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J G Lossick

Publications and source records attributed to J G Lossick.

18 recordsLinked to original sources
PubMed1991

Trichomoniasis: trends in diagnosis and management.

The mainstay of the diagnosis of trichomoniasis has been the saline vaginal wet preparation. With a less than desirable sensitivity, the wet preparation may be replaced in the near future by newer methods employing monoclonal antibodies, such as the enzyme immunoassay, which has the potential to become an in-office procedure. The direct fluorescent antibody test also represents an advance in laboratory diagnosis. However, until the sensitivity, specificity, and cost of these newer techniques are defined outside the research arena, the wet preparation will remain the first-line diagnostic tool. Current treatment of trichomoniasis in the United States is with metronidazole, which in repeated or increased dosage can often overcome the organism's resistance to the drug. Other treatments offer little or no chance for cure but may provide some relief of symptoms. Tinidazole (not available in the United States) may be effective in curing refractory cases of metronidazole resistance. Metronidazole treatment during pregnancy should be resorted to only when absolutely essential.

Drug Resistance↗
PubMed1991

Resolution of resistant vaginal trichomoniasis associated with the use of intravaginal nonoxynol-9.

An otherwise healthy, sexually inactive woman was determined by in vitro susceptibility testing to have vaginal infection by a strain of Trichomonas vaginalis with high-grade metronidazole resistance. Prolonged high-dose oral and intravaginal metronidazole therapy did not resolve the infection, but caused temporary peripheral neuropathy. Tinidazole was ineffective as well. Serendipitous use of topical intravaginal nonoxynol-9 for contraception appeared to resolve the infection. We reviewed reinfection, noncompliance with therapy, and concomitant use of other drugs that degrade the efficacy of metronidazole as possible causes of falsely "resistant" trichomoniasis. The literature suggests that mebendazole, furazolidone, and anisomycin may be effective for treatment of metronidazole-resistant trichomoniasis. This case and previously published laboratory data suggest that intravaginal nonoxynol-9 deserves further study as a treatment for resistant trichomoniasis, though trichomonal coinfection of the patient's urethra, Skene glands, and sexual partner would not likely be resolved by such therapy.

Adult↗
PubMed1989

Pharyngeal gonorrhea screening in adolescents: is it necessary?

A prospective study was performed to examine the prevalence of pharyngeal gonorrhea in two urban female adolescent populations and to compare pharyngeal infection with a history of orogenital activity and concurrent genital gonorrhea. Group I was drawn from a children's hospital adolescent clinic and group II was drawn from a public health clinic for sexually transmitted diseases. None of the 240 adolescents in group I had a pharyngeal culture positive for Neisseria gonorrhoeae compared with 3.4% in group II. Only 2.5% of group I had genital gonorrhea, but 33% of group II had positive genital cultures. In only two of the 20 patients with pharyngeal gonococcal infection was the pharynx the only infected site. The addition of routine pharyngeal culturing for gonorrhea yielded only 1% additional gonorrhea cases. There was a significant relationship between concurrent genital and pharyngeal gonorrhea. These findings indicate that routine screening for pharyngeal gonorrhea is not productive in some adolescent populations. A more economic approach would be to use gonorrhea treatment that is effective against both genital and pharyngeal gonorrhea or to obtain pharyngeal cultures in those adolescents returning for test-of-cure cultures after antibiotic treatment for genital gonorrhea.

Adolescent↗
PubMed1986

In vitro drug susceptibility and doses of metronidazole required for cure in cases of refractory vaginal trichomoniasis.

There are currently no laboratory or clinical guidelines for the identification and treatment of disease caused by metronidazole-resistant strains of Trichomonas vaginalis. Fifty-three isolates of T. vaginalis from cases of refractory vaginitis in the United States (26 states) and Canada were tested for aerobic and anaerobic metronidazole susceptibility, and after various dosages of metronidazole, the therapeutic outcomes were evaluated for 31 of these cases. The mean aerobic metronidazole susceptibility of these isolates was 195.5 micrograms/ml (range, 12.5-greater than 1,000), which was about eightfold higher than that seen in isolates that were not resistant to metronidazole. The mean anaerobic susceptibility was 5 micrograms/ml (range, 1.6-25), which was about threefold higher than that of isolates from nonresistant strains. The average aerobic-to-anaerobic ratio of metronidazole susceptibility in the highly resistant isolates was more than 3.5-fold greater than that seen in the nonresistant isolates. White women accounted for 88% of the resistant infections. Of 31 cases that were re-treated and monitored, the highest average dose that failed to achieve a cure was 2.1 g of metronidazole/day given over an eight-day period; 27 (87%) of 31 cases were ultimately cured with an average dosage of 2.6 g of metronidazole/day given over a mean period of nine days. Resistance to treatment with metronidazole varied from mild to severe, and the resistance was occasionally more severe than the susceptibility values indicate.

Adolescent↗
PubMed1984

Sexually transmitted vaginitis.

Urologic complaints in both men and women may be related to sexually transmissible infectious agents that frequently cause vaginitis in women. The author reviews the etiology, epidemiology, diagnosis, treatment, and clinical presentations of the various types of vaginitis. Vaginal infections in women often have their counterparts in men. Control of these communicable infections requires a better understanding of the vaginitis syndromes.

Antifungal Agents↗
PubMed1982

Comparison of cefuroxime and penicillin in the treatment of uncomplicated gonorrhea.

In a randomized double-blind trial, 216 men and 142 women infected with uncomplicated gonorrhea were treated with either 1.5 g of cefuroxime or 4.8 x 10(6) U of aqueous procaine penicillin G intramuscularly and 1.0 g of probenecid. The cure rates in the treatment groups were 96 and 95%, respectively. Intramuscularly administered cefuroxime was better tolerated than was procaine penicillin. Comparative antibiotic susceptibility studies revealed that cefuroxime and penicillin were about equally active and that both were more active than cefamandole or cefoxitin. Because cefuroxime is not degraded by the action of beta-lactamase enzymes, it has promise as an alternative to spectinomycin in the treatment of penicillinase-producing Neisseria gonorrhoeae infections.

Cefuroxime↗
PubMed1982

Vaginal colonization with Staphylococcus aureus in healthy women: a review of four studies.

Four studies assessed the frequency of vaginal Staphylococcus aureus colonization in healthy women and associated risk factors. An association was found between S. aureus vaginal colonization and colonization at the labia minora and the anterior nares. Significant risk factors associated with an increased risk of vaginal S. aureus in at least one study were a history of genital herpes simplex infection, insertion of tampons without an applicator, and the use of Rely (Procter & Gamble) tampons. The use of systemic antibiotics within 2 weeks of the vaginal culture decreased the risk of recovery of S. aureus. The overall frequency of vaginal S. aureus in the 808 women in the four studies was 9.2%.

Anti-Bacterial Agents↗
PubMed1981

Metronidazole.

Explore the source record for details and available documents.

Drug Resistance, Microbial↗
PubMed1980

Gonorrhea in the emergency department: management, case follow-up, and contact tracing of cases in women.

From June, 1978, to June, 1979, all ten Columbus hospital emergency departments (EDs) participated in a program which provided test-of-cure, follow-up of untreated cases, and contact investigation of women infected with gonorrhea. Four hundred and eighty-nine women were found to be infected with gonorrhea; 99% of these were treated rapidly with recommended schedules. Sixteen percent of women with positive cultures required inpatient care for an average of 6.3 days. Seventy percent of women with positive cultures received counseling and test-of-cure for gonorrhea. Of 134 men treated as a result of these counseling efforts, 79 (59%) were asymptomatically infected. Source-spread analyses suggested that one third of asymptomatically infected male contacts had been infected for longer than 30 days. Only one fourth of women with gonococcal pelvic inflammatory disease (GC-PID) interviewed named male source contacts who were treated prior to her presentation with PID. Future approaches to GC-PID prevention must include cooperative efforts between health department clinics for sexually transmitted disease and hospital EDs.

Emergency Service, Hospital↗
PubMed1980

Single-dose metronidazole treatment for vaginal trichomoniasis.

Incoming inmates to a female prison, with a 47% prevalence of trichomonas vaginitis, were treated with a single 2-g dose of metronidazole. Follow-up of 237 patients revealed a cure rate of 97%. Four patients in whom initial treatment failed responded to repeat single-dose treatment. Significant side reactions were not encountered. Treatment noncompliance was reduced from approximately 25% to zero. The cost of the trichomoniasis treatment program was reduced by approximately 60%. The simplicity and the reduced cost associated with the single-dose treatment regimen should reduce patient and consort therapeutic noncompliance and is a significant improvement over the currently recommended 7-day treatment regimen.

Female↗
PubMedDate not supplied

Treatment of sexually transmitted vaginosis/vaginitis.

Although much has been learned about sexually transmissible forms of vaginitis/vaginosis during the past decade, therapeutic options for these disorders remain limited. A single 2-g oral dose of metronidazole still remains highly effective against most Trichomonas vaginalis infections. Mildly resistant infections can usually be cured with metronidazole oral doses of 2 g daily for 3-7 days. When highly resistant infections occur, toxic levels of metronidazole may be needed for the drug to cure the infection. Metronidazole (500 mg twice daily for 7 days) continues to be highly efficacious in the treatment of bacterial vaginosis. Shorter oral treatment regimens that use single 2-g doses of metronidazole for 2-3 days appear promising but may be associated with higher relapse rates. Oral clindamycin (300 mg twice daily) or local 2% clindamycin cream (once daily for 7 days) also may be effective. Metronidazole intravaginal sponges (250-1,000 mg) used for 3 days may also be effective in the treatment of bacterial vaginosis.

Bacterial Infections↗
PubMedDate not supplied

The value of the cervical gram stain in the diagnosis and treatment of gonorrhea in women in a venereal disease clinic.

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.

Anti-Bacterial Agents↗
PubMedDate not supplied

In vitro susceptibility of Trichomonas vaginalis to metronidazole and treatment outcome in vaginal trichomoniasis.

We have identified Trichomonas vaginalis strains resistant in vitro to metronidazole, especially under aerobic conditions. Since little is known about the relationship of treatment outcome to metronidazole susceptibility of T. vaginalis, we studied the aerobic and anaerobic susceptibility to metronidazole of 310 clinical isolates of T. vaginalis. Of 199 patients with known outcomes after metronidazole treatment for vaginal trichomoniasis, the geometric mean minimal lethal concentration (MLC) under aerobic conditions for trichomonads associated with cases cured by a single 2-g dose was 24.1 micrograms/ml (n = 146), while that of treatment-resistant isolates (n = 53) was 195.5 micrograms/ml. The corresponding mean anaerobic MLC values were 1.6 and 5.05 micrograms/ml, respectively. The average aerobic:anaerobic MLC ratio was about twofold higher for the resistant isolates. Treatment resistance was more frequent at aerobic MLC values of greater than 25 micrograms/ml or anaerobic values of greater than 1.6 micrograms/ml. Although there was overlap of the metronidazole susceptibility distribution of susceptible and resistant isolates, significant resistance to treatment was common when isolates of T. vaginalis had aerobic MLC values of greater than 100 micrograms/ml or anaerobic MLC values of greater than 3.1 micrograms/ml.

Adult↗