J Clin Microbiol, 1984 Mar, 19(3), 347 - 50 Validity of an enzyme immunoassay for detection of Neisseria gonorrhoeae antigens; Papasian CJ et al.; An enzyme immunoassay (EIA; Gonozyme, Abbott Laboratories) for the antigenic detection of Neisseria gonorrhoeae in endocervical or urethral specimens was evaluated . EIA results were compared with results of conventional culture tests for N . gonorrhoeae . Specimens from 208 males (113 culture positive) and 252 females (72 culture positive) were tested . The sensitivity and specificity of EIA for specimens from males were 97.3 and 95.8%, respectively . The sensitivity and specificity of EIA for specimens from females were 79.2 and 87.2%, respectively. Infect Immun, 1984 Mar, 43(3), 994 - 9 Monoclonal antibody that recognizes an outer membrane antigen common to the pathogenic Neisseria species but not to most nonpathogenic Neisseria species; Cannon JG et al.; A hybridoma derived from a mouse immunized with gonococcal outer membranes produced an antibody, designated H.8, that bound to all strains of Neisseria gonorrhoeae and N . meningitidis tested, and to N . lactamica and N . cinerea, but only rarely to other nonpathogenic Neisseria species . Studies with the gonococcal strain used in production of the antibody showed that the antibody bound to a surface-exposed, protease-sensitive, and heat-modifiable outer membrane antigen that we believe is distinct from previously described gonococcal outer membrane proteins. Infect Immun, 1984 Mar, 43(3), 839 - 45 Conservation of peptide structure of outer membrane protein-macromolecular complex from Neisseria gonorrhoeae; Hansen MV et al.; The structural conservation of an outer membrane protein of Neisseria gonorrhoeae called OMP-MC (outer membrane protein-macromolecular complex) was investigated by determining the isoelectric point and amino-terminal amino acid sequence of the protein and by using high-performance liquid chromatography for comparative tryptic peptide mapping . The 76,000-dalton subunits generated by reduction and alkylation of the native 800,000-dalton complex from six test strains focused in ultrathin gels as bands of restricted heterogeneity at an approximate pI of 7.6 . Dansyl chloride labeling indicated that all strains shared glycine as the amino-terminal amino acid . Sequence analysis of OMP-MC from two strains revealed no amino acid differences within the first 11 residues . Dual-label peptide maps revealed an extremely high degree of conservation of peptide structure . The results indicate that (i) OMP-MCs isolated from various strains of N . gonorrhoeae share structural homology and (ii) the 800,000-dalton complex is a homopolymer composed of 10 to 12 apparently identical 76,000-dalton subunits. Rev Infect Dis, 1984 Mar-Apr, 6(2), 181 - 8 The significance of nongonococcal, nonmeningococcal Neisseria isolates from blood cultures; Feder HM Jr et al.; Nongonococcal, nonmeningococcal neisseriae are part of the normal respiratory flora and infrequently cause disease . These organisms include Neisseria lactamica, Neisseria mucosa, Neisseria sicca, Neisseria flavescens, Neisseria subflava , Neisseria perflava , Neisseria flava , and Branhamella catarrhalis (previously classified as Neisseria catarrhalis) . Blood cultures positive for these bacteria have been associated with serious infections, including endocarditis, septicemia, and meningitis . In a retrospective survey of a 10-year period, 1970-1980, eight patients were identified at Hartford Hospital (Hartford, Conn.) whose blood cultures were positive for nongonococcal, nonmeningococcal neisseriae . In four patients, the neisseria blood isolates were associated with serious infections: two with endocarditis, one with sepsis, and one with meningitis . In four other patients, the neisseria blood isolates were contaminants. J Clin Microbiol, 1984 Mar, 19(3), 338 - 41 Use of the API NeIdent system for identification of pathogenic Neisseria spp . and Branhamella catarrhalis; Janda WM et al.; The API NeIdent system (Analytab Products, Plainview, N.Y.) was evaluated for identifying Neisseria spp . and Branhamella catarrhalis commonly isolated from clinical specimens . The system identified 90% of 303 Neisseria gonorrhoeae isolates, 71% of 113 Neisseria meningitidis isolates, and 63% of 16 Neisseria lactamica isolates but failed to identify any of 22 B . catarrhalis isolates . Testing of gonococcal strains of various auxotypes revealed no relationship between nutritional requirements and NeIdent profile numbers . With the Neisseria species, interpretation of the cinnamaldehyde-coupled beta-naphthylamine reactions was difficult and resulted in profile numbers not listed in the Profile Register . Positive resazurin-glucose reactions resulted in unlisted numbers for all B . catarrhalis strains . Inconsistent results were also obtained when 62 N . gonorrhoeae isolates were tested more than once on the strip . In all cases, profile variability and failure to identify these organisms were related to the beta-naphthylamide substrate tests . Expansion of the data base and modification of the substrate formulations or their interpretive criteria may increase the reliability of the NeIdent system for identifying Neisseria spp . and B . catarrhalis. N Engl J Med, 1984 Mar 1, 310(9), 545 - 9 Effect of treatment regimens for Neisseria gonorrhoeae on simultaneous infection with Chlamydia trachomatis; Stamm WE et al.; We evaluated the effect of treatment of gonorrhea on simultaneous Chlamydia trachomatis infection by randomly assigning 293 heterosexual men and 246 heterosexual women with gonorrhea to receive one of the following treatment regimens: (1) 4.8 million units of aqueous procaine penicillin plus 1 g of probenecid, (2) nine tablets of trimethoprim-sulfamethoxazole daily for three days, or (3) 500 mg of tetracycline four times a day for five days . Among the men, gonococcal infection was cured in 99 per cent given penicillin plus probenecid, 96 per cent given trimethoprim-sulfamethoxazole, and 98 per cent given tetracycline . Among the women, only 90 per cent given tetracycline were cured, in contrast to 97 per cent given penicillin plus probenecid and 99 per cent given trimethoprim-sulfamethoxazole . Chlamydial infection, present in 15 per cent of the men and 26 per cent of the women, was cured in 30 of 32 patients given trimethoprim-sulfamethoxazole and 27 of 29 given tetracycline, but in only 10 of 23 given penicillin plus probenecid . Among chlamydia-positive patients, postgonococcal urethritis in men and cervicitis in women occurred more often in patients given penicillin plus probenecid . Salpingitis developed in 6 of 20 women given penicillin plus probenecid, but in only 1 of 26 given trimethoprim-sulfamethoxazole and in none of 24 given tetracycline . We conclude that the use of penicillin plus probenecid alone for gonorrhea in heterosexual patients carries an unacceptably high risk of postgonococcal chlamydial morbidity . Trimethoprim-sulfamethoxazole and tetracycline were highly effective against both pathogens and were well tolerated in men, but both drugs caused frequent side effects in women . The failure of tetracycline to cure gonorrhea in 10 per cent of women argues against its use alone; treatment with penicillin followed by tetracycline has been recommended for further trial. JAMA, 1984 Feb 3, 251(5), 620 - 5 Establishing the cause of genitourinary symptoms in women in a family practice . Comparison of clinical examination and comprehensive microbiology; Berg AO et al.; We conducted a prospective study comparing the diagnostic yield of standard clinical examinations and of comprehensive microbiological studies in establishing the etiology of genitourinary (GU) symptoms and the prevalence of GU tract infections in 204 women seen in a university-based family practice . Two thirds were initially seen with GU symptoms and one third were seen for routine examinations . In each case we obtained demographic and historical information, a physical examination, and a variety of laboratory tests, including research procedures not commonly available . Diagnoses considered were urinary tract infection and sterile pyuria; trichomonal, yeast, and nonspecific vaginitis; and GU tract infection with Neisseria gonorrhoeae, Chlamydia trachomatis, or herpes simplex virus . Using strategies commonly employed in practice, we reached a diagnosis in only 34% of symptomatic women, a figure rising to 66% when selected, nonroutine laboratory examinations were added. Br J Obstet Gynaecol, 1984 Feb, 91(2), 182 - 6 An assessment of pre-operative microbial screening on the prevention of post-abortion pelvic inflammatory disease; Mills AM; Five hundred women were examined for lower genital tract infection before vaginal termination of pregnancy . Pre-operatively, Neisseria gonorrhoeae was isolated from nine women (1.8%); five of eight male partners also had gonorrhoea . All the women with gonorrhoea were treated at least 48 h pre-operatively with ampicillin and probenicid; three of them had symptoms of pelvic infection pre-operatively and one had symptoms postoperatively . Of these women, 120 (24%) had a follow-up examination within 47 days of abortion; 15 (3%) required an evacuation of retained products of conception and only 12 (2%) had mild suspected pelvic infection . Screening for Neisseria gonorrhoeae and treatment pre-operatively prevented pelvic infection in a further eight patients. J Rheumatol, 1984 Feb, 11(1), 3 - 8 Arthritis in rabbits induced by killed Neisseria gonorrhoeae and gonococcal lipopolysaccharide; Goldenberg DL et al.; Intraarticular injections of viable N, gonorrhoeae, killed N . gonorrhoeae or gonococcal lipopolysaccharide (LPS) in rabbits' knees caused an acute, polymorphonuclear synovitis with abscess formation 24-72 h after the injection . At 5-7 days, a mononuclear infiltration with synovial lining cell hyperplasia developed, which in some rabbits persisted for one month . Gonococcal LPS, in amounts of 5 micrograms or greater, always caused a marked synovitis indistinguishable from that produced by viable N . gonorrhoeae . Gonococcal outer membrane protein used as a control in these experiments caused no or minimal synovitis in concentrations 50-fold higher than those used in the LPS inoculation experiments . These studies should provide a model to investigate the role of LPS in the arthritis associated with gonococcal infection. J Infect Dis, 1984 Feb, 149(2), 175 - 83 Serum sensitivity of Neisseria gonorrhoeae: the role of lipopolysaccharide; Shafer WM et al.; A lipopolysaccharide (LPS) mutant (FA5100) of a serum-resistant strain of Neisseria gonorrhoeae (FA19) was found to be highly sensitive to the bactericidal activity of normal human serum (NHS) . Both strain FA5100 and an unrelated serum-sensitive clinical isolate (F62) were killed by NHS via the classical complement pathway since killing required C2 and Ca++ . However, the fact that only strain FA5100 was sensitive to human hypogammaglobulinemic and cord serum suggested that this strain might activate the classical complement pathway in the absence of antibody . Anticomplementary concentrations of LPS from strain FA5100 inhibited the bactericidal activity of NHS against either strain FA5100 or strain F62 . However, concentrations of LPS from strain FA5100 that exhibited marginal anticomplementary behavior also inhibited the killing of strain F62 by NHS . The ability of LPS from strain FA5100 to inhibit the bactericidal activity of NHS against strain FA5100 and to activate complement was reduced by treatment with mild alkali . However, alkali-treated LPS from strain FA5100 still inhibited the bactericidal activity of NHS against strain F62. J Clin Microbiol, 1984 Feb, 19(2), 218 - 20 Isolation of Neisseria gonorrhoeae on selective and nonselective media in a sexually transmitted disease clinic; Bonin P et al.; To assess the practical significance of reported increases in the prevalence of vancomycin-susceptible strains of Neisseria gonorrhoeae on isolation of this organism, antibiotic-free chocolate agar (CA), modified Thayer-Martin medium (MTM), and a vancomycin-free selective medium (VFSM) were compared in a sexually transmitted disease clinic . Among 326 cervical gonococcal infections detected in a comparison of CA with MTM, 92.0% were detected on CA, compared with 98.2% on MTM (P less than 0.001) . Similarly, among 306 cervical infections detected in a comparison of MTM and VFSM, 95.8% of infections were detected with VFSM, compared with 98.4% for MTM (P = 0.10) . For 1,632 urethral infections in men, all three media were equivalent, with none detecting fewer than 98% of the infections . Compared with a single inoculation, dual inoculation of MTM increased the diagnostic yield by 1.5% for 206 urethral infections and 2.4% for 83 cervical infections . In our clinic population, MTM is superior to CA or VFSM for the diagnosis of genital gonococcal infections, especially in women . The increased yield that accrued from inoculation of both MTM and either of the other media was not sufficiently high to warrant routine use of this practice in our clinic. Br J Vener Dis, 1984 Feb, 60(1), 31 - 8 Interaction between Trichomonas vaginalis and other pathogenic micro-organisms of the human genital tract; Street DA et al.; Trichomonas vaginalis organisms were mixed with suspensions of Neisseria gonorrhoeae, Mycoplasma hominis or Chlamydia trachomatis to allow ingestion of these micro-organisms by the trichomonads . Culture studies indicated that gonococci and mycoplasmas were ingested and that the number of intracellular viable organisms decreased rapidly, most gonococci being killed within six hours and all mycoplasmas within three hours . Electron microscopy revealed phagocytic uptake and destruction of these two micro-organisms within the trichomonads, gonococcal degradation being associated with lysosomal enzyme activity . There was no evidence from cultural or electron microscopy studies that C trachomatis organisms persisted in mixed culture with T vaginalis. Br J Vener Dis, 1984 Feb, 60(1), 23 - 8 Epidemiology of PPNG infections in Amsterdam: analysis by auxanographic typing and plasmid characterisation; Ansink-Schipper MC et al.; In January 1981 the incidence of penicillinase producing Neisseria gonorrhoeae (PPNG) strains in Amsterdam had increased to 18% of all new cases of gonorrhoea . Auxanographic typing in combination with plasmid determination of 729 PPNG strains showed that in 1981 the predominant and endemic types were those with the Africa plasmid and transfer factor which were non-requiring and inhibited by phenylalanine . In 1982 proline requiring strains with the Asia plasmid and transfer factor increased after being imported and spread by prostitution . Four different plasmid patterns and 12 auxotypes were distinguishable . Unusual auxotypes of both African and Asian plasmid types are frequently imported, some disappearing soon after their introduction into Holland but others providing an opportunity to trace sources and contacts . Prostitution and the biological properties of PPNG strains seem to play an important role in their spread . Only 2.6% of them were isolated from homosexual men . In areas where PPNG strains are prevalent, auxotyping is an important tool in their surveillance. Arch Intern Med . 1984 Feb;144(2):391. Gonococcal inguinal lymphadenitis; DeHertogh DA et al.; Neisseria gonorrhoeae is an unusual cause of inguinal lymphadenitis . We describe herein a male patient with no evidence of urogenital or extragenital gonococcal infection who had bacteriologically proved lymphadenitis secondary to N gonorrhoeae . We were unable to elucidate the pathogenesis of this entity, but concluded that urethral, rectal, and pharyngeal cultures for gonorrhea should be included in the evaluation of sexually active persons with adenitis of uncertain etiology even in the absence of urogenital or extragenital symptoms or findings. J Med Microbiol, 1984 Feb, 17(1), 45 - 52 Chemotaxis of human polymorphonuclear leukocytes toward Neisseria gonorrhoeae; Rank EL et al.; Chemoattractive properties of Neisseria gonorrhoeae were studied by measuring leukocyte migration in agarose gel . Human serum albumin (0.5%) was present in the gel and normal human serum was excluded from all components of the assay . Viable cell populations and lysates of colonial types F62T1, F62T2 and F62T3 induced migration of polymorphonuclear leukocytes . Chemotactic activity of the lysate was not altered by heating at 100 degrees C for 10 min and was retained in the 12 100 g supernatant fraction of the heated lysate . Fractionation of the supernate by Sephadex G-100 chromatography showed that the chemotactic activity was associated primarily with an absorbance peak at 280 nm of relatively low mol . wt . The chemotactic activity of this fraction was lost after dialysis and the peak was no longer present in the Sephadex G-100 elution profile of the dialysed supernate . The gonococcal leukotaxins were sensitive to digestion by trypsin, pronase and amyloglucosidase, but insensitive to treatment with RNAase, DNAase or lipase at pH 5.7-7.1. J Exp Med, 1984 Feb 1, 159(2), 452 - 62 Purification and partial characterization of the opacity-associated proteins of Neisseria gonorrhoeae; Blake MS et al.; Gonococci, grown on agar, frequently give rise to opaque colonies . This opacity phenotype is associated with the presence of one or more outer membrane proteins of approximately 28,000 mol weight . These proteins are included within a class of proteins named proteins II . A method is described to isolate and purify the opacity-associated proteins from Neisseria gonorrhoeae . This method uses high concentrations of calcium and a zwitterionic detergent at pH 4.0 . Under these conditions proteins II are readily solubilized from the outer membrane . Further purification is achieved by ion exchange and molecular sieve chromatography in the presence of the zwitterionic detergent . The opacity-associated proteins are very basic with isoelectric points varying between 9.0 to 10.0 . Further evidence for their basic nature is their behavior on ion exchange chromatography and their amino acid composition. Urol Clin North Am, 1984 Feb, 11(1), 65 - 81 Acute pelvic inflammatory disease; Eschenbach DA; PIP: This discussion of acute pelvic inflammatory disease (PID) -- usually a spontaneous infection that occurs among sexually active, menstruating, nonpregnant women -- covers: pathophysiology; microbial etiology (gonorrhea, chlamydia, genital mycoplasmas, and aerobic and anerobic bacteria); epidemiology (number of sexual partners, age, IUDs, previous PID, previous gonorrhea, untreated male sexual contacts, and perihepatitis associated with PID); diagnosis (physical examination, laboratory examination, culdocentesis, examination of the male partner, cultures, and ultrasonography); treatment; and sequelae (recurrent PID, infertility, ectopic pregnancy, and pain) . The majority of infections are caused by bacteria and a polymicrobial bacterial infection is common . Neisseria gonorrhea, Chlamydia trachomatis, and a wide variety of aerobic and anerobic bacteria are most frequently isolated from women with PID . Primary PID is usually and acute infection in which organisms ascend into the uterus and fallopian tubes from the cervix . Chronic active infections are unusual except in neglected cases and in Actinomyces infection, but sterile chronic inflammatory adhesions are common residuals of acute infection . Except for women who have an IUD in place or the 15% who have had uterine instrumentation, spontaneous PID is almost totally confined to women who are sexually active . There is a much higher PID rate among younger than older women . Women who use an IUD for contraception are at least 2-4 times more likely to develop PID than nonusers . Women who have had PID are twice as likely to develop the infection as those who have never had it . A history of a prior uncomplicated gonococcal infection is more common among women with PID than among women without disease . Untreated males with urethral N . gonorrhea and possibly with C . trachomatis infection are an important source of infection both for the initial and for recurrent episodes of PID . Abdominal pain is the most common symptom although the pain may be mild or even absent in at least 5% of patients with PID verified by laparoscopy . In patients who have overt PID, it is possible to establish the diagnosis with reasonable certainty by a combination of history, physical examination, Gram stain of cervical secretions, culdocentesis, and examination of the male sexual partner . Adequate treatment of salpingitis includes an assessment of the severity of the infection, administration of appropriate antibiotics, employment of other health measures, close patient follow-up, and treatment of the male sexual patner . 25% of women with 1 episode of salpingitis develop a subsequent episode . Urol Clin North Am, 1984 Feb, 11(1), 55 - 64 Nongonococcal urethritis; Bowie WR; Nongonococcal urethritis is a frequent genital infection, in most cases caused by Chlamydia trachomatis or Ureaplasma urealyticum . Diagnosis requires demonstration of urethritis and exclusion of Neisseria gonorrhoeae infection . Preferred treatment is seven days of tetracycline hydrochloride or doxycycline, to both the patient and partners . Physical sequelae are infrequent but include epididymitis and Reiter's syndrome. Br J Vener Dis, 1984 Feb, 60(1), 29 - 30 Treating gonococcal urethritis in men: oral amoxycillin potentiated by clavulanate compared with intramuscular procaine penicillin; Latif AS et al.; In a study of 121 men with uncomplicated gonococcal urethritis, 64 were treated orally with a single dose of 3 g amoxycillin and 250 mg of the specific beta-lactamase inhibitor, clavulanic acid, and 57 with a single intramuscular injection of 2.4 MU procaine penicillin . After seven days, six (9.4%) patients treated with amoxycillin and clavulanic acid were still culture positive for Neisseria gonorrhoeae, compared with 26.3% of those treated with procaine penicillin. Urol Clin North Am, 1984 Feb, 11(1), 45 - 53 Gonococcal urethritis; Harrison WO; Gonorrhea continues to maintain its position as the most common reportable infectious disease in the United States . Penicillin is still the antibiotic of choice for the treatment of uncomplicated gonococcal urethritis in most of the United States, but the increasing incidence of penicillinase-producing Neisseria gonorrhoeae (PPNG) in many areas of the world necessitates a reconsideration of standard therapy . In addition to penicillin resistance, the gonococcus is also developing resistance to spectinomycin and tetracycline, which further complicates the choice of therapy. Infect Immun, 1984 Feb, 43(2), 706 - 9 Analysis of the antigen specificity of the human serum immunoglobulin G immune response to complicated gonococcal infection; Hook EW 3rd et al.; The antigen-specific basis of human serum immunoglobulin G antibody response to complicated gonococcal infection was studied in 13 patients by using the Western blot technique for transfer of proteins from sodium dodecyl sulfate-polyacrylamide gels to nitrocellulose paper . Of 13 patients (8 with disseminated gonococcal infection, 4 with pelvic inflammatory disease, 1 with gonococcal epididymitis), 12 reacted with protein I antigens and 9 with lipopolysaccharide (LPS) . Sera from eight patients reacted with both protein I and LPS, whereas sera from four reacted only with protein I, and one sera reacted with LPS alone . One serum with antibody to both protein I and LPS by Western blot analysis was tested for bactericidal activity before and after adsorption of antibody to LPS . Removal of antibody to LPS reduced the bactericidal titer of this serum from 1:100 to 1:50, indicating that antibody to both antigens may be bactericidal for Neisseria gonorrhoeae. J Infect Dis, 1984 Feb, 149(2), 166 - 74 Antigenic variation during infection with Neisseria gonorrhoeae: detection of antibodies to surface proteins in sera of patients with gonorrhea; Zak K et al.; Neisseria gonorrhoeae were cultured from the urethra of male patients and from the cervix and urethra of female contacts . Isolates from a given group of individuals were of the same strain but differed considerably in terms of the molecular weight of both protein II and pili . Radioimmunoprecipitation assays showed that most patients produced serum antibodies to protein I . Antibodies to pili, when present, showed limited cross-reactivity with the different pili produced by a single strain . Antibodies to protein II were highly specific, reacting with only one of the protein II-types produced by a single strain; this observation suggested that the host immune response may be an important factor in antigenic variation . Several sera also contained antibodies to a common surface protein with a molecular weight of 43,000 that was present in all strains tested. Microbios, 1984, 41(160), 99 - 106 The oral ecology of patients with severe Sjögren's syndrome; MacFarlane TW; An investigation of the commensal microflora, salivary flow rate, pH, and the degree of atrophy of the oral mucosa in ten patients with severe Sjogren's syndrome and ten control subjects, revealed a number of differences . The numbers of Streptococcus salivarius, Neisseria pharyngis, Veillonella species and Micrococcus mucilagenosus isolated from patients with Sjogren's syndrome were significantly reduced, while the numbers of Candida spp . and Staphylococcus aureus were significantly increased when compared with control subjects . In addition the salivary pH of the Sjogren's group was significantly reduced and the degree of mucosal atrophy increased compared with controls. Sex Transm Dis, 1984 Jan-Mar, 11(1), 34 - 5 Cutaneous gonococcal abscess: a case report; Fiumara NJ et al.; A 29-year-old man was diagnosed as having a gonococcal abscess of the prepuce and urethritis . Such abscesses, caused by fetal monitoring during labor of a mother infected with Neisseria gonorrhoeae, have been observed on the scalp of newborns . If antibiotic treatment is to be effective, these abscesses must be excised and drained. Sex Transm Dis, 1984 Jan-Mar, 11(1), 24 - 7 A comparison of rosoxacin with ampicillin and probenecid in the treatment of uncomplicated gonorrhea; Cohen AI et al.; Rosoxacin, a beta-lactamase-resistant, pyridyl quinolone derivative with in vitro activity against Neisseria gonorrhoeae, was compared to an oral regimen of ampicillin plus probenecid for the treatment of uncomplicated gonococcal infection . Fifty-seven patients were evaluated for the effectiveness of the two antibiotics . Thirty (97%) of 31 patients receiving rosoxacin were cured of their infection as were 25 (96%) of 26 patients who received the oral regimen of ampicillin plus probenecid . Both drug regimens were associated with a significant number of side effects . Of the ampicillin-treated group, 29% had diarrhea and/or abdominal cramping . Of the rosoxacin-treated patients, 52% had reactions classified as central nervous system effects; these included headaches, dizziness, euphoria, and drowsiness. Sex Transm Dis, 1984 Jan-Mar, 11(1), 18 - 23 Urinary tract infection among women attending a clinic for sexually transmitted diseases; Wong ES et al.; The symptoms, signs, and laboratory findings for 69 women who were seen at a sexually transmitted disease (STD) clinic and who had acute urinary tract infection (UTI) were compared with those for women who had vaginitis, gonorrhea, or chlamydial infection . Escherichia coli and Staphylococcus saprophyticus were the two most common causes of acute cystitis in this population and accounted for 62 (90%) of 69 infections . Forty-three percent of the women had positive tests for antibody-coated bacteria (ACB), an observation implying renal infection although symptoms of upper tract infection were infrequent . Frequency, urgency, dysuria, and suprapubic tenderness were significantly associated with cystitis, whereas vaginal discharge and vulvar itching were associated with vaginitis . There was, however, considerable overlap in symptoms among the four groups of women, and their accurate differentiation required objective information based upon pelvic examination, examination of vaginal fluid, and urinalysis . In the absence of vaginitis on wet mount and mucopurulent cervicitis on examination, pyuria, as determined by examination of centrifuged urine, had an 88% sensitivity, 76% specificity, 61% positive predictive value, and 93% negative predictive value for acute UTI . Because of the high prevalence of positive ACB tests and the possibility that infection with Chlamydia trachomatis and/or Neisseria gonorrhoeae may be mistaken for cystitis, we prefer a five- to seven-day course of antibiotics over single-dose therapy for treatment of patients with possible UTI in the setting of an STD clinic. Obstet Gynecol, 1984 Jan, 63(1), 81 - 4 Chlamydia trachomatis isolation in a symptomatic university student population; Wiesmeier E et al.; In a study of 638 women attending a University Student Health Service outpatient gynecologic clinic, their symptoms were either lower genital tract infection or a history of suspected exposure to sexually transmitted diseases . Forty-two (6.6%) harbored Chlamydia trachomatis, four (0.8%) Neisseria gonorrhoeae, and one (0.2%) both of these organisms . Chlamydia-positive patients were more likely to be using a contraceptive method, have multiple partners, and have partners with symptoms of urethritis (P = .05) . The Chlamydia-positive patients were no more likely to have increased or abnormal vaginal discharge than were controls . Of the women harboring Chlamydia trachomatis, only one of 36 (3%) of those who were available for follow-up at one to eight weeks posttreatment was still infected with the organism. Rev Chil Obstet Ginecol, 1984, 49(2), 84 - 7 {Gonococcal infection in pregnancy}; Donoso E et al.; PIP: 256 pregnant women were studied for the presence of Neisseria gonorrhea in the endocervical canal of the uterus . Those who had positive cultures also had cultures taken from the rectum and the pharynx before administering treatment . 7 days after treatment, control cultures were taken to confirm the effectiveness of the therapy . The cultures were taken at the Diagnostic Center of the Catholic University of Chile . The treatment consisted of two intramuscular doses of a mixture of clemizol penicillin (400,000 IU) and penicillin sodium (3,600,000 IU) . The prevalence of endocervical infection for gonorrhea amounted to 4 cases (1.56%) . They presented bacteria in the rectum and one of them presented bacteria in the pharynx . All cultures were negative 7 days after treatment . There were significantly fewer first-trimester pregnancy cases (58) compared to second-trimester (90) and third-trimester (108) cases . There were 116 primiparas and 140 multiparas . As to the couples, 65.6% of the female population and 61.3% of the male population was concentrated in the 21-30 age group . 87.9% of the population was married; 11.3% was single; and 0.8% was widowed . 48.9% of the pregnant women were exclusively housewives; 23.9% were employed in technical or university professions; 7.4% were engaged in commerce; 3.9% were employees; 4.7% were students; and 1.9% were laborers . Their average age was 26.4 years, while the average age of the healthy population was 26.7 years . G Batteriol Virol Immunol, 1984 Jan-Jun, 77(1-6), 9 - 18 Effects of different bacterial endotoxins on the drinking behaviour of the rat; Foca' A et al.; Endotoxins of Pasteurella multocida, Pseudomonas aeruginosa, Neisseria gonorrhoeae, and Shigella sonnei, when given in a single intravenous injection in the rat, showed antidipsogenic effects on drinking behaviour stimulated by 48 h water deprivation, or by intracerebroventricular injection of carbachol (250 ng) . In water deprived rats, the antidipsogenic effect was dose related . When drinking was induced by carbachol, endotoxins showed a very long-lasting inhibition . The effect was neither a consequence of behavioural alterations, nor due endotoxin peripheral vasodilatating properties. Bull Soc Pathol Exot Filiales, 1984, 77(5), 617 - 27 {Epidemiologic approach to gonococcal infections in Senegal through the study of auxotypes}; Buisson Y et al.; 287 strains of Neisseria gonorrhoeae isolated in Dakar during a 26 months period (April 1981-May 1983) were sent to Pasteur Institute of Paris for auxotyping . They are distributed in (+): 56%, (PRO-): 21%, (ARG-): 13%, and nine minor auxotypes to the exclusion of (AHU-) . Auxotypes distribution according to the sex, the kind of samples and the race do not give proof of significant difference . Monthly distribution shows an endemic circulation of auxotypes (+) and (PRO-), as well as an unstability of auxotype (ARG-) that was prevailing in early months . 22 strains of penicillinase-producing Neisseria gonorrhoeae (among which the first strains isolated in Senegal) belong to auxotypes (+), (PRO-) and (PRO-, ARG-) . This distribution does not differ from that of non-producer strains . Gonococcal auxotyping provides an useful epidemiologic marker in order to search after the source of a contamination, to discern a failure of the treatment from a later infection and, on a wide plan, to survey the resistant strains spreading. Scand J Infect Dis, 1984, 16(3), 267 - 70 Virulence markers in patient and carrier strains of Neisseria meningitidis; Holten E et al.; Patient and carrier strains of Neisseria meningitidis from 2 different periods were compared with respect to serogroups, serotypes and sensitivity to sulphadiazine . The majority of 249 patient strains were resistant to sulphadiazine, and belonged to the groups A, B or C . The group B and C strains were mainly type 15/16 and 2, respectively . In contrast, most of the 400 carrier strains belonged to serotypes other than 2 or 15/16, or were non-typable, and most strains were sensitive to sulphadiazine . Among the resistant group B and C carrier strains there were more type 2 and 15/16 strains than would have been expected from the average . The virulence markers: serogroup A, B and C, serotype 2 and 15/16, and resistance to sulphadiazine, coexist in more carrier strains than would be expected if the distribution of these markers was random. Sex Transm Dis, 1984 Jan-Mar, 11(1), 32 - 3 Etiology of acute epididymitis presenting in a venereal disease clinic; Kristensen JK et al.; Sixteen patients aged 19-42 years and suffering from acute epididymitis were investigated . In twelve patients evidence of acute epididymitis developed without premonitory urethral symptoms . The only microbiologic finding for ten patients was Chlamydia trachomatis; both C . trachomatis and Neisseria gonorrhoeae were isolated from four patients . Two patients, who had recently had antibiotic treatment, harbored neither of these microorganisms . These observations indicate that C . trachomatis must be considered a dominant cause of acute epididymitis in the younger age groups . This fact has implications for the choice of treatment (erythromycin or tetracycline) and the investigations and treatment of sexual contacts. Mol Cell Biochem, 1984, 59(1-2), 165 - 71 Characterization and inhibition of dihydrofolate synthetase from Neisseria gonorrhoeae; Pongsamart S et al.; Dihydrofolate synthetase (EC 6.3.2.12) from N . gonorrhoeae was isolated and enzyme characteristics were determined . The purified enzyme was found quite stable when stored at -60 degrees C . About 50% of the enzyme activity was destroyed within 6 weeks when kept at 4 degrees C . Maximum velocity was observed at pH 9.3 . The enzyme required a monovalent cation, K+ or NH4+, and divalent cation, Mg2+ or Mn2+, for its function . ATP at 5 mM concentration gave maximum activity . Km values for dihydropteroate and L-glutamate at pH 9.3 were 3.5 X 10(-5) M and 6.5 X 10(-4) M, respectively . Patterns of product inhibition by dihydrofolate were found to be non-competitive with respect to dihydropteroate, having a Ki value of 5.1 +/- 0.8 X 10(-4) M, and competitive with respect to L-glutamate, having a Ki value of 6.2 X 10(-4) M. Mol Gen Genet, 1984, 193(3), 561 - 3 A DNA excision repair system for Neisseria gonorrhoeae; Campbell LA et al.; The removal of pyrimidine dimers from deoxyribonucleic acid of ultraviolet irradiated cultures of Neisseria gonorrhoeae can not be readily ascertained by using radioactively labeled thymidine precursors . However, by adapting the alkaline agarose gel technique of Achey et al . (Photochem Photobiol 29, 305-310, 1979), it was possible to demonstrate that this human pathogen does possess an active excision repair system that functions on pyrimidine dimers. Clin Ther, 1984, 6(2), 193 - 7 Cefoperazone for urethritis due to penicillinase-producing Neisseria gonorrhoeae; Kim JH et al.; Thirty-two men infected with penicillinase-producing Neisseria gonorrhoeae were treated with a single intramuscular dose of 0.5 gm of cefoperazone . Of the 29 patients who were followed up, only two (7%) failed to recover; seven patients (26%) had postgonococcal urethritis . The MICs of cefoperazone were 0.03 microgram/ml (three strains), 0.06 microgram/ml (11), 0.12 microgram/ml (nine), 0.25 microgram/ml (one), and 0.5 microgram/ml (one). J Infect, 1984 Jan, 8(1), 70 - 83 Epidemiology of penicillinase-producing Neisseria gonorrhoeae in Liverpool from 1977 to 1982; Arya OP et al.; After the 1976 outbreak of penicillinase-producing Neisseria gonorrhoeae (PPNG) infections had been controlled, less than 1 per cent of cases of gonorrhoea in Liverpool in 1977 and 1978 were caused by PPNG . Thereafter the steady increase in PPNG infections to 5.6 per cent of all cases in 1982 was associated with marked changes in epidemiological pattern, plasmids and auxotypes . In 1976 nearly all PPNG infections were acquired by young black males living in the inner city from women frequenting clubs; the PPNG were all of the African 3.2 megadalton (MD) plasmid type and of arginine-requiring auxotype . Between 1977 and 1982 female patients were increasingly ship girl prostitutes associating with seamen who constituted more than 50 per cent of the male patients . These men and other travellers introduced PPNG into Liverpool from the Far East and West Africa . In 1978 PPNG of the Asian type with 4.4 MD plasmid with or without 24.5 MD transfer plasmids were isolated in Liverpool where in 1979 all PPNG carried 4.4 MD and 24.5 MD plasmids . In 1982 strains of the 'new' African type with 3.2 and 24.5 MD plasmids were isolated as were PPNG of the Asian type that had been acquired in West Africa . Auxotyping of the 1982 isolates showed that none were arginine-requiring but three other types were identified: proline-requiring: proline-arginine-requiring; non-requiring . For the control of PPNG, a strategy based on constant vigilance, appropriate diagnostic procedures, rapidly effective treatment and determined contact tracing is needed. Dermatologica, 1984, 168(2), 67 - 72 In vitro susceptibility of recent isolates of Neisseria gonorrhoeae to cephalosporins of different generations and penicillin G: a comparative evaluation; Korting HC; 98 recent clinical isolates of Neisseria gonorrhoeae (96 nonpenicillinase-producing N . gonorrhoeae (NPPNG) and 2 penicillinase-producing N . gonorrhoeae (PPNG) strains) were tested for their antibiotic susceptibility using the agar dilution test . The antibiotics examined all belonged to the beta-lactam group: penicillin G represented the penicillins, cephalothin, cefazolin, cefotiam, cefmenoxime and ceftizoxime represented the different groups of cephalosporins . In the in vitro tests cephalothin and cefazolin proved less active than penicillin G, cefotiam a bit more and both cefmenoxime and ceftizoxime much more active . These last three antibiotics should become promising alternatives to penicillin in the therapy of gonorrhea caused either by NPPNG or PPNG strains. JOGN Nurs, 1984 Jan-Feb, 13(1), 9 - 12 Sexually transmitted diseases and pregnancy; Osborne NG et al.; The association of adverse pregnancy outcome with Treponema pallidum, Neisseria gonorrhoeae and herpes simplex infections is well known and specific recommendations for management have been formulated . However, other agents that are not so well known can be transmitted sexually and threaten an otherwise healthy pregnancy . These agents are discussed in order to make the nurse more aware of related maternal and fetal diseases. J Clin Microbiol, 1984 Jan, 19(1), 63 - 7 Characterization of Neisseria cinerea, a nonpathogenic species isolated on Martin-Lewis medium selective for pathogenic Neisseria spp; Knapp JS et al.; An asaccharolytic, gram-negative, oxidase-positive diplococcus was isolated on Martin-Lewis medium from the cervix of a patient attending an arthritis clinic at Seattle Public Health Hospital, Seattle, Wash . This strain, NRL 32165, did not produce detectable acid from glucose, maltose, sucrose, fructose, mannitol, or lactose in either cystine Trypticase agar (BBL Microbiology Systems, Cockeysville, Md.) or modified oxidation-fermentation medium and was identified presumptively as a glucose-negative Neisseria gonorrhoeae strain, but was identified later as Neisseria cinerea on the basis of its biochemical reactions . Nitrate was not reduced, nitrite (0.001%, wt/vol) was reduced, and polysaccharide was not produced from sucrose . Proline, arginine, and cystine-cysteine were required for growth on defined medium . Strain NRL 32165 did not react with antigonococcal protein I monoclonal antibodies and did not produce immunoglobulin A protease . In DNA:DNA homology studies with N . gonorrhoeae NRL 8038 (F62) and N . cinerea type strain NRL 30003, strain NRL 32165 showed 95% homology relative to N . cinerea and 44% homology relative to N . gonorrhoeae . Thus, the identity of strain NRL 32165 was confirmed as N . cinerea (von Lingelsheim 1906) Murray 1939 . Of all Neisseria spp., N . cinerea is most likely to be misidentified as a glucose-negative N . gonorrhoeae strain. Acta Otolaryngol Suppl, 1984, 407, 40 - 2 Pathogenicity of Branhamella catarrhalis; Schreiner A; Branhamella catarrhalis--a Gram-negative diplococcus--differs biochemically from other Neisseriaceae and possesses a specific protein with antigenic properties . Although scattered cases of meningitis and endocarditis have been reported since 1907, B . catarrhalis has been considered a non-pathogenic, pharyngeal commensal . However, relatively recent reports have shown B . catarrhalis to play a significant role in the etiology of otitis media and bronchopulmonary infections . Some reports also indicate a pathogenic role in sinusitis and longstanding cough in children, and in acute laryngitis in adults . B . catarrhalis is susceptible to co-trimoxazole, erythromycin, cephalosporins and tetracyclines . Most strains are also susceptible to penicillin, but the frequency of beta-lactamase producing B . catarrhalis has increased from 4% to 25% during the last six years (Sweden) . First choice antibiotics in infections with penicillin-resistant strains would be erythromycin and co-trimoxazole. Sex Transm Dis, 1984 Jan-Mar, 11(1), 30 - 1 Ceftizoxime (FK-749) is effective therapy for urethritis caused by penicillinase-producing Neisseria gonorrhoeae; Harrison WO et al.; Fifty-five men with culture-proved gonococcal urethritis caused by either penicillin-sensitive or penicillinase-producing Neisseria gonorrhoeae were treated with 1 g of ceftizoxime given intramuscularly . All patients were cured, including 26 (47%) with penicillinase-producing strains . Patients experienced no local or systemic side effects and tolerated the injection of ceftizoxime well . These results show that ceftizoxime is an effective alternative to either spectinomycin or cefoxitin in treatment of uncomplicated gonococcal urethritis caused by penicillin-resistant bacteria. Antimicrob Agents Chemother, 1984 Jan, 25(1), 7 - 9 Resistance trends of Neisseria gonorrhoeae in the Republic of Korea; Piziak MV et al.; Penicillinase-producing Neisseria gonorrhoeae has increased in the Far East to the point that penicillin can no longer be recommended as the drug of choice, mandating a change to spectinomycin . As part of an ongoing surveillance of antibiotic susceptibilities, minimal inhibitory concentrations of penicillin, tetracycline, spectinomycin, trimethoprim-sulfamethoxazole, cefoxitin, ceftriaxone, cefotaxime, and moxalactam were determined . A disturbing, steady increase in resistance to spectinomycin was documented. Can J Microbiol, 1984 Jan, 30(1), 52 - 6 Inhibition of anion transport in human erythrocytes by pilated Neisseria gonorrhoeae; Wiseman GM et al.; Pilated gonococci added to human erythrocytes apparently bind to polypeptide band 3 and inhibit chloride-bicarbonate exchange across the membrane in contrast with nonpilated organisms . Known covalent inhibitors of anion transport (4,4'-diisothiocyano-2,2'-disulphonic acid stilbene and alpha-cyano-4-hydroxycinnamic acid) inhibit chloride efflux from erythrocytes and also reduce hemagglutination titres, strongly suggesting that band 3 is the major host-cell receptor involved in all interaction between gonococci and erythrocytes . In studies of other cell species, however, band 3 prepared from human erythrocytes inhibited adherence of pilated gonococci to human foreskin and HeLa cells, but was without effect in human buccal, Vero, and mouse L cells. Microbios, 1984, 41(164), 73 - 9 Nmel, a restriction endonuclease from Neisseria meningitidis; Sparling R et al.; A restriction endonuclease, Nmel, present in Neisseria meningitidis was partially purified by passing through a blue 2-cross linked agarose column; no contaminating nucleases remained detectable . This enzyme cleaved phage lambda, adenovirus type 2 and phi x 174 DNA but did not cleave SV40 DNA . It had an absolute requirement for Mg2+ for its activity and was inhibited by high concentrations of NaCl or MgCl2 . Nmel activity was completely abolished after 1 h of incubation at 65 degrees C . S-adenosyl-L-methionine and ATP had no effect on its activity suggesting that Nmel is a type II restriction endonuclease enzyme . It is the first report of a restriction enzyme present in N . meningitidis. Chemotherapy, 1984, 30(6), 366 - 72 Repeated exposition to subinhibitory concentrations of antibiotic in vitro readily decreases susceptibility of Neisseria gonorrhoeae to rifampicin, but not to new cephalosporins and penicillin G; Korting HC et al.; Repeated subcultivation of Neisseria gonorrhoeae in the presence of subinhibitory concentrations of antibiotic has turned out as a reliable model to predict the low potential for development of resistance with respect to the beta-lactam antibiotic penicillin . Before large-scale introduction of the new cephalosporins we exposed 5 N . gonorrhoeae strains of different susceptibility to penicillin repeatedly to subinhibitory concentrations of cefotiam, ceftizoxime, rifampicin and penicillin G incorporated into chocolate agar . each time the most resistant representatives of a strain were propagated, on the whole 25 times . While resistance to rifampicin increased readily (all strains became relatively resistant, MIC = 4 micrograms/ml), the same was not true of the cephalosporins . Although their susceptibility decreased, too, no strain acquired partial or even total resistance (final MIC less than or equal to 0.128 with cefotiam and ceftizoxime) . The cephalosporins thus rather parallelled penicillin G which hardly induced any increase of resistance . Thus, a quick loss of clinical efficacy need not be feared after large-scale introduction of the new cephalosporins into the therapy of gonorrhea. Chemotherapy, 1984, 30(5), 322 - 7 Susceptibility of Neisseria gonorrhoeae to ceftizoxime in vitro and in vivo; Korting HC et al.; Ceftizoxime - a new beta-lactamase-resistant cephalosporin - was tested for its potential efficacy in the cure of uncomplicated gonorrhea . While more than a half of the 102 freshly isolated Neisseria gonorrhoeae strains examined was partially or totally resistant to penicillin (MIC greater than or equal to 0.06 microgram/ml), most of these strains proved highly susceptible to ceftizoxime (as well as cefotaxime) . The MIC90% amounted to 0.004 micrograms/ml, while serum levels after the intramuscular application of as little as 0.5 g exceed 1 microgram/ml for more than 6 h . The clinical results were excellent . 105 male or female patients suffering from uncomplicated gonorrhea were treated with a single intramuscular application of 1 g of ceftizoxime . 61 of them reattended our clinic twice for follow-up . All of them were cured . Anaphylactic shock or rashes were not observed . Thus, we consider the intramuscular application of 1 g of ceftizoxime as a reliable and safe treatment for uncomplicated gonococcal urethritis and cervicitis. Chemotherapy, 1984, 30(5), 277 - 82 Plasma and skin blister fluid levels of cefotiam and cefmenoxime after single intramuscular application of 1 g in gonorrhea; Korting HC; To predict the clinical efficacy of a new antibiotic in uncomplicated gonorrhea, data pertinent to its pharmacokinetics in man are needed . Before starting clinical trials on cefotiam and cefmenoxime, 1 g of each antibiotic was administered intramuscularly as a single dose to 5 healthy volunteers . Both blood and skin blister fluid samples (obtained by suction and cantharides blistering) were repeatedly taken . Peak plasma levels amounted on average to 24.8 and 48.2 micrograms/ml, respectively . 6 h after dose still average plasma concentrations of 3.4 and 6.52 micrograms/ml were found . Suction blister fluid levels essentially paralleled plasma levels, whereas cantharides blister fluid levels increased and decreased more slowly than plasma levels . Cefotiam penetrated more readily into suction blister fluid than cefmenoxime as obtained from area ratios . Thus, the chosen dosage regimens considered apt for gonorrhea led to high initial as well as long-standing drug levels . And this does not only hold true for the plasma . Facing their good in vitro activity on Neisseria gonorrhoeae, cefotiam and cefmenoxime well deserve further studies in this field including clinical trials. JAMA, 1983 Dec 23-30, 250(24), 3319 - 21 Spontaneous bacterial peritonitis caused by a viridans Streptococcus or Neisseria perflava; McCue JD; Eight patients had nine episodes of presumed spontaneous bacterial peritonitis (SBP) caused by commensal bacteria that usually inhabit the oropharynx, including Neisseria perflava and the viridans streptococci Streptococcus milleri, Streptococcus mitis, and Streptococcus sanguis . Nonpurulent ascites (ascitic fluid WBC count, less than 1,000/cu mm) was present in four episodes, possibly caused by either bacterial colonization or early peritonitis; purulent ascites was present in five episodes . None died of their infection, and three episodes remitted without treatment . Poor condition of gums and teeth may play a pathogenic role in SBP caused by these bacteria. JAMA, 1983 Dec 16, 250(23), 3205 - 9 Risk of acquiring gonorrhea and prevalence of abnormal adnexal findings among women recently exposed to gonorrhea; Platt R et al.; We determined the conditions of 26 women who had recently been exposed to Neisseria gonorrhoeae . Infection was more common among women with more than one exposure (13/14) than among those with one exposure (6/12) . Gonococcal infection was significantly associated with the presence of findings on physical examination suggestive of upper genital tract inflammation . Nine of 19 infected women had such findings; no uninfected women did . Among infected women, the prevalence of abnormal physical findings was 47% +/- 23% (95% confidence interval) . These findings suggest that upper genital tract involvement is a common early complication of gonococcal infection. J Rheumatol, 1983 Dec, 10(6), 985 - 6 Branhamella catarrhalis septic arthritis; Craig DB et al.; An adult with spontaneous septic arthritis due to Branhamella catarrhalis is described and the literature reviewed . B . catarrhalis is an organism similar to the Neisseria species and has been implicated in a variety of systemic infections . As it is frequently resistant to penicillin, cephamycins or third generation cephalosporins may be the empiric drugs of choice for infections caused by this organism. Clin Orthop, 1983 Dec, (181), 115 - 7 Septic arthritis of the hip caused by Neisseria gonococcae; Rubinow A; In two patients septic monoarthritis of the hip was caused by Neisseria gonococcae . Treatment by parenteral penicillin in the first patient and oral erythromycin in the second resulted in complete recovery without residual loss of function in the affected hips . Gonococcal arthritis of the hip appears to respond favorably to appropriate antibiotic therapy, and immediate surgical drainage is probably unnecessary . This is in contrast to bacterial arthritis of the hip due to other organisms, for which surgical intervention and drainage are mandatory. Antimicrob Agents Chemother, 1983 Dec, 24(6), 952 - 4 Antibiotic susceptibilities and auxotypes of Neisseria gonorrhoeae strains from women with pelvic inflammatory disease or uncomplicated infections; Jacques M et al.; The purpose of the present study was to compare the auxotypes and the minimal inhibitory concentrations of four antibiotics for 50 isolates from women with gonococcal pelvic inflammatory disease with those of 55 isolates from uncomplicated anogenital gonococcal infections . No significant differences in auxotype patterns and susceptibilities were found between isolates from the two groups. J Clin Microbiol, 1983 Dec, 18(6), 1366 - 9 Amylase inhibits Neisseria gonorrhoeae by degrading starch in the growth medium; Gregory MR et al.; Highly purified salivary alpha-amylase inhibited the growth of fresh isolates of Neisseria gonorrhoeae on GC agar base medium supplemented with 2% IsoVitaleX (BBL Microbiology Systems) . Hydrolysis of starch in the medium by amylase resulted in a negative starch-iodine test . However, purified amylase did not inhibit gonococcal growth on agar plates that contained hemoglobin (chocolate agar) . This effect was not caused by inhibition of amylase, since amylase activity was the same in the presence or absence of blood products . Moreover, survival of N . gonorrhoeae in buffered saline was not affected by amylase . These results suggest that amylase inhibited the growth of N . gonorrhoeae on GC agar base plates by hydrolyzing starch. Am J Obstet Gynecol, 1983 Dec 1, 147(7), 781 - 4 Gonococcal ventriculitis associated with ventriculoamniotic shunt placement; Bland RS et al.; Use of a ventriculoamniotic shunt to control fetal hydrocephalus is a new procedure . Early experience suggests possible benefit to the fetus . Complications have been rare . This report describes the first case of Neisseria gonorrhoeae central nervous system infection associated with a ventriculoamniotic shunt and the third case reported in a neonate . On the basis of this clinical experience, we recommend that the mother be monitored closely for cervical pathogens, that delivery be performed prior to amniorrhexis, and that culturing of the shunt and ventricular fluid be carried out at delivery. Infect Immun, 1983 Dec, 42(3), 1034 - 40 In vivo degradation of gonococcal outer membrane proteins within human leukocyte phagolysosomes; Eaton LJ et al.; We previously showed in vitro hydrolysis of outer membrane proteins by lysosomal proteases and purified elastase . In this study we examined the in vivo relevance of the previous studies . Outer membranes were obtained from Neisseria gonorrhoeae type 3 (strain GC7) by LiCl2 extraction . Some preparations were labeled with 125I . Phagocytizable particles were prepared by coating latex beads with outer membranes, and polymorphonuclear leukocytes were allowed to phagocytize serum-opsonized particles . After homogenization of neutrophils, phagolysosomes were recovered by flotation through sucrose . Phagolysosomes were prepared for slab gel electrophoresis immediately or incubated further at 37 degrees C to allow continued degradation of outer membrane proteins . The principal protein (protein I) and minor proteins (proteins II) of outer membranes were hydrolyzed in whole neutrophils and in isolated phagolysosomes . Proteins II were more susceptible to hydrolysis than protein I . Hydrolytic products formed were nearly identical in vivo and in vitro . We also radiolabeled the surface-exposed proteins of live gonococci . Degradation of outer membrane proteins on the intact bacteria within neutrophil and monocyte phagolysosomes was shown . This indicates that our earlier in vitro model is relevant to in vivo hydrolysis of gonococcal outer membrane proteins. Br J Vener Dis, 1983 Dec, 59(6), 364 - 8 Imported penicillinase producing Neisseria gonorrhoeae becomes endemic in London; Thin RN et al.; We review all cases of gonorrhoea caused by penicillinase producing Neisseria gonorrhoeae (PPNG) seen between 1976 and 1983 at the sexually transmitted disease (STD) clinic of this hospital, which accounted for 11% of all such cases reported in that period in the United Kingdom . While the overall incidence of gonorrhoea remained relatively stable in this clinic, that of PPNG rose to 4.4% of all such cases by 1982 . Until last year, 75% of these cases were imported, mainly from Nigeria and Ghana, but a marked change was seen in the second half of 1982, when 71% of cases were indigenous in origin . Casual partners and prostitutes in London were mentioned as the source of infection by 34% of patients, a much higher percentage than that seen previously . Such sources are notoriously difficult to trace and these figures show a very disturbing trend . Although rectal infection tends to be asymptomatic, PPNG was isolated in rectal cultures from two of five homosexuals and 19 of 26 women . There is therefore a risk that PPNG could spread rapidly through the homosexual population . We suggest that spectinomycin should no longer be the first drug of choice in the treatment of gonorrhoea caused by PPNG but should be replaced by the newer cephalosporins. Jpn J Antibiot, 1983 Dec, 36(12), 3336 - 42 {Bacteriological and clinical evaluation of ceftizoxime in male gonorrheal urethritis}; Okazaki T; Forty-one male patients with gonorrheal urethritis were treated with ceftizoxime (CZX) administered concomitantly probenecid at the urological ward of Tokyo Metropolitan Taito Hospital during the period from October, 1982 to February, 1983, and clinically evaluated . Eighty strains of Neisseria gonorrhoeae isolated from the clinical specimens of these patients were bacteriologically studied . Of the 80 strains, 12(15%) were PPNG strains and the other 68 strains were non-PPNG strains . MICs of PCG to the 12 PPNG strains were 3.13 - 25 micrograms/ml and to the 68 non-PPNG strains were 0.0122 - 3.13 micrograms/ml . While MICs of CZX to the PPNG strains were less than or equal to 0.003 - 0.024 micrograms/ml and to the non-PPNG strains were less than or equal to 0.003 - 0.05 micrograms/ml . Those patients with gonorrheal urethritis were given a single 0.5 g intramuscular dose of CZX and a single 1 g oral dose of probenecid . The following clinical findings were obtained: The clinical efficacy rate of 41 cases was 98%; excellent in 24, good in 16, poor in 1 case . All 3 patients with gonorrheal urethritis caused by PPNGs were cured with the treatment . No subjective side effects were found. J Am Acad Dermatol, 1983 Dec, 9(6), 815 - 39 Inherited disorders of complement; Guenther LC; Isolated complement component deficiencies are uncommon . Deficiencies of all eleven components and two inhibitors of the classical pathway have been described . Complete absence of the components of the alternative pathway has not been described . The consequences of a single defect in complement are often predictable from an understanding of the biologic activities associated with activation of the complement system . Deficiency of C1 esterase inhibitor gives rise to the disease, hereditary angioedema; deficiency of the early components of the classical pathway are associated with lupus erythematosus; C3 and C3 inactivator deficiencies with pyogenic infections; C5 dysfunction with Leiner's disease; deficiencies of the terminal components with recurrent Neisseria bacteremia; and C9 deficiency with normal health . The complement system and its associated biologic activities are reviewed . The present knowledge of the inherited complement deficiencies and associated diseases, with particular emphasis on the dermatologic manifestations, genetics, and diagnosis, is summarized. J Infect Dis, 1983 Dec, 148(6), 1025 - 32 Gonococcal protein I-specific opsonic IgG in normal human serum; Sarafian SK et al.; Pooled normal human serum (NHS), as well as 10 individual NHS samples, markedly inhibited the reaction between monoclonal antibodies and their cognate epitopes on protein I of serum-sensitive, serum-resistant, and disseminated gonococcal infection-associated strains of Neisseria gonorrhoeae, as determined by ELISA inhibition . IgG was the immunoglobulin class responsible for the inhibition . Only the Fab fragment of IgG was inhibitory, making it likely that the IgG reacted specifically with protein I . After absorption with purified protein I, NHS did not inhibit the binding of a protein III-specific monoclonal antibody, thus excluding the possibility that protein III-specific antibodies in NHS masked epitopes on protein I . In addition, lipopolysaccharide-specific IgG in NHS did not appear to contribute to the inhibition of monoclonal antibody binding to protein I . The IgG from NHS was opsonic; opsonization was prevented by coating gonococci with the Fab fragment of protein I-specific monoclonal antibodies. Infect Immun, 1983 Dec, 42(3), 980 - 5 Inhibition of Neisseria gonorrhoeae attachment to HeLa cells with monoclonal antibody directed against a protein II; Sugasawara RJ et al.; This study showed that a protein II (PII) of Neisseria gonorrhoeae FA1090 appeared to act as a mediator of attachment to HeLa cells . Two colony variants of FA1090 were selected . Both gonococcal variants were nonpiliated, but one contained a PII and the other did not . A monoclonal antibody (1090-10.1), which was directed against the PII, inhibited the apparent PII-mediated attachment to HeLa cells . Antibodies produced from clone 1035-4, which had no PII specificity, did not inhibit the attachment and were used as controls . Inhibition of gonococcal attachment by the 1090-10.1 monoclonal antibodies was demonstrated by fluorescent microscopy analysis . Monoclonal antibody 1090-10.1 appeared to cause agglutination of the PII-containing organism . To block the clumping caused by the PII-specific monoclonal antibodies, Fab fragments of goat anti-mouse IgG were incubated with gonococci and the 1090-10.1 monoclonal antibodies . The results showed that the goat anti-mouse IgG Fab fragments partially blocked the agglutination caused by the PII-specific monoclonal antibody . The effect of the 1090-10.1 antibodies on attachment was also determined by monitoring the HeLa cells with attached iodinated gonococci . The monoclonal antibody appeared to inhibit the PII-mediated attachment. Ann Ophthalmol, 1983 Nov, 15(11), 1004, 1006 - 9 New issues in the prevention and treatment of ophthalmia neonatorum; Raucher HS et al.; We have recently seen two cases of ophthalmia neonatorum (ON) that illustrate a changing picture of this disease and raise a number of questions concerning optimal prophylaxis and treatment . Silver nitrate, which is the most widely used method for prevention of gonococcal ON, fails to prevent neonatal eye disease due to chlamydia . In addition, strains of gonococci which produce a penicillinase and are resistant to penicillin are becoming common in parts of the United States and Europe . Thus all gonococcal isolates must be tested for penicillinase production . The emergence of Chlamydia trachomatis as the most frequent cause of ON and the appearance of penicillin-resistant gonococci has led to new regimens for prophylaxis and therapy of neonatal ophthalmia . At our institution, we now use intramuscular penicillin and topical tetracycline ointment (1%) for eye prophylaxis . For initial therapy of gonococcal ON we recommend penicillin (systemic and topical) plus another antimicrobial with greater stability against the penicillinase of Neisseria gonorrhoeae. J Clin Microbiol, 1983 Nov, 18(5), 1264 - 5 Gono Gen coagglutination test for confirmation of Neisseria gonorrhoeae; Lawton WD et al.; The Gono Gen (Micro-Media Systems, Inc., Potomac, Md.) coagglutination test was compared with the sugar utilization test and with a direct fluorescent antibody test for confirmation of Neisseria gonorrhoeae . Of 110 gonococcal clinical isolates, 109 were positive by the Gono Gen test . Of 57 nongonococcal gram-negative diplococci, all were negative by the Gono Gen test . We conclude that the Gono Gen test is sensitive and highly specific and provides a rapid method for the confirmation of N . gonorrhoeae. J Clin Microbiol, 1983 Nov, 18(5), 1258 - 9 Ammonium bicarbonate as a replacement for carbon dioxide in Transgrow bottles for primary isolation of Neisseria gonorrhoeae; Potter LD et al.; Transgrow bottles with medium containing ammonium bicarbonate and Transgrow bottles gassed with 10% carbon dioxide performed equally well in detecting Neisseria gonorrhoeae in 434 clinical specimens . It appears that incorporation of ammonium bicarbonate into the medium increased the efficiency of the manufacturing process while maintaining the effectiveness of the medium. J Clin Microbiol, 1983 Nov, 18(5), 1150 - 9 Five years of experience with a national external quality control program for the culture and identification of Neisseria gonorrhoeae; Griffin CW 3rd et al.; In response to a need for monitoring the proficiency of public health laboratories in isolating and identifying Neisseria gonorrhoeae, a national external quality control program was developed . Essentially, three types of freeze-dried samples, representing different levels of challenge for identification, were sent to laboratories for testing . The quality of the samples was confirmed by external reference laboratories, and stability of the samples was confirmed by thermal degradation tests before the samples were sent to laboratories enrolled in the program . By analyzing laboratory results, we identified common errors and chronic problems in testing samples . As a group, laboratories testing small numbers of actual patient specimens did not perform as well in the program as did laboratories testing large numbers of specimens; however, the performance of laboratories testing small numbers of specimens improved over time . Overall, laboratories experienced the most difficulty with samples containing N . gonorrhoeae mixed with other microbial species . Laboratories that performed confirmatory tests committed fewer errors than did laboratories that performed presumptive tests only, but the failure to use pure cultures of gonococci for inoculation of cystine tryptic digest agar appeared to be a chronic problem in confirmatory carbohydrate testing . A review of the use of different plating media and confirmatory tests showed that the use of certain media and tests changed over time. Infect Immun, 1983 Nov, 42(2), 446 - 52 Strain distribution in extents of lysozyme resistance and O-acetylation of gonococcal peptidoglycan determined by high-performance liquid chromatography; Swim SC et al.; The extent of lysozyme resistance and O-acetylation of purified peptidoglycan (PG) from 20 strains of Neisseria gonorrhoeae was examined to determine how widespread these properties are among various subsets of gonococcal isolates . To determine digestibility by lysozyme, we treated {3H}- or {14C}glucosamine-labeled PG with hen egg white lysozyme (HEW-LZ) and determined the size distribution of HEW-LZ soluble PG at the completion of the reaction by molecular-sieve high-performance liquid chromatography, using a Varian TSK SW2000 column, a method that proved considerably more efficient than traditional chromatography for fractionating low-molecular-weight PG fragments solely on the basis of size . The extent of HEW-LZ resistance was expressed as the percentage of PG that was larger in size than disaccharide peptide tetramers (including insoluble PG removed by centrifugation) . The percent O-acetylation was determined by converting insoluble PG totally to uncross-linked monomers by the combined action of Chalaropsis B muramidase followed by Escherichia coli endopeptidase and then quantitating radioactivity in O-acetylated and non-O-acetylated monomers after paper chromatography . The PG of the vast majority (19 of 20) of gonococcal strains examined was extensively HEW-LZ resistant (range, 40 to 60% larger than tetramers) and extensively O-acetylated (range, 34 to 52%) . Only the PG of strain RD5 (highest rate of PG turnover among gonococci so far examined and the prototype of gonococci having O-acetyl-deficient PG) had greatly reduced O-acetylation (15%) and exhibited virtually no HEW-LZ resistance (2% larger than tetramers) . Extensive HEW-LZ resistance and O-acetylation were apparently not associated specifically with (i) a given type of colonial variant (piliated versus nonpiliated or opaque versus transparent), (ii) a given type of clinical isolate (local versus disseminated), (iii) the extent of laboratory passage, or (iv) (with the possible exception of penicillin-resistant strain FA102) the presence of one or more genetic loci governing antibiotic resistance among members of an isogenic set of gonococci . From this survey, we conclude that lysozyme resistance and extensive O-acetylation of PG are widespread among gonococci and, thus, that most strains are potential sources of hydrolase-resistant PG that conceivably could persist as macromolecular fragments in vivo. Medicine (Baltimore), 1983 Nov, 62(6), 395 - 406 Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms; O'Brien JP et al.; Forty-nine patients with disseminated gonococcal infection (DGI) hospitalized at Boston City and University Hospitals over a 7-year period were studied . Patients with clinical manifestations of DGI and with cervical, urethral, rectal, pharyngeal, synovial or blood cultures positive for Neisseria gonorrhoeae were separated into two groups based on the presence or absence of suppurative arthritis . There were 19 cases of suppurative arthritis (Group II) and 30 cases with only tenosynovitis, skin lesions, or both (Group I) . Blood cultures were positive only in Group I patients (43%) and synovial fluid cultures only in Group II patients (47%) . Polyarthralgia was the most common initial symptom in both groups of patients . Twenty-six Group I patients had tenosynovitis (87%), while only 4 Group II patients (21%) had tenosynovitis (p less than 0.001) . The knee was the most commonly involved suppurated joint . Twenty-seven Group I patients (90%) had skin lesions compared to 8 Group II patients (42%) (p less than 0.001) . Some of these lesions progressed on treatment; some patients were unaware of their lesions . Genitourinary symptoms were unusual in both groups of patients . Eleven women (33%) were menstruating or were pregnant at the onset of DGI . Thirteen patients had histories suggestive of previous gonococcal infections; one had recurrent DGI . This patient and one other were found to have complement abnormalities . There were no cases of endocarditis or meningitis . Four patients had unexplained liver function abnormalities . All patients recovered uneventfully . Strains isolated from disseminated sites were predominantly of the transparent phenotype (90%) . Many strains (58%) required arginine, hypoxanthine and uracil for growth . They were also more susceptible to penicillin than reported strains that cause pelvic inflammatory disease . Most strains were of a single outer membrane protein coagglutination serogroup, WI (85%) . These characteristics did not vary between the Group I and Group II isolates . The two groups of strains, however, did vary in their complement-dependent bactericidal reactivity to normal human sera . Eighteen of 24 Group I strains (75%) versus 9 of 19 Group II strains (47%) resisted killing by all normal human sera tested (p less than .05) . Likewise, convalescent sera from Group II patients were able to kill their infecting strains more often than did sera from Group I patients (70% vs 17%) (p less than 0.01) . Thus, variations in the clinical expression of disease in patients with DGI may be explained, in part, by differences in certain phenotypic and immunologic features of infecting strains. Gene, 1983 Nov, 25(2-3), 241 - 7 Construction and characterization of a new shuttle vector, pLES2, capable of functioning in Escherichia coli and Neisseria gonorrhoeae; Stein DC et al.; In vitro recombination techniques were used to construct a bifunctional shuttle vector capable of functioning in Neisseria gonorrhoeae and Escherichia coli . This 6-kb plasmid contains a selectable phenotype, beta-lactamase production, which functions in both organisms . It also contains the lac region from pUC9 that allows for the direct selection of hybrid plasmids in the appropriate E . coli hosts by disruption of beta-galactosidase alpha complementation . The lac region contains several unique restriction sites useful for cloning: EcoRI, SmaI, BamHI and SalI. J Clin Microbiol, 1983 Nov, 18(5), 1047 - 50 Inactivation of the polyanionic detergent sodium polyanetholsulfonate by hemoglobin; Edberg SC et al.; Sodium polyanetholsulfonate (SPS) has been added to blood culture media for many years . Its incorporation results in a higher yield of positive blood cultures due to its inactivation of antimicrobial cationic compounds . The most active of these cations include complement components, aminoglycoside-aminocyclitol antibiotics, and receptors on polymorphonuclear leukocytes . There have been reports from studies conducted outside patient blood culture bottles that SPS itself may possess antibacterial activity against some isolates of Neisseria meningitidis, Neisseria gonorrhoeae, and Peptostreptococcus anaerobius . Conversely, in patient clinical trials there has been no significant difference in pathogen isolation rates in the presence or absence of SPS . In an attempt to explain this in vitro/in vivo disparity, a search was undertaken to elucidate which variable constituent in blood, heretofore not studied quantitatively, might have a major effect on modulating the activity of SPS . It was found that hemoglobin combined stoichiometrically with SPS with a Kd of approximately 10(-7) mol/liter . Optimum SPS inactivation occurred at an SPS/hemoglobin ratio of 1:6 (wt/wt) . SPS-sensitive isolates of N . gonorrhoeae and N . meningitidis were protected by the addition of hemoglobin from the antimicrobial effects of this polyanion in time-kill studies . This protection was directly related to the amount of SPS combined in solution . Therefore, the amount of free hemoglobin in solution must be measured when studying the antimicrobial activity of polyanions or when evaluating the effect of different polyanions on the recovery rates of pathogens in patient blood culture clinical trials. Sex Transm Dis, 1983 Oct-Dec, 10(4 Suppl), 276 - 80 Mycoplasma hominis in cervicitis and endometritis; Paavonen J et al.; The presence of serum IgG antibody to Mycoplasma hominis was studied by enzyme immunoassay in 150 women with suspected cervicitis at a clinic for sexually transmitted diseases . Positive levels of antibody were associated with gravidity and parity but not with age, method of birth control, or sexual behavior . Women from whom M . hominis was isolated had higher antibody levels than those from whom M . hominis was not isolated, regardless of the presence or absence of mucopurulent cervicitis . In women with mucopurulent cervicitis, M . hominis did not interact synergistically with Chlamydia trachomatis to affect the severity of cervicitis or the number of polymorphonuclear leukocytes on gram-stained cervical tissue . A striking association was found between plasma cell endometritis and the prevalence and level of serum antibody to M . hominis . Similarly, clinical findings suggesting endometritis were associated with the prevalence and level of this antibody . In contrast, endometritis was not associated with the isolation of M . hominis from the cervix, although it was associated with the isolation of C . trachomatis and Neisseria gonorrhoeae . Urethritis in male sexual partners of women with mucopurulent cervicitis was associated with the isolation of C . trachomatis but not of M . hominis from the women. J Reprod Med, 1983 Oct, 28(10 Suppl), 712 - 5 The staging of acute salpingitis and its therapeutic ramifications; Monif GR; PIP: The classical signs of salpingitis are fever, bilateral adnexal tenderness and/or the presence of masses, and signs of an elevated white blood count (WBC) and erythrocite sedimentation rate . These are absent in the majority of women . Acute salpingitis should be suspected in any woman with lower abdominal discomfort and can be verified by needle culdocentesis . Proper staging can be a deciding factor in the patient's cure and future fertility and helps in the selection of antibiotics . The presence or absence of Neisseria gonorrhoeae should be determined first . Some complicating factors during these procedures include: 1) the presence of an IUD when disease within the fallopian tubes tends to be more advanced than can be ascertained from clinical findings, 2) prior inflammatory disease of the fallopian tube, and 3) bilateral tubal ligation . If peritonitis has been inferred by the demonstration of rebound tenderness or by culdocentesis, confirmation can be achieved by ultrasonography or CAT scan of the pelvis . Once the variables have been identified the information can be assessed according to the current classification of acute salpingitis; staging is an attempt to create clinical subjects based upon the fact that each differs in its major therapeutic goal . For acute salpingitis without peritonitis, therapy is with doxycycline . For acute salpingitis with peritonitis, in order to preserve fallopian structure and function, there has to be adequate coverage for principal venereal pathogens, and treatment is a combination of cefoxitin and doxycycline . For acute salpingitis with evidence of tubal occlusion or ruptured tuboovarian complex treatment is with penicillin, clindamycin, and tobramycin . For a case of ruptured tuboovarian complex combinations of antibiotics are used and if these fail surgery is indicated . Mikrobiyol Bul, 1983 Oct, 17(4), 259 - 66 {The causes of hospital infections in the Medical School Hospital of Cumhuriyet University}; Durmaz R et al.; Samples taken from the clinics were bacteriologically examined in order to find out the incidence of the hospital infections . During the winter, at the control of atmospheric flora in the clinics was isolated S . aureus (58.21%), S . albus (16.67%), E . coli (16.92%), Diphtheroid bacillus (6.22%), Streptococcus spp (5.3%), Neisseria (1.66%), Bacillus subtilis (0.19%), Fungus (0.77%) . Also in the summer it was isolated as following bacteria; S . albus (55.1%), S . aureus (17.9%), E . coli (10.5%), Streptococcus spp (9.6%), Neisseria (5.12%), Fungus (1.49%), Bacillus subtilis (0.07%) . 33.3% dirty result was found from the air of surgery . When the control of disinfectants and sterile instruments it was isolated bacteria mostly responsible from hospital infectants as Ps . aeruginosa Staphylococcus spp, E . coli ext. Sex Transm Dis, 1983 Oct-Dec, 10(4), 195 - 7 Physician utilization of a gonococcal antibody screening test; Beebe JL; A gonococcal antibody test was introduced for use by the physician-clients of a private reference laboratory accompanied by distribution of literature regarding recommended use and interpretation of the test . The pattern of use of the tests was analyzed, and a telephone survey of clients was conducted to determine the manner of physician utilization of the test with regard to 69 patients with reactive test results . Despite recommendations to the contrary, the group surveyed used the test for males (22%) and symptomatic individuals (61%) . Culture for Neisseria gonorrhoeae was not performed for 54% of patients with reactive tests for antibody to N . gonorrhoeae . Most physicians interviewed did not heed recommendations for the use of the test or correctly interpret test results. Sex Transm Dis, 1983 Oct-Dec, 10(4), 191 - 4 Treatment of uncomplicated gonorrhea in men with single-dose moxalactam; Handsfield HH; Men with uncomplicated urethral or rectal infection due to beta-lactamase-negative Neisseria gonorrhoeae were treated with single doses of moxalactam (1.0 g given intramuscularly) . Urethral or anorectal infection was eradicated in 95 of 100 men who returned for follow-up visits three to eight days after treatment; four of eight pharyngeal gonococcal infections were eradicated . The geometric mean minimal inhibitory concentration of moxalactam for 119 pretreatment gonococcal isolates was 0.088 micrograms/ml (range, 0.008-1.0 microgram/ml), and gonococci isolated from homosexual men were significantly more resistant to moxalactam and penicillin G than were isolates from heterosexual men . Post-gonococcal urethritis (PGU) developed in 24 (29%) of 84 subjects who were followed for 12-30 days; 17 (71%) of the cases of PGU were due to Chlamydia trachomatis . Among 21 homosexual men with rectal gonorrhea, five (24%) had coexisting rectal infection with C . trachomatis . Moxalactam is comparable to other single-dose regimens for the treatment of uncomplicated urethral or anorectal gonorrhea in men due to beta-lactamase-negative N . gonorrhoeae. Sex Transm Dis, 1983 Oct-Dec, 10(4), 187 - 90 Attachment of two auxotypes of Neisseria gonorrhoeae to cells of donors of African, European, and Indian descent; Noble RC et al.; Gonococci of the Arg-, Hyx-, Ura- auxotype are isolated most commonly from white patients and seldom from black patients . Five gonococcal isolates of the Arg-, Hyx-, Ura- auxotype and five of the Pro- auxotype were tested for their ability to attach to buccal epithelial cells or to attach or be ingested by polymorphonuclear leukocytes taken from two individuals each of three different racial backgrounds: European-American (caucasian), black American, and Indian from India . Despite the differences in race of the six individuals, there were no differences in the attachment or ingestion of the two gonococcal auxotypes to the two different cell types . The study does not explain why the Arg-, Hyx-, Ura- auxotype is isolated more frequently from whites. Sex Transm Dis, 1983 Oct-Dec, 10(4), 180 - 3 A preliminary evaluation of the Gonozyme test; Burns M et al.; Gonozyme is a solid-phase enzyme immunoassay that detects antigens of Neisseria gonorrhoeae in clinical specimens . The test was 100% sensitive and 96.8% specific when applied to 71 urethral specimens from men with symptomatic urethritis, and 89.5% specific for 19 urethral specimens from men examined after eradication of gonorrhea by antibiotics . For cervical specimens obtained before therapy from 368 women with gonorrhea, the Gonozyme test had a sensitivity of 88.5% and a specificity of 94.3% . The test was 100% specific when used for testing of 37 cervical specimens obtained after therapy of gonorrhea . The predictive values of a positive Gonozyme test were 90.5% for cervical specimens from women attending a sexually transmitted disease clinic and 97% for urethral specimens from men with urethritis . The predictive values of negative Gonozyme tests in these same circumstances were 100% for urethral specimens and 93.6% for cervical specimens. Sex Transm Dis, 1983 Oct-Dec, 10(4), 173 - 9 Gonococcal attachment to eukaryotic cells; James JF et al.; The attachment of Neisseria gonorrhoeae to eukaryotic cells grown in tissue culture was analyzed by use of light and electron microscopy and by labeling of the bacteria with {3H}- and {14C}adenine . Isogenic piliated and nonpiliated N . gonorrhoeae from opaque and transparent colonies were studied . The results of light microscopy studies showed that the gonococci attached to cells of human origin, including Flow 2000, HeLa 229, and HEp 2 . Studies using radiolabeled gonococci gave comparable results . Piliated N . gonorrhoeae usually attached in larger numbers than nonpiliated organisms, and those from opaque colonies attached more often than isogenic variants from transparent colonies . Day-to-day variation in rate of attachment was observed . Scanning electron microscopy studies showed the gonococcal attachment to be specific for microvilli of the host cells . It is concluded that more N . gonorrhoeae from opaque colonies, as compared with isogenic variants from transparent colonies, attach to eukaryotic cells grown in tissue culture. Can J Microbiol, 1983 Oct, 29(10), 1309 - 13 Growth responses of Neisseria gonorrhoeae auxotypes to required amino acids and bases in liquid medium; Hendry AT; Neisseria gonorrhoeae strains can be grouped or differentiated (auxotyped) by their requirements for none, or any one or more of proline, uracil, hypoxanthine, and citrulline or ornithine . Most strains were readily assessed because they responded with growth or no growth on each defined auxanographic medium . Other strains gave indeterminate responses on agar and the reasons were not obvious . Liquid growth studies for quantifying the usual responses showed that yields of appropriate N . gonorrhoeae auxotrophs were proportional to replacement concentrations of any one of these amino acids or bases, of methionine, or of cysteine plus cystine . This type of response, where log growth rates and lag times were unaffected, is proposed as the basis for defining (simple) auxotrophy in gonococci . The formula of the defined medium was improved by increasing proline, uracil, and hypoxanthine beyond limiting concentrations, and decreasing citrulline or ornithine, and cysteine plus cystine . Fatty acid--free bovine albumin was used to ensure homogeneous growth in liquid media . In agar, it was superior to starch for the nonnutritive protective effect required by many strains. Antimicrob Agents Chemother, 1983 Oct, 24(4), 597 - 9 In vitro antimicrobial susceptibility of penicillinase-producing and intrinsically resistant Neisseria gonorrhoeae strains; Cohen MS et al.; The in vitro susceptibility of penicillinase-producing and intrinsically resistant Neisseria gonorrhoeae strains to 13 antimicrobial agents was tested . Regardless of the type of resistance, these organisms remained quite susceptible to newer cephalosporin agents, including moxalactam, cefoperazone, cefotaxime, and ceftazidime. J Clin Lab Immunol, 1983 Oct, 12(2), 83 - 6 ABO blood groups and susceptibility to gonococcal infection . III . Role of isohemagglutinins in increased association of Neisseria gonorrhoeae to monocytes from blood group B individuals; Kinane DF et al.; The association of human monocytes of different ABO blood groups with gonococci was examined under various conditions . Blood group B monocytes in the presence of autologous heat inactivated serum (HIS) showed increased association over monocytes of the other ABO groups with their autologous sera . No statistically significant trends in ABO monocyte association were noted for assays carried out in the absence of autologous HIS . Absorptions of isohemagglutinins from sera reduced the gonococcus-monocyte association level to that of controls. South Med J, 1983 Oct, 76(10), 1325 - 6 Gonococcal endocarditis with initially negative blood cultures; Donachie RJ Jr et al.; This case of gonococcal endocarditis in a young man highlights the recognized capacity of Neisseria gonorrhoeae to destroy an infected valve, and illustrates that emergency valve replacement in the presence of congestive heart failure may be life-saving . The utility of the echocardiogram and the reportedly low yield of positive blood cultures in this disease are represented. Infect Immun, 1983 Oct, 42(1), 99 - 105 Phagocytic killing of Neisseria gonorrhoeae by human monocytes; Mezzatesta JR et al.; The ability of human monocytes to phagocytize and kill nonpiliated opaque (T3) and transparent (T4) gonococci was investigated in a tumbling tube suspension assay . A serum-sensitive strain, F62, and a serum-resistant strain, FA19, were studied . CFU remaining after incubation with monocytes were used to assess the extent of killing . The data show that 50% of T3 and T4 gonococci of both strains were killed by monocytes over a 2-h period . Serum was necessary for the killing of transparent gonococci of both strains as well as for FA19 T3 . Concentrations of serum ranging from 0.5 to 10% were equally effective, and heat-labile components were required . Killing of F62 T3, however, occurred in the absence of serum . An increased ratio of bacteria to monocytes decreased the rate of killing . A 30-min preopsonization of gonococci in 10% serum resulted in an enhanced rate of killing . Monocytes were able to kill plate-grown, but not log-phase, organisms . Disruption of the monocytes by sonication to release internalized bacteria did not increase the number of viable organisms . The addition of 10 micrograms of cytochalasin B per ml completely inhibited the reduction in colony numbers over time . These data indicate that freshly isolated human monocytes are capable of phagocytizing and killing nonpiliated gonococci. Br J Vener Dis, 1983 Oct, 59(5), 285 - 8 Epidemiological characterisation of Neisseria gonorrhoeae isolates from the Far East; Odugbemi TO et al.; One hundred strains of Neisseria gonorrhoeae (including 30 penicillinase producing (PPNG) strains) originating from Korea were characterised by plasmid analysis, auxotyping, and serogrouping . Eighty per cent of the isolates possessed the conjugative 24.5 megadalton (Mdal) plasmid . A novel 7.8 Mdal plasmid was present in four isolates (one PPNG and three non-PPNG strains) . Seventy five per cent of all the strains tested were wild type and belonged to serogroup WII, while 20% were proline requiring and belonged to serogroup WII . Two of the remaining strains were tyrosine auxotrophs, while another strain was arginine requiring; these three strains carried the conjugative plasmid and belonged to serogroup WII. Sex Transm Dis, 1983 Oct-Dec, 10(4 Suppl), 289 - 93 Enzyme immunoassay for serum antibody to Mycoplasma hominis in women with acute pelvic inflammatory disease; Miettinen A et al.; A sensitive, four-layer modification of an enzyme immunoassay was developed for the determination of serum antibodies to Mycoplasma hominis . The suitability of the test for diagnostic use was studied with women who had acute pelvic inflammatory disease (PID) . Twenty (23%) of 86 women with PID from whom paired sera were obtained demonstrated a significant change in levels of IgG antibody, a finding suggestive of recent infection with M . hominis . The occurrence of such change was not related to the isolation of Chlamydia trachomatis or Neisseria gonorrhoeae from the lower genital tract . Women with PID had significantly higher levels of IgG and IgA antibody to M . hominis, whereas the amount of IgM antibodies present did not differ between the groups . Levels of IgG antibody increased and those of IgM antibody decreased with increasing age . This change was found both among women with PID and among controls. Br J Vener Dis, 1983 Oct, 59(5), 293 - 7 Sultamicillin in the treatment of gonorrhoea caused by penicillin sensitive and penicillinase producing strains of Neisseria gonorrhoeae; Atia WA et al.; A single oral dose of 2 g of sultamicillin and 1 g of probenecid was effective in the treatment of men with uncomplicated gonococcal urethritis caused by both penicillin sensitive strains of Neisseria gonorrhoeae and penicillinase producing strains of N gonorrhoeae (PPNG) . Of 94 infected men who attended for at least one follow up examination, 91 (97%) were cured . The remaining three (3%) patients were still infected at follow up . Two of these patients had been re-exposed to an infected partner and were considered to be possible reinfections, while the third was deemed a treatment failure . Six of the 94 patients were infected with PPNG strains and all were successfully treated . Plasmid analysis of the PPNG strains showed Asian and African types both with and without transfer plasmid. Br J Vener Dis, 1983 Oct, 59(5), 289 - 92 Antimicrobial sensitivity of Neisseria gonorrhoeae . Comparison of penicillinase producing and non-penicillinase producing strains; Herzog C et al.; The sensitivity of 42 strains of penicillinase producing Neisseria gonorrhoeae (PPNG) and 46 strains of non-PPNG was tested against benzyl penicillin, spectinomycin, erythromycin, cefuroxime, ceftriaxone, tetracycline, sulphamethoxazole, and trimethoprim . The minimum inhibitory concentrations (MICs) of all antimicrobials, except trimethoprim and ceftriaxone, differed significantly for PPNG and non-PPNG strains . Ceftriaxone was the most active compound tested, the MIC for all strains being less than or equal to 0.015 mg/1 . PPNG were less sensitive than non-PPNG strains to spectinomycin . It remains to be seen whether the increase in prevalence of PPNG strains is followed by a gradual increase in low level resistance to spectinomycin as well as the occasional finding of high level resistance to this antibiotic. Br J Vener Dis, 1983 Oct, 59(5), 298 - 301 Cefaclor and cefamandole as alternatives to spectinomycin in the treatment of men with uncomplicated gonorrhoea; Panikabutra K et al.; Between 25 December 1981 and 11 March 1982, 400 men with uncomplicated gonococcal urethritis were randomly assigned to one of four treatment regimens: spectinomycin 2 g intramuscularly (group A); cefamandole 1 g intramuscularly after probenecid 1 g orally (group B); cefaclor 3 g orally with probenecid 1 g orally (group C); and cefaclor 3 g orally (group D) . The cure rates were 91 of 92 (98.9%) in group A, 68 of 96 (70.8%) in group B, 88 of 92 (95.8%) in group C, and 86 of 96 (89.6%) in group D . Cefaclor at a dose of 3 g given orally with 1 g probenecid appears to be an effective alternative to spectinomycin 2 g in the treatment of gonorrhoea in areas where strains of penicillinase producing Neisseria gonorrhoeae (PPNG) are prevalent. N Z Med J, 1983 Sep 28, 96(740), 716 - 8 Unsuspected Chlamydia trachomatis in females attending a sexually transmitted diseases clinic; Say PJ et al.; One hundred and five women attending Auckland sexually transmitted diseases clinic were reviewed because of positive cervical cultures for Chlamydia trachomatis . Their average age was 19 years, 70% were European; 28% were Maori . In half the patients the positive culture was a chance finding and therefore treatment was delayed resulting in six patients (12%) developing pelvic inflammatory disease . Eight out of nine male contacts, subsequently traced, had asymptomatic urethritis, one having epididymitis . One patient had no evidence of urethritis but was chlamydia positive . Associated pathogens present in the women were Neisseria gonorrhoeae (26%), Trichomonas vaginalis (6%), Gardnerella vaginalis (46%) and Candida albicans (19%) . These findings support a need for routine chlamydial testing in female patients attending sexually transmitted diseases clinics and epidemiological treatment of female contacts of men with non-specific urethritis. S Afr Med J, 1983 Sep 17, 64(12), 451 - 4 The enzyme-linked immunosorbent assay (ELISA) in the laboratory diagnosis of gonorrhoea . A comparative evaluation; De Klerk E et al.; An enzyme-linked immunosorbent assay (ELISA) was used to detect levels of antibodies to Neisseria gonorrhoeae in 100 male patients with suspected gonorrhoea attending a clinic for sexually transmitted diseases . Although significantly higher antibody levels were detectable in patients with clinically diagnosed gonorrhoea confirmed by laboratory tests, positive results were also obtained in 26% of the control subjects, who were presumed to be healthy . Serum anticomplement activity was present in 8% of the subjects with false-positive results, while tests for rheumatoid factor were positive in 14% . However, these problems could be eliminated to a certain extent by including a negative control or background well for each serum sample . Because the ELISA was found to be of high sensitivity and moderate specificity it is concluded that it is a useful serodiagnostic test for gonorrhoea. Ann Microbiol (Paris), 1983 Sep-Oct, 134B(2), 257 - 67 A new taxon in the genus Neisseria; Riou JY et al.; Among 3,520 strains of Neisseria and Branhamella received in the laboratory during the last seven years, 13 could not be speciated . These 13 strains (Neisseria sp . group) were isolated from the throats of healthy children in Europe and Africa . The Neisseria sp . group oxidized glucose and maltose similarly to N . meningitidis . The observation of polysaccharide synthesis prompted the authors to examine the genomic relationship between the Neisseria sp . group and the type strains of all species of Neisseria and Branhamella . Additional phenotypic characteristics were also examined . Results indicated that the 13 strains in this study belong to the genus Neisseria, in which they constitute one homogenous hybridization group . They belong to the same genospecies as N . gonorrhoeae, N . meningitidis, N . flavescens and N . lactamica . However, they differ from N . meningitidis in production of polysaccharides, growth requirements and the lack of gamma-glutamyl transferase activity. J Ethnopharmacol, 1983 Sep, 8(3), 279 - 86 Rwandese herbal remedies used against gonorrhoea; Van Puyvelde L et al.; In the course of systematic studies on biologically active substances from medicinal plants of Rwanda (Central Africa) we have screened the indigenous drugs used against gonorrhoea for their antimicrobial activity . From the 25 plants tested, 16 were found to have an activity against Neisseria gonorrhoea and N . meningitidis, 6 against Streptococcus pyogenes and 5 against Staphylococcus aureus . Thus, out of 23 indigenous drugs, 17 remedies (74%) were found to be associated with one or more plants with an activity against gonorrhoea. Mol Immunol, 1983 Sep, 20(9), 1039 - 49 Inhibition of microbial IgA proteases by human secretory IgA and serum; Gilbert JV et al.; Microbial IgA proteases cleave human serum IgA1 immunoglobulin, but human secretory IgA is resistant to hydrolysis . We have found this resistance to be due to an inhibition of protease activity that is mediated by the Fab region of secretory IgA . The IgA proteases of the genus Neisseria are more sensitive to inhibition than is the protease of Streptococcus sanguis . There is also a serum inhibitor of Neisseria proteases that co-chromatographs with IgG . Monoclonal (myeloma) human IgG proteins and plasma protease inhibitors such as alpha-1-antitrypsin and alpha-2-macroglobulin do not inhibit . Human sera do not contain inhibitor to S . sanguis protease activity . We conclude that microbial IgA proteases are subject to inhibition by IgA in secretions and IgG in serum, and this activity is most consistent with being an anti-enzyme antibody . The insensitivity of S . sanguis IgA protease to inhibition is unexplained but provides further evidence that the IgA proteases are structurally diverse. J Adolesc Health Care, 1983 Sep, 4(3), 171 - 3 Isolation of Neisseria meningitidis from anogenital sites in adolescents: clinical implications; Jaffe LR et al.; Neisseria meningitidis is being increasingly isolated from the urethra, cervix, and anal canal of sexually active individuals . We found a similar phenomenon in inner-city black and Hispanic adolescents . In 1981, cultures of 92 isolates of Neisseria were made from the anogenital region of sexually active adolescents; 81 (88.0%) were N . gonorrhoeae, 3 (3.3%) could not be speciated, and 8 (8.7%) were N . meningitidis . Since N . meningitidis has been associated with urethritis and pelvic inflammatory disease, it should be considered a pathogen when identified in the urethra or cervix and should be appropriately treated . The health implications of isolating N . meningitidis from the anal canal are less clear, although it has been rarely associated with proctitis . Neisseria isolates from anogenital sites cannot be assumed to be gonococci and, therefore, should be distinguished from N . meningitidis. J Infect Dis, 1983 Sep, 148(3), 462 - 71 DNA hybridization technique for the detection of Neisseria gonorrhoeae in men with urethritis; Totten PA et al.; A technique to detect Neisseria gonorrhoeae directly in clinical specimens was developed using a modified DNA-hybridization method . It uses the gonococcal cryptic plasmid as the radiolabeled probe, can detect as few as 100 colony-forming units of N gonorrhoeae or as little as 0.1 pg of purified gonococcal plasmid DNA, and is highly specific . This technique for differentiating between gonococcal and nongonococcal urethritis was evaluated in men with symptomatic urethritis in Seattle . Sixty-three (89%) of 71 who had cultures positive for N gonorrhoeae were also positive by DNA hybridization, and all 42 whose cultures were negative were also negative by DNA hybridization . Five of six isolates from patients who were positive by culture but negative by hybridization lacked the gonococcal cryptic plasmid and belonged to a unique auxo-type which requires proline, citrulline, and uracil for growth. J Bacteriol, 1983 Sep, 155(3), 1324 - 32 Sequence-specific DNA modification in Neisseria gonorrhoeae; Korch C et al.; Neisseria gonorrhoeae 82409/55(pJD1) is postulated to possess six DNA sequence-specific cytosine methyltransferases and one DNA sequence-specific N6-adenine methyltransferase . From the DNA sequencing of the plasmid pJD1 (manuscript in preparation) by a modification of the Maxam and Gilbert chemical cleavage procedure, the cytosine methylation specificities were demonstrated . Five of these methylating enzymes and their respective specificities are M . NgoI (formula; see text) does not methylate the cytosine of its recognition sequence, in agreement with a detected adenine modification . A biological implication of these different DNA methylating activities is discussed. Fertil Steril, 1983 Sep, 40(3), 322 - 9 Infertility after acute salpingitis with special reference to Chlamydia trachomatis; Svensson L et al.; Of 552 women with laparoscopically verified acute salpingitis (AS), 299 were reviewed 2.5 to 7.5 years later . Cervical secretions from these women had been cultured for the presence of Chlamydia trachomatis and Neisseria gonorrhoeae . For 49 of 82 women with visually normal pelvic organs, such cultures were also performed; these women served as control subjects . In women exposing themselves to pregnancy, 50 (23.3%) of 197 AS patients and 2 (6.7%) of 30 control women were infertile for at least 1 year (P less than 0.02) . After one episode of AS, women harboring chlamydiae, gonococci, both, or neither of these microorganisms in the cervix on admission seemed to have the same fertility prognosis . Infertility was correlated with the number of AS episodes, the erythrocyte sedimentation rate (millimeters per hour) at admission, and the severity of the inflammatory reactions of the tubes . The use of oral contraceptives at admission was found to be a positive prognostic factor regarding fertility . Oral contraceptives might protect the patient from severe tubal inflammatory reactions. Drug Intell Clin Pharm, 1983 Sep, 17(9), 615 - 22 Third-generation and investigational cephalosporins: II . Microbiologic review and clinical summaries; Garzone P et al.; In vitro susceptibility of Streptococcus pyogenes, Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Serratia marcescens, Hemophilus influenzae, Bacteroides fragilis, and Neisseria gonorrhea to three new second-generation and eight third-generation cephalosporins is tabulated . In general, the newer cephalosporins have an extended spectrum of activity against gram-negative bacteria, including Serratia marcescens, Pseudomonas aeruginosa, and Neisseria gonorrhea . They also tend to be active against anaerobes, including Bacteroides fragilis . However, they generally have less activity against gram-positive bacteria when compared with the first- and second-generation cephalosporins . Clinical summaries are given for each of the cephalosporins, with emphasis on the results of comparative clinical trials . These cephalosporins may prove especially useful in nosocomial infections with resistant organisms, intraabdominal infections, febrile episodes in the granulocytopenic patient, and meningitis. Z Hautkr, 1983 Aug 15, 58(16), 1165 - 76 {Winuron - alternative single-dose therapy of gonorrhea}; Fechner WC et al.; 152 ambulatory patients suffering from gonorrhoea were treated with Winuron in an open clinical trial . A single oral dose of rosoxacin 300 mg proved to be sufficient to cure 97.4% of the patients . Follow-up examination revealed only 4 cases of Neisseria gonorrhoea left . Already 3 days after therapy, the clinical symptoms had subsided in 84.1% of the patients . The substance was well-tolerated . Side effects were observed in 14.5% of the cases, being mild and transitory, though . Good and antibacterial efficacy of rosoxacin in vitro as well as the high healing quotient in combination with the shortest possible duration of therapy make Winuron a valuable alternative to penicillin. JAMA, 1983 Aug 12, 250(6), 794 - 5 Neisseria gonorrhoeae conjunctivitis . An outbreak during an epidemic of acute hemorrhagic conjunctivitis; Alfonso E et al.; Ten patients with gonococcal conjunctivitis were examined during an epidemic of acute hemorrhagic conjunctivitis (AHC) . Eye cultures in all cases demonstrated Neisseria gonorrhoeae, and seven also had isolates of N gonorrhoeae in genital specimens . All patients responded well to antimicrobial therapy . The patients had used a folk remedy in which they had applied urine to their eyes to treat the symptoms of AHC. Lab Anim Sci, 1983 Aug, 33(4), 377 - 9 Epistaxis and bullae in cynomolgus macaques (Macaca fascicularis); Olson LC et al.; Epistaxis and bullae occurred in 35 of 54 cynomolgus macaques (Macaca fascicularis) . Individual cases developed randomly during a 3 to 4 week period in the winter, and resolved within a week of onset . Clinical signs included nasal and eyelid swelling, bloody nasal discharge, sneezing, and bullous areas above the eyes . Affected animals remained active and alert . Staphylococcus aureus and Neisseria catarrhalis were isolated from nasal swabs . Hemagglutination inhibition titers for measles were negative . Biopsies of the bullous areas disclosed acute inflammatory edema and cellulitis. Acta Pathol Microbiol Immunol Scand {B}, 1983 Aug, 91(4), 257 - 60 Pyrimidine biosynthesis in Neisseria meningitidis . 2 . Regulation of enzyme synthesis; Jyssum S; In Neisseria meningitidis aspartate carbamoyltransferase (ACTase), ornithine carbamoyltransferase (OCTase), and carbamoylphosphate synthetase (CPSase) showed incomplete repression by uracil and arginine . De-repression studies with pyrimidine and arginine mutants showed no de-repressed levels of these enzymes. Acta Pathol Microbiol Immunol Scand {B}, 1983 Aug, 91(4), 245 - 50 Influence of blood cells on the expression of bacteriocin-like activity in Neisseria meningitidis; Jyssum K et al.; The inhibitors responsible for the bactericidal activity found in four strains of Neisseria meningitidis were strongly bound to or inactivated by blood cells . The bactericidal effects were specifically influenced by human cells of types O, A, B and AB . Cells from horse, sheep and rabbit had no significant effect . The bacteriostatic effect observed in one strain of N . meningitidis was more moderately reduced in the presence of animal cells as well as human cells . The effects of the blood cells were connected with pellets from lysates of the blood cells . The bacteriostatic effect was also moderately reduced in the presence of plasma, hemoglobin and methemoglobin regardless of origin, and to some extent of cytochrome C . CaCl2 slightly enhanced the bacteriostatic effect. J Clin Microbiol, 1983 Aug, 18(2), 436 - 7 Septicemia due to a maltose-positive, glucose-negative strain of group C Neisseria meningitidis; Watanakunakorn C et al.; A glucose-negative, maltose-positive strain of group C Neisseria meningitidis was isolated from the blood of a 63-year-old man . Interestingly, maltose degradation was detected by radiometric methods but not by growth methods. J Med Microbiol, 1983 Aug, 16(3), 295 - 302 Auxotyping of Neisseria gonorrhoeae isolated in the United Kingdom; Copley CG et al.; One hundred and twenty consecutive isolates of Neisseria gonorrhoeae from the County of Avon, UK, were examined by auxotyping and penicillin susceptibility testing . Requirements for proline (Pro), arginine (Arg), hypoxanthine (Hyp), uracil (Ura) and methionine (Met) were determined with a modified Heckels' medium . Prototrophic strains accounted for 29.9% of isolates and were a heterogeneous group as judged by penicillin sus