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 diagno