulin in vaginal fluid reacted comparatively more with protein I than did immunoglobulin in serum.

Genitourin Med, 1985 Oct, 61(5), 345 - 6
Colonisation of the urethra with Streptococcus pneumoniae: a case report; Noble RC; A 25 year old man developed mild urethritis and urethral colonisation with Streptococcus pneumoniae five days after a single orogenital sexual contact . The diagnosis was suspected because of the appearance of Gram positive diplococci in the urethral exudate . The incidence of urethral infection with S pneumoniae is not known . Pneumococci are unlikely to grow on the routine selective media used to identify Neisseria gonorrhoeae.

Sex Transm Dis, 1985 Oct-Dec, 12(4), 235 - 7
Ruptured tubo-ovarian abscess in pregnancy: recovery of a penicillinase-producing strain of Neisseria gonorrhoeae; Stubbs RE et al.; This report describes a patient, 15 weeks pregnant, who developed progressive disease of the female genital tract due to a penicillinase-producing strain of Neisseria gonorrhoeae . Standard therapy for gonorrhea did not abort progression of disease, which culminated in a ruptured tubo-ovarian complex in the second trimester of pregnancy.

Sex Transm Dis, 1985 Oct-Dec, 12(4), 209 - 14
Serologic classification and contact-tracing in the control of microepidemics of beta-lactamase-producing Neisseria gonorrhoeae; Ramstedt KM et al.; Serologic classification of isolated gonococcal strains and thorough contact-tracing were proved to be valuable in controlling an indigenous outbreak of infections caused by beta-lactamase-producing Neisseria gonorrhoeae (PPNG) . Only 1-2% of gonococcal strains isolated in Sweden are PPNG, and before 1983 most of them were imported . During January-August 1983, 43 PPNG strains were isolated from 42 patients in Gothenburg . The PPNG strains were auxotyped and classified serologically . PPNG strains of serogroup WI, serovar (subgroup) Ae and of the prototrophic auxotype were isolated from 27 patients, including six prostitutes . Information obtained at interviews with these patients indicated that there had been a chain of infections . Quick and thorough contact-tracing stopped this microepidemic within three months . The serologic classification of the PPNG strains helped us to concentrate the epidemiologic efforts on those persons known to be infected with the epidemic strain, to trace this infection to other parts of Sweden, and to determine when the outbreak was finished.

Sex Transm Dis, 1985 Oct-Dec, 12(4), 198 - 202
A solid-phase enzyme immunoassay (Gonozyme) test for direct detection of Neisseria gonorrhoeae antigen in urogenital specimens from patients at a sexually transmitted disease clinic; Nasello MA et al.; The Gonozyme test (Abbott Laboratories; North Chicago, IL), a solid-phase enzyme immunoassay (EIA), was evaluated for direct detection of antigens from Neisseria gonorrhoeae in clinical specimens . Results of the EIA were compared with those of culture and gram stain . Separate swab specimens for each procedure were collected from cervical secretions of 119 females and urethral exudate of 198 males (total, 324 specimens) seen in a sexually transmitted disease clinic . Cultures from 132 specimens were positive for gonococci (27 women and 105 men), and gram stains of 119 specimens were positive (14 women and 105 men) . The EIA test was positive for 145 specimens (34 women and 111 men) . The sensitivities of EIA for females and males were 88.5% and 99.0%, respectively, as compared with 29.6% and 98.1% for gram stain . Specificities of EIA were 89.2% and 92.5%, while those of gram stain were 93.5% and 86.0%, respectively . Overall accuracy of the EIA was 89.1% for females and 95.9% for males . In veiw of the speed and independence from viable organisms of the EIA test, the lack of good gram stain sensitivity for females, and the inherent drawbacks of culture, the Gonozyme test, if used in conjunction with culture, can detect a higher percentage of patients with genital gonorrhea than can culture alone . However, EIA in its present form cannot be used as the sole criterion for a laboratory diagnosis of gonococcal disease because of the ethical and medicolegal consequences of an EIA-positive, culture-negative result.(ABSTRACT TRUNCATED AT 250 WORDS)

Sex Transm Dis, 1985 Oct-Dec, 12(4), 188 - 92
Chemotaxis of polymorphonuclear leukocytes from donors of different races toward Neisseria gonorrhoeae of three different auxotypes; Noble RC et al.; Urethral gonorrhea is typified by the presence of large numbers of polymorphonuclear leukocytes, which are presumably attracted to the urethra by an as yet uncharacterized chemotaxin . Culture supernatants from three different auxotypes of Neisseria gonorrhoeae, one requiring arginine, hypoxanthine, and uracil (Arg-,Hyx-,Ura-), one requiring proline, arginine (not satisfied by ornithine), and uracil (Pro-,Arg-{Orn*},Ura-), and one requiring proline (Pro-), were tested for their chemotactic activity against leukocytes from men of two racial groups, white and black . These auxotypes were chosen because the Pro- auxotype is isolated more frequently from black patients, and the Arg-,Hyx-,Ura- and the Pro-,Arg-(Orn*),Ura- auxotypes are isolated more frequently from white patients . Chemotaxis was tested in blind-well chambers in the absence of complement; membranes with a pore size of 3 microns were used . The culture supernatants of the Pro- auxotype were the most chemotactic, while those of the Arg-,Hyx-,Ura- were the least chemotactic when analyzed by a three-way analysis of variance: F = 22.83, df = 2.6, P less than .001 . There were no differences in migration with respect to the race of the donor . Gonococcal culture supernatants did not require complement for chemotaxis.

J Clin Microbiol, 1985 Oct, 22(4), 481 - 3
Lectin characterization of gonococci from an outbreak caused by penicillin-resistant Neisseria gonorrhoeae; Schalla WO et al.; A total of 40 Neisseria gonorrhoeae isolates, representing 19 penicillin-resistant isolates (from 8 heterosexual patients and 11 homosexual patients) and 21 penicillin-susceptible isolates (from 15 heterosexual patients and 6 homosexual patients) and obtained from the same geographic area, were examined . Lectin agglutination patterns were based on the reactivity of the isolates with the following 14 lectins: concanavalin A, Lens culinaris, Trichosanthes kinlowii, Griffonia simplicifolia I, Arachis hypogeae (peanut agglutinin), Glycine max (soybean agglutinin), Dolichos bifloris, Griffonia simplicifolia II, Solanum tuberosum (potato starch agglutinin), Triticum vulgaris (wheat germ agglutinin), Limax flavus, Phaseolus vulgaris, Ulex europaeus I, and Lotus tetragonolobus . All isolates were serotyped with monoclonal antibodies specific for gonococcal outer membrane protein I and auxotyped, and the plasmid content was determined . Resistant patient isolates were selected for their decreased penicillin susceptibility, and control isolates were selected for their penicillin susceptibility . Even though the patient isolates demonstrated resistance to penicillin, no phenotypic differences in lectin-grouping patterns were demonstrated between the two study groups; i.e., two predominant lectin groups were observed . No resistance-associated plasmids were detected . All patient isolates were serogroup IB (serovars IB-1, IB-2, and IB-4), whereas 12 of 21 control isolates were serogroup IA (P less than 0.05) . Isolates obtained from different anatomical sites in the same patient (cervical and rectal) agreed with regard to lectin patterns and serovars but not auxotypes.

Can J Microbiol, 1985 Oct, 31(10), 893 - 5
Evaluation of a modified enzyme immunoassay for Neisseria gonorrhoeae in high- and low-risk females; Skeels MR et al.; A recently modified commercial enzyme immunoassay (Gonozyme; Abbott Laboratories, North Chicago, IL) for Neisseria gonorrhoeae antigens was compared with bacteriological culture for diagnostic sensitivity, specificity, and predictive value . A total of 480 specimens were tested by both methods; 355 from females attending a sexually transmitted disease clinic ("high-risk") and 125 from female Family Planning clients ("low-risk") . Sensitivity and specificity of enzyme immunoassay for sexually transmitted disease clinic specimens were 79.7 and 97.9%, respectively (55 positive, 280 negative, 6 false positive, 14 false negative) . In the low-risk population, sensitivity and specificity were 100 and 97.5%, respectively (3 positive, 119 negative, 3 false positive, 0 false negative) . Despite modification, sensitivity of the method remains low for our sexually transmitted disease clinic population, but the test may have applicability for preliminary screening in low-prevalence settings.

J Clin Pathol, 1985 Oct, 38(10), 1142 - 5
Evaluation of a direct immunofluorescence test for diagnosing gonorrhoea; Ison CA et al.; A new direct immunofluorescence reagent (Syva and Genetic Systems Inc) was evaluated for its ability to detect Neisseria gonorrhoeae in specimens from populations with a high prevalence of the infection . Gonorrhoea was diagnosed by culture in 45 of 105 (43%) urethral specimens from men and 17 of 90 (28%) urethral and 25 of 60 (42%) cervical specimens from women . In men the immunofluorescence test had a sensitivity of 84.4% and a specificity of 100%; Gram staining gave values of 94% and 100%, respectively . The sensitivity of the immunofluorescence test could be increased to 89% by testing duplicate smears . In women the immunofluorescence test had a sensitivity of 65% and a specificity of 98% for urethral samples and values of 72% and 94%, respectively for cervical samples . At both sites the sensitivity of the Gram stain was 40% and the specificity 100% . The testing of duplicate immunofluorescence smears increased the sensitivity to 76% for urethral and 88% for cervical samples.

Ann Rheum Dis, 1985 Oct, 44(10), 716 - 22
Terminal complement component deficiencies and rheumatic disease: development of a rheumatic syndrome and anticomplementary activity in a patient with complete C6 deficiency; Wisnieski JJ et al.; Hereditary deficiencies of early complement components have usually been associated with the development of rheumatic diseases like systemic lupus erythematosus (SLE), while terminal component deficiency is well known to predispose to recurrent neisserial infection . In contrast, only recently have patients been reported with rheumatic disease and hereditary deficiency of a terminal component . The clinical syndrome in these patients has been characterised as 'SLE-like' . We describe here a third patient with complete C6 deficiency and a systemic rheumatic illness characterised by fever, anaemia, lymphadenopathy, hepatosplenomegaly, episcleritis, and asymmetric arthritis . After blood transfusion her serum became anticomplementary; IgG antibody to human C6 was found to be the cause of anticomplement activity . Persistent absence of C6 in this patient and production of anti-C6 antibody after antigenic challenge indicate hereditary C6 deficiency . This case supports an association between hereditary deficiency of a terminal complement protein and the development of systemic rheumatic disease.

J Med Microbiol, 1985 Oct, 20(2), 197 - 202
Auxotypes of Neisseria gonorrhoeae in Toronto: relationship to penicillin resistance and to sex of patient; Shtibel R; The relationship of auxotype to penicillinase production, penicillin susceptibility, and sex of the patient, has been studied in 8446 non-penicillinase-producing and 153 penicillinase-producing Neisseria gonorrhoeae (PPNG) strains isolated during 1980-1983 in Toronto . Proline-requiring types constituted 51% of the PPNG and 13% of the non-PPNG strains; ornithine-requiring types constituted only 4% of the PPNG compared with 12% of the non-PPNG isolates . The various auxotypes of the non-PPNG isolates showed marked differences in their degree of resistance to penicillin; and the proportions of each auxotype from male and female patients were dissimilar.

J Bacteriol, 1985 Oct, 164(1), 461 - 5
Autoplaquing in Neisseria gonorrhoeae; Campbell LA et al.; Irregularly shaped autoplaques were observed on a lawn of two different strains of Neisseria gonorrhoeae . Autoplaquing occurred on gonococcal genetic medium lacking arginine and was noninducible on complete gonococcal genetic medium . The cell density, incubation temperature, and agar base influenced autoplaquing . Single-colony suspensions varied in plaque morphology . We were unable to isolate a stable nonplaquing variant but separated strain RUN5287 into two plaquing phenotypes.

Infect Immun, 1985 Oct, 50(1), 116 - 22
Stimulation of human leukocytes by protein II+ gonococci is mediated by lectin-like gonococcal components; Rest RF et al.; We investigated the ability of carbohydrates, glycosidases, and concanavalin A to inhibit the stimulation of the human leukocyte oxidative burst by gonococci in the absence of serum . The gonococci used in this study contained protein II (P.II) outer membrane proteins, and neutrophil oxidative burst was measured by luminol-enhanced chemiluminescence (CL) . The following carbohydrates inhibited CL induced by nonpiliated P.II+ gonococci: beta-D-glucosamine greater than N-acetylneuraminic acid (sialic acid) greater than mannose greater than alpha-methylmannoside greater than N-acetyl-beta-D-glucosamine greater than or equal to glucose greater than or equal to lactose . Fucose, galactose, or beta-D-galactosamine (all 100 mM) did not inhibit or slightly increased CL, indicating a specificity for the observed effects . Mannose and alpha-methylmannoside also inhibited induction of monocyte CL by P.II+ gonococci . Incubation of neutrophils with concanavalin A inhibited subsequent gonococcus-induced CL but not phorbol myristate acetate-induced CL . Treatment of neutrophils with alpha-mannosidase reduced subsequent gonococcus-induced CL greater than 99%, whereas such treatment of gonococci had no effect on their ability to induce neutrophil CL . Incubation of a P.IIb-containing variant of Neisseria gonorrhoeae FA1090 with anti-P.IIb monoclonal antibody inhibited subsequent stimulation of neutrophil CL in a dose-responsive manner, indicating a specific role for P.IIb in the stimulatory process . The data suggest that one or more lectin-like components on the surface of P.II+ gonococci mediate their ability to stimulate the oxidative burst of human phagocytes.

Genitourin Med, 1985 Oct, 61(5), 302 - 5
Single dose ciprofloxacin for treating gonococcal infections in men; Loo PS et al.; A single oral dose of ciprofloxacin 500 mg was used to treat five men with gonococcal urethritis and five men with gonococcal proctitis, and all were cured . In a subsequent study the dose of ciprofloxacin was reduced to 250 mg, and 54 men with 57 gonococcal infections (47 urethral, seven rectal, and three pharyngeal) were treated; of the isolates of Neisseria gonorrhoeae, four were penicillinase producing strains . All the patients were cured of gonococcal infection . Urethral specimens from nine of the men with gonococcal urethritis yielded Chlamydia trachomatis before treatment . These organisms were isolated again from all these patients seven days after treatment, and from a further seven men who had been chlamydia negative before treatment . It is concluded that a single oral dose of ciprofloxacin is an effective treatment for uncomplicated gonorrhoea, but is ineffective against C trachomatis . Of the 54 men given 250 mg ciprofloxacin, six (11%) showed minor abnormalities of liver function tests after treatment.

Biochemistry, 1985 Sep 24, 24(20), 5592 - 8
Structural determination of the capsular polysaccharide of Neisseria meningitidis group I: a two-dimensional NMR analysis; Michon F et al.; The capsular polysaccharide antigen of Neisseria meningitidis group I was isolated by Cetavlon precipitation and purified by ion-exchange chromatography . The structure of the I polysaccharide was determined largely by comprehensive proton and carbon-13 nuclear magnetic resonance studies in which both one-dimensional and two-dimensional experiments were carried out directly on the I polysaccharide . The I polysaccharide is composed of the repeating unit----4)alpha-L-GulpNAcA(1----3){4-OAc}beta-D-ManpNA-cA(-- --in which the former residue adopts the 4C1 (L) conformation and the latter residue adopts the 4C1 (D) conformation . The one-bond coupling between the anomeric carbon and proton (1J13C,H) of the 2-acetamido-2-deoxy-beta-D-mannuronopyranosyl residue is not consistent with its beta-D configuration . This anomalous value of 1J13C,H for this residue is due to through-space anisotropy effects on its anomeric proton, generated by the proximity of the carboxyl group of the neighboring 2-acetamido-2-deoxy-alpha-L-guluronopyranosyl residue . The O-acetyl substituents of the I polysaccharide are essential for its antigenicity to group I polysaccharide-specific antibodies.

Lancet, 1985 Sep 21, 2(8456), 625 - 6
Rapid identification of penicillinase-producing Neisseria gonorrhoeae by detection of beta-lactamase in urethral exudates; Taylor DN et al.; The production of fluorescent end-products with ampicillin as substrate can be used to detect beta-lactamase activity in biological fluids . A fluorescent spot test was evaluated as a rapid method of detecting beta-lactamase in the urethral exudates of men infected with Neisseria gonorrhoeae in Thailand . Among 208 men with culture-proven gonococcal urethritis, the fluorescent spot test was positive in 92 of 101 men from whom penicillinase-producing N gonorrhoeae (PPNG) were isolated and in 4 of 107 men from whom non-PPNG were isolated . The fluorescent spot test is a rapid, inexpensive, and sensitive method to detect PPNG and may be valuable in determining appropriate treatment for patients with gonococcal urethritis.

Z Hautkr, 1985 Sep 15, 60(18), 1461 - 71
{Current status of the antibiotic resistance of Neisseria gonorrhoeae}; Lind I; We give a review on the history of antimicrobial resistance of Neisseria gonorrhoeae, especially penicillinase-producing Neisseria gonorrhoeae (PPNG) . Various mechanisms of antimicrobial resistance are described, and the present state concerning the therapy of gonorrhoea is discussed . The importance of the surveillance of the antimicrobial susceptibility pattern is supported by statistic data obtained in recently finished studies.

Schweiz Med Wochenschr, 1985 Sep 14, 115(37), 1268 - 73
{Clinical evaluation of the Gonozyme enzyme immunoassay in comparison with the modified Thayer-Martin medium and the Jembec transport medium}; Rufli T et al.; A solid phase enzyme immunoassay (GC-EIA, Gonozyme Abbott) for detection of Neisseria gonorrhoeae was tested in 185 male patients with urethritis purulenta sive serosa, and compared with the results obtained by bacterial culture . In 69 men gonorrhoea was confirmed by bacterial culture as method of reference . In 60 patients detection of Neisseria gonorrhoeae was carried out by means of direct inoculation on to Thayer Martin selective medium and immediate incubation, as well as on Jembec transport medium, which was mailed once a day to the respective laboratory . In 8 cases, N.go . was diagnosed with the Thayer-Martin medium only, in 1 case with the Jembec medium only . In 68 out of the 69 patients (sensitivity 98.6%) diagnosis was established with Gonozyme . An additional 8 positive results were obtained with this test, which could not be confirmed by bacterial culture (specificity 93.1%) . 2 of these so-called false positive results can with great probability be assessed as true positive results on the basis of the case history . The positive predictive value with the Gonozyme method was 81.5% and the negative predictive value was 99.1% . The advantages, disadvantages and indication for this method are discussed and compared with the experience of other authors to date.

N Engl J Med, 1985 Sep 5, 313(10), 607 - 11
A community-based outbreak of infection with penicillin-resistant Neisseria gonorrhoeae not producing penicillinase (chromosomally mediated resistance); Faruki H et al.; From February through November of 1983, 199 cases of penicillin-resistant Neisseria gonorrhoeae infection were identified in a localized epidemic in Durham, North Carolina . The isolates did not produce beta-lactamase but were unusually resistant to penicillin (minimum inhibitory concentration, 2.0 to 4.0 micrograms per milliliter), and 15 of 16 patients treated with 4.8 million units of penicillin G procaine plus 1.0 g of probenecid did not respond to therapy . Recognition of the outbreak was impeded by a lack of routine surveillance for resistance other than that mediated by beta-lactamase . All epidemic isolates had a single serotype, auxotype, and antibiotic-susceptibility profile . The outbreak was halted by changing the treatment for all patients and their contacts to spectinomycin, and by intensive epidemiologic case-finding efforts . The emergence of such resistant strains poses potential major public health problems and indicates a need for reassessment of current surveillance procedures.

Pediatr Neurol, 1985 Sep-Oct, 1(5), 278 - 85
Seizures in bacterial meningitis: prevalence, patterns, pathogenesis, and prognosis; Rosman NP et al.; Of 207 patients with acute bacterial meningitis previously reported by Dodge and Swartz, seizures occurred in 56 (27%) . Most seizures began on the first or second day, and most stopped within two days . Seizures occurred most often at the extremes of life . Age-adjusted seizure frequency was greater with Hemophilus influenzae meningitis than with Streptococcus pneumoniae or Neisseria meningitidis . When seizures complicated bacterial meningitis, age-corrected mortality increased from 24% to 38% . Though seizures after recovery were infrequent (2.7% of cases), recurrences were five times more frequent in patients who convulsed acutely than in those who did not . When focal seizures accompanied focal pathology (extracranial or intracranial), the seizures were usually not lateralized to the opposite side of the body . Of factors of potential importance in causation of seizures, fever was the most important risk factor regardless of patient age.

Eur J Epidemiol, 1985 Sep, 1(3), 166 - 71
Epidemiological studies on Neisseria gonorrhoeae isolated in the United Kingdom; Copley CG et al.; Seven hundred and seventy nine isolates of Neisseria gonorrhoeae from the County of Avon, United Kingdom, were examined by auxotyping and penicillin susceptibility testing . Prototrophic strains which were heterogeneous as judge by penicillin susceptibility were the most commonly isolated and increased in prevalence over the three year period . The group most generally susceptible to penicillin required ArgHypUra for growth and decreased in prevalence over the three year period . Ten strains failed to grow on the auxotyping medium . Serogrouping was undertaken on 408 isolates . All strains reacting with the WI reagents were ArgHypUra requiring . However auxotypically similar strains (ArgHypUra) reacted with WII/WIII reagents suggesting a distinct and separately evolved group . Twenty four strains did not type with the serogrouping reagents . Using contact pairs, W-class serology was found to be a stable marker during natural transmission . However auxotypes were found to be unstable in 22 of 104 contact pairs and of these 18 involved a single requirement for proline . This very high incidence of instability with respect to this marker means it is not possible to reliably differentiate between the prototrophic group and the group with a single requirement for proline.

Antimicrob Agents Chemother, 1985 Sep, 28(3), 461 - 3
In vitro activity of Ro 15-8074, a new oral cephalosporin, against Neisseria gonorrhoeae; Ng WS et al.; Ro 15-8074, a new cephalosporin the pivaloyloxymethylester of which (Ro 15-8075) is orally absorbable, showed greater in vitro activity than cefaclor against 48 Neisseria gonorrhoeae strains, including 25 penicillinase-producing strains . Unlike cefaclor, Ro 15-8074 was unaffected by increase in inoculum size, and it exhibited a remarkable stability against gonococcal beta-lactamase hydrolysis.

Antimicrob Agents Chemother, 1985 Sep, 28(3), 393 - 6
Antimicrobial susceptibility testing and phenotyping of Neisseria gonorrhoeae isolated from patients with ophthalmia neonatorum in Nairobi, Kenya; Brunham RC et al.; Antimicrobial susceptibility testing, auxotyping-serotyping, and plasmid analysis were performed on 41 ocular isolates, 7 nasopharyngeal isolates, and 18 cervical isolates of Neisseria gonorrhoeae obtained during a recent treatment trial of gonococcal ophthalmia neonatorum in Nairobi, Kenya . Fourteen distinct serovar-auxotype patterns were observed with IB-1/Pro-strains which accounted for 59% of the isolates . Infection with multiple types of gonococci appeared to occur in 22% of the mothers since 4 of 18 paired maternal cervical and neonatal ocular isolates had mismatched serovar-auxotype patterns . Among 10 treatment failure isolates only 1 had a mismatched serovar-auxotype pattern . Six (15%) of the ocular isolates were penicillinase-producing N . gonorrhoeae (PPNG) . Five had the 4.4-megadalton (Md) beta-lactamase plasmid and one had the 3.2-Md beta-lactamase plasmid . The 24.5-Md plasmid was found in 5 of 6 PPNG strains and in 8 of 35 non-PPNG strains (P less than 0.02) . For most antimicrobial agents, PPNG and non-PPNG strains showed similar patterns of susceptibility . Ceftriaxone was the most active of the antibiotics tested, with all strains having an MIC less than or equal to 0.06 mg/liter . Among non-PPNG strains, 15 (43%) had a penicillin MIC greater than or equal to 2 mg/liter and were considered intrinsically resistant to penicillin . Overall, non-PPNG intrinsically resistant strains had greater resistance to other antibiotics than did non-intrinsically resistant strains (P less than or equal to 0.006) . The Mtr phenotype was found in 53% of these strains.

Zh Mikrobiol Epidemiol Immunobiol, 1985 Sep, (9), 46 - 9
{Interactions between Neisseria meningitidis and cell cultures (data of cytomorphologic studies)}; Ruzal' GI et al.; The present work shows that the cytopathogenic action of N . meningitidis on continuous human amniotic epithelial cell culture FL begins from their active adhesion and subsequent invasion . The degree of the manifestation of the cytopathic effect depends on the capacity of the infective agent for adhesion and invasion and on its biological properties, as well as on the initial state of the cells . The infection of the cells is accompanied by disturbances in their mitotic activity together with the lesions of their chromosomal apparatus . The cells die either in the state of degenerative mitosis, or as the result of the rupture of the cytoplasm in massively invaded cells . The response of the cells to the invasion of faintly cytopathogenic and noncytopathogenic strains takes the form of nonprofessional phagocytosis.

J Clin Microbiol, 1985 Sep, 22(3), 416 - 8
Production of 14C-labeled gas in BACTEC Neisseria Differentiation kits by Neisseria cinerea; Boyce JM et al.; Six strains of Neisseria cinerea were tested in BACTEC Neisseria Differentiation kits (Johnston Laboratories, Inc., Towson, Md.), and all yielded positive glucose growth indices and negative maltose and fructose growth indices . These results were similar to those achieved with Neisseria gonorrhoeae . However, most of the N . cinerea isolates tested yielded 3-h glucose growth indices that were lower than those obtained with gonococci . 14C-labeled gas was produced significantly faster (P less than 0.02) by N . gonorrhoeae than by N . cinerea . Additional studies suggested that the 14C-labeled gas produced by N . cinerea was carbon dioxide . N . cinerea strains were similar to Branhamella catarrhalis strains because both species failed to produce detectable acid from glucose, maltose, sucrose, fructose, and lactose in cysteine-tryptic agar media . However, in contrast to N . cinerea strains, B . catarrhalis strains did not metabolize glucose in BACTEC Neisseria Differentiation kits.

J Clin Microbiol, 1985 Sep, 22(3), 379 - 82
Epidemiological characterization of Neisseria gonorrhoeae by lectins; Schalla WO et al.; A total of 101 isolates of penicillinase-producing and non-penicillinase-producing Neisseria gonorrhoeae with known nutritional requirements, plasmid content, and serovars, were examined for lectin agglutination patterns . These isolates were from outbreaks in Georgia, California, Hawaii, and Pennsylvania . Cell suspensions made from 16- to 18-h cultures were mixed with 14 different lectins, and the resultant agglutination patterns were classified as agglutination groups . Among the 101 isolates tested, 24 different agglutination groups were demonstrated . Of the organisms tested, 55% were located in 3 of the 24 groups, and 86% of the isolates reacted with the lectins Trichosanthes kinlowii, Griffonia simplicifolia I, peanut agglutinin, soybean agglutinin, potato agglutinin, and wheat germ agglutinin . One isolate did not react with peanut or potato agglutinin, five isolates lacked reactivity with potato agglutinin, and six isolates did not react with wheat germ agglutinin . Of the wheat germ-negative isolates, four were from Pennsylvania and were identical with regard to auxotype, plasmid content, serovar, and lectin group . The other two wheat germ-negative isolates were from California and were unrelated by the same criteria to the four Pennsylvania isolates and to each other . Among the isolates tested, there were no differences in lectin groups with regard to the sex of the patient . In the Georgia collection, agglutination with one lectin group was confined to isolates of serogroup IA . This association was not observed for the other geographic areas . Some isolates showing identical auxotype, plasmid content, and serovars could be differentiated based on lectin agglutination patterns, whereas other isolates were identical by all testing criteria.

Yale J Biol Med, 1985 Sep-Oct, 58(5), 443 - 52
Immunodiagnosis of sexually transmitted disease; Schachter J; Methods for detecting microbial antigens in clinical specimens offer an alternative to culture in the diagnosis of some sexually transmitted diseases . Developers of the immunologic methods are faced with a number of problems in evaluating the new tests . Traditionally, these tests are compared to culture as the "gold standard." Unfortunately, culture for Neisseria gonorrhoeae or Chlamydia trachomatis--the two agents most commonly sought--is considerably less sensitive than 100 percent . Immunologic methods may appear to produce false positives when the paired specimens are actually false-negative cultures . Another source of discordant results is sampling variation . These considerations, however, will not account for all false-positive results . Even the best non-culture methods have a low rate of false-positive results . If a new test has a specificity of 97 percent, it, by definition, yields approximately 3 percent false-positive reactions . In low-prevalence settings this false-positive rate will create problems in interpreting the results . For example, in a population with 3 percent prevalence of infection, a positive result in a 97 percent specificity test could only have a predictive value of 50 percent . Most testing for STD agents is performed in low-prevalence settings . None of the currently available immunodiagnostic procedures has a performance profile that suggests it will be satisfactory for diagnostic use in the low-prevalence setting.

Scand J Prim Health Care, 1985 Sep, 3(3), 151 - 4
Treatment of the Gardnerella vaginalis syndrome . A controlled, double-blind study comparing pivampicillin and metronidazole; Hansen JG et al.; A double-blind, randomized, therapeutic study was carried out in 289 patients with vaginal discharge and growth of Gardnerella vaginalis (GV) and no growth of Neisseria gonorrhoeae, Trichomonas vaginalis or Candida . Treatment consisted of either pivampicillin (Pondocillin), 700 mg twice daily for seven days, or metronidazole, 500 mg twice daily for seven days . The effect was evaluated on the basis of the patient's statement and on the result of culture for GV immediately after end of treatment . Evaluated from the culture results metronidazole was significantly more effective than pivampicillin in eradicating GV . The efficacy of the two medications was 69% and 54%, respectively . The evaluations by the patients in the two groups, on the other hand, did not differ significantly, although there was a tendency to consider metronidazole as the most effective . Metronidazole must be considered the most potent drug today, and we recommend it as the medication of choice, provided that the diagnosis is confirmed by the clinical picture and microscopy and not only by culture.

Arch Dermatol, 1985 Sep, 121(9), 1157 - 9
Antibacterial properties of lidocaine on bacteria isolated from dermal lesions; Miller MA et al.; We studied the antibacterial properties of lidocaine and lidocaine with methylparaben, employing bacteria that were isolated from dermal lesions . Our study was significant because local anesthetics utilized before obtaining material for biopsy and/or culture may result in false-negative results . Killing curves were calculated to ascertain exposure times of bacteria to various concentrations of lidocaine with and without methylparaben that could affect recovery of viable bacteria from clinical specimens . The bacteria studied varied greatly in their susceptibility to lidocaine, with Neisseria species being the most sensitive . Greater inhibitory activity was noted against bacteria when methylparaben was present . Our study suggests that lower concentrations of lidocaine without methylparaben should be employed.

Obstet Gynecol, 1985 Sep, 66(3), 384 - 90
Anatomic sites of upper genital tract infection; Heinonen PK et al.; The microbiologic correlates of upper genital tract infection were studied among 36 women with suspected upper genital tract infection and 11 control women undergoing tubal ligation . Laparoscopic evidence of confirmed salpingitis was seen in 25 (69%) of the 36 women . Pathologic evidence of endometritis was present in 26 women (72%), and 22 (85%) of them had salpingitis as well . Thus, four women had endometritis but no salpingitis, three women had salpingitis but no endometritis, and seven women had neither . Among the 25 women with salpingitis, one or more organisms were isolated from the fallopian tubes of nine women (36%) and from the cul-de-sac of six women (24%), versus none and one (9%), respectively, among the 11 cases without salpingitis, and one (9%) and none among the 11 control women . Among the 26 cases with endometritis, one or more organisms were isolated from the endometrium of 19 women (73%) versus 12 (67%) among the 18 women without endometritis . Chlamydia trachomatis was isolated from the uterine cavity of nine women and from the fallopian tubes of three women with upper genital tract infection . The corresponding figures for Neisseria gonorrhoeae were three and two . Other nongonococcal nonchlamydial organisms were commonly isolated from the fallopian tubes and/or culde-sac of women with salpingitis . Bacteria frequently were isolated from the endometrium of both study cases and control subjects, but the latter were more likely to have nonpathogens of low virulence.

Afr J Med Med Sci, 1985 Sep-Dec, 14(3-4), 169 - 73
Single dose treatment of gonococcal urethritis with augmentin in Ibadan; Osoba AO et al.; Augmentin, a new orally absorbed broadspectrum antibacterial agent comprising of amoxycillin trihydrate and potassium clavulanate, was investigated in the treatment of gonococcal urethritis in Ibadan, Nigeria, where penicillinase producing Neisseria gonorrhoeae (PPNG) constitute about 80% of the circulating strains of gonococci . Two different formulations of the agent were employed in the study . The first formulation consisting of 3.0 g amoxycillin and 125 mg clavulanic acid, achieved a cure rate of 75% (i.e . eighteen out of twenty-four patients) among PPNG infections, but 100% cure rate among nine patients with non-PPNG infections . The second formulation consisting of 3.0 g amoxycillin and 250 mg clavulanic acid, had a cure rate of 86% (i.e . fifty-seven out of sixty-six patients) among PPNG infections, and 91% (i.e . ten out of eleven patients) among non-PPNG infections . Clavulanic acid appears to potentiate and enhance the activity of amoxycillin against the beta-lactamase produced by the gonococci . Augmentin seems to be a good and acceptable agent for the treatment of gonococcal infections, in this environment and further studies on its efficacy are therefore justified, such as the simultaneous administration of probenecid.

Clin Lab Med, 1985 Sep, 5(3), 463 - 73
Use of nonradioactive DNA probes for the detection of infectious bacteria; Pollice M et al.; Application of the biotinylated DNA probe systems in the detection of Chlamydia trachomatis and penicillin-resistant Neisseria gonorrhoeae is presented . The three formats employed are the dot-blot, in-situ, and Southern hybridization.

Infect Immun, 1985 Sep, 49(3), 621 - 8
Role of anti-pilus antibodies in host defense against gonococcal infection studied with monoclonal anti-pilus antibodies; Virji M et al.; Several monoclonal antibodies directed against gonococcal pili have been used to investigate the potential contribution of anti-pilus antibodies to host defense against gonococcal infection . Included were two antibodies (SM1 and SM2) which reacted with conserved determinants present on pili from all strains tested and others which exhibited antigenic specificity . Immunoblotting experiments revealed that antibodies SM1 and SM2 recognize epitopes on two different peptides derived by CNBr cleavage of alpha-pili from Neisseria gonorrhoeae P9-2 . All antibodies used were capable of activating complement, as shown by their ability to bind Clq, and one type-specific antibody was effective in complement-mediated bactericidal killing . Antibodies directed against at least some pilus epitopes may therefore contribute to bactericidal activity during the course of natural infection . The opsonic effect of type-specific antibodies was demonstrated by their ability to stimulate luminol-dependent chemiluminescence of human polymorphonuclear leukocytes and promote phagocytic killing of variant P9-2 . Phagocytic killing in the presence of each monoclonal antibody paralleled the increase in chemiluminescence, suggesting that for this variant killing was an inevitable consequence of the interaction of polymorphonuclear leukocytes with gonococci opsonized with anti-pilus antibodies . Antibody-mediated chemiluminescence of polymorphonuclear leukocytes was enhanced in the presence of human complement, and a weak opsonic effect was detected with one of the cross-reacting antibodies (SM1) when this system was used . Although cross-reacting antibody SM1 and type-specific antibody SM13 showed considerable differences in biological properties, they were of the same isotype and bound to native pili on intact gonococci in similar numbers and with similar avidity.

Infect Immun, 1985 Sep, 49(3), 576 - 80
Purification and antigenic relatedness of proteins II of Neisseria gonorrhoeae; Newhall WJ5th et al.; Gonococcal proteins II from three strains were purified by chromatofocusing, and antisera was raised against them . These antisera were examined by immunoblotting to explore the antigenic relatedness of proteins II of seven different strains . The strongest reactions of the antisera were with the homologous proteins II . The antiserum against the proteins II of one strain also reacted with the proteins II present in all of the heterologous strains, whereas the antisera against the proteins II of two other strains showed little cross-reactivity with heterologous proteins II . Monoclonal antibodies produced against the three proteins II of strain F62 were specific for homologous proteins II and recognized epitopes unique to each individual protein II . These studies confirm the extensive intra- and interstrain variability in the antigenic structure of these proteins.

Am J Med, 1985 Aug 9, 79(2A), 52 - 5
Ceftazidime in the treatment of meningitis in infants and children over one month of age; Rodriguez WJ et al.; Ceftazidime, a new beta-lactamase-resistant cephalosporin, was compared with a combination of ampicillin and chloramphenicol for the treatment of meningitis in 100 infants and children aged one month to 15 years . In this open, randomized trial conducted in the Dominican Republic, 61 patients received 50 mg/kg of ceftazidime intravenously every eight hours; 39 received ampicillin plus chloramphenicol in conventional dosages . Seventy-eight of the patients had discernible isolates in samples from cerebrospinal fluid, six had a positive diagnostic Directogen result, and the remainder either had miscellaneous pathogens evident in samples of cerebrospinal fluid, bacteriologic growth in cultures of blood samples only, or no bacteriologic growth in cultures of either cerebrospinal fluid or blood . Among patients with discernible etiologic agents in samples of cerebrospinal fluid, 11 of 57 (19 percent) ceftazidime-treated patients died, and five of 27 (19 percent) patients treated with the combination died . Mortality by pathogen was as follows for patients who received ceftazidime or ampicillin plus chloramphenicol, respectively: Hemophilus influenzae, two of 27 (7 percent) and one of 15 (6 percent); Streptococcus pneumoniae, six of 12 (50 percent) and two of five (40 percent); Neisseria meningitidis, none of 11 (0 percent) and one of six (17 percent); and Salmonella, neither of two (0 percent) and one of one (100 percent) . Overall mortality in the ceftazidime group was 20 percent versus 21 percent in the combination group . No significant toxicities were noted in the patients treated with ceftazidime.

Am J Med, 1985 Aug, 79(2), 216 - 20
Cerebrospinal fluid lymphocytosis in acute bacterial meningitis; Powers WJ; Cerebrospinal fluid lymphocytosis (more than 50 percent lymphocytes or mononuclear cells) occurred in 14 of 103 cases of bacteriologically proved acute bacterial meningitis . Patients with cerebrospinal fluid lymphocytosis accounted for 32 percent (13 of 41) of all patients with bacterial meningitis with a cerebrospinal fluid white blood cell concentration of 1,000/mm3 or less . Cerebrospinal fluid lymphocytosis was significantly more common in neonates and in those without meningismus, but occurred in all ages and without any clear identifying clinical characteristics . The most common etiologic organisms were Streptococcus pneumonia (five), Neisseria meningitidis (two), and Hemophilus influenzae (two) . Cerebrospinal fluid lymphocytosis is common in acute bacterial meningitis when the cerebrospinal fluid white blood cell concentration is below 1,000/mm3 . It is therefore of little value in differentiating bacterial meningitis from viral, fungal, and tuberculous meningitis.

J Antimicrob Chemother, 1985 Aug, 16(2), 143 - 7
Relationship between auxotype, plasmid pattern and susceptibility to antibiotics in penicillinase-producing Neisseria gonorrhoeae; van Klingeren B et al.; The relationship between auxotype, plasmid pattern and susceptibility to antibiotics has been studied in 2396 penicillinase-producing Neisseria gonorrhoeae isolated in The Netherlands during 1982 and 1983 . The most prevalent auxotypes were proline requiring (Pro-; 44%) and non-requiring with inhibition by phenylalanine (NR Pheni; 39%) . The majority (97%) of the Pro- strains carried the 4.5 Mdal resistance plasmid and 99% of the prototrophic strains the 3.2 Mdal plasmid . MICs were determined for cefuroxime, cefotaxime, erythromycin, tetracycline, thiamphenicol and sulphamethoxazole . Pro- isolates were usually less susceptible to antibiotics than prototrophic strains . Evidence was obtained that the level of relative resistance is related to the nutritional requirement as well as the plasmid type.

J Gen Microbiol, 1985 Aug, 131 ( Pt 8), 1963 - 72
Purification, characterization and immunological properties of the capsular polysaccharide of Pasteurella haemolytica serotype T15: its identity with the K62 (K2ab) capsular polysaccharide of Escherichia coli and the capsular polysaccharide of Neisseria meningitidis serogroup H; Adlam C et al.; Capsular polysaccharide from two strains of Pasteurella haemolytica serotype T15 was purified and characterized by chemical analysis and NMR spectroscopy . The polymer, a teichoic acid, proved to be very similar in structure to the capsular polysaccharide of P . haemolytica serotype T4 and identical to the previously described K62 (K2ab) capsular polysaccharide of Escherichia coli, and the capsular polysaccharide of Neisseria meningitidis serotype H, i.e . ----(2-glycerol-3)----(phosphate)----(4-alpha-D-galactopyranose -1)---- with partial O-acetylation on the galactose residues . Electron microscopy with Protein A-gold labelled antisera showed that the polysaccharide was peripherally located on the surface of all three organisms . Chemical removal of O-acetyl groups from the polysaccharide yielded a structure identical to that previously described for E . coli K2 (K2a) . Both O-acetylated and de-O-acetylated P . haemolytica T15 polymers, when absorbed on to sheep erythrocytes in passive haemagglutination assays, yielded identical antibody titres with sera raised against P . haemolytica T15, E . coli K2 or N . meningitidis H whole cells . De-O-acetylation of the Pasteurella polysaccharide influenced its precipitability with immune sera, but this could not be related to the absence of O-acetyl groups because the non-acetylated E . coli K2 polymer readily precipitated with a line of 'identity' with the acetylated P . haemolytica T15 polymer.

J Infect Dis, 1985 Aug, 152(2), 339 - 43
Correlation of auxotype and protein I type with expression of disease due to Neisseria gonorrhoeae; Brunham RC et al.; To explore the correlation of outer membrane protein I (PI) type and auxotype to clinical expression of infection with Neisseria gonorrhoeae, we characterized nutritional requirements by auxotyping and PI serovars by coagglutination assay with monoclonal antibodies of 325 consecutive clinical isolates of N . gonorrhoeae . The clinical status of each infected individual was determined by chart review . The predominant auxotype required proline, citrulline, and uracil with or without hypoxanthine (Pro-Cit-Ura-{Hyx-}) and accounted for 22% of all gonococcal strains . Pro-Cit-Ura-(Hyx-) strains were recovered from seven of 15 men with asymptomatic urethral infections (P less than .01) . Of the 325 strains, 33% were PIA and 67% were PIB serovars . All five isolates in disseminated gonococcal infection were PIA serovars (P less than .01) . Three percent of 168 urethral infections in men were complicated by epididymitis, and 17% of 135 cervical infections in women were complicated by pelvic inflammatory disease (P less than .0005) . Neither of these complications was associated with a particular auxotype or PI serovar.

J Infect Dis, 1985 Aug, 152(2), 330 - 8
Effect of growth in serum on uptake of Neisseria gonorrhoeae by human neutrophils; Britigan B et al.; Because serum exposure precedes interaction of invasive Neisseria gonorrhoeae with neutrophils, neutrophil association with gonococci grown in serum was assessed . Uptake of a nonpiliated serum-resistant strain grown in 20% serum was reduced to 63.5% of control values . Heated serum (20%) yielded similar results . Stimulation of hexose monophosphate shunt activity in neutrophils by heated serum-grown gonococci (a phenomenon reflecting phagocytosis) was 64.5% of control values . Because gonococcal outer membrane (OM) structures mediate interaction with neutrophils, lithium acetate-treated OM preparations of gonococci grown in heated serum were examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis . Multiple new protein bands and a quantitative decrease in amounts of proteins I, II, and III were noted . However, a decrease in the amounts of these membrane proteins was not observed with alternative membrane extraction techniques . Gonococcal growth in 20% serum dialyzed in 3,500-molecular-weight exclusion tubing allowed normal neutrophil association and OM protein expression.

Cutis, 1985 Aug, 36(2), 161 - 3
Preputial abscesses caused by beta-lactamase-producing gonococci; Neubert U et al.; Preputial abscesses occurred in three men who had had sexual intercourse with prostitutes in Thailand . Neisseria gonorrhoeae could be grown from the lesions . Two of the strains were tested for beta-lactamase production and proved positive . While all three patients showed no clinical signs of urethritis, urethral swabs were positive for gonococci in two.

Genitourin Med, 1985 Aug, 61(4), 234 - 40
Penicillinase producing strains of Neisseria gonorrhoeae in the West Midlands 1979-83; Clay JC; All cases of gonorrhoea caused by penicillinase producing strains of Neisseria gonorrhoeae (PPNG) occurring in the population served by the West Midlands Regional Health Authority were surveyed . Isolates that were subjected to plasmid analysis were found to be mainly the "Asian" type in travellers from abroad and their immediate contacts, whereas isolates apparently indigenous in origin were mainly "African" type . The emerging sigmoid curve of yearly incidence, which is apparent for both the country and the region, may indicate that a dynamic equilibrium is being approached in the susceptible core populations . The importance of vigorous contact tracing is underlined by the contrast between the incidence of PPNG strains in the United Kingdom and the larger numbers found in areas where they are hyperendemic and where contact tracing is ineffectual or non-existent.

Genitourin Med, 1985 Aug, 61(4), 230 - 3
Epidemiology and control of gonorrhoea in Sheffield; Talbot MD et al.; During the period 1977-83, the fall in the yearly incidence of gonorrhoea in the United Kingdom was greatly exceeded by the fall that occurred in Sheffield (p less than 0.001) . This local fall occurred despite a large rise in the yearly number of people with sexually transmitted diseases (STDs) presenting at this clinic, and was associated with falls in the incidence of complications of the disease and ratios of men to women with gonorrhoea, and with significantly improved success in tracing contacts of infected persons (p less than 0.001) . Although penicillinase producing strains of Neisseria gonorrhoeae, were rare, the number of local isolates exhibiting relative resistance to penicillin (MIC greater than or equal to 0.3 mg/l) rose significantly (p less than 0.001) and were more often isolated from well defined "at risk" groups: homosexual men (p less than 0.001), patients with repeat infections (p less than 0.01), and people infected outside Sheffield (p less than 0.05) . The relevance of these observations in the assessment of control of gonorrhoea and to the development of an antibiotic treatment policy are discussed.

J Clin Microbiol, 1985 Aug, 22(2), 238 - 40
Evaluation of a one-hour test for the identification of Neisseria species; Lairscey RC et al.; This study presents an evaluation of the RIM-N kit (Austin Biological Laboratories, Inc., Austin, Tex.), a commercial system for rapid identification of Neisseria spp . and Branhamella catarrhalis . The system was compared with the cystine-Trypticase (BBL Microbiology Systems, Cockeysville, Md.) agar method; 218 isolates were tested by each method . There was 96% agreement between the two methods, and only nine discrepancies were encountered . The results suggest that the RIM-N kit may provide a rapid and reliable method for identifying Neisseria spp . and B . catarrhalis.

Am J Obstet Gynecol, 1985 Aug 1, 152(7 Pt 1), 808 - 17
Moxalactam versus clindamycin plus tobramycin in the treatment of obstetric and gynecologic infections; Sweet RL et al.; The clinical efficacy of moxalactam versus clindamycin/tobramycin was evaluated in a comparative, randomized, prospective study . Sixty patients were treated: 30 with moxalactam and 30 with clindamycin/tobramycin . There were 15 cases of tuboovarian abscess, 36 cases of severe pelvic inflammatory disease with peritonitis, eight cases of endomyometritis, and one wound abscess . Aerobic and anaerobic cultures from the sites of infection yielded 441 microorganisms from 53 patients; an average of 8.3 bacteria per infection (4.5 anaerobes and 3.8 aerobes) . The infections tended to be mixed aerobic-anaerobic with anaerobes isolated in 90% of cases . The most frequently isolated possible pathogens were Bacteroides sp . (37), Bacteroides bivius (23), Bacteroides asaccharolyticus (12), Peptococcus asaccharolyticus (29), Peptostreptococcus anaerobius (19), unidentified anaerobic gram-positive cocci (18), Escherichia coli (17), nonhemolytic streptococci (16), Neisseria gonorrhoeae (13), and Gardnerella vaginalis (38) . Clinical cure was noted in 29 of 30 moxalactam-treated and 29 of 30 clindamycin/tobramycin-treated patients . Moxalactam was effective in five of six cases of tuboovarian abscess, all 22 cases of pelvic inflammatory disease with peritonitis, the one case of endomyometritis and the one wound abscess . Clindamycin/tobramycin was effective in eight of nine cases of tuboovarian abscess, all 14 cases of pelvic inflammatory disease with peritonitis, and all seven cases of endomyometritis . No adverse hematologic, renal, or hepatic effects were noted with either regimen.

Obstet Gynecol, 1985 Aug, 66(2), 233 - 8
Laparoscopic findings and contraceptive use in women with signs and symptoms suggestive of acute salpingitis; Wolner-Hanssen P et al.; Laparoscopic findings in women with clinical signs and symptoms of pelvic inflammatory disease were correlated with contraceptive use in a case-control study . Of the 738 women, 544 (73.7%) had laparoscopic signs of acute salpingitis, whereas 194 (26.3%) had visually normal fallopian tubes (nonsalpingitis) . Acute salpingitis was seen in 59.8% of the 286 patients using oral contraceptives, in 80.6% of the 227 patients using an intrauterine device (IUD), and in 84.4% of the 225 patients using barrier methods or not using contraceptives (reference group) . To estimate the relative risk of acute salpingitis, logistic regression analysis adjusting for age and duration of pain before laparoscopy was used . For oral contraceptive users versus the reference group the adjusted relative risk was estimated at 0.24 (95% confidence interval 0.15 to 0.38, P less than .0001), and for IUD users versus the reference group a relative risk was estimated at 0.83 (95% confidence interval 0.49 to 1.38, P = .46) . The relative risk of salpingitis among oral contraceptive users versus the reference group was 0.22 (P = .005), and 0.06 (P = .001) for women infected with Chlamydia trachomatis and/or Neisseria gonorrhoeae, respectively . In patients with pelvic inflammatory disease, spread of the inflammation to the fallopian tubes seems to be inhibited in oral contraceptive users.

Genitourin Med, 1985 Aug, 61(4), 241 - 3
Testing sensitivity of Neisseria gonorrhoeae to spectinomycin; Hilton JM et al.; A concentration of 16 mg/l spectinomycin incorporated in agar gave the best discrimination between Neisseria gonorrhoeae sensitive and resistant to spectinomycin . This method was compared with spectinomycin sensitivity testing with 25 micrograms or 100 micrograms discs . Both methods agreed fully for 197 spectinomycin sensitive and three spectinomycin resistant gonococci . The agar incorporation "breakpoint" concentration technique failed to detect a small spectinomycin resistant population in a fourth isolate, which was detected by disc testing . It may be possible to predict the emergence of spectinomycin resistance among strains of N gonorrhoeae.

J Bacteriol, 1985 Aug, 163(2), 430 - 8
Cryptic plasmid of Neisseria gonorrhoeae: complete nucleotide sequence and genetic organization; Korch C et al.; The naturally occurring cryptic plasmid pJD1 of Neisseria gonorrhoeae is 4,207 base pairs long and is found in about 96% of gonococcal strains . The total probable coding capacity of pJD1 was determined from the complete nucleotide sequence by using computational probes to identify open reading frames with similar codon usage and by screening for the presence of ribosomal binding sites before the start codons . Candidates for promoters and terminators were also found in the sequence . Based on these findings, we propose a model for the genetic organization of the plasmid . The model predicts two transcriptional units, each composed of five compactly spaced genes . A promoter of one of the transcripts was shown to function in Escherichia coli, and the products of three of the five genes in this operon were identified in minicell expression experiments . Of these, the cppA gene encoded a 9-kilodalton protein, and the cppB and cppC genes both coded for 24-kilodalton proteins . No expression of the other transcriptional unit was detected, but two genes in this operon were expressed in minicells when transcribed from an E . coli promoter . The experimental data were consistent with the model.

J Reprod Med, 1985 Aug, 30(8), 567 - 82
The Fitz-Hugh-Curtis syndrome revisited . Changing perspectives after half a century; Lopez-Zeno JA et al.; The Fitz-Hugh-Curtis syndrome is an extrapelvic manifestation of pelvic inflammatory disease . Classically it consists of adhesions between the liver capsule and the diaphragm or the anterior peritoneal surface . Two recent changes have been made in the assessment of this syndrome . One, the syndrome was originally thought to be caused solely by Neisseria gonorrhoeae . Recent studies using tissue cultures and serum antibody titers have documented a major etiologic role for Chlamydia trachomatis as well . Two, the condition has recently been reported to exist in men, whereas previously it was believed to be limited to sexually active women in their reproductive years.

Sex Transm Dis, 1985 Jul-Sep, 12(3), 99 - 102
Contraceptive practices of women attending the Sexually Transmitted Disease Clinic in Nashville, Tennessee; Quinn RW et al.; PIP: The effects of particular contraceptive methods on gonococcal infection were examined in 1303 women attending a public venereal disease clinic during 1979 . 1132 (87%) of clinic attenders were using some method of fertility control . The major methods in this series were oral contraceptives, 47%; surgical methods, 18%, and IUDs, 12% . Barrier methods accounted for 5% of contraceptive usage . Of all the women who came to the clinic, 518 (40%) were actually infected with N gonorrhoeae . Those infected with N gonorrhoeae were likely to be younger than those not infected and were more often black and single . Significantly more noncontraceptors than contraceptors were black and young (under 20 years of age) . Women not using contraceptives were over 3 times more likely to be infected than contraceptive users (94% infection rate versus 30%) . All methods of contraception provided some degree of protection against gonococcal infection . Barrier methods appeared to have the strongest protective effect; only 9.4% of barrier method users were infected (relative risk 0.11) . In some cases, the relationship observed in this study between use of specific contraceptive methods and lower rates of gonorrhea may be biological . The explanation in other cases may be behavioral: women who use birth control may be less risk taking in their sexual behavior . It is concluded that motivating women to use contraception, especially barrier methods, could help reduce the incidence of sexually transmitted diseases . Extrapolation of the findings of this study suggests that nearly 200,000 of the 250,000 cases of gonorrhea reported in the US in 1983 could have been averted by use of barrier methods of contraception on the part of noncontraceptors and those using nonbarrier methods .

Sex Transm Dis, 1985 Jul-Sep, 12(3), 114 - 6
Gonococcal vulvovaginitis among female children in Malaysia; Ismail R et al.; In this retrospective review of 16 children with vulvovaginitis due to Neisseria gonorrhoeae, the authors attempt to estimate the incidence of this infection and to ascertain the routes of transmission . From January 1977 to December 1982, 422 cases of gonococcal vulvovaginitis in women of all age groups were encountered at the University Hospital, Kuala Lumpur, Malaysia . Of these, 406 cases (96.2%) occurred in adults, and 16 cases (3.8%) occurred in children younger than 12 years of age . Penicillinase-producing N . gonorrhoeae (PPNG) strains were isolated from five (31%) of the 16 girls; all five cases were subsequently treated with cefuroxime and probenecid . The rest responded to intramuscular procaine penicillin . Although all patients appeared to be cured, only ten of 11 (two with PPNG) had test-of-cure cultures performed after treatment . Although interviewing the parents revealed no history of sexual contact in these children, nine of the girls were linked to culture-positive adult(s).

J Comp Pathol, 1985 Jul, 95(3), 415 - 23
Exposure of bovine cornea to different strains of Moraxella bovis and to other bacterial species in vitro; Chandler RL et al.; A collection of strains of Moraxella bovis, some pathogenic and some non-pathogenic in cattle, together with other M . bovis preparations, Neisseria ovis, Staphylococcus aureus and Moraxella non-liquefaciens were studied by scanning electron microscopy for their affinity to bovine corneal preparations in vitro . The in vitro procedure provides a convenient method for studies on host-pathogen interactions at the early stage of pathogenesis . The results corresponded well with the pathogenicity of the respective strains and species in cattle . It is considered that the pathogenicity of M . bovis is associated with at least two factors, piliation and the ability to produce pit-like depressions in corneal epithelial cells . The other bacterial species, which are not thought to play an important role in infectious bovine keratoconjunctivitis, had the ability to adhere to the bovine cornea but did not produce pits . The pitting factor of M . bovis is of interest in relation to studies on vaccination against infectious bovine keratoconjunctivitis.

Br J Ophthalmol, 1985 Jul, 69(7), 525 - 8
Destructive epidemic Neisseria gonorrheae keratoconjunctivitis in African adults; Schwab L et al.; An epidemic of Neisseria gonorrheae keratoconjunctivitis in African adults occurred in Malawi in 1983 . Sixteen patients, seven females and nine males, aged 18 to 60 years, were admitted to the inpatient ocular services at Queen Elizabeth Central Hospital in Blantyre from 1 February to 28 May 1983, all with severe bilateral purulent keratoconjunctivitis and concomitant venereal infection secondary to N . gonorrheae . Corneal melting, corneal perforation with iris prolapse, and endophthalmitis occurred in 10 eyes, of which five required enucleation . Thirteen additional eyes sustained severe visual loss secondary to corneal ulceration, leucomata, and healed corneal perforation . The route of transmission and factors of epidemicity are speculative . Because of worldwide epidemic venereal infection ophthalmologists and epidemiologists should be alert to probable sporadic N . gonorrheae epidemics in adults . Such outbreaks could occur elsewhere, especially in the developing world, and ocular gonococcal infection might become a significant cause of irreversible blindness.

Ann Inst Pasteur Microbiol, 1985 Jul-Aug, 136B(1), 29 - 38
{Enzymatic profile and plasmid content of Neisseria polysacchareae}; Delmas C et al.; The enzymatic profile of "Neisseria polysacchareae" was determined by using chromogenic substrate (API System), and was compared to that of N . meningitidis, N . gonorrhoeae and N . lactamica . The tested classes of enzymes were aminopeptidase, proteases, esterases, lipases, glycosidases, phosphatase and phosphoamidase . "N . polysacchareae" exhibited various aminopeptidase and protease activities and a strong esterase activity . No lipase and glycosidase activities were detected by the tested substrates . The strains of "N . polysacchareae" differed from that of N . meningitidis in the presence of hydroxyproline aminopeptidase and the lack of gamma-glutamyl-transferase activity . Five strains harboured extrachromosomal elements . The plasmids were of 4.2 Kb in size in four cases and of more than 40 Kb in four cases . Three strains simultaneously harboured these two plasmids . This plasmid content is another characteristic of strains of this new taxon . No phenotypic modification was observed in plasmid-containing strains.

J Antimicrob Chemother, 1985 Jul, 16 Suppl A, 213 - 5
In-vitro comparison of macrolides, lincosamides and synergistins on Neisseria gonorrhoeae; Thabaut A et al.; The MIC of erythromycin, oleandomycin, spiramycin, josamycin, lincomycin and pristinamycin was determined for 100 strains of Neisseria gonorrhoeae isolated from cases of acute urethritis in men . The method of dilution in agar was used: blood agar with the addition of 'Polyvitex' and an innoculum of 10(3)-10(4) bacteria per spot . With respect to the break points defined by the C.F.A . all the strains of N . gonorrhoeae studied are sensitive to erythromycin, spiramycin, josamycin and pristinamycin, 12% strains are resistant to oleandomycin and 75% to lincomycin . The active antibiotics are classified as follows according to the active weight expressed by the MIC50: erythromycin, pristinamycin, 0.125 mg/l; josamycin, 0.5 mg/l; spiramycin, oleandomycin, 2 mg/l.

J Antimicrob Chemother, 1985 Jul, 16 Suppl A, 209 - 12
Antibiotic susceptibility of 83 penicillinase-producing Neisseria gonorrhoeae strains isolated in France (May 1979-April 1983); Riou JY et al.; Antibiotic susceptibility testing of 83 strains of penicillinase producing Neisseria gonorrhoeae PPNG isolated in France (May 1979-April 1983) . Study of the action of light antibiotics: penicillin G, spectinomycin, thiamphenicol, tetracycline, kanamycin, pristinamycin, streptomycin and cefoxitin . Comparison (on two media) with the susceptibility of five proposed WHO reference strains.

Antimicrob Agents Chemother, 1985 Jul, 28(1), 90 - 5
Involvement of a change in penicillin target and peptidoglycan structure in low-level resistance to beta-lactam antibiotics in Neisseria gonorrhoeae; Dougherty TJ; A penicillin-susceptible gonococcus and its low-level resistant penA transformant were examined with regard to their penicillin-binding proteins (PBPs) and their peptidoglycan structures . Treatment of the susceptible strain with its MIC of penicillin (0.01 microgram/ml) led to significant binding to PBPs 2 and 3 and a substantial decrease in the O-acetyl modification on the peptidoglycan . Peptidoglycan synthesis gradually ceased over an extended time . When the penA strain was treated with the same concentration of penicillin, only binding to PBP 3 was observed and there was no O-acetylation decrease, with continued peptidoglycan synthesis . This suggested that PBP 2 was the primary target in penicillin-susceptible gonococci and that this protein participated in the O-acetylation of peptidoglycan . Penicillin concentrations representing the MIC for the penA transformant (0.06 microgram/ml) caused significant binding to PBPs 1, 2, and 3 in the susceptible strain and PBPs 1 and 3 in the penA strain . In both strains the rate of peptidoglycan synthesis and the cross-linkage of the peptidoglycan made declined sharply, suggesting that significant inhibition of PBP 1 interfered with transpeptidation . A model for low-level resistance is proposed in which a decreased PBP 2 affinity leads to assumption of the role of primary target in the resistant transformant by PBP 1 . The differences observed in peptidoglycan metabolism are a direct consequence of this change.

Antimicrob Agents Chemother, 1985 Jul, 28(1), 21 - 7
Genetic analysis of spontaneous resistance to ampicillin in Neisseria gonorrhoeae; Jones F et al.; Step-wise intrinsic resistance to ampicillin in Neisseria gonorrhoeae was analyzed genetically by DNA-mediated transformation experiments . A first-step ampicillin-resistant (Ampr1) mutant and a second-step ampicillin-resistant (Ampr2) mutant generated during sequential selection were used in these studies . Each selection step was accompanied by an approximate twofold increase in resistance . Four amp alleles were found to account for full resistance of the Ampr2 phenotype . All four amp alleles lie among a cluster of genes which code for ribosomal functions . This region has the map order rif str fus tet cam . First-step resistance was caused by two amp alleles, ampA2 and ampB1, neither of which independently caused detectable ampicillin resistance . Outcrossing of the ampA2 or the ampB1 mutation resulted in wild-type susceptibility to ampicillin . Mapping studies indicate that ampB1 lies between str and fus, whereas ampA2 lies to the right of cam . Second-step resistance required two mutations, ampC3 and ampD4, in addition to ampB1 and ampA2 . Transformation of ampC3 to ampC3+ in an Ampr2 mutant resulted in the Ampr1 phenotype . Both ampC3 and ampD4 showed transformation linkage to rif and str . ampC3 was positioned at a site between rif and str . ampD4 apparently occupied a site, outside of the rif-str region, proximal to rif and distal to str . We postulate the gene order to be ampD rif ampC str ampB fus tet cam ampA.

Sex Transm Dis, 1985 Jul-Sep, 12(3), 163 - 5
Treatment of gonorrhea with clavulanate-potentiated amoxicillin (Augmentin); Munday PE et al.; One hundred sixty-one patients with culture-proved Neisseria gonorrhoeae infection were treated with a single oral dose of amoxicillin trihydrate (3 g) and potassium clavulanate (Augmentin, 0.25 g) . Of 153 patients infected with non-penicillinase-producing strains of N . gonorrhoeae, 139 (91%) were cured, and five (62.5%) of eight patients infected with penicillinase-producing N . gonorrhoeae were cured . Augmentin was successful in eradicating N . gonorrhoeae from the rectum; 30 (97%) of 31 such infections were cured.

Sex Transm Dis, 1985 Jul-Sep, 12(3), 159 - 60
Conjunctivitis caused by beta-lactamase-producing Neisseria gonorrhoeae; Pareek SS; Unilateral conjunctivitis caused by penicillinase-producing Neisseria gonorrhoeae was diagnosed in a 21-year-old man . The conjunctivitis apparently resulted from autoinfection from the urethral discharge . The patient was satisfactorily treated with a single dose intramuscular of cefoxitin (2 g) and oral probenecid (1 g).

Sex Transm Dis, 1985 Jul-Sep, 12(3), 150 - 4
Parents of infants with ophthalmia neonatorum: a high-risk group for sexually transmitted diseases; Fransen L et al.; One hundred forty-nine mothers and 74 fathers of infants who presented at the Special Treatment Clinic (Nairobi) with ophthalmia neonatorum were evaluated . Neisseria gonorrhoeae was isolated from 60 (40%) of 149 mothers and Chlamydia trachomatis was isolated from 31 (21%) . Twenty-six mothers (17.5%) had clinical evidence of endometritis or pelvic inflammatory disease . Mothers with endometritis and/or pelvic inflammatory disease were more often infected with N . gonorrhoeae (65%) than were mothers without these conditions (24%) (P less than or equal to .001) . N . gonorrhoeae was isolated from ten (14%) and C . trachomatis from three (9%) of 32 fathers, and nongonococcal urethritis was diagnosed in an additional 21 fathers (28%) . Seven of ten men with gonococcal urethritis and 18 of 21 with nongonococcal urethritis had no symptoms . These data confirm that the presence of ophthalmia neonatorum in a neonate should be considered as a strong indicator of sexually transmitted disease in the parents . Although most infections in fathers were asymptomatic, the mothers were at high risk for complications.

Sex Transm Dis, 1985 Jul-Sep, 12(3), 140 - 4
Sexually transmitted diseases in females in a juvenile detention center; Bell TA et al.; PIP: The medical staff of the King County, Washington, juvenile detention facility attempts to evaluate all new detainees within 72 hours of admission to the facility (or sooner if a history of genitourinary symptoms is elicited when they are questioned on admission about their health) . In 1981 100 females who had received no antimicrobial agents in the month prior to examination and who were detained for more than 24 hours and available for comprehensive examinations were selected for this study of the prevalence of sexually transmitted diseases in females in a juvenile detention center . The procedure for examining these young women was identical to that used in the Seattle-King County Harborview Medical Center clinic for sexually transmitted diseases (STDs) . It included a medical history, a speculum examination of the vagina and cervix, and a bimanual examination of the uterus and adnexa . Complete data were not available for all 100 female detainees . The mean age of those studied was 15.2 +- 1.3 years; 66% were white, 30% were black, 1% was Asian or Pacific Islander, and 3% were of other ethnic groups . None were married . 37 of the 100 females were known or strongly suspected by the medical staff to be prostitutes . The median number of reported sexual consorts during the month prior to detention was 3 for prostitutes and 1 for other detainees . 68% of the 98 responding detainees used no contraception; 23% used foam and/or condoms, and 8% used oral contraceptives . Volunteered or elicited symptoms related to the genitourinary system did not significantly differ between prostitutes and other detainees . The most common symptom, abnormal vaginal discharge, was present in 81% of the detainees . Only 8 had no genitourinary symptoms . None of the conditions sought differed significantly in prevalence between prostitutes and other detainees . Of detainees appropriately tested, 18 (18%) of 98 were found to be infected with N . Gonorrhoeae and 17 (20%) of 86 with C . Trachomatis . Trichomoniasis was diagnosed in 38 (48%) of 80 detainees examined for it; bacterial vaginosis was diagnosed in 23 (25%) of 92 detainees . Vulvovaginal candidiasis was diagnosed in 6 detainees, herpes genitalis in 2, vulvar warts in 4, and scabies in 1 . Of 61 young women tested, none had a reactive serologic test for syphilis . Recovery of either N . gonorrhoeae or C . Trachomatis was not significantly associated with complaints of vaginal discharge . Users of barrier methods were less likely to have C . trachomatis than were those not using contraception . Otherwise, there was no statistically significant associations between the presence of N . gonorrhoeae or C . trachomatis and contraceptive method .

Sex Transm Dis, 1985 Jul-Sep, 12(3), 128 - 34
In-vitro stability of beta-lactam antibiotics to hydrolysis by beta-lactamases of Neisseria gonorrhoeae from Southeast Asia; Wong PC et al.; Extracts of penicillinase-producing strains of Neisseria gonorrhoeae obtained from several localities in Southeast Asia exhibited similar patterns of relative rates of hydrolysis of benzylpenicillin, ampicillin, carbenicillin, and cephaloridine . Methicillin and oxacillin were not hydrolyzed . The isoelectric point of the beta-lactamase from these strains was 5.38 +/- 0.05, and the molecular weight was approximately 22.5 . These properties, as well as the Km values determined for a range of substrates, were the same for the enzyme purified from one of the strains . These observations are consistent with those reported for other gonococcal beta-lactamases of the TEM-1 type . Cefamandole and to a lesser extent, cefoperazone, were also hydrolyzed by these extracts; however, the newer beta-lactam antibiotics piperacillin, cefuroxime, cefoxitin, ceftriaxone, ceftazidime, and moxalactam were stable . These stable compounds had little inhibitory effect on the activity of the enzyme toward benzylpenicillin or cephaloridine.

Sex Transm Dis, 1985 Jul-Sep, 12(3), 103 - 9
Effects of Mycoplasma hominis on in-vitro studies of Neisseria gonorrhoeae; Alfa MJ et al.; This study examined the effects Mycoplasma hominis might have on Neisseria gonorrhoeae . Two auxotype standard strains of N . gonorrhoeae were found by culture and by light, fluorescence, and electron microscopy to be contaminated with M . hominis . In the presence of M . hominis, these strains of N . gonorrhoeae were typed as prototrophic . Removal of the mycoplasmas by passage of the N . gonorrhoeae on serum-free medium resulted in a second change in growth requirements rather than a reversion to the initial auxotypes . For one of these gonococcal strains, the presence of M . hominis also coincided with a change in colonial morphology and the appearance of a 2.6 X 10(6)-dalton plasmid, changes which persisted after the mycoplasmas had been eliminated from the culture of N . gonorrhoeae . The plasmid was not detected in a pure culture of the M . hominis strain or when it and the N . gonorrhoeae strain were intentionally co-cultivated . While these findings cannot be fully explained, they emphasize the importance of ensuring that all strains of N . gonorrhoeae used for in vitro studies are free of mycoplasmas.

J Infect, 1985 Jul, 11(1), 63 - 9
Penicillinase-producing Neisseria gonorrhoeae: epidemiology, antimicrobial susceptibility and plasmid types; Goh BT et al.; Between 1976 and 1984 204 infections by penicillinase-producing Neisseria gonorrhoeae (PPNG) were seen in the Whitechapel Clinic . In 1984 PPNG were isolated from 4.7% of all patients attending with gonorrhoea . Three infections were homosexually acquired; 140 infections (68%) were acquired in the U.K . Strains that were tested were fully sensitive to spectinomycin (190), cefuroxime (177), kanamycin (170), amoxycillin combined with clavulanic acid (24) and rosoxacin (18) . Of 135 strains 61% were resistant to co-trimoxazole, 69% of 169 to tetracycline (MIC greater than or equal to I mg/l) and 32% of 75 to streptomycin . Of 109 strains subjected to plasmid typing, 72(66%) were Asian strains . Of these, 55 (50% of the total) were without and 17 (16% of the total) possessed the 24.5 Mdal transfer plasmid; 27 (25%) were African strains without and 10 (9%) with the transfer plasmid . Of the Asian strains 10 were acquired in Africa . All four plasmid-containing strains are now endemic in the U.K . On the basis of the sensitivity tests, spectinomycin, cefuroxime and kanamycin should be effective in treatment, but not co-trimoxazole and tetracycline.

J Clin Microbiol, 1985 Jul, 22(1), 101 - 4
Comparative evaluation of five commercial systems for the rapid identification of pathogenic Neisseria species; Philip A et al.; Prompt diagnosis and effective treatment of urogenital gonococcal infections require rapid isolation and identification of Neisseria gonorrhoeae from urogenital specimens . We evaluated a new, rapid (30-min) test called Gonochek II (E-Y Laboratories, San Mateo, Calif.) which utilizes chromogenic substrates for the identification of pathogenic Neisseria species . It was compared with the API NeIdent (Analytab Products, Inc., Plainview, N.Y.), Minitek (BBL Microbiology Systems, Cockeysville, Md.), and RapID NH (Innovative Diagnostics, Atlanta, Ga.), systems and the Phadebact GC (Pharmacia Diagnostics, Piscataway, N.J.) test for its performance in identifying known strains of N . gonorrhoeae (39 strains), Neisseria meningitidis (22 strains), Neisseria lactamica (12 strains), and Branhamella catarrhalis (17 strains) . The Gonochek II system correctly identified 100% of N . gonorrhoeae, N . lactamica, and B . catarrhalis strains and 95.4% of N . meningitidis strains . The percent agreement for correct identification of all strains tested was 98.8% . In contrast, the Minitek, RapID NH, and API NeIdent systems correctly identified 86.6, 80.0, and 73.3% of the strains, respectively . The Phadebact GC test identified 94.9% of the N . gonorrhoeae isolates but also cross-reacted with 41.6% of the N . lactamica strains . The Gonochek II system is rapid, simple to perform, and easy to interpret, requires 1 to 2 min to set up, and more accurately identifies pathogenic Neisseria species when compared with other systems used in this study.

J Infect Dis, 1985 Jul, 152(1), 59 - 63
Evaluation of a DNA-hybridization method for detection of African and Asian strains of Neisseria gonorrhoeae in men with urethritis; Perine PL et al.; The 2.6-megadalton (MDa) cryptic plasmid and the 4.4-MDa beta-lactamase plasmid of Neisseria gonorrhoeae were radiolabeled with {32P} nucleotides and used as probes for direct detection of gonococci and beta-lactamase plasmids in urethral exudates from men with urethritis . The sensitivity and specificity of the DNA probes were compared with culture isolation of N . gonorrhoeae and biochemical tests of gonococcal isolates for beta-lactamase production . Of 216 urethral specimens, 180 were positive for N . gonorrhoeae by DNA probe and culture, 27 were negative by both tests, and 9 gave discordant results . Compared with culture and with the chromogenic cephalosporin assay, the sensitivity and the specificity of the DNA probe was 99% and 93% and that of the beta-lactamase probe assay was 91% and 96%, respectively . Electrophoresis of plasmids isolated from 90 gonococcal cultures showed that all contained the 2.6-MDa plasmid, 29 possessed a 3.2-MDa plasmid, 18 a 4.4-MDa beta-lactamase plasmid, and 11 had a 24.5-MDa conjugal plasmid . We conclude that the sensitivity of our DNA probes was comparable to that of culture for diagnosis of gonorrhea and to conventional tests for detection of beta-lactamase.

J Bacteriol, 1985 Jul, 163(1), 69 - 74
Analysis of Neisseria gonorrhoeae peptidoglycan by reverse-phase, high-pressure liquid chromatography; Dougherty TJ; The muramidase digest of peptidoglycan from Neisseria gonorrhoeae was isolated and analyzed by the use of a reverse-phase, high-pressure liquid chromatography system . As was found previously in the case of Escherichia coli, gonococci peptidoglycan is also composed of a greater number of muropeptides than can be resolved with thin-layer chromatography systems . Preliminary classification of the muropeptide components into subclasses based on O-acetyl modification and degree of cross-linkage was achieved . Examination of a penicillin-susceptible strain and a highly resistant strain with two penicillin-binding protein alterations synthesized distinctly different peptidoglycan structures, as revealed by this technique.

Infect Immun, 1985 Jul, 49(1), 7 - 13
Influence of protein synthesis inhibitors on regulation of extent of O-acetylation of gonococcal peptidoglycan; Rosenthal RS et al.; The effects of protein synthesis inhibitors on the extent of O-acetylation of Neisseria gonorrhoeae peptidoglycan (PG) and on the resistance of PG to degradation by human PG hydrolases were examined . Addition of chloramphenicol, tetracycline, and streptomycin (in amounts equal to approximately twice their respective MICs) rapidly increased the level of O-acetylation of {3H}glucosamine-labeled N . gonorrhoeae FA19 PG from 46% to about 70% and simultaneously enhanced the resistance of the PG to degradation by human polymorphonuclear leukocyte lysozyme . Entry into the stationary phase also enhanced O-acetylation of FA19 PG, but neither protein synthesis inhibitors nor the stationary phase had a detectable effect on the O-acetyl-deficient, lysozyme-sensitive PG of N . gonorrhoeae RD5 . Mild alkali treatment of PG derived from chloramphenicol-treated FA19 specifically removed O-acetyl groups and simultaneously reduced the extents of O-acetylation and polymorphonuclear leukocyte lysozyme resistance to the level of RD5 PG, suggesting that the O-acetyl substituents were solely responsible for the increased PG hydrolase resistance of PG from chloramphenicol-treated FA19 . Pulse-chase experiments indicated that the drug-mediated enhancement of O-acetylation was limited to newly assembled PG . In summary, conditions favoring unbalanced macromolecular synthesis and bacteriostasis increased the level of O-acetylation and the PG hydrolase resistance of gonococcal PG . Similar conditions encountered by gonococci in vivo might potentiate the pathobiological consequences of PG-host interactions.

Infect Immun, 1985 Jul, 49(1), 250 - 2
Variation of Neisseria gonorrhoeae protein II among isolates from an outbreak caused by a single gonococcal strain; Schwalbe RS et al.; Gonococci isolated from localized urogenital infections usually possess one or more protein II (P.II) species in the outer membrane, but the structural and antigenic variation of these proteins among different gonococcal strains has made it difficult to determine if specific proteins of the P.II class are associated with particular sites or types of infection . A recent outbreak of gonorrhea in Durham, N.C., was unusual in that over 200 isolates were derived from a single strain, which provided an opportunity to address these questions . The P.II profile of 54 isolates was determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of outer membrane proteins . At least seven distinct P.II proteins were seen; no single protein or combination of proteins predominated in the different isolates, and there was no association of P.II profile with site of isolation . Gonococci recovered from the same patient at different times had different P.II profiles, confirming that P.II variation occurred in vivo.

Rev Infect Dis, 1985 Jul-Aug, 7 Suppl 3, S522 - 7
Imipenem/cilastatin in the treatment of obstetric and gynecologic infections: a review of worldwide experience; Sweet RL; Worldwide experience with imipenem/cilastatin in the treatment of 72 patients with a variety of obstetric and gynecologic infections is reviewed . Clinical cure or improvement occurred in 97% of 72 assessable patients . The most common etiologic pathogens were Escherichia coli, group B streptococci, Neisseria gonorrhoeae, Staphylococcus epidermidis, enterococci, Bacteroides bivius, Bacteroides species, Bacteroides fragilis, and Peptostreptococcus . Of the recovered pathogens, 99.5% were susceptible to imipenem/cilastatin . Bacteriologic response was also excellent and none of the pathogens acquired resistance to imipenem . Most patients tolerated intravenous administration of imipenem/cilastatin well to moderately well.

J Adolesc Health Care, 1985 Jul, 6(4), 298 - 310
Pelvic inflammatory disease and its sequelae in adolescents; Washington AE et al.; Pelvic Inflammatory Disease (PID) is the most common serious complication of sexually transmitted diseases (STDs) . Each year over one million women in the United States experience an episode of PID, with approximately 16-20% of cases occurring in teenagers . Acute PID increases a woman's risk for recurrent PID, chronic pelvic pain, infertility, and ectopic pregnancy . Recent reports indicating that PID rates are rising and are highest among adolescent females aged 15-19 underscore the need to remain current on the clinical as well as the epidemiologic aspects of PID . We present such an update in this article . Trends in incidence and key risk factors are discussed; besides adolescence itself and STD, other important categories of risk factors include sexual activity, contraceptive method, and previous episode(s) of PID . The polymicrobial nature of PID is discussed along with an analysis of the role of specific organisms, such as Chlamydia trachomatis, Neisseria gonorrhoeae, anaerobic and aerobic bacteria, and mycoplasmas in PID . Early diagnosis and the institution of appropriate treatment regimens are essential to the prevention of PID's devastating sequelae . Clinicians must maintain a high index of suspicion for the wide range of clinical presentations associated with PID and be prepared to provide effective management, including proper evaluation and prompt treatment of sexual partners.

J Adolesc Health Care, 1985 Jul, 6(4), 286 - 97
Adolescent misadventures with urethritis and cervicitis; McGregor JA; Inflammation of the cervix and urethra in adolescents is primarily due to infection by sexually transmitted disease (STD) organisms . These organisms are most commonly Chlamydia trachomatis, Neisseria gonorrhoeae, Urea-plasma urealyticum, and herpes simplex virus . The frequency and seriousness of these infections is, in part, due to developmental, behavioral, and biological changes which put adolescents at special risk for acquisition of these syndromes . Medical knowledge is now sufficient to effectively recognize and treat these STD syndromes . What is further needed is the personal and institutional determination, adaptability, and resources to apply present knowledge among adolescents . It is among these teenagers that the personal and societal costs of STDs are the greatest.

J Bacteriol, 1985 Jul, 163(1), 132 - 9
Cloning and sequencing of a Moraxella bovis pilin gene; Marrs CF et al.; Moraxella bovis pili have been shown to play a major role in both infectivity and protective immunity of bovine infectious keratoconjunctivitis . Sonicated M . bovis DNA from the piliated strain EPP63 was inserted into the vector lambda gt11 with EcoRI linkers . Recombinant phage were screened with an oligonucleotide probe based on the amino-terminal portion of the DNA sequence of a Neisseria gonorrhoeae pilin gene . Two candidate phages produced a protein that comigrated with EPP63 beta pilin in sodium dodecyl sulfate-polyacrylamide gels and bound anti-pilus antisera . The 1.9-kilobase insert from one of these, lambda gt11M182, was subcloned in both orientations into pBR322, forming the plasmids pMxB7 and pMxB9, both of which produced beta pilin, as did pMxB12, a HindIII deletion derivative of pMxB7 . In HB101(pMxB12), the M . bovis pilin protein was shown to be primarily localized in the inner membrane . The entire 939-base-pair insert of pMxB12 was sequenced, revealing a ribosome binding site just upstream of the coding region and an AT-rich region further upstream containing some potential RNA polymerase recognition sites . The translation of the sequence predicts a six-amino-acid leader sequence preceding the phenylalanine that begins the mature protein . Codon usage analysis of the M . bovis beta pilin gene revealed greater use of the CUA codon for leucine than usual for a well-expressed Escherichia coli gene . Comparisons of the M . bovis EPP63 beta pilin protein sequence with other pilin gene sequences are presented.

Am J Med, 1985 Jun 28, 78(6B), 188 - 93
Choice of antibiotics and length of therapy in the treatment of acute salpingitis; Monif GR; This article reviews the rationale for the therapy of acute salpingitis and the conceptual basis for the length of therapy . The key to therapy of acute salpingitis is the need to accommodate polymicrobial etiology, polymicrobial bacterial superinfection, and the potential presence of penicillinase-producing strains of Neisseria gonorrhoeae into a therapeutic equation that has been determined by the appropriate staging of disease . The anticipated therapeutic response identified for monomicrobial disease due to Neisseria gonorrhoeae constitutes the end titration point for drug administration . Duration of continued therapy beyond this point is governed by the need to complete therapy for Chlamydia trachomatis or to assure resolution of advanced disease.

Am J Med, 1985 Jun 28, 78(6B), 194 - 203
The next 10 years in the treatment of pelvic infections; Ledger WJ; The future developments in the treatment of pelvic infections in women are based on recent changes . There is an expanded knowledge of the complex multibacterial nature of pelvic infections, the clinical view of salpingitis has radically changed, and there have been great modifications in antibiotic treatment strategies with particular emphasis on anaerobes and Chlamydia . In the next 10 years, the following new developments may be expected . In the diagnosis of pelvic infection, there will be new efforts to have better clinical tests and the use of nonspecific and specific laboratory tests . The rapid identification of Neisseria gonorrhea, group B beta-hemolytic Streptococcus, Chlamydia, and Bacteroides fragilis would be an important laboratory aid . The treatment of pelvic infection will not be significantly altered by the introduction of new antibiotics . There will be an emphasis on new combinations of currently available antibiotics and studies that focus on the long-term follow-up of treated patients . In the understanding of the pathophysiology of pelvic infections, the importance of the spermatozoa as a carrier of bacteria and the potent immunosuppression due to seminal fluid will be investigated in detail, along with a greater emphasis on treatment of the male.

Am J Med, 1985 Jun, 78(6 Pt 1), 1038 - 40
Neisseria sicca pneumonia . Report of two cases and review of the literature; Gilrane T et al.; Neisseria sicca is considered part of the normal flora of the oropharynx . Although usually believed to be a harmless saprophyte, it has rarely been recognized as an etiologic agent in human disease, particularly in immunodeficient hosts . Two immunodeficient women are described in whom N . sicca pneumonia of the left lower lobe developed . One patient was 30 years old and had just completed a full-term pregnancy, and the other patient was 73 years of age and was receiving prednisone for bullous pemphigoid . Each had an uncomplicated pulmonary course, the pneumonia being successfully treated with penicillin or cephalothin . Only one patient with N . sicca pneumonia has been previously described in the literature . The significance of N . sicca pneumonia is discussed on the basis of a review of findings in these three patients . Although unusual N . sicca should be considered among the organisms causing pneumonia in immunodeficient patients.

Genitourin Med, 1985 Jun, 61(3), 168 - 71
Single dose oral amoxycillin 3 g with either 125 mg or 250 mg clavulanic acid to treat uncomplicated anogenital gonorrhoea; Lawrence AG et al.; A single supervised oral dose of amoxycillin 3 g combined with clavulanic acid 125 mg as a suspension (Augmentin 3.125G) plus probenecid 1 g, cured 97 of 100 assessable patients who had uncomplicated anogenital gonorrhoea . Thirteen of the 100 patients were infected with penicillinase producing strains of Neisseria gonorrhoeae (PPNG) and 11 (85%) of these patients were cured, including one infected with a PPNG strain that was also resistant to spectinomycin . Another group of 93 assessable patients was treated with ampicillin 3 g plus probenecid 1 g, and only 85 (91%) patients were cured . Of the eight treatment failures in this group, five were found to be infected with PPNG strains . In a second study 144 assessable patients were treated with amoxycillin 3 g combined with clavulanic acid 250 mg, (Augmentin 3.250G) plus probenecid 1 g, and a 97% cure rate was again obtained . Five of seven (71%) patients infected with PPNG strains were cured . Although both Augmentin regimens were effective for treating gonorrhoea caused by PPNG and non-PPNG strains, side effects were noted in more patients treated with 250 mg clavulanic acid (24%) than with 125 mg clavulanic acid (5%) . In addition, a similar cure rate was obtained in the three primary sites of infection, the urethra, cervix, and rectum.

Carcinogenesis, 1985 Jun, 6(6), 911 - 5
Screening of microorganisms for nitrosation catalysis at pH 7 and kinetic studies on nitrosamine formation from secondary amines by E . coli strains; Calmels S et al.; Thirty-eight strains of microorganisms isolated from infected human trachea, urine, blood and faeces were examined for their ability to form N-nitrosomorpholine from morpholine and nitrite at pH 7.25 . Twenty-five bacterial strains exhibited nitrosation activity, including 18 out of 19 strains of Escherichia coli and three out of nine Pseudomonas aeruginosa, Proteus morganii, Proteus mirabilis, Klebsiella pneumoniae and Neisseria strains; E . coli A10 strain showed the highest activity . Formation of N-nitrosomorpholine was proportional to the incubation time up to 2 h and to the number of resting E . coli A10 cells; the reaction followed Michaelis-Menten kinetics . Nitrosation rate appeared to be dependent on the pKa value of several amines studied . As the nitrosation catalysis was heat-labile, our data suggest that N-nitrosation is catalysed by a bacterial enzyme(s) . This reaction may lead to enhanced endogenous nitrosation in subjects suffering from an achlorhydric stomach or from chronic urinary tract infections.

J Clin Microbiol, 1985 Jun, 21(6), 989 - 90
Evaluation of the phadebact and bactigen reagents for detection of Neisseria meningitidis in cerebrospinal fluid; Kurzynski TA et al.; The Phadebact and Bactigen reagents were evaluated for detection of Neisseria meningitidis in cerebrospinal fluids . The Bactigen test yielded stronger agglutination reactions from clinical specimens and was significantly more sensitive when used with whole-cell suspensions and purified antigens.

Genitourin Med, 1985 Jun, 61(3), 179 - 84
Infections with Neisseria gonorrhoeae and Chlamydia trachomatis in women with acute salpingitis; Kristensen GB et al.; The value of cultural and serological procedures in diagnosing gonococcal and chlamydial infections was investigated in 85 women who had provisional diagnoses of pelvic inflammatory disease . The correlation between certain clinical variables and the absence or presence of such infections was also studied . In 46 the diagnosis of acute salpingitis was verified by laparoscopy . The laboratory and clinical findings in the patients with acute salpingitis were compared with those in the remaining 39 women in whom laparoscopy did not show signs of inflammation . Salpingitis was considered to be gonococcal if Neisseria gonorrhoeae was isolated or a fourfold or more change in titre of antibodies to gonococcus pilus antigen was found . The diagnosis of chlamydial salpingitis was based on the isolation of Chlamydia trachomatis, a fourfold or more change in titre of IgG antibodies to or from a titre of greater than or equal to 1/256, or the presence of IgG antibodies at a titre of greater than or equal to 1/512 . Patients with chlamydial salpingitis had less severe symptoms but a more protracted course of disease than patients with gonococcal salpingitis or with acute salpingitis not associated with the two pathogens.

Genitourin Med, 1985 Jun, 61(3), 175 - 8
Prevalence of antibodies to Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis in infertile women; Tjiam KH et al.; A total of 57 infertile women, who had been referred for in vitro fertilisation or for diagnostic laparoscopy, were tested for the presence of antibodies to Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis . Four were excluded from the study . Of the remaining 53, 33 had laparoscopically obvious tubal disorders, such as adhesions, distal occlusions and strictures, and 20 did not . Antibodies to C trachomatis were found in 7/33 (21.2%) v 0/20, antibodies to N gonorrhoeae in 20/38 (60.6%) v 5/20 (25%), and antibodies to M hominis in 18/24 (75%) women with tubal disorders v 13/19 (68.4%) of those with no disorder . Antibodies to C trachomatis and N gonorrhoeae were significantly (p less than 0.05) more common in women with tubal disorders . The high prevalence of antibodies to N gonorrhoeae in infertile women without tubal disorders suggests that ciliated tubal epithelium is damaged after inflammation without this being laparoscopically visible . Our results confirm the important role of N gonorrhoeae and C trachomatis in the aetiology of infertility after tubal inflammation.

Genitourin Med, 1985 Jun, 61(3), 165 - 7
Augmentin compared with amoxycillin in treating uncomplicated gonorrhoea; Key PR et al.; We studied 220 patients (138 men and 82 women) with uncomplicated gonorrhoea who were entered into a randomised double blind trial and treated with either Augmentin (amoxycillin 3 g and potassium clavulanate 125 mg) or amoxycillin 3 g, with probenecid 1 g by mouth in all cases . Seven (6.5%) of 108 patients treated with Augmentin were still culture positive after treatment, compared with 15 (13.4%) of 112 of those treated with amoxycillin . Penicillinase (beta lactamase) producing strains of Neisseria gonorrhoeae (PPNG) were found in 23 (10.5%) patients, of whom 10 were treated with Augmentin and 13 with amoxycillin . Treatment failed in all 13 patients who received amoxycillin . Augmentin was shown to be an effective treatment for gonorrhoea caused by PPNG strains.

Am J Obstet Gynecol, 1985 Jun 1, 152(3), 280 - 6
Prevalence and manifestations of endometritis among women with cervicitis; Paavonen J et al.; Thirty-five women referred from a clinic treating sexually transmitted diseases, because of suspected cervicitis, were studied for the presence of endometritis by transcervical endometrial biopsies and cervical and endometrial cultures . Fourteen (40%) of the patients had histologic evidence of endometritis . Findings that significantly correlated with endometritis included a history of intermenstrual vaginal bleeding, the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, or Streptococcus agalactiae in the cervix, and the presence of serum antibodies to C . trachomatis or to Mycoplasma hominis.

J Clin Microbiol, 1985 Jun, 21(6), 987 - 8
Evaluation of a rapid identification method for Neisseria spp; Germer JJ et al.; A comparison was made of carbohydrate degradation reactions of Neisseria gonorrhoeae, Neisseria meningitidis, Neisseria lactamica, Neisseria mucosa, Neisseria sicca, Neisseria subflava, and Branhamella catarrhalis in a rapid (0.5- to 1-h) identification micromethod (RIM-N Kit; Austin Biological Laboratories, Inc., Austin, Tex.) and in a serum-free agar slanted medium (72 h) . Reactions after 1 h in the RIM-N system agreed completely with those after 72 h in the conventional system.

Pathol Biol (Paris), 1985 Jun, 33(5 Pt 2), 554 - 6
{Development of the sensitivity to antibiotics in strains of Neisseria gonorrhea isolated in Touraine over a 5-year period}; Pinon G et al.; 347 Neisseria gonorrhoeae strains isolated in Touraine, France, from December 1978 to March 1984 were tested for susceptibility to seven antibiotics using an agar dilution method . Percentage of strains with a penicillin G MIC = 0.06 micrograms/ml rose from 58% in 78-80 to 69% in 82-84 . Consistent amoxicillin MICs were found throughout the survey (MIC 50: 0.125 and MIC 90: 0.5 micrograms/ml) . Three penicillinase-producing strains were recovered from patients contaminated outside the study area . For tetracycline, minocycline, chloramphenicol and spectinomycin, variations of MICs 50 and 90 did not exceed one dilution either way . For spiramycin, MICs 50 and 90 fell from 2 and 8 micrograms/ml respectively in 78-80 to 1 and 2 micrograms/ml in 82-84 . Our findings show that susceptibility of Gonococci to the main antibiotics used for treating gonococcal infections in our area has not changed significantly over the last five years . Moreover, implantation and diffusion of penicillinase-producing strains has failed to occur.

Int J Gynaecol Obstet, 1985 Jun, 23(3), 171 - 5
Factors predicting abnormal hysterosalpingographic findings in patients treated for acute pelvic inflammatory disease; Paavonen J et al.; One hundred forty-six consecutive inpatients with acute pelvic inflammatory disease (PID) were randomly treated either with the combination of doxycycline and metronidazole or with the combination of penicillin G/amoxicillin and metronidazole . Forty-three women underwent hysterosalpingography (HSG) 6 months after the treatment, and a multivariate statistical analysis was used to study the effect of 11 different variables (parity, history of previous abortion, history of previous PID, use of an intrauterine contraceptive device (IUD), use of oral contraceptives, presence of adnexal mass, results of cervical cultures for Neisseria gonorrhoeae, and Chlamydia trachomatis, presence of serum antichlamydial antibodies, penicillin-metronidazole treatment, and doxycyclin-metronidazole treatment) on the hysterosalpingographic findings . Abnormal HSG was most likely to occur in women who had antichlamydial antibodies present in the serum, an adnexal mass detected on the initial bimanual examination, or had an IUD (positive associations) and least likely to occur in women who had been treated with the combination of doxycycline and metronidazole (negative association).

Hautarzt, 1985 Jun, 36(6), 320 - 5
{Gonococcal surface antigens and their significance for serotyping and vaccines}; Kohl PK et al.; Outer membrane components of Neisseria gonorrhoeae play an important role in the initial steps of infection . Precise knowledge about the surface antigens is needed for the development of a serotyping system and of a vaccine against local and systemic gonorrhea . Structure, antigenicity, and function of the best-known membrane components, i.e., lipopolysaccharide, protein I, protein II, protein III, and pili, are discussed . Lipopolysaccharide is a strong immunogen and induces bactericidal antibodies, but is unsuitable for use as a vaccine because of its toxicity . Protein I and protein III are stable proteins, not subject to antigenic variation . Antibodies against protein I, which are able to kill N . gonorrhoeae, are detectable in the serum of patients with disseminated gonococcal infection . Protein II and pili are highly variable antigens with constant, very slightly immunogenic regions . To interrupt the pathomechanism of gonococcal infection at different stages, future vaccines should contain more than one surface antigen.

Clin Obstet Gynecol, 1985 Jun, 28(2), 365 - 74
Ectopic pregnancy; DeCherney AH et al.; PIP: The presentation, diagnosis, and treatment of ectopic pregnancy are reviewed . The current trend in treatment of tubal ectopic pregnancy is toward preservation of reproductive function whenever possible . The incidence of ectopic pregnancy has not increased as much over the past several years as some reports indicate; the discrepancy is due to bias introduced by excluding numbers of abortions from the denominators . Pelvic inflammatory disease (PID) is the principal etiologic factor in ectopic pregnancy, and Neisseria gonorrhoeae is the causative agent in most primary tubal infection . Patients with previous abdominal surgery, a history of PID, or who use IUDs have more ectopic pregnancies . The clinical presentation of ectopic pregnancy is variable, and women may be asymptomatic . Any sexually active woman with abnormal bleeding, abdominal pain, or an adnexal mass should be examined immediately to rule out ectopic pregnancy . Culdocentesis may be used to determine whether intraperitoneal hemorrhage is present . The beta human chorionic gonadotropin (hCG) radioimmunoassay is unsurpassed as an endocrine test for diagnosis of ectopic pregnancy, but is time consuming . Diagnostic laparoscopy should not be postponed if a ruptured ectopic gestation is suspected . Ultrasound identification of an intrauterine gestational sac and a serum concentration of beta hCG that exceeds 6500 IU/1 rules out ectopic pregnancy . A sonographically normal uterus and a serum concentration of beta hCG that does not exceed 6500 IU/1 is highly indicative of ectopic pregnancy . Diagnostic laparoscopy to confirm the presence of tubal pregnancy has become routine since technical improvements restored interest in the laparoscope in the early 1960s . Early diagnosis is crucial for preservation of fertility . When a tubal pregnancy is diagnosed, the physician must choose a radical or conservative approach based on the patient's immediate medical condition and desire for future fertility as well as the surgeon's experience . Salpingectomy is the procedure of choice if a fallopian tube is irreparably damaged or if there is a hemoperitoneum associated with shock or profuse bleeding . Rigorous cornual resection is not recommended because it does not exclude a subsequent interstitial pregnancy and may also weaken the myometrium . Colpotomy is rarely indicated, and the removal of a normally functioning ipsilateral ovary is unwarranted . If a conservative approach is feasible, salpingostomy and closure by secondary intention is preferred over salpingotomy and primary closure, which may be complicated by bleeding and edema . Fimbrial evacuation is the easiest procedure but has the highest number of undesirable effects . Midsegment anastomosis, tubouterine implantation, and the Gepfert procedure are either controversial or are associated with poor prognoses . Of all conservative procedures, only salpingostomy offers better results in term pregnancy rates than the radical operations . Salpingectomy is the most efficient treatment for tubal gestation if the patient does not desire future fertility .

Nature, 1985 May 9-15, 315(6015), 156 - 8
Intragenic recombination leads to pilus antigenic variation in Neisseria gonorrhoeae; Hagblom P et al.; The pilus of the bacterium Neisseria gonorrhoeae is a fimbriate surface structure which promotes attachment of the bacterium to host epithelial cells . Gonococcal pilus phase variation is characterized by a rapid on/off switch in which piliated (P+) cells throw off non-piliated (P-) variants and vice versa . Two regions of the gonococcal chromosome (pilE1 and pilE2) act as pilin expression loci, reminiscent of the MAT locus in the yeast Saccharomyces cerevisiae, while several other chromosomal regions contain silent (non-expressing) pilin sequences . Biochemical and antigenic diversity is seen in pili from a wide variety of clinical isolates . Pilins (pilus subunits) are composed of conserved N-terminal and variable C-terminal regions; the conserved region of gonococcal pilin is also found in pilins produced by widely disparate bacteria . We show here that the gonococcal pilin undergoes antigenic variation in vitro and in vivo . The protein consists of constant, semi-variable and hypervariable regions . This antigenic variation probably involves gene conversion of mini-cassettes of pilin information.

Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi, 1985 May, 18(2), 143 - 8
Enzyme immunoassay for detection of Neisseria gonorrhoeae antigens; Ding MJ et al.; An enzyme immunoassay (EIA; Gonozyme, Abbott Laboratories) for the detection of Neisseria gonorrhoeae antigens was assessed . Clinical isolates of N . gonorrhoeae or specimens obtained from male urethra or female cervix were tested by EIA . EIA results were compared with results of conventional culture identification for N . gonorrhoeae . Fifty clinical isolates of gonococci reacted positively with Gonozyme . Five strains of E . coli showed negative reaction to Gonozyme . Five strains of nonpathogenic Neisseria reacted differently with Gonozyme depending upon the viable number of the test organisms . The sensitivity and specificity of EIA for specimens form both sex were 72.4% and 93.8%, respectively . The corresponding figures for the male specimens were 84.6% and 71.4%, and for the female specimens 62.5% and 95%, respectively.

J Antimicrob Chemother, 1985 May, 15(5), 539 - 44
Differentiation of fluorinated quinolone antibacterials with Neisseria gonorrhoeae isolates; Rohlfing SR et al.; Clinical isolates of Neisseria gonorrhoeae were tested for growth inhibition by various quinolones . One acrosoxacin-resistant isolate was also resistant to several fluorinated quinolones with 7-heterocyclic substitution, but, inhibitory concentrations were not elevated for quinolones substituted with a methyl group in the corresponding position (nalidixic acid:position 7, S-25930:position 8) or unsubstituted (flumequine:position 8) . Isolates resistant to flumequine demonstrated elevated inhibitory concentrations for all quinolones examined.

Infect Immun, 1985 May, 48(2), 452 - 7
Structure and surface exposure of protein IIs of Neisseria gonorrhoeae JS3; Judd RC; Colonies of Neisseria gonorrhoeae JS3, each bearing a predominate protein II (PII) type, were derived from a progenitor transparent colony . Five distinct PIIs were identified and isolated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis . The PII bands were excised from gels of unlabeled whole cells and from gels containing lysates of surface-radioiodinated bacteria . These were subjected to alpha-chymotrypsin digestion and two-dimensional peptide mapping, which allowed for a comparison of both the primary structures of the PIIs and the identification of surface-exposed regions of the molecules . The results demonstrated that PIIs are unrelated to either Protein I or Protein III in structure but are closely related to one another, sharing about two-thirds of the peptides generated by alpha-chymotrypsin . The remaining third of the peptides varied with each PII, resulting in unique portions of the molecule being exposed on the bacterial surface . However, the variable peptides were not always among the exposed peptides, suggesting that the structural differences in the PIIs occur at a discrete site (or sites) of the PII molecule and not randomly throughout the protein . Such alterations can result in the exposure of distant, nonvariant portions of the molecule to the surface, perhaps by conformational changes . These bacteria can thus present a variety of new immunodeterminant sites to the host during the course of disease.

J Immunol, 1985 May, 134(5), 3411 - 9
Monoclonal antibodies directed against gonococcal protein I vary in bactericidal activity; Joiner KA et al.; Monoclonal antibodies (Mab) with specificity for protein I (PI) from Neisseria gonorrhoeae (GC) were examined for bactericidal activity . Mab 4G5 (gamma 3), ID3 (gamma 2a), and 1G6 (gamma 2a) bound to surface-exposed epitopes on PI of GC strain R11 (IA serotype) as assessed by co-agglutination and 125I protein A uptake . Mab 2H1 (gamma 3) that were directed against IB serotype strains and Mab 2E9 (gamma 2a) were negative in co-agglutination and protein A uptake assays and served as controls for some experiments . Only 4G5 and 1D3 were bactericidal for R11 when presensitized organisms were incubated in 10% absorbed, pooled normal human serum (PNHS) or 10% hypogammaglobulinemic serum (H gamma S) despite binding of nearly equivalent numbers of 4G5, 1D3, and 1G6 to R11 during presensitization, as assessed by 125I-protein A uptake . These Mab activated complement to a similar extent on GC R11, leading to deposition of 56.4 X 10(3), 61.9 X 1093), and 47.1 X 10(3) molecules of C3/organism during incubation in 10% C8-deficient serum . Deposition occurred almost exclusively via the classical complement pathway . Measurement of complement component C9 binding to R11 during incubation in H gamma S showed 35,700 molecules of C9/organism with 4G5, 32,600 C9/organism with 1D3, and surprisingly, 29,600 C9/organism with 1G6 . Eight thousand four hundred molecules of C9/organism bound to 2E9-coated organisms, 6000 C9/organism to 2H1-coated bacteria, and 3600 C9/organism to nonpresensitized organisms . The C5b-9 complex deposited by 4G5 had a different sedimentation profile by sucrose density gradient analysis from the C5b-9 complex deposited by 1G6, consistent with a different molecular configuration of the bound complex . Mab 1G6 and 1D3, but not 2E9 or 2H1, were able to compete with 125I-4G5 for binding to GC R11 . A Mab (2E6) directed against protein III of GC competed weakly with 125I-4G5 for binding to GC R11 . Mab 1G6, but not 1D3, blocked 4G5-dependent killing in a dose-related fashion . Both 4G5 and IG6 reacted weakly with native PI of GC R11 by immunoblotting, but neither Mab recognized the 34,800 m.w . fragment of PI generated by trypsin and chymotrypsin treatment of outer membranes . In contrast, 2E9 reacted strongly by immunoblot with both native and cleaved PI of GC R11, suggesting binding to buried determinants of PI . These experiments show that Mab directed against identical or closely associated, surface-exposed epitopes on gonococcal PI differ markedly in bactericidal activity, despite leading to deposition of nearly equivalent numbers of C3 and C9 molecules per organism.

Ann Inst Pasteur Microbiol, 1985 May-Jun, 136A(3), 329 - 38
Susceptibility of Neisseria gonorrhoeae DNA to cleavage by restriction endonuclease KpnI; Prere MF et al.; We compared the susceptibility of Escherichia coli and Neisseria gonorrhoeae DNA to cleavage by KpnI and found that KpnI has a lower affinity for gonococcal DNA . Site-specific methylation is suggested as the cause of this altered affinity.

J Clin Microbiol, 1985 May, 21(5), 686 - 8
Effect of sodium polyanetholesulfonate and gelatin on the recovery of Gardnerella vaginalis from blood culture media; Reimer LG et al.; Sodium polyanetholesulfonate (SPS) is used as a routine supplement to blood culture media to enhance recovery of microorganisms, but it inhibits the growth of Peptostreptococcus anaerobius, Neisseria meningitidis, Neisseria gonorrhoeae, and Streptobacillus moniliformis . Comparative clinical blood culture studies at the University of Colorado Hospital suggested that SPS also inhibits the growth of Gardnerella vaginalis . We inoculated 16 blood culture isolates of G . vaginalis into 11 blood culture media containing SPS or sodium amylosulfate, with and without gelatin . In the absence of gelatin, only brain heart infusion and thiol broths with SPS supported the growth of more than five strains of G . vaginalis, whereas all media except Bactec 6B and 7C and brucella broths recovered most isolates with SPS and gelatin or with sodium amylosulfate alone . We conclude that SPS inhibits the growth of G . vaginalis in blood culture media but that this inhibition is medium dependent and can be overcome by supplementation of most media with gelatin.

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