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PubMedDate not supplied

Evaluation of hysterectomized women seen at a clinic for treatment of sexually transmitted diseases.

Thirty-one women who had had total hysterectomies, seen in a venereal disease clinic, were interviewed and examined. Thirteen (31%) of the 31 women had acquired one or more venereal infections after hysterectomy. The diseases, listed in order of decreasing frequency, were trichomoniasis (four cases), gonorrhea (three), early latent syphilis (three), vaginal candidiasis (three), secondary syphilis (two), late latent syphilis (two), and condyloma acuminatum (one). These results indicate that clinicians working in venereal disease clinics must maintain as high an index of suspicion of sexually transmissible diseases for women with hysterectomies as for all other women.

Adult↗
PubMedDate not supplied

Analysis of a recent epidemic due to penicillinase-producing Neisseria gonorrhoeae: epidemiologic and medical considerations.

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.

Communicable Disease Control↗
PubMedDate not supplied

One gram of cefoxitin cures uncomplicated gonococcal urethritis caused by penicillinase-producing Neisseria gonorrhoeae (PPNG).

Therapy of disease caused by penicillinase-producing Neisseria gonorrhoeae with lower-than-standard doses of cefoxitin was evaluated. A pilot study showed that doses of greater than or equal to 1 g were adequate, whereas 500-mg doses consistently failed. After the pilot study, 89 men with gonorrhea were treated with 1 g of cefoxitin given intramuscularly plus 1 g of probenecid given orally. Of the 89 men, 86 were cured. Sixty per cent were infected with penicillin-resistant strains of N. gonorrhoeae. The three men who were culture-positive on follow-up had been sexually reexposed, whereas none of those with negative cultures had had reexposure. These clinical results indicate that a treatment regimen of 1 g of parenteral cefoxitin plus 1 g of oral probenecid appears to be as effective as the standard 2-g dose. Regimens using doses lower than 1 g are ineffective.

Adolescent↗
PubMedDate not supplied

Introductory address: gonorrhea today.

The counterattack to the resurgence of one of the commonest infectious diseases, gonorrhea, still consists of epidemiologic measures, correct clinical and microbiological diagnosis, and effective treatment. Few antibiotics effective against Neisseria gonorrhoeae fulfill the criteria of the World Health Organization (i.e., the antibiotic should be effective, safe, free from side effects, capable of aborting simultaneously acquired or coexisting infection with Treponema pallidum or Chlamydia trachomatis, should entail a low incidence of postgonococcal urethritis, and should not be the sole antibiotic used for other, more serious conditions). Therefore, current attention is focused on the use of thiamphenicol for the treatment of uncomplicated urogenital, rectal, and oropharyngeal gonorrhea caused by both beta-lactamase-producing and non-beta-lactamase-producing Neisseria gonorrhoeae.

Aminoglycosides↗
PubMedDate not supplied

Symptomatic response to therapy of men with gonococcal urethritis: do all need posttreatment cultures?

Because the large majority of men with gonorrhea respond to antimicrobial therapy with the rapid disappearance of signs and symptoms, it was hypothesized that a symptomatic response to therapy would predict successful treatment. The records of 4897 men with gonorrhea, of whom 183 (3.7%) were treatment failures on days 3-7 after treatment were studied, and the clinical response to therapy with microbiologic outcome was correlated. Before therapy, 4662 men (95.2%) had dysuria and/or urethral discharge. Of the 582 men who remained symptomatic, 103 (17.7%) had a positive culture after treatment, as compared with only 78 (1.9%) of 4080 men who became asymptomatic (P less than .01). The conclusion was that men who are initially symptomatic and become asymptomatic after therapy have a small chance (one of 50) of being infected at the posttreatment visit. However, because of its very large size, this group contributed almost one-half of all treatment failures (78 of 183; 42.6%).

Amoxicillin↗
PubMed1977

Recent advances in antimicrobial therapy.

Metronidazole is a relatively nontoxic, oral agent which may prove to be useful in the treatment of infections caused by susceptible anaerobic organisms. Use of metronidazole to treat anaerobic infections presently is investigational.

Amikacin↗
PubMed1993

Functional and physiological characterization of the Tn21 cassette for resistance genes in Tn2426.

The Tn21 subgroup of class II transposons plays an important role in the dissemination of resistance genes and especially in the epidemic spread of multi-resistance. This ability reflects the variety of resistance genes that associate with the streptomycin/spectinomycin-resistance gene (aadA) of Tn21. Deletion experiments with Tn2426, a typical member of the Tn21 subgroup, and sequencing of the region that accommodates additional resistance genes revealed significant structural characteristics. Each resistance gene was flanked by short, directly repeated recombinationally active sequences with unexpected variability in their sequence and length. The consensus for a recombinationally active sequence appeared to be 13 bp in length (TAAAACAANGNNA), compared to previous estimates of 54 bp. This sequence, in combination with the product of the integrase gene, is responsible for the genetic variability of members of the Tn21 family of transposable elements and the dissemination of multi-resistance.

Amikacin↗