Evaluation of urethral culture for Neisseria gonorrhoeae in the routine investigation of men attending a STD clinic.

Urethral gonorrhoea was diagnosed by culture in 957 (18.8%) of 5076 new male patients attending a sexually transmitted diseases clinic; the infection was asymptomatic in 38 (4%) of these patients. The diagnosis in only six (0.3%) out of 2159 men with urethral gonorrhoea but with no symptoms or signs of urethritis would have been missed if urethral cultures had not been performed.     

Evaluation of urethral culture for Neisseria gonorrhoeae in the routine investigation of men attending a STD clinic.

Urethral gonorrhoea was diagnosed by culture in 957 (18.8%) of 5076 new male patients attending a sexually transmitted diseases clinic; the infection was asymptomatic in 38 (4%) of these patients. The diagnosis in only six (0.3%) out of 2159 men with urethral gonorrhoea but with no symptoms or signs of urethritis would have been missed if urethral cultures had not been performed.     

One-step staining of Neisseria gonorrhoeae in urethral discharge by methyl green-pyronin.

Methyl green-pyronin (MGP) was used in a one-step procedure to stain smears of urethral discharge from 169 men. Duplicate smears were stained by Gram's method and discharge was cultured for Neisseria gonorrhoeae. The organisms were isolated from 67 specimens and intracellular diplococci were seen in 74 smears after Gram staining and in 77 after staining by MGP. Furthermore, more extracellular and intracellular diplococci were seen in smears stained by MGP than by Gram's method and the proportion of polymorphonuclear leucocytes found to contain the organisms was greater after staining with MGP. Staining with MGP is simple, rapid, inexpensive, and easily automated.     

Characterisation of PPNG and non-PPNG Neisseria gonorrhoeae isolates from Singapore.

OBJECTIVE--To characterise Neisseria gonorrhoeae isolates from Singapore. DESIGN--Characterisation of Neisseria gonorrhoeae isolates by auxotyping, serological analysis and plasmid profile analysis. SPECIMENS--Sixty randomly collected isolates from 41 symptomatic, untreated males and 19 female prostitutes were studied. RESULTS--Auxotyping of 25 PPNG and 35 non-PPNG strains showed that the Pro-auxotype was prevalent among both PPNG (56%) and non-PPNG (42.5%) strains. Prototrophic strains comprised 28% of PPNG and 32.5% of non-PPNG strains respectively. Serovar analysis showed that with the exception of seven serogroup WI strains, the majority belonged to serogroup WII/III. Serovar Aedih was predominant among both serogroup WI PPNG (80%) and non-PPNG (100%) strains. Serogroup WII/III PPNG strains were represented by nine serovars with the predominant serovars being Bacjk (28%) and Bcgjk (16%). Eleven serovars were identified in the WII/III non-PPNG strains and the major serovars were Bajk (20%), Bacjk (17%), Back (11.4%) and Beghjk (11.4%). Analysis of the 25 PPNG strains showed that 16 of them carried the 4.4 MDa (Asian type) resistance plasmid and nine strains harboured the 4.4 MDa plasmid in conjunction with the 24.5 MDa transfer plasmid. The cryptic plasmid of 2.6 MDa was present in 27 of the 35 non-PPNG strains. Five of the non-PPNG strains harbouring the cryptic plasmid also contained the 24.5 MDa transfer plasmid. The plasmid combination of 2.6 + 7.8 + 24.5 MDa was detected in three non-PPNG strains. CONCLUSION--The combination of epidemiological methods used in this study indicated the heterogeneity of N gonorrhoeae strains in Singapore. A total of 16 different combinations of auxotype, plasmid profile and serovar were seen in the 25 PPNG strains compared with 24 such combinations in the 35 non-PPNG strains. Such sensitive differentiation would otherwise not be possible using either auxotype-serovar (A/S) or auxotype-plasmid analysis.     

Penicillinase-producing Neisseria gonorrhoeae infection in India

In 1986-1987, health workers at the Banaras Hindu University Hospital in Varanasi, India took gonococcal smears from both men and women so laboratory personnel could test for detection of penicillinase-producing Neisseria gonorrhoea (PPNG). None of the cultures tested positive for PPNG. They were detected in 3 cases in Varanasi in 1983, however. Nevertheless PPNG strains remained rare in Varanasi. The 1st reported case of PPNG occurred in Madras in 1981. In 1989, only 52 cases of PPNG had been reported nationwide. The researchers suggested that such a low yield of PPNG isolates may be due to underreporting of STDs in general and inadequate laboratories and equipment to culture gonococci at most centers. Furthermore, many health practitioners treat urethritis patients without laboratory confirmation and switch antibiotics at the 1st possible sign of treatment failure. The researchers proposed educating practitioners about wise use of recommended effective STD therapies to not deplete the antimicrobial reserve. In addition, researchers should conduct studies to determine the exact prevalence of PPNG strains in an area. They should also conduct studies on treatment failure rates with the 1st line drug of choice to monitor drug efficacy. For example, cure rates 90% should be unacceptable for gonorrhea. They concluded by advocating the provision of a test for penicillinase production at all centers in India.     

A mouse intracerebral infection with Neisseria gonorrhoeae.

An intracerebral challenge of HPB black mice with Neisseria gonorrhoeae is described. In this mode, the mice died from 1 to 6 days after challenge, and T1 organisms were obtained up to the fifth day from brain, liver, kidney, and spleen. Experimental gonococcal vaccines gave good protection against the challenge.     

Prepartal infection of the placenta with Neisseria gonorrhoeae.

Placentas from 191 consecutive deliveries were cultured for Neisseria gonorrhoeae and other bacteria before being examined histologically. N gonorrhoeae was seen on direct microscopical examination and cultured from two placentas, one of which had chorioamnionitis and the other had a granulocytic invasion of the membranes. In both patients, rupture of the membranes had occurred two hours or less before delivery, and thus after infection. A third patient was also found to have light gonococcal infection of the placenta. Six infections with group B streptococci were identified, but only one correlated with chorioamnionitis. Chorioamnionitis was observed in 16 (8.4%) and granulocytic infiltration of the membranes in 18 (9.4%) of the deliveries.     

One-step staining of Neisseria gonorrhoeae in urethral discharge by methyl green-pyronin

Methyl green-pyronin (MGP) was used in a one-step procedure to stain smears of urethral discharge from 169 men. Duplicate smears were stained by Gram's method and discharge was cultured for Neisseria gonorrhoeae. The organisms were isolated from 67 specimens and intracellular diplococci were seen in 74 smears after Gram staining and in 77 after staining by MGP. Furthermore, more extracellular and intracellular diplococci were seen in smears stained by MGP than by Gram's method and the proportion of polymorphonuclear leucocytes found to contain the organisms was greater after staining with MGP. Staining with MGP is simple, rapid, inexpensive, and easily automated.     

Comparison of Neisseria gonorrhoeae isolates from homosexual and heterosexual men.

The gene locus known as mtr confers resistance to hydrophobic dyes, detergents, and antibiotics. It has been suggested previously that the host environment is important in the selection of gonococcal strains with this outer membrane phenotype, and thus that strains with mtr gene loci should predominate in environments high in hydrophobic molecules. Furthermore, resistance to hydrophobic molecules has been related to a sevenfold increase in a minor outer membrane protein. To test these suggestions the outer membrane phenotypes of 61 strains of Neisseria gonorrhoeae were identified using 27 rectal isolates from homosexual men and 34 urethral isolates from heterosexual men who were matched for age. The cell envelope phenotype of each strain was identified on the basis of resistance to various hydrophobic compounds. The results were compared with the protein profiles of these strains on sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE); no significant correlation was found.     

Detection of mixed infection of Neisseria gonorrhoeae

We report the first published evidence, to our knowledge, of the demonstration of the potential existence of mixed infections of Neisseria gonorrhoeae in vivo through the use of a highly discriminatory genotypic technique.     

Chlamydia trachomatis and Neisseria gonorrhoeae infection and the sexual behaviour of men who have sex with men

BACKGROUND: Rates of bacterial sexually transmitted infections (STIs) continue to rise among men who have sex with men (MSM) in the UK. OBJECTIVE: To evaluate factors associated with Chlamydia trachomatis and Neisseria gonorrhoeae among MSM attending a genitourinary medicine clinic in inner London. STUDY DESIGN: 599 MSM undergoing testing for STIs were recruited. Specimens for ligase chain reaction (LCR), strand displacement amplification (SDA) assay and culture were collected from the pharynx, urethra and rectum for the detection of C trachomatis and N gonorrhoeae. Details regarding demographics, symptoms, signs and sexual behaviour were recorded. Associations of these factors with each infection were tested, adjusting for other risk factors. RESULTS: The prevalence of C trachomatis and N gonorrhoeae was 11.0% and 16.0%, respectively. LCR and SDA performed well for the detection of C trachomatis and N gonorrhoeae from urethra and rectum. Using either method, compared with our current testing policy, over 18% of those with C trachomatis and N gonorrhoeae would not have had their infection diagnosed or treated. Age, sexual behaviour, urethral and rectal symptoms and signs were strongly associated with both infections. A total of 33.7% of men reported at least one episode of unprotected anal intercourse in the previous month. Men reporting multiple episodes were markedly more likely to be HIV positive. CONCLUSION: The prevalence of infection, rates of partner acquisition and unprotected anal intercourse reported among these MSM are alarming. Improved detection of C trachomatis and N gonorrhoeae using nucleic acid amplification tests has major public health implications for STI and possibly HIV transmission in this population.     

Characterisation of Neisseria gonorrhoeae from women with simultaneous infections at two sites.

Infection with two strains of Neisseria gonorrhoeae was found in paired cultures from 8.7% (6/69) of women who had infections of the cervix, rectum, or urethra. Paired gonococcal cultures from each patient were characterised by auxotyping, susceptibility to four antibiotics, and acrylamide gel electrophoresis patterns of the gonococcal cell proteins.     

Immunogenetic correlates of Neisseria gonorrhoeae infection in adolescents

BACKGROUND: Understanding host factors modulating immunity to Neisseria gonorrhoeae infection may benefit work on vaccine development. METHODS: We analyzed longitudinal data collected from 485 male and female adolescents to determine genetic correlates of genital gonorrhea. Cytokine data from 388 females were analyzed to assess immunologic markers of gonorrhea and their relationship to genetic correlates. RESULTS: The T-G haplotype defining interleukin-2 (IL-2) gene promoter and intron 1 polymorphisms (-330T and -166G) was more frequently found in individuals who had gonorrhea (relative odds = 3.2, P = 0.01). Among 3 endocervical cytokines measured, IL-10 and IL-12 concentrations were higher and IL-2 lower when gonorrhea was detected. The decrease in endocervical IL-2 after gonorrhea acquisition was mostly restricted to subjects with the IL2 T-G haplotype, which may reflect involvement of a pathogen-specific and genetically mediated mechanism for differential IL-2 responses at genital mucosa. In addition, 2 human leukocyte antigen variants (Cw*04 and DQB1*05) were also independently associated with gonorrhea (adjusted relative odds = 1.9 and 0.5, respectively; P <0.05 for both). CONCLUSIONS: Confirmation of immunogenetic correlates of gonorrhea in larger cohorts may be useful in guiding further research on both innate and adaptive immune responses to N. gonorrhoeae.     

Fulminant endocarditis due to infection with penicillinase-producing Neisseria gonorrhoeae.

Endocarditis is a rare but potentially lethal manifestation of gonococcal infection. We report the case of a patient with fulminant endocarditis secondary to infection with penicillinase-producing Neisseria gonorrhoeae (PPNG). The patient had rapid deterioration from extensive destruction of the aortic valve with abscess and fistula formation. Lifesaving emergency surgery was performed. To our knowledge this is the first reported case of gonococcal endocarditis secondary to infection with a penicillinase-producing organism.     

Azithromycin in the treatment of infection with Neisseria gonorrhoeae

The efficacy of azithromycin as sole antimicrobial treatment for infection with Neisseria gonorrhoeae is reviewed. Aggregate cure rates for urethral and endocervical infection were 520/539 (96.5%; 95% CI 94.3% to 97.6%) for a 1 g dose from nine studies and 392/396 (99%; 95% CI 97.5% to 99.6%) for a 2 g dose from two studies. Azithromycin cured 46/47 (97.9%) cases of oropharyngeal infection and 34/35 (97.1%) cases of rectal infection evaluated within the clinical trials. Reports of in vitro resistance to azithromycin reveal a wide geographical spread of clinical isolates, with raised minimal inhibitory concentration to azithromycin and the emergence of high-level resistance in 2001. Concerns about resistance preclude azithromycin from general recommendation as sole antimicrobial therapy for gonorrhoea. However, azithromycin may have a valuable role in specific clinical situations and in combination with extended spectrum cephalosporins in the treatment of gonorrhoea.     

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in Turkey among men With urethritis.

BACKGROUND: Chlamydia trachomatis and Neisseria gonorrhoeae are known to cause urethritis. However, only a small number of studies in Eastern European countries have investigated the causes of urethritis. GOALS: To determine the prevalence of C trachomatis and N gonorrhoeae among men with symptomatic urethritis in Istanbul, Turkey, and to determine whether contact with a commercial sex worker increased the likelihood of chlamydial infections. STUDY DESIGN: Men with a diagnosis of urethritis at the Istanbul Faculty of Medicine were screened for C trachomatis and N gonorrhoeae by Abbott's ligase chain reaction (LCR) using either urethral swabs or first-void urine. N gonorrhoeae cultures were done on a subset of these patients. RESULTS: The study enrolled 813 men. All of the men denied condom use during their previous sexual exposures. The overall prevalence of C trachomatis, as determined by LCR, was 15.7%. Only 192 patients were screened for both organisms. N gonorrhoeae prevalence was 9.4%. There was no difference in the chlamydia prevalence between men who had contact with commercial sex workers (CSWs) and men who had no such contact (15.3% versus 17.2%). However, clients of foreign CSWs were more likely to have chlamydia than clients of registered Turkish CSWs. CONCLUSIONS: C trachomatis and N gonorrhoeae are commonly found in Turkish men with urethritis. The findings did not show more chlamydial infection among men who had contact with CSWs than among men who had no such contact. The failure to use condoms among these men must be addressed.