Br Med J (Clin Res Ed), 1982 Jul 31, 285(6338), 337 - 40 Penicillinase-producing Neisseria gonorrhoeae in Great Britain, 1977-81: alarming increase in incidence and recent development of endemic transmission; McCutchan JA et al.; Since penicillinase-producing Neisseria gonorrhoeae appeared five years ago in West Africa and South-east Asia reported cases have doubled annually in Great Britain, primarily as a result of increasing importation . Importation of penicillinase-producing Neisseria gonorrhoeae has increased exponentially because dramatic expansion of these strains in their regions of origin has led to increasing infection of male air travellers . From 1977 to 1980 infections acquired in Great Britain played only a minor part in the exponential increase . During 1981 the number of indigenous cases increased much more rapidly than imported cases, indicating that these strains have become truly endemic in Great Britain . Currently, identification of patients at high risk and initial treatment with penicillinase-resistant antibiotics offers the best hope of containing the strains . The emergence and rapid spread of penicillinase-producing Neisseria gonorrhoeae shows the international consequences of the abuse of antibiotics. Am J Obstet Gynecol, 1982 Jul 1, 143(5), 489 - 95 Clinical staging of acute bacterial salpingitis and its therapeutic ramifications; Monif GR; The use of single-drug therapy results in an overall 13% to 17% failure rate, and even this figure is misleading, because of the high prevalence of patients with uncomplicated disease . In patients with polymicrobial peritonitis, the failure rate varies between 30% and 60%, depending upon whether Neisseria gonorrhoeae can be concomitantly isolated from the cul-de-sac and the criteria used to define therapeutic cure . THe complexity of disease as we now understand it requires a corresponding degree of therapeutic individualization . In the Gainesville staging, acute salpingitis is subdivided into five stages . Stage I is acute endometritis-salpingitis without peritonitis . Stage II is salpingitis with peritonitis . Stage III is acute salpingitis with superimposed tubal occlusion or tuboovarian complex . Stage IV is where a tuboovarian abscess has ruptured . Stage V is a repository category for different etiologic agents which may emulate acute salpingitis, i.e., Mycobacterium tuberculosis . Each stage of disease differs by virtue of its therapeutic goal and the means by which this goal is achieved. Sex Transm Dis, 1982 Jul-Sep, 9(3), 124 - 7 The value of the cervical gram stain in the diagnosis and treatment of gonorrhea in women in a venereal disease clinic; Lossick JG et al.; In a venereal disease clinic population of 8,537 women, 1,179 (70%) of 1,675 cases of gonorrhea were detected at the initial visit by the use of the cervical gram stain . The results of cervical cultures indicated that specificity of the gram stain was 97% . Use of the cervical gram stain, combined with epidemiologic treatment of potentially exposed patients, permitted treatment of 1,531 (91%) of 1,675 infected women at the initial clinic visit; this proportion represented an increase of 42% over treatment based solely upon epidemiologic grounds . Of the 124 patients who were not treated at the initial visit and who required treatment at a second visit, nine (7.3%) developed pelvic inflammatory disease during the interval between visits . Although a test of only moderate sensitivity, the cervical gram stain, used as an adjunct to the culture for Neisseria gonorrhoeae, provided the advantages of diagnosis at the initial visit and informed treatment, facilitated the case-finding process, and minimized treatment defaulter rates and the potential risks of sequelae and transmission of gonorrhea before results of cultures were known. Sex Transm Dis, 1982 Jul-Sep, 9(3), 120 - 3 Antibiotic sensitivities of Neisseria gonorrhoeae in the Far East: comparison of plasmid species in isolates from six countries; Ng WW et al.; In vitro susceptibility testing of 36 strains of Neisseria gonorrhoeae isolated in the Far East in 1979 and 1980 demonstrated that 27 penicillinase-producing (PPNG) isolates and nine non-penicillinase-producing (non-PPNG) isolates were susceptible to chloramphenicol, thiamphenicol, spectinomycin, trimethoprim-sulfamethoxazole, cefoperazone, moxalactam, cefotaxime, and ceftriaxone . In comparison, 50% of the strains had MICs of tetracycline of greater than 2 micrograms/ml, and 75% had MICs, of streptomycin of greater than 128 micrograms/ml . Eighty-two per cent of PPNG and 100% of non-PPNG isolates examined had MICs of kanamycin of greater than 32 micrograms/ml . None of the nine non-PPNG strains had MICs of ampicillin and penicillin of greater than 1 microgram/ml . A 4.4-megadalton plasmid, previously associated with beta-lactamase production, was found in all 27 PPNG isolates examined; 93% of PPNG and 22% of non-PPNG isolates contained a 24-megadalton plasmid previously associated with transfer of the 4.4-megadalton plasmid. J Pharm Sci, 1982 Jul, 71(7), 799 - 802 Synthesis of omega-(4-aminophenylsulfonamido)alkyl disulfides and thiosulfates and their activity against dihydropteroate synthetase from sulfanilamide-resistant Neisseria gonorrhoeae; Foye WO et al.; A series of omega-(4-aminophenylsulfonamido)alkyl disulfides and omega-(4-aminophenylsulfonamido)alkanethiosulfates was synthesized from the reaction of p-acetamidobenzenesulfanilyl chloride and either the aminoalkyl disulfide dihydrobromide or the aminoalkyl bromide hydrobromide followed by sodium thiosulfate . Several of the compounds showed inhibitory activity against dihydropteroate synthetase isolated from a sulfanilamide-resistant strain of Neisseria gonorrhoeae of the same order of activity as that of sulfanilamide . An increase in the hydrophobic nature of the sulfanilamide structure did not increase inhibitory activity against this enzyme. J Bacteriol, 1982 Jul, 151(1), 295 - 302 Arginine and pyrimidine biosynthetic defects in Neisseria gonorrhoeae strains isolated from patients; Shinners EN et al.; Neisseria gonorrhoeae strains with nutritional requirements that include arginine (Arg-), uracil (Ura-), and hypoxanthine have attracted attention because of their tendency to cause disseminated infections, as a basis for genetic studies of arginine and pyrimidine biosynthesis, we examined the activities of four enzymes of these pathways in cell-free extracts of both prototrophic and Arg- Ura- strains . Activities of glutamate acetyltransferase, aspartate transcarbamylase, and orotate phosphoribosyltransferase, encoded respectively by argE, pyrB, and pyrE, were absent in some Arg- Ura- isolates . Gonococci that were unable to utilize ornithine for growth in place of citrulline lacked activity of carbamyl phosphate synthetase (encoded by car) . Defects of car imposed requirements for both citrulline (or arginine) and a pyrimidine because of the dual role of carbamyl phosphate in the two pathways . Defects of argE, car, pyrB, and pyrE were separately introduced by genetic transformation into representatives of a gonococcal strain which initially was prototrophic . Results of enzyme assays of these isogenic auxotrophic transformants confirmed the gene-enzyme relationships. J Bacteriol, 1982 Jul, 151(1), 172 - 6 Detection of a gonococcal endo-beta-N-acetyl-D-glucosaminidase and its peptidoglycan cleavage site; Gubish ER Jr et al.; Neisseria gonorrhoeae contains several hydrolases which may be responsible for gonococcal cell lysis . One of these enzymes, an endo-beta-N-acetyl-D-glucosaminidase, has been extracted from supernatants of sonicated gonococci and partially purified by ammonium sulfate precipitation and affinity and ion-exchange chromatography . This enzyme has a different specificity than egg white lysozyme and cleaves the beta 1 leads to 4 glycosidic linkage between N-acetylglucosamine and N-acetylmuramic acid in gonococcal peptidoglycan. Sex Transm Dis, 1982 Jul-Sep, 9(3), 135 - 7 Penicillin and spectinomycin in treatment of gonococcal urethritis; Ratnam AV et al.; In view of the recent discovery of penicillinase-producing strains of Neisseria gonorrhoeae in Zambia, the efficacies of single intramuscular doses of aqueous procaine penicillin G (4.8 x 10(6) units plus 1 g of oral probenecid) and 2 g of spectinomycin were evaluated in an open clinical trial of the treatment of acute gonococcal urethritis in men . The former regimen was given to 123 men; failure of treatment was observed in 9.1% of the 88 men followed for two weeks . Spectinomycin was given to 124 men; treatment failure occurred in 3.8% of the 104 men followed for two weeks . During the trial, 190 unselected isolates of N . gonorrhoeae were screened by rapid iodometric test, and two penicillinase-producing strains were detected . MICs of penicillin and spectinomycin were determined by the agar dilution method for 110 and 98 isolates, respectively . MICs of penicillin of greater than or equal to 0.125 micrograms/ml were observed with 78.2% of the strains, while 83.7% had MICs of spectinomycin of less than or equal to 15.0 micrograms/ml . It was suggested that penicillin be given routinely for treatment of gonorrhea in Zambia and that spectinomycin be reserved for treatment of gonococcal infections not cured by penicillin. Sex Transm Dis, 1982 Jul-Sep, 9(3), 132 - 4 Analysis of a recent epidemic due to penicillinase-producing Neisseria gonorrhoeae: epidemiologic and medical considerations; Pariser H et al.; In Norfolk, Virginia, two epidemics of disease due to proved penicillinase-producing Neisseria gonorrhoeae were investigated intensively, both epidemiologically and medically . The first epidemic appeared in October 1976 and was controlled in one month; it was followed by a hiatus of four years before the emergence of the second epidemic in October 1980 . The latter apparently was brought under control by December 1980, since no more patients with penicillinase-producing N . gonorrhoeae have been discovered to date (March 1982) . Certain interesting medical aspects emerged from the investigation . Resistant organisms were cultured from asymptomatic as well as symptomatic patients and from all potentially infected sites . At times, resistant organisms were cultured from only one of several sites in a given patient or both resistant and sensitive organisms were cultured from a single site . It was concluded that this type of gonorrhea can be contained by intensive epidemiologic investigation combined with adequate diagnosis and treatment. J Gen Microbiol, 1982 Jul, 128(7), 1613 - 22 Purification of pili and outer membrane vesicles of Neisseria gonorrhoeae by wheat germ agglutinin affinity chromatography; Perera VY et al.; Previous studies indicated that OMVs of Neisseria gonorrhoeae reacted specifically with WGA . A technique was therefore developed for the separation of gonococcal pili and OMVs by WGA affinity chromatography . This method was more convenient and more effective than isopycnic centrifugation for obtaining OMVs free of pili . The antigens were further purified but though homogeneous as judged by in vitro analytical methods, they both elicited an antibody response in animals to minor impurities previously undetected. Infect Immun, 1982 Jul, 37(1), 189 - 94 Attachment of gonococcal pili to lectin-resistant clones of Chinese hamster ovary cells; Gubish ER Jr et al.; Pili facilitate the attachment of virulent Neisseria gonorrhoeae to host cells . Isolated pili and peptides from pili obtained by cyanogen bromide cleavage were used in attachment assays to Chinese hamster ovary cells and their lectin-resistant clones . Pili and the largest cyanogen bromide fragment (CNBrI) from the amino-terminal portion of the pilin molecule attached to a greater degree to the parent cell and showed 40 to 75% reduced attachment to clones deficient in cell surface oligosaccharides . The CNBrI fragment, with a molecular weight of approximately 10,000, bound specifically to host proteins with subunit molecular weights of 14,000 to 16,000 that were electrophoretically transferred onto nitrocellulose sheets from polyacrylamide gel patterns of host cells . Periodate or galactosidase treatment of pili or the CNBrI fragment markedly reduced attachment, suggesting the importance of galactose residues on pili for their attachment function . Similarly, highly purified exoglycosidase or trypsin treatment of the parent cell reduced attachment, suggesting that oligosaccharide moieties of cell surface components (glycoproteins or glycolipids or both) were receptors for pili attachment . This study indicated that the portion of the pilin molecule involved in attachment resides on the CNBrI fragment and that sugar moieties, both on pili and on the host cell, were required for optimal attachment. Quad Sclavo Diagn, 1982 Jun, 18(2), 195 - 202 {Use of the radiometric method in microbiological diagnosis}; Nicoletti P et al.; The authors reported the results of a radiometric method (Bactec) on the detection of gentamicin serum levels, bacteriaemia and identification of Neisseria gonorrhoeae . The serum gentamicin assay procedure proved to be sensitive, accurate, reliable and correlated well with radioimmunoassay (RIA) . Positivity revelation of bacteriaemia, evaluated on simulated blood cultures, was much more sensitive than the Castaneda method . The radiometric method, performed on 14 recent isolates of Neisseria gonorrhoeae, gave perfect identification in all cases. Acta Pathol Microbiol Immunol Scand {B}, 1982 Jun, 90(3), 243 - 50 Genetic linkage between serogroup specificity and antibiotic resistance in Neisseria gonorrhoeae; Bygdeman S et al.; In previous works statistically significant differences were demonstrated in antibiotic susceptibility between gonococcal strains of the recently described W serogroups, W I, W II and W III, respectively . Strains of serogroup W I were almost always sensitive to penicillin and other antibiotics while those of the W II and W III serogroups showed a higher incidence of decreased susceptibility . Transformation experiments were therefore undertaken with an antibiotic sensitive serogroup W I gonococcal strain as recipient and a multi-resistant W II strain as DNA-donor . Transformants, with increased resistance to penicillin and several other antibiotics as compared with the recipient, acquired the same serogroup specificity as the W II donor . With one of these W II transformants as donor and the sensitive W I strain as recipient all transformants acquired the same antibiotic susceptibility pattern as well as the same serogroup as the donor . SDS-PAGE, performed on sarkosyl extracted outer membrane proteins from donor, recipient and some transformants, showed an increase in the molecular weight of the Protein I of the outer membrane of the W II transformants as compared with that of the recipient strain . In rocket-line and crossed-line immunoelectrophoresis the W II transformants could not be distinguished from the W II donor strain . A genetic linkage between antibiotic multi-resistance and serogroup W II specificity was thus shown . This is in agreement with the demonstrated higher incidence of W II strains with increased antibiotic resistance as compared with that of serogroup W I strains. Acta Pathol Microbiol Immunol Scand {B}, 1982 Jun, 90(3), 173 - 80 Effect of penicillin on the morphology of a Neisseria meningitidis strain not liberating free endotoxin . An electron microscopy study; Andersen BM et al.; A strain of Neisseria meningitidis which did not release filtrable endotoxin during in vitro growth was treated with 100 times MIC values of benzylpenicillin . After 2 h of exposure to penicillin, most of the bacterial cells were plasmolysed, and only a few bacteria were alive after 20 h . The peptidoglycan layer could be demonstrated in samples investigated after 2 h of penicillin treatment, but was undetectable after 20 h . Only a few outer cell wall structures, small enough to be filtered through a 0.45 micrometer filter were separated from the bacterial cells . Such structures could be observed in all samples studied, both untreated as well as treated cells cultures . This observation corresponded well to the very low content of free endotoxin in filtrates from the samples . Adhesiveness between completely divided cells and between aggregates of cells and cell wall structures was a characteristic finding in the untreated control cultures, but penicillin treatment seemed to amplify this tendency. Zh Mikrobiol Epidemiol Immunobiol, 1982 Jun, (6), 79 - 82 {Fractionation of Neisseria allergenic preparations by a gel chromatographic method on sepharose 4B}; Kondu EI et al.; The fraction composition of allergens obtained by different methods from the microbial mass of N . meningitidis, N . gonorrhoeae and N . perflava has been studied . Each method produced its characteristic number of fractions, irrespective of the Neisseria species used . Their molecular weights: more than 2,000,000 daltons, 160,000 daltons, 31,000 daltons and 14,000 daltons . All these fractions are biologically active. J Clin Microbiol, 1982 Jun, 15(6), 1001 - 8 Radioimmunoassay for detection of antibodies to Neisseria gonorrhoeae; Usategui M et al.; A radioimmunoassay has been developed and evaluated for the serological diagnosis of gonorrhea . Purified gonococcal antigen was obtained from a culture of Neisseria gonorrhoeae (B370) and labeled with 125I for use in a double-antibody test system . The test was evaluated in populations segregated by sex and risk . The specificity of the assay in females was 90.2% (55/61) in low risk, 82.2% (2,245/ 2,732) in medium risk, and 54.1% (335/619) in high risk . The sensitivity was 69% (20/29) in medium risk and 78.3% (288/367) in high risk . In males, test specificity was 92.3% (24/26) in low risk and 50% (48/96) in high risk . The sensitivity was 70.8% (143/202) in the high-risk group . The data in this study indicate that this assay should not be employed for screening of either high- or medium-risk populations. Infect Immun, 1982 Jun, 36(3), 1042 - 53 Serological classification of Neisseria gonorrhoeae with monoclonal antibodies; Tam MR et al.; Hybrid cells producing monoclonal antibodies against antigens of Neisseria gonorrhoeae were obtained by the polyethylene glycol-mediated fusion of mouse myeloma cells and lymphocytes from mice immunized with gonococcal protein I or outer membrane proteins . From four fusions, 16 phenotypically stable, independently cloned hybrid cell lines were selected for continued study . Each of the cell lines produced a characteristically different monoclonal antibody which reacted in immunoprecipitation assays with a unique antigenic determinant on protein I of the outer membrane complex of the bacteria . In antibody binding, immunofluorescence, and coagglutination assays these antibodies each reacted with a restricted group of N . gonorrhoeae strains . None of the monoclonal antibodies reacted with 17 other different species of Neisseria or with Branhamella catarrhalis . When tested on 34 N . gonorrhoeae reference serotyping strains, the monoclonal antibodies demonstrated serological relationships between the strains which paralleled those observed with conventional polyvalent antisera . These antibodies now provide standardized reagents for the rapid and precise serological characterization of many strains of N . gonorrhoeae. Br J Vener Dis, 1982 Jun, 58(3), 176 - 9 Single oral dose of cefaclor for the treatment of infections with penicillinase-producing strains of Neisseria gonorrhoeae; Tupasi TE et al.; A single oral dose of 3 g cefaclor was effective in the treatment of uncomplicated gonococcal infection in women due to penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) . Cefaclor was equally active in vitro against both PPNG (MIC range, 0.01-1.0 microgram/ml) and non-PPNG strains (MIC range, 0.005-2.0 micrograms/ml) . As empirical treatment cefaclor was effective in 53 of 57 (93%) patients compared with ampicillin, to which only 37 of 53 (69.8%) patients responded . This difference was attributed to the 40% incidence of PPNG in the patients studied; as expected, such patients responded poorly to ampicillin. Br J Vener Dis, 1982 Jun, 58(3), 166 - 75 Auxotypes and antibacterial resistance to gonococci with differing susceptibilities to vancomycin; Exner AC et al.; The responses to vancomycin and 11 other antibacterial drugs and the nutritional requirements of gonococci recovered from two selective media were determined . Single urogenital specimens from 508 patients attending a social hygiene clinic in 1975 yielded 97 strains of Neisseria gonorrhoeae; 95 were recovered on VCNT (a modification of Thayer-Martin medium), always inoculated first, and 69 on LC medium containing lincomycin (4 micrograms/ml) and colistin (5 micrograms/ml) . The two drugs at these concentrations in LC medium were not inhibitory for isolates from either medium . Unexpectedly, three isolates on VCNT were susceptible to vancomycin at the concentrations (3 micrograms/ml) in VCNT medium; these three were typically sensitive to penicillins but were hypersusceptible to erythromycin (inhibited by less than or greater than 0.05 micrograms/ml) and rifampin (less than or equal to 0.02 micrograms/ml) . Resistance to streptomycin (greater than or equal to 500 micrograms/ml) (22% of the strains) was correlated with increased resistance to penicillins, erythromycin, and rifampin in most instances . All streptomycin-resistant gonococci required proline, or arginine, or none of the test compounds . Strains requiring arginine, hypoxanthine, and uracil were uniformly sensitive to antibiotics but not hypersusceptible . In contrast, six strains of N gonorrhoeae isolated in Denmark required arginine (not satisfied by ornithine), hypoxanthine, and uracil and were hypersusceptible to vancomycin (inhibited by 0.5 micrograms/ml), erythromycin, and rifampin . DNA-mediated transformation showed that all three hypersusceptibilities of one Danish strain were introduced together into a wild-type gonococcus, suggesting that a mutation of an env (envelope) locus might be responsible for the atypical permeability. Br J Vener Dis, 1982 Jun, 58(3), 158 - 65 Neisseria gonorrhoeae isolated from disseminated and localised infections in pre-penicillin era . Auxotypes and antibacterial drug resistances; Catlin BW et al.; Interest in the evolution of gonococcal auxotrophy led to a study of 72 strains isolated between 1935 and 1948 from the urogenital tract (57 patients), the eye (two patients), and from disseminated gonococcal infections (11 patients and probably two others) . Two cervical isolates with nutritional requirements for proline, arginine, histidine, and biotin were oxidase-positive, Gram-negative diplococci, but their identity as Neisseria gonorrhoeae was uncertain because they were atypically susceptible to colistin and did not produce acid in glucose media . The N gonorrhoeae strains were highly susceptible to 11 other antibacterial drugs but not to sulphadiazine . Defects of one or more pathways for the biosynthesis of methionine, proline, arginine, threonine, lysine, the branched-chain amino acids, hypoxanthine, and thiamine pyrophosphate were found in 39 of the 70 strains, including four isolated in the presulphanilamide era . Unexpectedly, methionine was required for the growth of 11 (21%) of the 52 Danish strains and for 13 (72%) of 18 strains isolated in the USA . The Danish strains included 28 (54%) that did not require any of the compounds used for differentiating auxotypes, whereas this type was represented by only three (17%) of the USA strains . None of the gonococci required uracil or other pyrimidines . This suggests that the requirements for arginine, hypoxanthine, and uracil commonly found in recent isolates from disseminated gonococcal infections probably evolved treatment with sulphonamide was replaced by penicillin. Pathol Biol (Paris), 1982 Jun, 30(6 Pt 2), 513 - 6 {Ceftriaxone (Rocéphine) in major African infectious pathology . Results at the Niamey Hospital (Niger) }; Rey JL et al.; Ceftriaxone is a wide-spectrum-third generation cephalosporin characterized by outstandingly high efficacy as well as pharmokinetic properties making it suitable for administration in a single daily injection . Ceftriaxone has been found to be useful for treatment of the very severe infectious pathology in countries where hygiene and medical superstructures are still rudimentary . Eighteen of 20 patients with purulent meningitis (13 to Neisseria meningitidis A, 3 to Streptoc . pneumoniae, 1 to Listeria and 3 aseptic) recovered (there being 2 deaths at the 36th hour) after a mean 6 days of hospitalization . Despite the very delicate patient condition, recovery was seen in all 11 cases of very grave bronchopneumopathy, generally due to Streptoc, pneumonia . A dose of 2 g/day in 1 or 2 IV injections is sufficient in the adult, 0.50 g in a single dose being injected to infants weighing less than 10 kg, Meningitis required 4 to 7 days treatment (9 days in a case of Listeria) while the treatment period was longer for respiratory infections . Seven patients had been refractory to treatment with beta-lactamines and/or aminosides, and no adverse drug reactions were noted. J Clin Microbiol, 1982 May, 15(5), 906 - 14 Characterization of atypical aerobic gram-negative cocci isolated from humans; Hoke C et al.; Six atypical aerobic gram-negative cocci, isolated from humans, were classified taxonomically by genetic relatedness (DNA base pairs and DNA homology), fatty acid content, pigment absorption profile, and other physiological and biochemical characteristics . One strain (M448), which produced acid only from glucose, was identified as Neisseria meningitidis; one strain (CH), which produced acid from glucose, maltose, and sucrose, was identified as N . gonorrhoea; Branhamella catarrhalis was confirmed in a case of acute meningitis; N . canis was identified in a cat bite wound; and representative isolates of a proposed new pigmented species were found to have genetic affinities with N . meningitidis and N . perflava. Am J Med Sci, 1982 May-Jun, 283(3), 165 - 8 Gonococcal endocarditis in a patient with mitral valve prolapse: study of host immunology and organism characteristics; Sugar AM et al.; The first case of gonococcal endocarditis on a prolapsing mitral valve is reported . The organism was found to be highly sensitive to penicillin G, Arg- Hyp- Ura-, and sensitive to the bactericidal action of normal serum . This combination of characteristics in a strain of Neisseria gonorrheae causing systemic disease is distinctly unusual . With high dose penicillin therapy the immunologic parameters returned to normal and the patient made an uneventful recovery . High levels of circulating immune complexes were detected in the patient's serum. J Dent Res, 1982 May, 61(5), 627 - 31 Extracellular iodophilic polysaccharide synthesized by Neisseria in human dental plaque; Ruby JD et al.; Dental plaque collected from the label aspect of the anterior dentition of children harbored Neisseria that synthesized an extracellular iodophilic polysaccharide (EIP) from sucrose . Gas chromatograms of fully-acetylated EIP derivatives indicated that glucose (97%) and galactose (3%) were the only monosaccharide constituents present . The characterization of the partially-methylated alditol acetate (PMAA) derivatives of EIP indicated that it was primarily a linear 1,4 glucan (75.5%), with some 1,6 glucan (8.4%) . The relative linearity of EIP (96.6%) as compared to that of amylose and glycogen was confirmed by spectrophotometric absorption studies. J Clin Microbiol, 1982 May, 15(5), 915 - 9 Anaerobic survival of clinical isolates and laboratory strains of Neisseria gonorrhoea: use in transfer and storage; Short HB et al.; Eleven laboratory strains and 67 clinical isolates of Neisseria gonorrhoeae were tested for the ability to survive during anaerobic incubation . The survival of the laboratory strains was dependent on auxotype, temperature, and cell density on agar plates . For both the laboratory strains and the clinical isolates, anaerobic survival was better at lower temperatures . We concluded that anaerobic incubation, for as long as 7 days, is useful when transporting or storing N . gonorrhoeae. J Clin Microbiol, 1982 May, 15(5), 865 - 8 Culture medium for confirmation of penicillin-resistant and penicillinase-producing Neisseria gonorrhoeae; Perine PL et al.; A culture method for the isolation and identification of penicillinase (beta-lactamase)-producing Neisseria gonorrhoeae (PPNG) was evaluated in the Philippines where PPNG are common . The method uses plastic biplates containing standard Martin-Lewis gonorrhea culture medium in one side of the biplate and PPNG-selective medium containing 1.5 microgram of penicillin G per ml and a suspension of Sarcina lutea (Micrococcus lutea) that was susceptible to 0.01 microgram of penicillin G per ml in the other side . Penicillin-resistant gonococci grow on both sides of the biplate . The hydrolysis of penicillin by beta-lactamase permits the growth of S . lutea around PPNG colonies . With this medium we successfully identified 11 of 12 PPNG strains growing on primary isolation plates . A 48- to 72-h incubation period was needed, however, for visible growth of S . lutea around PPNG colonies . A unique advantage of this method was the identification of non-PPNG strains which also grew on penicillin-containing medium but did not allow growth of S . lutea . These relatively penicillin-resistant strains were the cause of infections which were not cured by penicillin treatment in 2 of 11 patients. Infect Immun, 1982 May, 36(2), 586 - 90 High correlation of the presence of methyladenine in Neisseria gonorrhoeae DNA with the AHU auxotype; Kolodkin AB et al.; Strains of Neisseria gonorrhoeae were tested for the presence of methyladenine in the DNA sequence GATC by using the site-specific restriction endonucleases MboI and DpnI . It was found that 43 of 83 strains tested contained methylated DNA . When methylation was compared with the auxotype of the organism, 35 of 35 strains with the AHU (arginine-, hypoxanthine-, and uracil-requiring) auxotype and 8 of 48 strains with other auxotypes contained methyladenine . When the incidence of methylation in strains isolated from patients suffering from disseminated gonococcal infection was compared with that in strains isolated from patients suffering from uncomplicated gonococcal infection, no correlation with methylation and disseminated gonococcal infection was observed. Obstet Gynecol, 1982 May, 59(5), 649 - 52 Pragmatic factors influencing the detection of Neisseria gonorrhoeae; Monif GR et al.; The effects of the suboptimal temperature caused by delayed incubation or prolonged transport on the recovery of Neisseria gonorrhoeae were studied in 2 separate patient populations . The individual components of the John E . Martin Biological Environmental Chamber were used to define more precisely other variables that might influence the incidence of recovery . In a study of 1500 urethral and endocervical specimens processed in parallel for N gonorrhoeae, results quantitatively and qualitatively superior were achieved when an immediate source of CO2 and a zip-lock bag were used . The zip-lock bag appears to be a significant factor in the enhanced demonstration of N gonorrhoeae . Failure to incubate specimens before transportation decreased the numeric representation of N gonorrhoeae in 50 sets of triple cultures studied in parallel . Most low-inoculum cultures subjected to prolonged transportation without prior incubation will not demonstrate the presence of N gonorrhoeae . Even if preincubated before transportation, the cultures demonstrate a significant reduction in the number of colony-forming units per plate when subjected to normal room temperature during the course of transportation. Infect Immun, 1982 May, 36(2), 541 - 7 Pyocin-resistant lipopolysaccharide mutans of Neisseria gonorrhoeae: alterations in sensitivity to normal human serum and polymyxin B; Guymon LF et al.; Pyocins from Pseudomonas aeruginosa were used to select several lipopolysaccharide (LPS) mutants of Neisseria gonorrhoeae strain FA19 . Three classes of LPS mutans were found in the initial group selected for study . The LPS of one class lacked galactose . That of a second group lacked the typical heptose found in the parental LPS, was reduced in glucose, galactose, and N-acetylglucosamine content, appeared to contain a new unidentified sugar component, and consisted of two species of LPS separable on sodium dodecyl sulfate-polyacrylamide gels . The LPS of a third strain lacked the heptose, glucose, galactose, and N-acetylglucosamine found in the oligosaccharide portion of parental FA19 LPS . The minimal inhibitory concentration for polymyxin B of the mutant strains was 3 to 4 times that of the parental strain . The strains lacking only galactose were as resistant as the parent to the bactericidal action of normal human serum, but cells of the other two classes were quickly killed by serum . Gonococcal LPS thus appears to be important in determining phenotypic properties of the cells. Antimicrob Agents Chemother, 1982 May, 21(5), 727 - 9 Comparison of piperacillin and penicillin in the treatment of uncomplicated gonorrhea; Simpson ML et al.; A total of 120 men with uncomplicated infections caused by beta-lactamase-negative, highly penicillin-susceptible strains of Neisseria gonorrhoeae were included in this study . They were randomly assigned to regimens of either piperacillin (2.0 g) or procaine penicillin G (4.8 X 10(6) U) intramuscularly, both delivered concomitantly with an oral dose of 1.0 g probenecid . A total of 103 patients completed the study, providing data from 112 infected sites: for the penicillin regimen--urethra, 46; pharynx, 5; and rectum, 4; for the piperacillin regimen--urethra, 53; pharynx, 3; and rectum, 1 . In the penicillin group, there were no failures at any of the infected sites . In the piperacillin group, all except one pharyngeal infection were cured . Also, in the piperacillin group, four men visit, whereas no cases of this type occurred in the penicillin group . No major side effects were noted in either group . Clinically, piperacillin was as effective as procaine penicillin G in the treatment of gonococcal urethritis in men . Pharyngeal infection may be refractory to piperacillin therapy. J Gen Microbiol, 1982 May, 128 (Pt 5), 1095 - 100 Effect of anti-pilus antisera on virulence of variants of Neisseria gonorrhoeae for cultured epithelial cells; Virji M et al.; Variants of Neisseria gonorrhoeae P9 possessing a, gamma or delta pili were shown to vary in their toxicity and virulence for human epithelial cells . Studies with antisera raised against purified pili showed that attachment and virulence were reduced to a significant degree in the presence of antisera to homologous pili . Heterologous antisera, while capable of agglutinating whole organisms, were largely ineffective in reducing attachment and cytotoxicity . Using an enzyme-linked immunosorbent assay (ELISA) system, the cross-reactivity between pili and heterologous antisera was estimated to be no more than 10-20%. Fortschr Med, 1982 Apr 22, 100(15), 693 - 5 {Triple bacterial infection of the cervix uteri in benign gonococcal sepsis}; Korting HC et al.; Benign gonococcal sepsis or disseminated gonococcal infection is a well defined clinical entity . Although the coincidence of several sexually transmitted diseases in the same patient has recently gained interest no case has been reported so far in which benign gonococcal sepsis was combined with further bacterial infections of the genitals . Therefore the case of a 25-year-old woman is reported who suffered from cervicitis, arthritis, and dermatitis due to neisseria gonorrhoeae infection and also harboured chlamydia trachomatis and ureaplasma urealyticum in her cervix . Facing this coincidence certain therapeutical and epidemiological conclusions must be drawn. N Engl J Med, 1982 Apr 22, 306(16), 950 - 4 Epidemiology of penicillinase-producing Neisseria gonorrhoeae infections: analysis by auxotyping and serogrouping; Handsfield HH et al.; Auxotyping and serogrouping by coagglutination were used to characterize penicillinase-producing Neisseria gonorrhoeae and penicillinase-negative isolates from the state of Washington, Shreveport (Louisiana), and the Far East . Fifty-four of 75 penicillinase-producing isolates (72 per cent) from Washington required proline for growth and were serogroup W-l (Pro-1), the predominant type of penicillinase-producing strains in the Philippines; none of 86 penicillinase-negative isolates from Washington was Pro-1 (P less than 0.0001) . All 38 penicillinase-producing isolates from Shreveport required proline and were serogroup W-11 (Pro-11); five of 26 penicillinase-negative isolates (19 per cent) from Shreveport were also Pro-11 (P less than 0.0001) but had antigenic specificities within serogroup W-ll that distinguished them from the penicillinase-producing isolates . We conclude that the Washington and Shreveport outbreaks resulted from the spread of imported strains rather than transmission of penicillinase-encoding plasmids to indigenous gonococci . The Shreveport outbreak involved a single strain of penicillinase-producing N, gonorrhoeae and probably originated from a common source, whereas several types were involved in the multiple-source Washington outbreak, indicating repeated introduction of new strains. Am J Obstet Gynecol, 1982 Apr 15, 142(8), 962 - 7 Vaginitis in sexually active women: relationship to nine sexually transmitted organisms; Osborne NG et al.; Women seen for symptoms suggestive of vulvovaginitis were studied for the detection of Mycoplasma hominis . Ureaplasma urealyticum, yeast, Neisseria gonorrhoeae, Chlamydia trachomatis, Gardnerella vaginalis, herpes simplex virus, group B beta-hemolytic streptococci, aerobes, anaerobes, and Trichomonas vaginalis . Asymptomatic women who reported to be sexually active and agreed to undergo comprehensive genital cultures were used as controls . There was a significant association of vulvovaginitis with the recovery of sexually transmitted organisms . However, all organisms were also recovered from asymptomatic patients . A total of 468 sexually transmitted organisms were recovered from 253 symptomatic patients (1.85 organisms per patient), while 125 were recovered from 130 asymptomatic patients (0.96 organisms per patient) . The difference in prevalence between symptomatic and asymptomatic women for Chlamydia trachomatis, group B streptococcus, and the mycoplasmas was not statistically significant . Factors that predispose patients to the manifestations of symptoms are not clearly understood. Eur J Clin Microbiol, 1982 Apr, 1(2), 69 - 75 Epidemiology of chlamydial infection of the human genital tract: evidence for the existence of latent infections; Oriel JD et al.; A group of 536 women attending a clinic for sexually transmitted diseases was investigated for cervical infection by Neisseria gonorrhoeae and Chlamydia trachomatis . Conclusions have been reached concerning the existence and significance of latent and subclinical chlamydial infection of the female genital tract, and on the sexual infectivity of Chlamydia trachomatis to women . The results of the study indicate (1) demonstrable chlamydial infection in 25% of all women attending the clinic for the first time, and in 11% of those with unknown contact history; (2) sexual transmission of Chlamydia trachomatis; 45% of women exposed to chlamydiae contract the infection compared with 75% of those exposed to Neisseria gonorrhoeae; (3) the possibility of reactivation of latent chlamydial infection by Neisseria gonorrhoeae in some women. Sex Transm Dis, 1982 Apr-Jun, 9(2), 93 - 5 Single-dose treatment of uncomplicated gonococcal urethritis: a comparison of cefonicid and penicillin; Duncan WC et al.; Cefonicid, a parenterally administered semisynthetic cephalosporin, produces high and sustained serum levels in humans . It is active in vitro against Neisseria gonorrhoeae, including beta-lactamase-producing strains . Therefore, the efficacy of cefonicid in treatment of men with uncomplicated gonococcal urethritis was evaluated in a two-phase study . Initially, 58 men were treated intramuscularly with 1 g of cefonicid . There were four failures among the 50 patients who could be evaluated . In the second phase (a double-blind study), 57 men received either 1.0 g of cefonicid or 4.8 x 10(6) units of procaine penicillin G plus 1.0 g of probenecid . Among 17 men treated with penicillin, there were two failures; among the 33 cefonicid-treated patients, there was only one failure . Thus, 78 (94%) of 83 patients receiving cefonicid were cured . Of the 85 pretreatment and four posttreatment isolates tested, 31 were inhibited by less than 0.0625 microgram of penicillin/ml and 87 were inhibited by less than 1.0 microgram/ml . Twenty-eight of the 89 isolates were inhibited by less than 0.0625 microgram of cefonicid/ml and 88, by less than 1.0 microgram of cefonicid/ml . It is concluded that 1.0 g of cefonicid given intramuscularly is effective therapy for uncomplicated gonococcal urethritis. Sex Transm Dis, 1982 Apr-Jun, 9(2), 79 - 83 Resources needed to culture Chlamydia trachomatis in laboratories of clinics for sexually transmitted diseases; Rodrigues LG et al.; Genital infections with Chlamydia trachomatis may be more prevalent than infection with Neisseria gonorrhoeae and may have serious sequelae such as epididymitis and pelvic inflammatory disease in adults and conjunctivitis and pneumonia in neonates . A culture of the organism is the most sensitive and specific means for detecting C . trachomatis in the genital tract, yet this procedure is available only in specialized centers and universities . Establishment of a chlamydia laboratory as part of a clinic for sexually transmitted diseases (STD) requires major technical and financial resources . Technical resources include the expertise of technicians as well as specialized equipment, glassware, and reagents . The current (August, 1981) minimal cost of performing a chlamydial culture is estimated to be $14.69. South Med J, 1982 Apr, 75(4), 446 - 7 Vulvovaginitis in prepubertal girls: the importance of group A Streptococcus; Schwartz RH et al.; We report four cases of group A streptococcal vulvovaginitis in prepubertal children . All cases were acute in onset . This illness presents with nonspecific signs and symptoms of labial inflammation . In a suburban community, streptococcal vulvovaginitis in prepubescent girls may be more common then genital infections due to Neisseria gonorrhoeae . Since media used for the selective isolation of N gonorrhoeae do not readily support the growth of streptococci, we suggest that the routine bacteriologic approach to the diagnosis of vulvovaginitis in young girls include inoculation of the culture swab on 5% sheep blood agar and the application of a bacitracin disk (taxo A disc) to detect any small beta-hemolytic, presumptively group A streptococcal colonies after overnight incubation . Penicillin therapy results in prompt cure. Oral Surg Oral Med Oral Pathol, 1982 Apr, 53(4), 358 - 62 Oral gonococcal infections . Report of two cases; Jamsky RJ et al.; Oral gonorrhea is not a commonly reported entity . A case of stomatitis associated with an oral Neisseria infection and concomitant with a trichomonal vaginitis in a sexually-promiscuous 30-year-old Caucasian woman is described . A second case of gonococcal pharyngitis in a 21-year-old Caucasian man is also reported . The clinical and laboratory findings, differential diagnosis, and treatment of gonococcal infections are briefly reviewed. Sex Transm Dis, 1982 Apr-Jun, 9(2), 89 - 92 Repeated infections with Neisseria gonorrhoeae in a population of Alaska natives; Blackwood LG; Medical and laboratory records of 171 Alaska Natives were studied retrospectively, and the incidence of repeated infections with Neisseria gonorrhoeae was determined . Thirty-four per cent of the subjects had more than one gonorrheal infection within 18 months . The largest proportion of reinfections occurred within a relatively short period of time following the most recent previous infection: 29.3% within the first six weeks and, greater than 50% within 15 weeks . Men aged greater than or equal to 30 years were 2.4 times more likely than women in the same age group to acquire reinfections . The rate of reinfection for teenage women was nearly twice that for older women . Goodness-of-fit tests indicated the existence of a group of chronic repeaters responsible for a large number of reinfections. Sex Transm Dis, 1982 Apr-Jun, 9(2), 74 - 8 The recovery of Neisseria gonorrhoeae from clinical specimens: effects of different temperatures, transport times, and media; Sng EH et al.; Factors influencing the recovery of Neisseria gonorrhoeae from patients were studied . By comparison of the survival times of N . gonorrhoeae in Amies and modified Thayer-Martin media at different temperatures, it was found that the organism survived better at low temperature in the former medium, but at higher temperature on the latter . Even at 4 C, N . gonorrhoeae showed a loss of viability in Amies medium . Culture plates inoculated with cervical specimens can be kept in a CO2-enriched environment at high ambient temperature (approximately 24-30 C) for 18-24 hr before incubation with only a slight loss in isolation rate . Urine specimens are unsuitable for recovery of N . gonorrhoeae from female prostitutes, and urine specimens from male patients should not be kept overnight . Non-penicillinase-producing N . gonorrhoeae isolates from prostitutes not only had fewer colonies on culture plates but also required more time for growth to be visible. Sex Transm Dis, 1982 Apr-Jun, 9(2), 70 - 3 Detection of polysaccharide cell wall antigen of Neisseria gonorrhoeae in a rabbit model by counterimmunoelectrophoresis; Slama TG et al.; A rabbit chamber model was developed and inoculated with 10(9) colony-forming units (cfu) of viable Neisseria gonorrhoeae to determine whether the lipopolysaccharide-derived Gc2 polysaccharide cell wall antigens could be detected by counterimmunoelectrophoresis (CIE) . Four hours after inoculation, a polymorphonuclear leukocyte response was noted in the chambers; this response was followed by progressive phagocytosis of the organisms and a fall in number of cfu/ml . All visible bacteria were intracellular, and chamber fluids were sterile 6 hr after inoculation . Use of sero specific antisera permitted detection by CIE of the Gc2 polysaccharide antigen in sera of all rabbits within 48 hr after inoculation of the chambers, whereas blood cultures remained sterile throughout the experiment . At 2-6 hr after inoculation, the Gc2 polysaccharide antigen was also detected as a single precipitin band in the chamber fluid of inoculated rabbits . At 24 hr the precipitin band was not observed; rather, a halo above the antigen well was noted . The halo was found to be a nonspecific complex containing the Gc2 polysaccharide antigen and no antibody . In the rabbit model studied, CIE was sufficiently sensitive to detect concentrations of the Gc2 polysaccharide antigen of greater than or equal to 0.97 microgram/ml in serum and chamber fluid. Sex Transm Dis, 1982 Apr-Jun, 9(2), 63 - 9 Factors affecting the performance of smear and culture tests for the detection of Neisseria gonorrhoeae; Goodhart ME et al.; The probability of gonorrhea in men attending the DeKalb County, Georgia, clinic for sexually transmitted diseases with the chief complaint of urethral discharge and/or dysuria and whose urethral smears contain intracellular gram-negative diplococci is 94.8% . Absence of intracellular gram-negative diplococci from smears of the same men in associated with a 92.6% probability that they have nongonococcal urethritis rather than gonorrhea . There is a 97.3% probability of gonorrhea in our female patients at high risk of being infected and whose cervical smears contain intracellular gram-negative diplococci . Absence of intracellular gram-negative diplococci is associated with a probability of only 51.2% that these women do not have gonorrhea . The probability of gonorrhea in our male patients, whose smears contain intracellular gram-negative diplococci, drops from 94.8% to 34.9% when specimens are obtained from sexually active men without urethritis and to 53.9% when an inexperienced technician interprets smears from patients with urethritis . Vancomycin . HCl, which is included in Neisseria gonorrhoeae--selective media for suppression of microbial contaminants, also inhibited 2.4% of our gonococcal isolates and resulted in a falsely negative test . Awareness of these and other limitations of tests for gonorrhea, and of the magnitude and means of control of these limitations is essential to determining the presence or absence of gonococcal disease. Am J Med Technol, 1982 Apr, 48(4), 233 - 8 Neisseria gonorrhoeae: methods for laboratory identification; Morello JA; Clinical laboratorians must use methods that will allow isolation of gonococci from both genital and extragenital sites . Whenever possible, nonselective as well as antibiotic-containing media sould be used because some gonococci are susceptible to the concentrations of vancomycin present in selective media . For identification, subculture of the primary isolate onto nonselective medium not only assures that a pure culture is used, but also provides sufficient inoculum for a rapid result . At present, the most common gonococcal identification methods are carbohydrate degradation tests performed with CTA-base carbohydrate media, buffered carbohydrate solutions, the Minitek and the BACTEC systems, and the coagglutination immunologic method . Although penicillinase-producing N . gonorrhoeae have not become as widespread a problem as expected, methods for their detection should be available in the laboratory. Acta Pathol Microbiol Immunol Scand {B}, 1982 Apr, 90(2), 145 - 52 Studies on Neisseria gonorrhoeae strains from test-of-cure specimens . Correlation between the in vitro susceptibility to penicillin and the sensitivity to the complement-dependent bactericidal activity of normal and convalescent human serum; Odum L et al.; Sixty-seven out of 88 Neisseria gonorrhoeae strains isolated from test-of-cure (TOC) specimens during a five-months' period were included in the study . For 62 patients sufficient information was obtained in order to distinguish between relapse (34 ptt) and re-infection (28 ptt) . For comparison with strains from these two groups of patients, 63 urogenital and 21 pharyngeal gonococcal strains isolated during the same period of time were randomly selected . The distributions according to susceptibility to penicillin for TOC strains and control strains corresponded to those found for the total number of TOC strains (275) and other strains (3,345) tested in 1979, respectively . The TOC strains did not differ from the control strains in sensitivity to the complement-dependent . The TOC strains did not differ from the control strains in sensitivity to the complement-dependent bactericidal activity of normal human serum . However, gonococcal strains less susceptible to penicillin in vitro (MIC values within the range 0.1-2.0 microgram/ml) were significantly more sensitive to the complement-dependent activity of normal human serum (P less than 0.01) than strains fully susceptible to penicillin (MIC less than 0.01 microgram/ml.) Penicillin-resistant strains (MIC greater than 2.0 microgram/ml) did not differ from strains susceptible to less than 0.1 microgram penicillin/ml and were slightly more serum-resistant than the less susceptible strains (P less than 0.05) . No difference in serum-sensitivity of urogenital and pharyngeal isolates could be demonstrated . The level of bactericidal activity of homologous convalescent serum was unrelated to the presence of antibodies either to gonococcal pili or crude gonococcal antigen preparations . The sensitivity to normal human serum of a certain strain was not correlated with sensitivity to homologous convalescent serum. Acta Pathol Microbiol Immunol Scand {B}, 1982 Apr, 90(2), 141 - 4 Reliability of the plaque assay to determine the sensitivity of Neisseria gonorrhoeae to the bactericidal activity of normal human serum; Odum L; A plaque assay for determination of the sensitivity of Neisseria gonorrhoeae to the complement-dependent bactericidal activity of normal human serum was evaluated . The method was found to be rapid and easy to perform . All strains, which gave a positive result by the plaque assay, were serum-sensitive in a quantitative assay, whereas only 78% of strains giving negative results by the plaque assay were true serum-resistant . The growth of a few gonococcal strains was inhibited, i.e . formed plaques, after exposure to genuine as well as to heat-inactivated normal human serum. Infect Immun, 1982 Apr, 36(1), 277 - 83 Purification and partial characterization of the major outer membrane protein of Neisseria gonorrhoeae; Blake MS et al.; A procedure is described to isolate the major outer membrane protein (protein I) from Neisseria gonorrhoeae in large quantities . The method involves precipitation of protein I by hexadecyltrimethylammonium bromide (CTB) at low ionic strength . CTB is lethal for the gonococci and solubilizes most other proteins . Protein I is brought into solution by raising the ionic strength, and the nucleic acids are subsequently removed by 20% ethanol precipitation . The CTB is removed by precipitating protein I with ethanol and replaced by N-tetradecyl-N,N-dimethyl-3-ammonia-1-propanesulfonate, a dipolar ionic detergent . Further purification is accomplished by ion-exchange and molecular sieve chromatography . Two species of protein I (34,000 daltons {34K} and 32K) were purified by these methods . The purified proteins reacted with antisera prepared against the homologous organisms . The 34K proteins I generated proteolytic fragments upon treatment with trypsin and chymotrypsin similar to those generated by 34K protein in intact gonococci . The amino acid compositions of the three proteins were much like those of other major proteins of gram-negative organisms. Am J Clin Pathol, 1982 Apr, 77(4), 456 - 8 Comparison of methods for the immunological identification of Neisseria gonorrhoeae in clinical specimens using commercially-obtained reagents; Freundlich LF et al.; Neither an immunofluorescent nor a co-agglutination method was adequately sensitive for the detection of Neisseria gonorrhoeae when commercially-obtained reagents were used to test oxidase positive organisms taken directly from Transgrow medium . The sensitivity of co-agglutination, the better of the two methods, was improved from 83% to 96% when organisms were subcultured for colony isolation prior to identification . False positive results were obtained with both methods. J Clin Microbiol, 1982 Apr, 15(4), 668 - 76 Passive hemagglutination test for detection of antibody to gonococcal ribosomal antigen in sera from patients with asymptomatic gonorrhea; Kita E et al.; Ribosomal fractions were obtained from a culture of type 2 Neisseria gonorrhoeae strain P-17 which was isolated from a patient with an acute gonococcal infection; these fractions were purified to eliminate the components of the outer membrane complex by affinity chromatography (Sepharose-anti-outer membrane complex antibody conjugates were used as the solid immunosorbent), and the resulting preparation was designated the purified ribosomal fraction, The purified ribosomal fraction was used to detect antibody activity in sera obtained from culture-positive asymptomatic carriers and healthy controls by a passive hemagglutination test . This passive hemagglutination test had a specificity of 100% for both sexes and sensitivities of 99.4 and 88.2% for female and male carriers, respectively, when an antibody titer of more than 1:3 was defined as abnormal . Absorption of the sera with nongonococcal organisms did not affect the antibody activity, and no significant difference in antigenicity among various N . gonorrhoeae strains was observed in ribosomal fractions . An enzyme-linked immunosorbent assay was also used to measure the relative amounts of specific antibodies to the purified ribosomal fraction, and this assay revealed that the anti-purified ribosomal fraction antibodies were immunoglobulin G. Br J Vener Dis, 1982 Apr, 58(2), 96 - 100 Inhibition of Neisseria gonorrhoeae isolates by Martin-Lewis medium . Epidemiology, susceptibility profile, and plasma analysis; Miller MA et al.; A study was undertaken on the premise that if an increase of 1 microgram/ml in the concentration of vancomycin in Martin-Lewis medium (MLM) could improve inhibition of Gram-positive cocci, then a concomitant increase in the inhibition of gonococci could also occur . Isolates of Neisseria gonorrhoeae that failed to grow on MLM accounted for 18-5% of all positive culture results for gonorrhoea . The incidence of isolates susceptible to vancomycin was 14% and of those susceptible to trimethoprim 2.4%; one isolate was susceptible to both vancomycin and trimethoprim . The antibiotic-susceptible isolates were more frequently isolated from asymptomatic white men . Plasmid analysis showed that the 2.4-megadalton cryptic plasmic was absent in the vancomycin-susceptible isolates . The large proportion of isolates failing to grow on selective MLM has important clinical implications for the diagnosis of gonorrhea. Br J Vener Dis, 1982 Apr, 58(2), 105 - 8 Effects of tampon components on growth and dissemination of Neisseria gonorrhoeae; Arko RJ et al.; Six components used in vaginal tampons were tested for their effects on a strain of Neisseria gonorrhoeae isolated from a patient with disseminated infection . Tampon components containing carboxymethyl cellulose or its derivative prolonged the in-vitro survival of gonococci and, when injected with mucin into mice, significantly (P less than 0.0001) increased the dissemination of gonococci from the peritoneal cavity . In contrast, a component extracted from rayon tampons reduced in-vitro survival and appeared to suppress gonococcal dissemination in mice . Since tampons are used by a large number of women at a time when the risk of developing complications from venereal infections are increased, their effects on potential urogenital pathogens warrant further study. JAMA, 1982 Mar 5, 247(9), 1292 - 4 Effect of menstrual cycle and method of contraception on recovery of Neisseria gonorrhoeae; McCormack WM et al.; We examined the records of 5,287 women who were names as sexual contacts of men who had gonococcal urethritis in the National Gonorrhea Therapy Monitoring Study . Neisseria gonorrhoeae was recovered from endocervical cultures from 3,247 (61.4%) of the women . Participants who were seen during the first five days of the menstrual cycle were slightly more likely to have a positive culture (64.9%) than women who were seen on days 6 through 10 (61.3%), days 11 through 15 (60.0%), days 16 through 20 (59.8%), days 21 through 25 (60.4%), or after day 25 (61.2%) . Similar data were obtained for 1,489 untreated women who presented because a recent screening culture contained N gonorrhoeae . Neisseria gonorrhoeae was isolated from pretreatment cultures from 231 (79.7%) of 290 such women who were examined during the first five days of their menstrual cycle and from 884 (73.7%) of 1,199 women who were examined later in the cycle . Method of contraception had no statistically significant influence on the recovery of N gonorrhoeae. Rev Infect Dis, 1982 Mar-Apr, 4(2), 491 - 9 Treatment of concomitant Neisseria gonorrhoeae and Chlamydia trachomatis infections in women: comparison of trimethoprim-sulfamethoxazole with ampicillin-probenecid; Brunham RC et al.; Sixty-nine women with known or suspected uncomplicated gonorrhea were treated randomly either with a single dose of 3.5 g of ampicillin plus 1 g of probenecid or with four doses of trimethoprim-sulfamethoxazole (TMP-SMZ) in two double-strength tablets (160 mg of TMP plus 800 mg of SMZ) twice daily for two days . Overall, 56 (81%) of the women had gonococcal infections, 26 (38%) had chlamydial infections, and 23 (33%) had coexisting Chlamydia trachomatis and Neisseria gonorrhoeae infections . Among the women with genital or anal gonorrhea, two (9%) of 23 treated with TMP-SMZ and three (12%) of 25 treated with ampicillin and probenecid remained infected . TMP-SMZ cured four of four pharyngeal gonococcal infections . C . trachomatis was isolated at the first posttreatment visit significantly more often after treatment with ampicillin and probenecid (10 of 11 times) than after treatment with TMP-SMZ (1 of 10 times; P = 0.003) . However, at the second follow-up visit, C . trachomatis was isolated from 30% of the women treated with TMP-SMZ . The area of ectopic columnar epithelium (ectopy) on the ectocervix and edema of this area were highly correlated with the presence of C . trachomatis, and persistence of C . trachomatis was associated with persistent edema of ectopy and with friability . TMP-SMZ is as effective as ampicillin-probenecid for the treatment of uncomplicated genital gonorrhea in women and may be more effective for the treatment of pharyngeal gonorrhea . The optimal dose and duration of TMP-SMZ therapy for C . trachomatis infection requires further study. Can J Microbiol, 1982 Mar, 28(3), 301 - 6 The differential susceptibility of gonococcal opacity variants to sex hormones; Salit IE; Neisseria gonorrhoeae exist in transparent (Tr) and opaque (Op) colony forms . Op forms are recovered from patients early in the menstrual cycle; Tr colonies predominate late in the cycle . The mechanism for this colonial variation was examined by determining the influence of gonodal hormones on growth inhibition of Op and Tr isogenic variants of gonococci . The estrogens, estrone and estradiol, enhanced growth whereas 19-nortestosterone, testosterone, and progesterone significantly inhibited gonococcal growth . Testosterone and progesterone inhibited growth of the Op variants to a greater degree than the Tr variants . Mixture of Tr and Op colonies grown in the presence of progesterone became predominantly Tr, as occurs in the luteal phase of the menstrual cycle . This study supports the hypothesis of hormonal influence on colonial variation but employed artificial in vitro conditions and high hormone levels. J Clin Microbiol, 1982 Mar, 15(3), 522 - 4 Effect of various analgesics and lubricants on isolation of Chlamydia trachomatis and Neisseria gonorrhoeae; Osborn MF et al.; Five preparations used as analgesics or lubricants in surgical, obstetrical, gynecological, and investigative procedures were tested for their effect on the isolation of Chlamydia trachomatis . Three lignocaine preparations and a lubricating jelly containing 2% phenol were inhibitory to chlamydiae . In contrast, K-Y lubricating jelly was relatively nontoxic to chlamydiae . Since K-Y jelly also had only slight toxic activity against gonococci, it is recommended for the lubrication of instruments which need to be used for the efficient isolation of these microorganisms. J Clin Microbiol, 1982 Mar, 15(3), 475 - 7 Superoxol(catalase)test for identification of Neisseria gonorrhoeae; Saginur R et al.; The Superoxol (Merck & Co., Inc., Rahway, N.J.) test (catalase test using 30% H2O2) was used to differentiate Neisseria gonorrhoeae from other Neisseria species . A positive test was defined as immediate, brisk bubbling upon dropping 30% H2O2 onto a bacterial colony . One hundred percent of the gonococci were Superoxol positive . Only 1% of Superoxol-positive isolates on Thayer-Martin agar were organisms other than gonococci (99% specificity) . The test was more reliable than the coagglutination test . Individual strains of a wide variety of Neisseria and Branhamella species were Superoxol positive . They could usually be differentiated from N . gonorrhoeae by their poor growth on selective media, colonial morphology on nonselective media, and simple biochemical tests . The Superoxol test is an excellent screening test for N . gonorrhoeae . A positive result on a clinical isolate growing on Thayer-Martin agar is strongly suggestive of the presence of gonococci. J Clin Microbiol, 1982 Mar, 15(3), 435 - 8 Identification of problem Neisseria gonorrhoeae cultures by standard and experimental tests; Arko RJ et al.; Standard and experimental tests were used by a reference diagnostic laboratory to determine the identity of 182 "suspected" Neisseria gonorrhoeae isolates submitted by state health departments because of inconclusive laboratory results . More than 97% of these cultures were subsequently identified by a rapid microcarbohydrate test in conjunction with confirmatory immunological procedures . The experimental rapid slide agglutination test using rough-lipopolysaccharide antibody, the Phadebact co-agglutination test, and fluorescent antibody test identified 49.3 to 94.1% of these cultures . Because of frequent problems with carbohydrate utilization, Neisseria meningitidis and Branhamella catarrhalis were the two microorganisms most often confused with N . gonorrhoeae by submitting laboratories. Infect Immun, 1982 Mar, 35(3), 826 - 33 Gonococci with mutations to low-level penicillin resistance exhibit increased sensitivity to the oxygen-independent bactericidal activity of human polymorphonuclear leukocyte granule extracts; Daly JA et al.; Gonococci which cause disseminated gonococcal infection are nearly always highly penicillin sensitive, in contrast to many isolates causing uncomplicated gonorrhea . We questioned whether any of the known chromosomal mutations to low-level penicillin resistance might adversely affect virulence . The penA2 locus is known to result in low-level resistance to penicillins, whereas mtr-2 results in nonspecific resistance to a variety of antimicrobial agents . We found that the penA2 and mtr-2 mutations each markedly increased sensitivity of strain FA19 to oxygen-independent killing by human polymorphonuclear leukocyte mixed or isolated azurophilic granule extracts . The penA2 and mtr-2 mutations had no effect on sensitivity to serum antibody and complement . Isogenic opaque or transparent variants of several strains of Neisseria gonorrhoeae were equally resistant to human polymorphonuclear leukocyte mixed granule extract bactericidal systems . There were also no differences in susceptibility of piliated type 1 and nonpiliated type 4 variants to human polymorphonuclear leukocyte mixed granule extracts . Since the penA2 and mtr-2 loci are known to increase the degree of cross-linking of cell wall peptidoglycan, the structure of peptidoglycan apparently affects sensitivity to killing by one or more polymorphonuclear leukocyte azurophilic granule extract bactericidal systems . These observations might explain why gonococci with mutations similar to penA2 and mtr-2 are almost never isolated from patients with disseminated gonococcal infection. Infect Immun, 1982 Mar, 35(3), 764 - 9 Identification of a new genetic site (sac-3+) in Neisseria gonorrhoeae that affects sensitivity to normal human serum; Shafer WM et al.; A previously undescribed genetic site (sac-3) affecting susceptibility of the gonococcus to normal human serum was localized on the gonococcal chromosome . The presence of the sac-3+ allele in a clinical isolate (FA889) resulted in sensitivity only to relatively high concentrations of serum (greater than or equal to 12.5%) . Genetic mapping experiments demonstrated that sac-3+ was tightly linked to another genetic site (sac-1+) involved in determining susceptibility to normal human serum and to a locus (nmp-3) involved in the replacement of outer membrane protein I . The sac-1+ and sac-3+ loci resulted in phenotypically distinct levels of sensitivity to human serum . The sac-3+ serum sensitivity and sac-1+ serum sensitivity loci recombined with high frequency, resulting in serum resistance . The results show that serum sensitivity in clinical isolates may be due to different serum sensitivity loci and suggest that different antigens and immunological mechanisms could be responsible for sensitivity of different gonococcal isolates to human serum. Southeast Asian J Trop Med Public Health, 1982 Mar, 13(1), 96 - 9 Susceptibility of Neisseria gonorrhoeae isolates from Jakarta, Indonesia, to antibiotics; Rockhill RC et al.; The minimum inhibitory concentration (MIC) of penicillin, tetracycline and spectinomycin was determined for 6 beta-lactamase (PPNG) and 73 non beta-lactamase producing Neisseria gonorrhoeae isolates from Jakarta, Indonesia . All PPNG were resistant to greater than or equal to 128 micrograms/ml penicillin . Forty-six percent of the non-PPNG strains were inhibited by less than or equal to 1.0 microgram/ml of penicillin and 97% by less than or equal to 4 micrograms/ml . Most of the PPNG and non-PPNG isolates (90%) were inhibited by less than or equal to 4 micrograms/ml tetracycline and less than or equal to 16 micrograms/ml spectinomycin . Two non-PPNG strains were resistant to 64 micrograms/ml of tetracycline, 8 micrograms/ml penicillin and 32 micrograms/ml spectinomycin . The non-PPNG strains generally were more resistant to penicillin and tetracycline compared to strains tested from other parts of the world in previously reported studies. Acta Pathol Microbiol Immunol Scand {A}, 1982 Mar, 90(2), 103 - 11 A histochemical and ultrastructural study of human urethral uroepithelium; Alm P et al.; The ultrastructure and histochemistry of the human urethral mucosa was studied . By scanning electronmicroscopy (SEM) the cover cell of the urethra was found to be polygonal and with a surface topography characterized by numerous microvilli and micro-ridges . By transmission electronmicroscopy (TEM) the cover cells were shown to be interconnected with tight junctions but to lack the asymmetric luminal membrane and the fusiform vacuoles that characterize urothelium above the bladder neck . Histochemical analyses showed the human urethral cells to harbour large amounts of glycogen, and the glycocalyx facing the urethral lumen displayed high affinity for alcian blue and colloidal iron, indicating the presence of acid mucopolysaccharides . The reactivity with alcian blue appeared at pH 2.5, but was abolished by pre-treatment with sialidase . Studies with TEM or using SEM with energy-dispersive X-ray spectrometry (EDX) confirmed the high content of acid mucopolysaccharides in the luminal glycocalyx of the cover cells by demonstrating high binding capacity for ruthenium red . The quantitative binding of ruthenium red was not influenced by pH shifts between 4.5 and 7.5 . Utilizing the SEM + EDX technique, small variations in quantity of negative charge (i.e . of bound ruthenium red) were detected within individual cover cells, but considerable variations were found between cells . The significance of these physicochemical properties of the human urethral lining is discussed with special reference to the previously demonstrated liability of this mucosal surface to interact with microorganisms such as Escherichia coli, Staphylococcus saprophyticus and Neisseria gonorrhoeae. J Gen Microbiol, 1982 Mar, 128(Pt 3), 585 - 91 Antigenic variation of outer membrane protein II in colonial variants of Neisseria gonorrhoeae P9; Diaz JL et al.; Antibodies were detected by an enzyme-linked immunosorbent assay (ELISA) in sera from rabbits immunized wtih outer membranes from colonial opacity variants in Neisseria gonorrhoeae P9 . ELISA-inhibition experiments with purified antigens revealed approximately equal proportions of antibodies directed against each of the three major surface antigens, lipopolysaccharide, the major outer membrane protein (protein I) and protein II, the variable protein associated with colonial opacity . Inhibition experiments with intact gonococci showed considerable antigenic diversity which could be correlated with differences between the protein II species present . Despite their considerable structural homology, different protein II species from colonial variants of the same strain showed little cross-reactivity with specific anti-protein II sera, thus demonstrating the considerable variation in that part of the antigen which is exposed on the surface of the gonococcus and is closely involved in pathogenic mechanisms. J Clin Microbiol, 1982 Mar, 15(3), 379 - 83 Type-specific antigens of Neisseria meningitidis serogroup A; Di Ninno VL et al.; By using Ouchterlony immunodiffusion techniques, we defined three unique antigenic determinants (A1, A2, and A3) among six isolates of Neisseria meningitidis serogroup A . Two of these determinants (A2 and A3) were identified as lipopolysaccharides in nature and were not found to occur on the serogroup B strains of N . meningitidis that we examined . The A1 determinant commonly occurred among the serogroup B strains and was identified as a protein determinant. Urology, 1982 Mar, 19(3), 252 - 5 Gonodecten--new 3-minute in vitro diagnostic test for gonorrhea in the male without use of conventional culture or gram stain; Felman YM et al.; A method for a rapid (within three minutes) detection of Neisseria gonorrhoeae in a urethral exudate from male patients without the use of a Gram stain or culture, was evaluated in 201 patients . Analyses of the data obtained from the study indicate no difference with respect to sensitivity and specificity compared to the Gram stain . The use of the Gonodecten test kit as a differential diagnostic tool would decrease materially the time necessary to determine if a urethritis is gonococcal or nongonococcal while the patient is still in the office . The ability to diagnose rapidly gonococcal urethritis at the time of the patient's examination should contribute substantially to improved disease control, especially in the private sector . The Gonodecten test kit provides a diagnostic tool for the clinician who does not have a laboratory or qualified personnel to carry out the necessary tests for making a presumptive diagnosis of gonorrhea. J Infect Dis, 1982 Mar, 145(3), 300 - 10 Gonococcal pili: safety and immunogenicity in humans and antibody function in vitro; Siegel M et al.; In a phase I clinical trial, 39 volunteers received an initial and booster subcutaneous injection of 100 or 112 microgram of a pili vaccine prepared from Neisseria gonorrhoeae strain F62 in Tris buffer with an aluminum phosphate adjuvant (alum) or 220 microgram of the F62 pili vaccine prepared in ethanolamine, with or without alum . Antibody responses were quantitated with an enzyme-linked immunosorbent assay . All four groups had significant (P less than 0.0001) responses to the vaccine preparations with peak mean antibody responses one to three weeks after the booster . Differences in antibody responses among the groups were due to the administration of alum and not to use of Tris buffer vs . ethanolamine . In vitro, postimmunization sera enhanced phagocytosis of piliated strain F62 organisms by human polymorphonuclear leukocytes; preabsorption of the sera with strain F62 pili blocked this activity . Thus, gonococcal pili given subcutaneously are immunogenic and lead to production of functional serum antibodies. Sem Hop, 1982 Feb 4, 58(5), 263 - 7 {Endocarditis due to commensal Neisseria (author's transl)}; Bricaire F et al.; Three cases of endocarditis due to Neisseria mucosa are reported . The pathogenic role of these commensal microorganisms is reviewed . A survey of the literature found a dozen cases of endocarditis due to commensal Neisseria before the antibiotic era, and fourteen more since then (not including our three observations) . Some of distinctive features can be delineated from the study of cases seen during the second period . Patients mean age is fairly low (34 years), incidence of cutaneous manifestations is high, and vascular complications (mainly embolism) are common (52, 1% of the cases) . Overall prognosis is good and the recovery rate (82 %) is similar to that seen in non-D Streptococcus endocarditis. Obstet Gynecol, 1982 Feb, 59(2), 210 - 3 Pelvic infection after elective abortion associated with Chlamydia trachomatis; Moller BR et al.; Two groups in Denmark and Sweden, totalling 943 healthy women in the first trimester of pregnancy who were undergoing elective abortion, were examined in a prospective study . Group 1 consisted of 432 women from Denmark, all examined prior to and 2 weeks after the operation . At the first examination, samples were taken from the cervix for the isolation of chlamydiae and gonococci . Chlamydia trachomatis was isolated from 23 (5.3%) of the women . Postoperatively, 15 patients developed acute pelvic inflammatory disease (PID) . Five of these patients harbored C trachomatis before the operation, and all 5 developed a significant change in the titer of immunoglobulin G microimmunofluorescence antibodies to the organism . In group 2, 25 (4.9%) of the 511 women from Sweden harbored C trachomatis before the intervention . Patients with chlamydiae were treated, before or in conjunction with the operation, with antibiotics active against chlamydiae . None of the women with cultures positive for chlamydiae showed signs of PID postoperatively . The difference in the postoperative frequency of PID in chlamydia-positive patients between groups 1 and 2 was significant (2P = .0393, Fisher exact test) . Gonorrhea was diagnosed in 1% of the women in both groups . Only 1 of these patients developed PID postoperatively, but no pili antibodies to Neisseria gonorrhoeae were found during the course of the disease . It is concluded that women applying for abortion should be examined and treated not only for gonorrhea but also for infection with C trachomatis either before or, at the latest, in conjunction with the abortion. J Clin Microbiol, 1982 Feb, 15(2), 253 - 9 Development of a selective medium for detection and enumeration of Actinomyces viscosus and Actinomyces naeslundii in dental plaque; Zylber LJ et al.; A selective medium (CFAT) was developed for the detection and enumeration of Actinomyces viscosus and Actinomyces naeslundii in dental plaque . Neutral acriflavin and potassium tellurite were used in combination with the known selective agents cadmium and fluoride to eliminate most of the competing plaque flora . Composition of CFAT per liter was as follows: Trypticase soy broth (BBL Microbiology Systems), 30 g; glucose, 5 g; agar, 15 g' cadmium sulfate, 13 mg; sodium fluoride, 85 mg; neutral acriflavin, 1.20 mg; potassium tellurite, 2.50 mg; basic fuchsin, 1.25 mg; defibrinated sheep blood, 50 ml . A . viscosus reference strains of human origin grew on CFAT without reduction in numbers under an atmosphere of 90% air-10% CO2 . Animal strains of A . viscosus were inhibited at the level of cadmium in CFAT . Two of six A . naeslundii strains did not grow on CFAT . Improved recovery of A . viscosus and A . naeslundii from dental plaque occurred on CFAT, as compared with two other selective media which contained either cadmium sulfate or sodium fluoride, respectively, as selective agents . CFAT was more selective with regard to much of the extraneous gram-positive flora . Bacterionemia, Neisseria, yeasts, and streptococci were virtually eliminated. Acta Pathol Microbiol Immunol Scand {B}, 1982 Feb, 90(1), 73 - 7 Improved medium for the transportation of gonococcal specimens; Sandven P et al.; A modification of Stuart medium, denominated SIFF transport medium, was compared with Stuart (Ringertz's modification), Amies and SBL transport media for its ability to preserve viability of gonococci during transport . The SIFF medium was superior both when using laboratory strains of Neisseria gonorrhoeae and when using clinical specimens . The new transport medium distinguishes itself mainly by an increased osmotic pressure and by its starch content. Acta Pathol Microbiol Immunol Scand {B}, 1982 Feb, 90(1), 1 - 5 Induction of leukochemotaxis, primary skin inflammation and local Shwartzman reaction by Neisseria gonorrhoeae extract; Sveen K et al.; The leukochemotactic activity of ultrasonicate of the N . gonorrhoeae strain 8551 was studied by in vitro and in vivo experiments . No chemotactic activity was observed with extract incubated in Gey's solution alone or with heat-inactivated rabbit serum . Activity attracting polymorphonuclear cells was generated on injection of the extract into chambers implanted subcutaneously in rabbits, and in vitro when incubated with fresh rabbit serum, normal guinea pig serum or serum deficient in C4 . Chemotactic activity was not observed on incubation with mouse serum deficient in C5.The extract showed pronounced activity in the preparing of rabbits for the local Shwartzman reaction and in inducing primary skin inflammatory reaction . Gonococci this contain chemotaxigens that induce chemotaxin production by means of complement activation via the alternative pathway, and these or other components initiate strong inflammatory responses in vivo. Obstet Gynecol, 1982 Feb, 59(2), 206 - 9 Epidemiologic and serodiagnostic aspects of chlamydial salpingitis; Osser S et al.; Cultural, serologic, and epidemiologic aspects of Chlamydia trachomatis in acute salpingitis were assessed . Of 111 patients, 52 (47%) harbored C trachomatis in the cervix urethra, or both . Neisseria gonorrhoeae was isolated in 41 patients of 209 (20%) . A majority (79%) of women with gonorrhea were also infected with C trachomatis . A fourfold titer rise of chlamydial IgG antibodies or significant IgM titer, or both, was demonstrated in 37 patients of 72 (51%) from whom paired sera were obtained . The serologic response distinguished 3 different phases of chlamydial infection: acute, subacute, and chronic or reinfection . The patients' male sex partners were examined on a voluntary basis, and C trachomatis was detected in 68%, indicating a need for effective partner examination and treatment. J Gen Microbiol, 1982 Feb, 128(Pt 2), 303 - 6 The effect of benzyl penicillin on the ultrastructure of Neisseria gonorrhoeae; Jamil JJ et al.; Electron microscopy of Neisseria gonorrhoeae grown on solid medium with a subinhibitory concentration of penicillin suggested that the amount of penicillin reaching each pair of gonococci was different, as illustrated by the ultrastructural appearance of N, gonorrhoeae cells in the colony . This supports the view that the concentration of penicillin in different parts of the colony is not uniform, causing some cells to lyse while the others remain intact. J Clin Pathol, 1982 Feb, 35(2), 215 - 8 Failure of the fluorescent antibody reaction to identify penicillinase-producing gonococci; Waitkins SA et al.; The fluorescent antibody test is now widely used to confirm the identity of Neisseria gonorrhoeae but may fail to identify penicillinase-producing strains (PPNG) . This problem arises when conjugates are used that incorporate only gonococci that are not penicillinase-producers . We have shown that conjugates prepared from mixtures of PPNG and non-penicillinase producing gonococci give good fluorescent reactions . This difference in the reactions of PPNG strains is clearly related to their penicillinase-producing abilities, further study of the antigenic relation between penicillinase production and the antigenic structure of N gonorrhoeae is evidently required. J Clin Microbiol, 1982 Feb, 15(2), 231 - 4 Evaluation of the Phadebact Test for identification of Neisseria gonorrhoeae; Carlson BL et al.; The Phadebact Gonococcus Test (Pharmacia Diagnostics, Piscataway, N.J.) is used for the identification of Neisseria gonorrhoeae . In this test, boiled organisms are examined by using a 3-min coagglutination technique . A total of 313 isolates of Neisseria confirmed by the fluorescent-antibody technique or identified to the species level by the cysteine-tryptose agar utilization technique, were tested by the coagglutination technique . Of 229 isolates of N . gonorrhoeae, 13 (5.7%) were negative by the coagglutination technique on the first testing, 4 (1.7%) of which remained negative on subsequent testing after subculture . Of the 84 isolates of Neisseria other than N . gonorrhoeae, none showed a positive coagglutination reading . The Phadebact Gonococcus Test provides rapid, accurate identification for most isolates of N . gonorrhoeae . As with any new technique, standard procedures (fluorescent-antibody or cysteine-tryptose agar analysis or both) should be performed along with the new technique until laboratory workers are comfortable with the performance and interpretation of the test . We must, however, emphasize that it is very important to follow carefully the procedures outlined on the package insert. Can J Microbiol, 1982 Feb, 28(2), 219 - 22 The nature of human erythrocyte receptors for Neisseria gonorrhoeae; Wiseman GM et al.; Normal and trypsinized human erythrocyte membranes were used as a model in the study of host cell receptors for Neisseria gonorrhoeae . Receptor sites were identified by adherence inhibition assays of fractions of membranes eluted from polyacrylamide gel electrophoresis columns . Results indicated that inhibition of gonococcus T1 and T4 adherence was associated with erythrocyte protein band 3 and 4 and glycophorin A, the major sialoglycoprotein . Further investigation revealed that band 3 preparations isolated by affinity chromatography on concanavalin A - Sepharose 4B columns continued to inhibit T1 adherence to erythrocytes but did not inhibit adherence of T4 organisms . It is suggested that protein band 3 is the receptor on erythrocytes for T1 gonococci and that glycophorin A may be the receptor for T4 cells. Infect Immun, 1982 Feb, 35(2), 442 - 8 Complement consumption gonococcal peptidoglycan; Petersen BH et al.; Purified peptidoglycan (PG) obtained from Neisseria gonorrhoeae was tested for the ability to consume complement in normal human sera . Sonicated PG (S-PG), a heterogeneous mixture of soluble fragments (molecular weight, greater than 10(6)), as well as intact (insoluble) PG, reduced the level of whole hemolytic complement in a pool of four human sera . The minimal concentration of S-PG required for this activity was approximately 500 micrograms of S-PG per ml of serum . Complete lysozyme digestion of S-PG, yielding PG fragments of less than 10(4) molecular weight, eliminated complement-consuming activity . S-PG-mediated complement consumption resulted in depletion of the individual complement components C4 and C3 . Consumption of complement did not occur when C4-deficient human serum or normal human sera treated with Mg2+-(ethylene glycol-bis(beta-aminoethyl ether)-N,N-tetraacetic acid to specifically impair classical complement pathway activity were used . The addition of rabbit anti-PG antibody greatly enhanced gonococcal PG-mediated complement consumption . Together, the data suggested that gonococcal PG-mediated complement consumption occurred via the classical complement pathway, was dependent on the presence of anti-PG antibody, and required glycosidically linked polymers of PG . Individual human sera varied widely in the extent of gonococcal PG-mediated reduction of complement levels, presumably a reflection of either different amounts of natural antibody to gonococcal PG, different levels of human PG hydrolase(s) capable of degrading PG to inactive fragments, or both. Br J Vener Dis, 1982 Feb, 58(1), 29 - 31 Penicillinase-producing gonococcal strains in Zambia . Observations on treatment failures; Ratnam AV et al.; Penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) were detected in nine out of 27 (3.2%) treatment failures in 310 cases of acute gonococcal urethritis in men in Lusaka, Zambia . Minimum inhibitory concentrations of penicillin for 17.2% of 233 gonococcal isolates were less than or equal to 0.05 microgram/ml, for 38.2% between 0.125 and 0.25 microgram/ml, and for 46.6% greater than or equal to 0.5 microgram/ml . At present the prevalence of PPNG in African countries is not known but is likely to increase rapidly unless simplified control schemes are adopted within the existing health care programmes . Endemic pockets of PPNG in a few countries can threaten worldwide efforts to control gonorrhoea. Br J Vener Dis, 1982 Feb, 58(1), 23 - 8 In-vitro activity of 21 antimicrobial agents against Neisseria gonorrhoeae in Brussels; Gordts B et al.; The minimum inhibitory concentrations (MIC) of 21 antimicrobial agents was measured for 80 strains of Neisseria gonorrhoeae isolated in Brussels in 1978 . Bimodal distributions were found for penicillin G, ampicillin, amoxycillin, carbenicillin, and cephalexin . Of the strains, 17.5% were relatively resistant to penicillin G (MIC greater than 0.08 microgram/ml) 27.5% to ampicillin (MIC greater than 0.16 microgram/ml), 23.8% to amoxycillin, and 43.3% to carbenicillin . Cefotaxime was the most active antibiotic, with MICs in the nanogram range; 3.8% and 5% of the strains were relatively resistant to cephaloridine and cephalexin respectively, but no strains were resistant to cefazolin, cefuroxime, or cefotaxime . Resistance to tetracycline, doxycycline, minocycline, erythromycin, and spiramycin (MIC greater than 1 microgram/ml) was found in 6.3%, 2.5%, 5%, and 51.3% of the strains respectively . A very good correlation was present between chloramphenicol and thiamphenicol, with 16.3% and 10% of relatively resistant strains respectively . Only two isolates showed an MIC greater than 1.25 microgram/ml for rifampicin, and 10% of the strains needed greater than or equal to 12 microgram/ml of spectinomycin for complete inhibition of growth . A very high energy was found for the 20 : 1 combination of sulphamethoxazole and trimethoprim, with only one isolate resistant to this combination . None of the strains tested produced beta-lactamase. J Infect Dis, 1982 Feb, 145(2), 206 - 16 Isolation of a lipopolysaccharide mutant of Neisseria gonorrhoeae: an analysis of the antigenic and biologic difference; Morse SA et al.; Analysis of the surface constituents of a pyocin 611 131-resistant variant of strain no . JW-31 of Neisseria gonorrhoeae revealed substantial differences in the lipopolysaccharide (LPS) but not changes in the auxotype or outer-membrane proteins . Immunodiffusion and an enzyme-linked immunosorbent assay showed that the variant strain (no . JW-31R) lost both the LPS serotype and the variable antigens while retaining at least a portion of the common determinant . The use of monoclonal antibody indicated that LPSs from strain no . JW-31R and pyocin 611 131-resistant strains of other LPS serotypes lack a D-galactosaminyl-D-galactopyranosyl-D-glucose moiety . The LPS-derived polysaccharide from strain no . JW-31 binds to wheat-germ lectin in precipitin and inhibition systems, whereas the JW-31R polysaccharide exhibits a markedly reduced affinity . In the presence of normal human serum, 99% of strain no . JW-31R was killed within 20 min and strain no . JW-31 was not. Hautarzt, 1982 Feb, 33(2), 65 - 72 {Hereditary complement deficiencies}; Fischer E; Complement deficiencies of all nine C-components have been observed . Hereditary defects of early components of the classical pathway - C1, C4, C2 - are often associated with diseases of the immuncomplex-type especially with systemic lupus erythematosus, dermatomysitis, vasculitis and nephritis . Deficiencies of C3 and C3b inactivator are linked to severe and recurrent bacterial infections . Patients with hereditary defects of the so-called late components, C5-C9, show increased susceptibility to recurrent disseminated infections by neisseria gonorrhoeae and meningitidis . The most frequent of the defects of the complement system is the hereditary deficiency of C1-inactivator which is associated with hereditary angioneurotic edema . In this paper the C-defects and their genetics are described and possible pathomechanisms are discussed. Acta Pathol Microbiol Immunol Scand {C}, 1982 Feb, 90(1), 47 - 52 Demonstration of antigenic heterogeneity of Neisseria gonorrhoeae pili antigens using human sera in the test system; Reimann K et al.; Antigenic heterogeneity of gonococcal pili using human sera in the test system was demonstrated by means of indirect haemagglutination (IHA) inhibition studies . The reactivities of sera from 104 females with current gonococcal infection were compared by the IHA test using different pili preparations as antigens . Sera and gonococcal strains were collected from 365 patients . Pili were purified from strains infecting patients who met the following three requirements: 1) no history of previous gonococcal infection(s), 2) an infection that had lasted a week or more, 3) a seronegative result when tested by the IHA test using pili from Buchanan's strain 2686 as antigen . Each patient's serum was tested against pili produced by the gonococcal strain infecting this particular patient . A seropositive reaction obtained by using pili antigen from the strain infecting the seronegative (strain 2686) patient indicates an antigenically heterogeneous pili preparation . Two such strains, antigenically different from one another and from strain 2686, were found among 22 pili preparations investigated. MMWR Morb Mortal Wkly Rep, 1982 Jan 22, 31(1-2), 1 - 3 Global distribution of penicillinase-producing Neisseria gonorrhoeae (PPNG); Rosoxacin (Win 35 et al.; The results of this open multicenter trial with 100 patients of both sexes show that a single 300-mg dose of rosoxacin (Win 35,213) was effective in achieving a 94% cure rate, both clinical and bacteriological, on the seventh day after treatment in patients with uncomplicated acute gonococcal infection . The cure rate in men was 94% (86/92) and in women 100% (8/8) . All isolates of Neisseria gonorrhoeae were susceptible to rosoxacin, as determined by 5-micrograms sensitivity disks . Adverse effects were seen in 14 patients--13 men and one woman . Twelve patients reported dizziness, one drowsiness, and one visual changes . It is concluded that rosoxacin can be of great usefulness in the epidemiological control of acute gonococcal infection, because of the lack of in vitro resistance to it, its minimal adverse effects, the low dose requirements, and the effectiveness of a single dose . The drug does not appear to have any treponemicidal action. Infection, 1982, 10 Suppl 1, S53 - 6 Diagnosis and treatment of chlamydial venereal disease; Thelin I; We examined patients attending an STD clinic (Department of Dermatology, Lasarettet, Lund) . Chlamydia trachomatis was demonstrated in 26% of 2021 male patients by culture from the urethra (using cyclo-heximide-treated McCoy cells) . The corresponding figure for Neisseria gonorrhoeae was 15% . Both organisms were found in 5% of the patients . In women, culture from the cervix demonstrated C . trachomatis in 16% of 1039 patients . N . gonorrhoeae was found in 14%, and both organisms in 4% of the patients . Men with chlamydial urethritis were more frequently found to have a watery discharge than those with gonococcal urethritis . They also had fewer leucocytes in smears from the urethra . Treatment with different tetracyclines gives good therapeutic results in both men and women infected with C . trachomatis . In contact-tracing, 53% of 95 male partners and 65% of 103 female partners were found to harbour C . trachomatis . About 50% of these contacts were free of symptoms . This indicates the importance of contact-tracing in genital chlamydial infection. Infection, 1982, 10 Suppl 1, S46 - 52 In vitro and in vivo efficacy of antimicrobials against Chlamydia trachomatis; Bowie WR; With the exception of lymphogranuloma venereum, the treatment of Chlamydia trachomatis infections in the genital tract or acquired from the genital tract is relatively easy . In general, in vivo activity of antimicrobials against C . trachomatis correlates well with in vitro activity if sufficient antimicrobial is given for a long enough duration . Tetracycline and erythromycin and their derivatives remain the treatments of choice because of combined activity against C . trachomatis, in addition to most isolates of Neisseria gonorrhoeae and Ureaplasma urealyticum . Rifampin, sulfonamides, or trimethoprim-sulfamethoxazole can only be used if C . trachomatis alone is being treated . Although multiple dose penicillins may be significant activity in vivo, their use is not encouraged . Other antimicrobials like aminocyclitols, cephalosporins, and metronidazole have no activity . Seven day regimens of either a tetracycline or erythromycin are generally preferred for uncomplicated infections, but ten days of a tetracycline is preferred for complications like acute pelvic inflammatory disease or epididymitis . For ocular or pulmonary infection in infants, a two to three week regimen of oral sulfonamide or erythromycin is preferred . for the treatment of concurrent N . gonorrhoeae and C . trachomatis, a tetracycline should be administered for at least five days. Scand J Infect Dis Suppl, 1982, 32, 182 - 8 Treatment of acute salpingitis--with special reference to Chlamydia trachomatis; Svensson L et al.; Conservative treatment of acute salpingitis should be the rule, surgery the exception . Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma hominis, are common etiological agents in pelvic inflammatory disease, particularly in women below the age of 25 years . In women above that age as well as in those with two or more episodes of acute salpingitis, there is a higher proportion of tubal infections caused by aerobic and facultatively anaerobic bacteria . Apart from some resistant strains, tetracycline generally has an effect on all three of the above-mentioned agents of sexually transmitted diseases (STD) . We recommend that this drug be chosen if the results of etiological studies are not known when therapy is started . If there is reason to believe that anaerobic bacteria may be involved, tetracycline may be combined with nitroimidazole . The short-term effects of various antibiotic drugs in acute salpingitis suggest that women with gonococcal salpingitis will respond sooner than will women with non-gonococcal salpingitis, regardless of which antibiotic regimen is given . The long-term effect of several different antibiotics on the post-salpingitic fertility does not differ . Glucocorticosteroids do not seem to positively influence the prognosis for fertility . To help prevent salpingitis, it is important to advise patients on appropriate contraceptive usage and to examine and treat both patients and consorts for STD. Scand J Infect Dis Suppl, 1982, 32, 177 - 81 Treatment of Chlamydia trachomatis infections of the female lower genital tract; Gjonnaess H; Chlamydia trachomatis infections of the female lower genital tract may cause cervicitis, a condition which, even when asymptomatic, as it often is, can have serious consequences in both the short and the long term . Treatment, therefore, should be instituted as soon as such infections are diagnosed . Tetracyclines are the therapy of choice, with erythromycin and trimethoprim/sulfamethoxazole as therapeutic alternatives . The duration of treatment should be for not less than 8 to 10 days . Concomitant infections with C . trachomatis and Neisseria gonorrhoeae require special therapeutic considerations . As with any other sexually transmitted infection, management of chlamydial infections demands simultaneous partner treatment . Screening by culture is proposed for high-risk groups, such as women applying for legal abortion and those undergoing implantation of an intrauterine contraceptive device. Scand J Infect Dis Suppl, 1982, 31, 34 - 40 Humoral factors in host defense against microbial invaders; Quie PG; Normal host defense against microbial invaders depends upon an intact humoral and cellular system of inflammation and specific immunity . The major weapons for killing microbes that invade tissue are phagocytic cells, however, humoral factors enable these phagocytic cells to recognize, migrate toward, efficiently ingest, and kill the invaders . Humoral factors essential for host defense include specific antimicrobial immunoglobulin antibodies and multiple proteins which comprise the complement system . The complement system is the oldest phylogenetically and the most important protein in this system is C3 . When C3 is activated on the surface of the microbe, ligan is formed which provides a firm bond between organisms and phagocytic cells . This process is termed opsonization and activated C3/C3b is a highly efficient opsonin . C3b attachment stimulates efficient engulfment by phagocytic cells and most microbes are rapidly killed once they are ingested . Complement may also function as a direct bactericidal factor when associated with specific antibody on the bacterial surface . Neisseria meningitidis and Neisseria gonorrheae are susceptible to this action of complement which requires participation of the terminal proteins of the system C6, 7, 8, and 9 . Patients without these terminal components, therefore, are susceptible to systemic infections with Neisseria . Septicemia from Streptococcus pneumoniae and other encapsulated microbial species occurs with greatly increased frequency in patients without spleens . Complement and other as yet unidentified humoral factors which contribute to host defense against microbial invaders appear to be deficient in patients without spleens . Antimicrobial antibodies produced in response to antigenic stimulation by microbes are also essential humoral factors . Effective levels of antimicrobial antibodies develop only after microbes have colonized their host and the immune system has been stimulated and protection is delayed . Once produced, however, specific antibodies are potent opsonins and are effective activators of complement . Highly effective and efficient host defense is present when there are circulating specific antibacterial antibodies and an intact complement system . Septicemia may occur when there is a traumatic portal or entry of an exceptionally large bacterial challenge, however, deficiency of humoral or cellular factors of host defense is frequently involved in the pathogenesis of septicemia . Measures for preventing septicemia in susceptible persons include active immunization with microbial antigens or passive therapy with specific antimicrobial antibodies. J Clin Microbiol, 1982 Jan, 15(1), 103 - 8 Presence of hydrogen peroxide in media used for cultivation of Neisseria gonorrhoeae; Norrod EP et al.; Defined complex media used for cultivation of Neisseria gonorrhoeae were tested for the presence of H2O2 by both a spectrophotometric and a polarographic assay . H2O2 (35 to 165 microM) was present in all media tested . In the defined media, H2O2 was generated by the interaction of cysteine with other amino acids . The addition of the chelator 8-hydroxyquinoline prevented formation of detectable H2O2, suggesting that metal ions were necessary . The persistence of H2O2 varied greatly among different media . Medium components which affected the presence of H2O2 were pyruvate, oxalacetate, and sodium sulfite . Sodium sulfite also generated superoxide radical . In liquid medium containing H2O2, the endogenous gonococcal catalase present in an inoculum of about 2 X 10(7) colony-forming units/ml destroyed detectable H2O2 . The long lag phase which resulted from a 10-fold lower inoculum could not be shortened by the addition of exogenous catalase . Small amounts of residual H2O2 in agar plates of complex medium affected the viability of gonococci which had been suspended in buffer and incubated for 60 min at 37 degrees C . Addition of pyruvate or catalase increased viable counts in medium containing H2O2. Zentralbl Gynakol, 1982, 104(17), 1106 - 14 {Results and experience with the diagnosis of Neisseria gonorrhoeae}; Baumann L; Between January 1978 and August 1981, 4,708 examinations for detection of Neisseria gonorrhoeae were carried out at the Gynaecological Hospital of Karl-Marx Universitat Leipzig . Certain aspects relating to laboratory diagnosis of gonorrhoea are expounded, against the findings obtained from these examinations.--Culturing yield was increased by the factor of 2.6, from 4.8 per cent (1978/1979) to 12.3 per cent (1980/1981) by improvement of culturing media . Substrate quality proved to be essential to effectiveness of culturing.--Most of the above examinations, relating to 45 per cent of all positive cases, had been performed for adnexitis . The cervix was confirmed to be the most useful site from which to take swabs . Eighty-five per cent of gonococcal strains isolated in 1980 and 1981 were sufficiently responsive to penicillin . Beta-lactamase formers were not recorded . Methods and culturing media are described in some detail. J Gen Microbiol, 1982 Jan, 128 (Pt 1), 13 - 22 Immunological basis of serum resistance of Neisseria gonorrhoeae; Schneider H et al.; The immunological basis for resistance of certain strains of Neisseria gonorrhoeae to the bactericidal action of normal human serum was studied by investigating the potential role of factors which are known to interfere with each of the sequential steps that result in immune lysis of Gram-negative bacteria . Strains of N . gonorrhoeae were characterized as serum-sensitive (sers) or serum-resistant (serr) on the basis of their sensitivity to lysis by the sera of six normal individuals . Neither intrinsic resistance to the lytic action of activated human complement nor inaccessibility of the cell membrane to C5b accounted for serr . Outer membrane lipopolysaccharide (LPS) was the target antigen for lytic antibody in normal human sera . The gross chemical composition and molecular size of the LPS of the strains were heterogeneous and no consistent patterns of differences between those extracted from serr and from sers strains were found . Neither IgA nor IgG 'blocking' antibody in normal human serum was responsible for serr . We conclude that serr results from the absence from the LPS of the strains of antigenic loci for the lytic antibody in most normal human sera, or, expressed as a function of the host, the absence from the sera of most normal humans of lytic antibody directed against LPS antigenic loci for immune lysis. Am J Med Technol, 1982 Jan, 48(1), 43 - 6 Comparison of a rapid micromedia method to cystine trypticase agar (CTA) and fluorescent methods for the identification of pathogenic Neisseria; Brake SR et al.; A four-hour micromedia method which detects enzymes formed by bacteria for the degradion of carbohydrates was compared to the utilization of carbohydrates was compared to the utilization of carbohydrates in cystine tyrpticase agar (CTA) for the identification of Neisseria gonorrhoeae and Neisseria meningitidis . This rapid micromedia method (RMM) correlated 100% with the utilization of carbohydrates in CTA . Identification of N . gonorrhoeae by RMM was compared to the identification achieved by a commercially available coagglutination method and a fluorescent antibody (FA) technique . Of 144 isolates identified as N . gonorrhoeae by RMM, 122 (84.7%) were identified by coagglutination and 141 (97.9%) were identified by FA as N . gonorrhoeae . Five (13%) of 40 isolates identified as N . meningitidis by RMM were identified as N . gonorrhoeae by coagglutination while eleven (28%) were identified as N . gonorrhoeae by the FA technique . One (14%) and four (57%) of seven isolates identified as Neisseria species were identified as N . gonorrhoeae by coagglutination and the FA technique respectively . The rapid micromedia method was found to be a quick, sensitive, specific and economic way of identifying N . gonorrhoeae and N . meningitidis. J Infect Dis, 1982 Jan, 145(1), 37 - 44 Relation of protein I and colony opacity to serum killing of Neisseria gonorrhoeae; James JF et al.; Serum bactericidal tests were done for isogenic Neisseria gonorrhoeae that formed transparent or opaque colonies . Analysis of the data from individual strains showed that the molecular weight of protein I was a highly significant, but not universal, determinant of serum sensitivity or resistance . N . gonorrhoeae organisms with high-molecular-weight protein I were more serum-sensitive . Multivariate analysis of the data from 43 strains indicated that N . gonorrhoeae organisms from transparent colonies were more serum-resistant than isogenic organisms from opaque colonies (P = 0.01) . Survivors of bactericidal reactions in which the initial inoculum was from opaque colonies tended to form transparent colonies . Bactericidal action by sera from men was highly associated (P less than 0.02) with the molecular weight of protein I and with the presence of protein II bands on sodium dodecyl sulfate-polyacrylamide gel electrophoresis, whereas bactericidal action by sera from women was associated only with the molecular weight of protein I. J Infect Dis, 1982 Jan, 145(1), 103 - 9 Chemoprophylaxis for Neisseria meningitidis in an isolated Arctic community; Nicolle LE et al.; Community chemoprophylaxis with a regimen of sequential minocycline/rifampin (adults) or rifampin alone (children {less than 12 years of age}) was undertaken in a remote Arctic community one year after an outbreak of meningitis due to Neisseria meningitidis serogroup B . Nasopharyngeal carriage rates of N . meningitidis before prophylaxis were 32.4% in Inuit (Eskimos) and 6% in Caucasians, with maximal carriage (44.8%) in adolescents . Serogroup B accounted for 63.9% of all isolates before prophylaxis . One week after prophylaxis, the nasopharyngeal carriage rates were 0.8% in Inuit who had received prophylaxis and 33.3% in those who had not received prophylaxis (P less than 0.005) . This reduction persisted at nine weeks after prophylaxis, when carriage rates were 1.2% in those who had received prophylaxis and 22.6% in individuals who had not received prophylaxis . Of the strains obtained before prophylaxis, 7.8% were sulfadiazine-resistant, whereas 35% of all isolates obtained from prophylaxis were sulfadiazine-resistant . Rifampin- or minocycline-resistant strains were not identified either before or after prophylaxis. Med Clin North Am, 1982 Jan, 66(1), 169 - 73 Spectinomycin; Holloway WJ; Spectinomycin is a broad-spectrum aminocyclitol antibiotic that is highly effective i