Blood ethanol concentrations in patients attending special clinics in Glasgow.

Blood samples for measurement of ethanol concentration were taken on a routine basis from 543 male and 158 female patients attending Special Clinics in Glasgow. Ethanol was detected in 56 (10-3 per cent.) of the men and eight (5-1 per cent.) of the women, and at concentrations in excess of 0-1 g./l. in 37 (6-8 per cent.) and three (1-9 per cent.) respectively. In nine men and one woman, the blood ethanol concentration was over 0-8 g./l. when they attended the clinic. The majority (84 per cent.) of positive findings were obtained in specimens collected after 2 p.m. and one-quarter on Tuesday afternoons, the local half-day. The other peak periods related to attendance at football matches on Wednesday evenings, and to receiving wages on Friday mornings. Male new patients attending a clinic for the first time had the highest incidence, 32 (11-6 per cent.) having detectable amounts of ethanol among whom 26 (9-4 per cent.) had levels in excess of 0-1 g./l., compared with only 4-1 per cent. among those either returning to the clinics with a fresh infection or on surveillance. Only 5 per cent. of female patients attending for the first time and 3 per cent. of those on surveillance had detectable amounts of ethanol in the blood, compared with 9 per cent. of those few returning with fresh infections. Levels in excess of 0-1 g./1. were only found in promiscuous women. Those with concentrations in excess of 0-8 g./1. were unreliable attenders. Only one, a known alcoholic, completed surveillance; one defaulted after his fourth visit, four after the second, and four after the first visit.     

Blood ethanol concentrations in patients attending special clinics in Glasgow.

Blood samples for measurement of ethanol concentration were taken on a routine basis from 543 male and 158 female patients attending Special Clinics in Glasgow. Ethanol was detected in 56 (10-3 per cent.) of the men and eight (5-1 per cent.) of the women, and at concentrations in excess of 0-1 g./l. in 37 (6-8 per cent.) and three (1-9 per cent.) respectively. In nine men and one woman, the blood ethanol concentration was over 0-8 g./l. when they attended the clinic. The majority (84 per cent.) of positive findings were obtained in specimens collected after 2 p.m. and one-quarter on Tuesday afternoons, the local half-day. The other peak periods related to attendance at football matches on Wednesday evenings, and to receiving wages on Friday mornings. Male new patients attending a clinic for the first time had the highest incidence, 32 (11-6 per cent.) having detectable amounts of ethanol among whom 26 (9-4 per cent.) had levels in excess of 0-1 g./l., compared with only 4-1 per cent. among those either returning to the clinics with a fresh infection or on surveillance. Only 5 per cent. of female patients attending for the first time and 3 per cent. of those on surveillance had detectable amounts of ethanol in the blood, compared with 9 per cent. of those few returning with fresh infections. Levels in excess of 0-1 g./1. were only found in promiscuous women. Those with concentrations in excess of 0-8 g./1. were unreliable attenders. Only one, a known alcoholic, completed surveillance; one defaulted after his fourth visit, four after the second, and four after the first visit.     

Shigellosis. Another sexually transmitted disease?

Following the clinical observation that there appeared to be an association between shigellosis and male homosexuality, the medical records of 113 patients at The New York Hospital were reviewed retrospectively. Of the 38 males studied who were between the ages 19 and 61, seventeen were homosexual (44-7 per cent.). Only one of the matched controls was homosexual. Of the men with shigellosis who had a history of foreign travel, 10 per cent. were homosexual; however, among the patients without a travel history, 57-1 per cent. were homosexual (P less than 0-05). For male patients with shigellosis who do not have an appropriate travel history, the physician should expand his epidemiological investigation to include sexual contacts. Men and women who perform rectal intercourse should be cautioned to abstain from this activity until their stool cultures are negative for shigella. If a male patient with shigellosis is homosexual, he should be screened for other sexually transmitted diseases such as syphilis, gonorrhoea, hepatitis B, and amoebiasis.     

Shigellosis. Another sexually transmitted disease?

Following the clinical observation that there appeared to be an association between shigellosis and male homosexuality, the medical records of 113 patients at The New York Hospital were reviewed retrospectively. Of the 38 males studied who were between the ages 19 and 61, seventeen were homosexual (44-7 per cent.). Only one of the matched controls was homosexual. Of the men with shigellosis who had a history of foreign travel, 10 per cent. were homosexual; however, among the patients without a travel history, 57-1 per cent. were homosexual (P less than 0-05). For male patients with shigellosis who do not have an appropriate travel history, the physician should expand his epidemiological investigation to include sexual contacts. Men and women who perform rectal intercourse should be cautioned to abstain from this activity until their stool cultures are negative for shigella. If a male patient with shigellosis is homosexual, he should be screened for other sexually transmitted diseases such as syphilis, gonorrhoea, hepatitis B, and amoebiasis.     

The erythrocyte sedimentation rate in syphilis.

The erythrocyte sedimentation rate was studied in 520 men and 202 women with syphilis. It was raised in 66-6 per cent. of sero-negative primary cases, 80 per cent. of sero-positive cases, 100 per cent. of secondary cases, 80 per cent. of early latent cases, and 73-9 per cent. of late latent cases. It was also raised in sixteen out of seventeen cases of neurosyphilis and in all eleven cases of cardiovascular syphilis. It was concluded that the ESR had little place in the management of syphilis in general, but could be helpful in the post-treatment follow-up of late syphilis.     

The syphilis epidemic in Connecticut: relationship to drug use and prostitution

Syphilis rates in Connecticut increased four-fold between 1986 and 1988. During this time there were also signs of a large increase in cocaine use in the state. We studied links between these parallel trends in drug use and syphilis by examining two sources of data: information collected during syphilis case interviews and information from the syphilis screening program at the state's prison for women. As syphilis rates rose, there were large increases in the percentage of women with syphilis who reported prostitution or illicit drug use. In 1988, 41% of women with syphilis reported cocaine use, and 19% reported prostitution; 21% of male heterosexuals with syphilis reported cocaine use, and 31% reported sexual contact with prostitutes. Among incarcerated women, syphilis infection was frequent: of 113 women incarcerated for possession of illicit drugs in 1987-88, 7% were found to be infected with Treponema pallidum, and of 187 women incarcerated for prostitution in these years, 14% were infected. In both groups of incarcerated women studied, cocaine users had the highest syphilis rates, and those who administered drugs nonintravenously had rates similar to those who administered drugs intravenously. We concluded that the syphilis epidemic in Connecticut is related to the increase in use of illicit drugs (primarily cocaine) and that female drug users are at very high risk of syphilis regardless of whether they administer drugs intravenously or nonintravenously. We recommend that syphilis control efforts focus on wider serologic screening and early treatment of drug users, prostitutes, and their sex partners.     

Automation of a flocculation test for syphilis on Groupamatic equipment.

A flocculation reaction employing a cardiolipid antigen was used for syphilis screening on Groupamatic equipment in parallel with conventional screening reactions: Kolmer CF, RPCF, Kahn, Kline, and RPR. The positive samples were confirmed by FTA-200, FTA-ABS, TPI, and in some cases by TPHA. There were 5,212 known samples which had already been tested by all methods and of which 1,648 were positive, and 58,636 screened samples including 65 positives. Half of the samples in the first series were taken without anticoagulant; the remainder were collected in potassium EDTA. The percentage of false positives with the Groupamatic was about 1-4 per cent. The percentage of false negatives among positve (greater than or equal+) samples varied from 0-18 to 1-3 per cent.; on the other hand the sensitivity was less good for samples giving doubtful and/or dissociated reactions in conventional screening reactions. The specificity and sensitivity of this technique are acceptable for a blood transfusion centre. The reproducibility is excellent and the automatic reading of results accurate. Additional advantages are rapidity (340 samples processed per hour); simultaneous performance of eleven other immunohaematological reactions; no contamination between samples; automatic reading, interpretation, and print-out of results; and saving of time because samples are not filed sequentially and are automatically identified when the results are obtained. Although the importance of syphilis in blood transfusion seems small, estimates of the risk are difficult and further investigations are planned.     

广东省佛山市2004~2011年淋病和梅毒流行特征分析

目的:分析佛山市2004~2011年淋病和梅毒的流行特征,为制定防治策略提供科学依据.方法:对2004~2011年佛山市淋病和梅毒疫情报告资料进行描述性分析.结果:自2005年以来,淋病报告发病率呈减少趋势;在梅毒报告病例中,隐性梅毒构成比为50%,其报告发病率呈上升趋势,而Ⅰ期+Ⅱ期梅毒报告发病率呈减少趋势.淋病及梅毒报告病例中,男女性别比分别为1:0.13、1:0.85,发病均以20~39岁青壮年为主,职业构成均以工人、民工为主.报告例数主要集中在南海区、顺德区.结论:由于近年来采取有效的防治措施,自2005年以来佛山市淋病与梅毒的流行呈减少趋势,但控制梅毒母婴传播的任务依然艰巨.     

Some characteristics of homosexual men.

Although recognition of homosexuals is often important, many doctors lack the necessary skill or experience, so to assist them a group of 5,302 men was surveyed using a computer-based data system and 9-1 per cent. were recorded as homosexual. Analysis showed a relatively high proportion of homosexuals among men with syphilis and gonorrhoea, and a low proportion among men with nonspecific genital infection (non-specific urethritis and proctitis) and other infections. All men with secondary syphilis were homosexual. A relatively high proportion of men born in Eire, Spain, and North America were homosexual and a relatively high proportion of men living in the West End of London were homosexual. While these findings will be of most value to those working in STD clinics in London they may also be helpful to those working elsewhere and in other disciplines.     

Some characteristics of homosexual men.

Although recognition of homosexuals is often important, many doctors lack the necessary skill or experience, so to assist them a group of 5,302 men was surveyed using a computer-based data system and 9-1 per cent. were recorded as homosexual. Analysis showed a relatively high proportion of homosexuals among men with syphilis and gonorrhoea, and a low proportion among men with nonspecific genital infection (non-specific urethritis and proctitis) and other infections. All men with secondary syphilis were homosexual. A relatively high proportion of men born in Eire, Spain, and North America were homosexual and a relatively high proportion of men living in the West End of London were homosexual. While these findings will be of most value to those working in STD clinics in London they may also be helpful to those working elsewhere and in other disciplines.     

Commercial sex venues: a closer look at their impact on the syphilis and HIV epidemics among men who have sex with men

OBJECTIVE: To provide insight into the role of commercial sex venues in the spread of syphilis and HIV among men who have sex with men (MSM). Study: A cross sectional study of 1351 MSM who were diagnosed with early syphilis who did and did not encounter sexual partners at commercial sex venues. RESULTS: Overall, 26% MSM diagnosed with syphilis had sexual encounters at commercial sex venues. Of these, 74% were HIV positive, 94% reported anonymous sex, and 66% did not use a condom. Compared to those who did not have a sexual encounter at these venues, they were twice as likely to be HIV positive (OR = 1.91, 95% CI 1.36 to 2.68), six times more likely to have anonymous sex (OR = 6.18, 95% CI 3.37 to 11.32), twice as likely not to use condom (OR = 2.02, 95% CI 1.71 to 2.38), and twice as likely to use non-injecting drugs (OR = 1.65, 95% CI 1.21 to 2.37). CONCLUSIONS: MSM diagnosed with syphilis who frequent commercial sex venues are engaging in high risk behaviours for syphilis and HIV transmission and acquisition. Thus commercial sex venues are one of the focal points of syphilis and HIV transmission and acquisition.     

Surfing with spirochaetes: an ongoing syphilis outbreak in Brighton

BACKGROUND/OBJECTIVES: There has been a recent shift in the epidemiology of early syphilis in the developed world with sporadic outbreaks on a historic low level of background disease. Here we describe an ongoing outbreak of syphilis in Brighton. METHODS: Data collected on all patients with a diagnosis of early infectious syphilis at Brighton GUM clinic. RESULTS: 30 cases of early syphilis were diagnosed over a 25 month period beginning in July 1999. 28 were homosexual or bisexual men, giving a rate of 134 cases per 100 000 homosexual men. The cases reported a median of three sexual contacts (range 1-50) in the preceding 6 months and 77% had concurrent regular and casual partners. 83% of contacts were casual and untraceable. Over one third (11) of these cases reported oral sex as their only risk factor for syphilis acquisition and were unaware of this transmission route. 70% were diagnosed with primary or secondary infection, the remaining 30% being asymptomatic with early latent infection. Eight of the cases were HIV positive and a further eight remain untested for HIV. At least one concurrent STI was found in 40% of cases. Regular outbreak control meetings, involving relevant healthcare professionals, were held to plan appropriate interventions. CONCLUSION: The high rate of casual and untraceable contacts in this outbreak suggest that alternative control measures are necessary, including on-site testing and further health education regarding the oral transmission of syphilis. Continued vigilance for syphilis is essential, especially in those patients who are HIV positive.     

Human immunodeficiency virus and other sexually transmitted infections among female sex workers in two major cities in Papua New Guinea

BACKGROUND: Treatable sexually transmitted infections are very common in developing countries and quite often are inadequately treated or remain untreated despite the fact that they enhance the transmission of human immunodeficiency virus (HIV). GOAL: To estimate the prevalence of HIV, syphilis, chlamydial infection, gonorrhea, and trichomoniasis among female sex workers in Port Moresby and Lae, Papua New Guinea, and to collect data on associated behaviors. STUDY DESIGN: Self-identified female sex workers recruited through our peer-mediated sexually transmitted disease (STD)/HIV risk-reduction community outreach program were invited to participate in the study. Participants underwent pretest counseling, were interviewed, and were asked to self-collect vaginal swab specimens for the detection of STDs and to provide 10 mL of blood for HIV and syphilis testing. RESULTS: A total of 407 female sex workers, 207 in Port Moresby and 200 in Lae, were enrolled in the study. The overall prevalence rates of HIV, syphilis, genital chlamydial infection, gonorrhea, and trichomoniasis among these women were estimated to be 10%, 32%, 31%, 36%, and 33%, respectively. The sex workers in Port Moresby had a significantly higher HIV infection rate (17%) than those in Lae (3%) and a significantly lower trichomoniasis rate (21%) than those in Lae (44%). Mixed infections were common, occurring in 45% of the cases. Despite a high rate of symptoms, the rate of treatment-seeking was low. Condom use among the sex workers was very inconsistent; 85% reported that they did not use condoms at all times when having sex with their clients. Common reasons cited were dislike by clients, unavailability, alcohol use, and familiarity with a client. CONCLUSIONS: STDs are very common among female sex workers in Port Moresby and Lae and very often present as multiple infections. Despite STD/HIV awareness campaigns, unsafe sex-particularly irregular use of condoms-continues among sex workers and their clients. Barriers to safer sexual behavior need to be addressed, as do improvements in provision of STD services.     

Seroepidemiological study of gonorrhoea in Ethiopian women. 1. Prevalence and clinical significance.

OBJECTIVE--To measure the prevalence of gonorrhoea in Ethiopian women attending gynaecologic, obstetric and family planning clinics: to determine the reliability of patient self history of sexually transmitted disease (STD); to correlate the serological diagnosis of gonorrhoea with clinical evidence of pelvic infection in order to define a reliable clinical diagnosis of gonorrhoea in a country where pelvic inflammatory disease is very common but where routine laboratory culture and serological tests for gonorrhoea are unavailable. SUBJECTS--1851 Ethiopian women: 50% symptomatic, 50% asymptomatic. SETTING--Gynaecological outpatient department, antenatal, postnatal and family planning clinics (Ethiopian Family Guidance Association (EFGA)), in two teaching hospitals and a mother and child health centre in Addis Ababa, Ethiopia. METHODS--The indirect haemagglutination test with gonococcal pilus antigen as an epidemiological tool was used in a cross-section study to screen 1851 sera for evidence of past or current gonococcal infection. The gonococcal antibody test (GAT) seropositivity was correlated with patient's history of STD, age, clinic attended and the clinical evidence of infection in "gonococcal target organs" urethra, salpinges or Bartholin glands. RESULTS--Fifty nine per cent of the study group were seropositive for the gonococcal antibody test, 22% with titres greater than or equal to 1/320, indicative of current, recent or recurrent infection. Seropositivity indicating past or present gonococcal infection was highest in those who gave a history of having had treated syphilis (85%), in women aged 40-49 (72%), and family planning attenders (EFGA) (66%) of whom 31% had titres greater than or equal to 1/320. Fifty per cent had clinical evidence of past or present infection in the urethra, salpinges or Bartholin glands. Gonococcal antibodies were present in 54% of women with no evidence of clinical infection, compared with 91% of those with pyosalpinx and 86% of those with triple infection of urethra, salpinges and Bartholin glands. CONCLUSION--The high prevalence of gonococcal antibodies in Ethiopian women, especially in asymptomatic clinic attenders must be of concern for all health workers especially those in gynaecology and obstetrics and the related disciplines of family planning and neonatal paediatrics. While seropositivity was highest in those giving a past history of syphilis, the patient's history of STD was unreliable, as of those who denied having any history of STD, fifty per cent were GAT seropositive. Despite a high correlation between GAT seropositivity with pyosalpinx and clinical evidence of infection in urethra, salpinges and bartholin glands, gonococcal antibodies were present in 54% of women with no clinical evidence of infection. Thus we were unable to define a diagnostic clinical picture of gonorrhoea in Ethiopian women.     

2006-2010年贵阳市梅毒流行状况分析

目的分析贵阳市梅毒流行状况,为制定预防控制措施提供依据。方法对贵阳市2006-2010年梅毒疫情资料进行分析。结果 2006-2010年贵阳市梅毒报告累计数为5489例,年平均发病率为28.11/10万,2010年达55.73/10万,年均增幅53.38%。男女比例为1:1。以隐性梅毒、一期梅毒、二期梅毒为主,三者共占报告梅毒总例数的96.76%。隐性梅毒和早期显性梅毒(一、二期梅毒)病例数逐年增加。22～44岁的性活跃期青壮年组所占比例最高,为44.34%。职业分布以无业及工人(包括民工)居多,占66.10%,这两类人群及高年龄组(65岁及以上)人群发病比例有逐年增加趋势。结论贵阳市梅毒发病率呈逐年上升趋势,应规范梅毒的诊疗,加强监测,采取有效的干预措施,控制梅毒的传播和蔓延。     

2014—2019年中国梅毒流行趋势与特征分析

【摘要】 目的 分析2014—2019年中国梅毒流行趋势和特征,为制定防治对策提供依据。方法 应用描述性流行病学方法对2014—2019年中国梅毒报告病例数据进行“三间分布”分析。结果 2014—2019年,梅毒报告发病率由30.93/10万增长至38.37/10万,年均增长4.41%;其中一期与二期梅毒、胎传梅毒报告发病率年均下降10.95%和26.16%,三期梅毒和隐性梅毒年均增长1.61%和10.75%。高发省份为新疆、青海、浙江、海南和福建等。各年男性梅毒报告发病率略低于女性,男女性别比为0.86∶1～0.96∶1。15～19岁组呈逐年快速增长趋势,年均增长13.54%。2014—2018年梅毒高发年龄段为25～34岁,2019年为20～24岁。各职业人群均有病例报告,以农民和民工最多,占41.19%～46.80%,学生人群增幅最大,年均增长20.72%。一期与二期梅毒构成比逐年减少,隐性梅毒构成比逐年增加,2019年达82.95%。结论 2014—2019年中国梅毒总报告发病率逐年增长,一期和二期梅毒报告发病率下降;年轻人群报告发病率快速增长;农民、民工为重要受影响人群;高发地区为西北部分地区和东南沿海部分省份。     

Tumour necrotizing factor-alpha promoter and GST-T1 genotype predict skin allergy to chromate in cement workers in Taiwan

BACKGROUND: Construction workers exposed to cement are known to suffer from occupational contact dermatitis because of chromate sensitization. It is not clear whether certain genotypes are associated with increased susceptibility of chromate sensitization in those workers regularly exposed to cement. OBJECTIVE: The objective of this study was to determine the genotypes predisposing workers to cement-induced contact dermatitis. METHODS: A total of 153 current cement workers who had regular contact with cement were telephone interviewed for skin problems in the past 12 months, work exposure, and personal protection. A dermatologist examined their skin and conducted patch test with common skin allergens. Blood samples were donated for genotypic determination by polymerase chain reaction-based assays for GST-T1, GST-M1 (null/non-null), tumour necrosis factor (TNF) alpha promoter-308G/A, and interleukin (IL) 4-590C/T. RESULT: High percentage of dermatitis was noted in the 153 workers examined, which was correlated with reported skin problems. By patch testing, construction workers had a high-prevalence rate (12%) of sensitivity to chromate. Sensitivity to chromate was significantly associated with TNF alpha promoter-308 heterozygous (GA) as compared with GG genotype (odds ratio 3.9, 95% confidence interval 1.1-13.2), as well as with GST-T1 null genotype (odds ratio 5.5, 95% confidence interval 1.4-36.2), but neither the GST-M1 nor the IL-4 genotypes. CONCLUSION: It is concluded that among workers frequently exposed to cement in Southern Taiwan, those with TNF alpha promoter-308 heterozygous (GA) genotype or GST-T1 null genotype had increased risk of chromate sensitization.     

青岛市2010-2017年梅毒流行趋势及高危人群梅毒流行情况分析

目的：了解青岛市梅毒流行病学特征，为制定防控策略和措施提供依据。方法：对2010－2017年青岛市梅毒发病资料和血清学检测结果进行统计分析。结果：2010－2017年青岛市共报道梅毒16769例，年均发病率在18.32/10万～30.01/10万之间，整体呈上升趋势，年均增长3.18%。患者以青壮年为主，20~49岁占72.64%，60岁以上人群报告病例所占比例逐年上升，构成比由2010年的6.11%上升到2017年的25.78%；职业以家务及待业占比最高（26.97%），其次为农民占18.87%。暗娼、男男性行为人群及吸毒人群的梅毒平均感染率分别为9.65%，6.85%，9.25%。地区分布以市北区年均发病率最高，其次为李沧区、市南区，分别为47.58/10万、33.08/10万、32.05/10万。结论：青岛市梅毒年发病率总体呈上升趋势，老年人梅毒发病上升明显。     

A consequence of the syphilis epidemic among men who have sex with men (MSM): neurosyphilis in Los Angeles, 2001-2004

OBJECTIVES: To describe the epidemiology and clinical findings of neurosyphilis (NS) cases diagnosed during the current syphilis epidemic occurring predominantly among men who have sex with men. METHODS: Syphilis cases reported to the health department were reviewed for diagnosis of NS, cerebrospinal fluid venereal disease research laboratory results, and/or treatment for NS. RESULTS: During 2001-2004, 7083 cases of syphilis were diagnosed in Los Angeles. One hundred nine cases of confirmed or probable NS occurring among persons aged 19 to 65 years were identified during this period (1.5%). Symptomatic NS was present in 1.2% of reported syphilis cases (86 of 7083). NS cases were inclusive of 71 (65%) men who have sex with men. Forty-two (49%) of the symptomatic NS cases occurred during secondary (N = 28) or early latent (N = 14) syphilis. Sixty-eight percent (N = 74) of the NS cases were human immunodeficiency virus (HIV)-positive. The estimated incidence of symptomatic NS among HIV-infected persons with early syphilis was 2.1% as compared with 0.6% among HIV-negative persons. CONCLUSION: Providers should maintain a high index of suspicion for NS among patients with syphilis, particularly those with HIV infection.     

Gonorrhoea in 1972. A 1-year study of patients attending the VD Unit in Uppsala.

During 1972 a total of 2,090 men and 1,489 women were seen in the VD clinic in Uppsala, Sweden. The most frequent diagnosis among the men was non-gonococcal urethritis (38 per cent.) and among the women non-gonococcal vaginitis (34 per cent.), N. gonorrhoeae was found in 22 per cent. of the men and in 33 per cent. of the women, 68 per cent. of the men with gonorrhoea attended because of symptoms, but 67 per cent. of the men without gonococcal infections came for the same reason. 39 per cent. of the women with gonorrhoea attended after being told by their sexual partner; it was found that women coming because of symptoms were most likely to have non-gonococcal infection. Gonorrhoea without subjective symptoms was found in 23 per cent. of the men and 50 per cent. of the women. Gonorrhoea was found in association with scabies in 9 out of 18 men and in 3 out of 5 women. A rising incidence of pharyngeal gonococcal infections has been noticed at the clinic and the figures for 1972 were 6 per cent. of the men and 9 per cnet. of the women with gonorrhoea. The route of infection was usually oro-genital contact, but in some cases other routes had to be considered. It was not possible to define a promiscuous group of patients suitable for a planned study of prophylactic treatment, as only 2 per cent. of the men and 1 per cent. of the women had had nore than one gonococcal infection during the preceding year. The standard treatment for genital gonorrhoea (ampicillin 2 times 1 g. orally with a 5-hour interval) was very satisfactory and gave a 98 per cent. cure rate. This was possible because there were few gonococcal strains with decreased panicillin sensitivity. There were considerable problems in treating the pharyngeal infections, the standard treatment failing in 61 per cent.