Antibiotic susceptibilities and auxotypes of Neisseria gonorrhoeae strains from women with pelvic inflammatory disease or uncomplicated infections

The purpose of the present study was to compare the auxotypes and the minimal inhibitory concentrations of four antibiotics for 50 isolates from women with gonococcal pelvic inflammatory disease with those of 55 isolates from uncomplicated anogenital gonococcal infections. No significant differences in auxotype patterns and susceptibilities were found between isolates from the two groups.     

Gonorrhea in pregnancy and in the newborn

Prevalence rates of gonorrhea in pregnancy range from 0.2 to 15 percent. Pharyngeal gonorrhea is more frequent in some prenatal populations. A degree of protection against pelvic inflammatory disease occurs in pregnancy, but there is an increased risk for disseminated gonococcal infection. Maternal gonococcal infection is associated with ectopic pregnancy, prematurity and ophthalmia neonatorum. Prompt and aggressive treatment is required for ophthalmia neonatorum.     

Analysis of clinical manifestations of male patients with urethritis

Almost all physicians involved in treating sexually transmitted infections recognize the specific clinical manifestations of patients with urethritis. However, in previous studies, the diagnosis of gonococcal urethritis was based on cultures or staining methods. In this study, we examined in detail the clinical manifestations of patients with urethritis diagnosed by the nucleic acid amplification test (NAAT). A total of 154 patients with male urethritis were included in the study. The NAAT could distinguish 64 patients with gonococcal urethritis, 45 patients with chlamydial urethritis, and 45 patients with nongonococcal and nonchlamydial urethritis. Forty-three (67.2%) patients with gonococcal urethritis had more severe symptoms, i.e., moderate or profuse urethral discharge, and cloudy or purulent discharge, than patients with chlamydial urethritis, nongonococcal and nonchlamydial urethritis. There were 39 (86.7%) patients in the chlamydial urethritis group with mild symptoms, clear discharge or none, and moderate or profuse discharge. Although the diagnosis of male urethritis can be performed by microbiological examination, the typical symptoms help us to distinguish each type of urethritis and understand this kind of disease.     

Antibodies to opacity proteins (Opa) correlate with a reduced risk of gonococcal salpingitis.

Acute salpingitis complicating cervical gonococcal infection is a significant cause of infertility. Relatively little data are available concerning the pathophysiologic mechanisms of this disease. A cohort of 243 prostitutes residing in Nairobi were followed between March 1985 and April 1988. Gonococcal cultures were performed at each visit, and acute salpingitis was diagnosed clinically. Serum at enrollment was tested by immunoblot for antibody to gonococcal outer membrane proteins. 8.6% (146/1689) of gonococcal infections were complicated by salpingitis. Increased risk of salpingitis was associated with younger age, shorter duration of prostitution, HIV infection, number of gonococcal infections, and episodes of nongonococcal salpingitis. Rmp antibody increased the risk of salpingitis. Antibody to Opa decreased the risk of salpingitis. By logistic regression analysis, antibody to Opa was independently associated with decreased risk of gonococcal salpingitis (adjusted odds ratio [OR], 0.35; 95% confidence interval [95%CI], 0.17-0.76); HIV infection (adjusted OR, 3.5; 95% CI, 0.96-12.8) and episodes of nongonococcal salpingitis (adjusted OR, 3.4; 95% CI, 1.8-6.4) were independently associated with an increased risk of salpingitis. Antibody to Opa appears to protect against ascending gonococcal infection, perhaps by interfering with Opa mediated adherence and endocytosis. The demonstration of natural immunity that protects against upper genital tract infection in women suggests that a vaccine to prevent gonococcal salpingitis is possible.     

In Vitro Activity of p-Hydroxybenzyl Penicillin (Penicillin X) and Five Other Penicillins Against Neisseria gonorrhoeae: Comparisons of Strains from Patients with Uncomplicated Infections and from Women with Pelvic Inflammatory Disease

Minimum inhibitory concentrations (MICs) of six penicillins against 95 strains of Neisseria gonorrhoeae from patients with uncomplicated anogenital infections and 22 strains from women with pelvic inflammatory disease were determined by an agar plate dilution method, using an inocula replicator. Against all 117 strains, the order of activity observed was: BL-P1654 > penicillin X > penicillin G > ampicillin > amoxicillin = carbenicillin. MICs against strains isolated from women with gonococcal pelvic inflammatory disease were significantly higher than those against isolates from uncomplicated infections: BL-P1654, P < 0.001; penicillin X, P < 0.001; penicillin G, P < 0.001; ampicillin, P < 0.001; and amoxicillin, P < 0.05. MICs of penicillin G were >/=0.125 mug/ml against 33 (36%) of the 92 strains from patients with uncomplicated infections, as contrasted with 15 (68%) of the 22 isolates from women with pelvic inflammatory disease (P < 0.01). The means of the MICs of penicillin G were 0.06 mug/ml for the former and 0.14 mug/ml for the latter.     

Complications of coexisting chlamydial and gonococcal infections

Physicians need to take every opportunity to educate their patients regarding the pathogenesis of sexually transmitted diseases and the risks of acquiring them. If the current epidemic of these diseases is to be curtailed, concurrent infections must be detected and treated according to the guidelines of the Centers for Disease Control. In addition, cultures should be obtained and appropriate treatment administered to sexual partners of patients treated for gonorrhea, acute urethral syndrome, mucopurulent cervicitis, pelvic inflammatory disease, nongonococcal urethritis, and epididymitis. Finally, screening should be done in patient groups at high risk for chlamydial infection.     

Gonococcal perihepatitis in a surgical ward.

Within a three-year period six female patients with gonococcal perihepatitis were encountered. In the acute stage they had clinical symptoms indistinguishable from acute cholecystitis. In all six patients the diagnosis was established by positive growth of Neisseria gonorrhoeae from cervix specimens. Evidence of previous gonococcal pelvic infection was disclosed in three of the patients. In two patients the gonococcal aetiology of the disease was suggested by papular skin lesion and arthritis. Of the annual mean number of patients admitted to the emergency ward with suspicion of acute cholecystitis within the same three year period, 2.6% presented with gonococcal perihepatitis. As the incidence of gonorrhoea is increasing, complications such as perihepatitis are seen more frequently among young female patients admitted to surgical emergency wards because of acute abdominal pains.     

Chlamydial infections

Chlamydia trachomatis is a unique intracellular parasite that causes a number of common sexually transmitted disease syndromes, including nongonococcal urethritis in both men and women, epididymitis in men, and pelvic inflammatory disease in women. Infants exposed at delivery are at risk for the development of conjunctivitis and pneumonia. There is strong evidence that Chlamydia is a cause of obstructive infertility and ectopic pregnancy in women. It appears that these complications result from the chronic inflammatory response and secondary scarring that are elicited by long-term asymptomatic or nearly asymptomatic fallopian tube infections. Because treatment with tetracycline, doxycycline, or erythromycin is simple, effective, and inexpensive, major efforts should be put into identifying asymptomatic young women through screening of the subpopulations at highest risk. These include sexually active adolescent women and older women who are not monogamous. Blacks are at higher risk than other ethnic groups for infection. The cost of diagnosing chlamydial infection has decreased with the introduction of new nonculture diagnostic tests. This should increase the availability of testing for screening purposes. It is critical to remember that male sex partners of infected women must be treated; otherwise all efforts to prevent long-term complications by identifying and treating asymptomatic women are doomed to failure.     

盆腔炎患者血清MCP-1、CRP、GM-CSF、前炎因子及血液流变学的变化研究

目的观察及研究盆腔炎患者血清单核细胞趋化蛋白-1(MCP-1)、C反应蛋白(CRP)、粒细胞-巨噬细胞集落刺激因子(GM-CSF)、前炎因子及血液流变学的变化情况。方法选取2011年12月至2013年12月收治的58例盆腔炎患者为观察组,并以同期的58名健康同龄妇女为对照组,然后比较对照组和观察组的血清MCP-1、CRP、GM-CSF、前炎因子及血液流变学指标,并比较观察组中急性和慢性、不同严重程度者的检测水平。结果观察组的血清MCP-1、CRP、GM-CSF、前炎因子及血液流变学指标均高于对照组,且重度盆腔炎患者高于轻度与中度盆腔炎,中度盆腔炎则高于轻度盆腔炎,而急性盆腔炎患者仅血清前炎因子及CRP高于慢性盆腔炎患者,差异均有显著性(P均0.05)。结论盆腔炎患者血清MCP-1、CRP、GM-CSF、前炎因子及血液流变学均呈现较高的状态,并且轻度、中度及重度患者之间存在明显的差异。     

中药灌肠联合抗生素治疗慢性盆腔炎的Meta分析

目的:评价中药灌肠联合抗生素治疗慢性盆腔炎的疗效。方法:在中国期刊全文数据库(CNKI)、维普中文期刊全文数据库、万方数据库中检索中药灌肠联合抗生素治疗慢性盆腔炎的临床随机对照试验研究文献,采用Rev Man5.3统计软件进行Meta分析。结果:检索符合RCTs纳入标准的中药灌肠联合抗生素治疗慢性盆腔炎的随机对照试验论文25篇,均为中药灌肠联合抗生素与单用抗生素治疗慢性盆腔炎的比较。Meta分析结果显示中药灌肠联合抗生素治疗慢性盆腔炎较单用抗生素具有更好的临床疗效。结论:中药灌肠联合抗生素治疗慢性盆腔炎的总有效率比单用抗生素有优势。     

女性盆腔炎性疾病患者T淋巴细胞亚群变化分析

目的探讨女性盆腔炎性疾病患者T淋巴细胞亚群的变化。方法选取2008年12月至2010年12月来我院门诊及住院的盆腔炎性相关疾病患者84例,对盆腔炎性疾病患者T淋巴细胞亚群失衡发生率、治疗效果和孕产次与T淋巴细胞失衡的关系进行探讨,同时对两组T淋巴细胞亚群变化进行分析。结果在所研究的84例盆腔炎性疾病患者中,T淋巴细胞亚群失衡率为73.81%;异常组患者孕产≤1次患者所占百分比明显低于正常组患者,异常组患者孕产=2次及孕产≥3次所占百分比明显高于正常组,两组比较差异有统计学意义（P〈0.05）;与正常组比较,异常组患者CD3＋、CD4＋及CD4＋/CD8＋比值显著下降（P〈0.05）;异常组患者经7d治疗后,患者CD3＋、CD4＋及CD4＋/CD8＋比值显著升高,其总有效率为93.55%,与治疗前比较差异有统计学意义（P〈0.05）。结论 T淋巴细胞亚群的变化与女性盆腔炎性疾病密切相关,临床治疗该病时应调节机体免疫功能。     

Outbreak of penicillinase-producing Neisseria gonorrhoeae with an African connection

Previous outbreaks of penicillinase-producing gonococcal infection in the United States have generally been attributed to importation of Southeast Asian strains. During July 1982 through July 1983, 110 cases of gonorrhea caused by penicillinase-producing strains were reported in metropolitan Atlanta, Georgia. Among the 53 infected women, 14 (26%) had pelvic inflammatory disease (PID). Compared to other infected women, those with PID experienced a greater delay from the time of last sexual exposure (19.1 vs 8.1 days) to receipt of appropriate antibiotic therapy (P less than .01). At least 22 prostitutes were involved in the outbreak. Sixteen (76%) of 21 isolates tested were serogroup 1A; 15 required arginine and proline for growth; and 17 (81%) possessed a 3.2 megadalton plasmid. Our data suggest that this outbreak was associated with both African and Southeast Asian strains.     

腹腔镜检查继发不孕症136例分析

目的：应用腹腔镜诊断技术,探讨继发不孕症的病因,评价腹腔镜继发不孕症的诊断价值。方法：应用腹腔镜,对136例继发不孕症妇女的盆腔疾病和不孕的影响因素进行分析。结果：腹腔镜检查发现盆腔器质性病变134例,检查阳性率为98．5％。慢性盆腔炎、盆腔粘连和子宫内膜异位症是继发不孕症的第1位病因,占53．6％（73／136）,子宫内膜异位症是第2位病因,占41．2％（56／136）,慢性盆腔炎、盆腔粘连患者中90．4％有一侧或双侧输卵管梗阻;子宫内膜异位症患者中仅7．2％有输卵梗阻。慢性盆腔炎、盆腔粘连者多无急性盆腔炎病史,60．2％（44／73）没有自觉症状。结论：生殖道炎症和节育手术引起盆腔感染是继发不孕的重要原因。且以亚临床感染为主,应引起临床高度重视。应用腹腔镜技术对继发不孕症的病因诊断有重要价值,对继发不孕的盆腔疾病分出亚类,便于针对性地治疗,并可在直视下通液,动态观察输卵管通畅度和形态。     

Pelvic inflammatory disease

This article reviews current knowledge on the diagnosis, pathogenesis, epidemiology, treatment, and prognosis of pelvic inflammatory disease (PID). Since PID has important implications for future health and fertility, its diagnosis and management are of utmost importance. A recent study of the accuracy of clinical diagnosis of PID indicated that, even when as many as 7 reliable symptoms and signs were present, there was still possibility for diagnostic error. This has led some to advocate diagnostic laparoscopy. In older women, IUD users, and women who have recently delivered or undergone pelvic surgery, endogenous organisms are more likely to be the initial infecting agents. Treatment of PID should be begun before the results of microbiological investigations are available and should cover a wide spectrum of organisms. The author's preference is a combination of penicillin or ampicillin in high dose, gentamicin, and rectal metronidazole. Follow up treatment with tetracycline or erythromycin is needed to eradicate chlamydial infection. The author also prefers to remove an IUD in place once antibiotic cover has been established. The longterm prognosis in such cases is not good, especially after nongonococcal PID. 25% of a group of 415 PID patients followed for 10 years had reinfections and 18% suffered chronic pelvic pain. 21% were involuntarily infertile, and tubal occlusion rates rose from 13% after 1 attack to 75% in those who had been infected 3 or more times. When PID patients did become pregnant, ectopic pregnancy was 6 times more common than in a group of matched controls.     

妇炎舒胶囊与康妇消炎栓联合应用治疗盆腔炎70例临床观察

目的探讨妇炎舒胶囊联合康妇消炎栓治疗盆腔炎的效果。方法对开发区医院妇产科门诊的盆腔炎患者共70例随机进行分组治疗。观察组为慢性盆腔炎急性发作,首先使用抗生素联合口服妇炎舒胶囊5粒,3次/天及外用康妇消炎栓1枚,1次/天。慢性盆腔炎直接口服妇炎舒胶囊5粒,3次/天,并联合康妇消炎栓1枚,1次/天塞肛门连续使用1个月。并连续随访3个月。对照组为慢性盆腔炎急性发作期及慢性盆腔炎单独使用抗生素1周至10 d。结果治疗30 d后临床症状体征及评分改善比例分别为:观察组36.50%,(78.97±17.75)%;对照组:34.66%,(78.66±19.95)%。治疗60 d后临床症状体征评分及评分改善比例为:观察组22.63%,(87.47±11.42)%;对照组13.88%,(96.82±7.22)%,差异有统计学意义(症状体征评分:Z=-2.687,P=0.007;评分改善:F=-2.895,P=0.007)。结论妇炎舒胶囊联合康妇消炎栓治疗盆腔炎效果良好。     

Pharyngeal <Emphasis Type="Italic">Neisseria gonorrhoeae</Emphasis> detection in oral-throat wash specimens of male patients with urethritis

Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in the pharynx has been highlighted in the prevention of the unexpected spread of sexually transmitted diseases. We tried to clarify the detection rate of Neisseria gonorrhoeae in the pharynx and the clinical relevance of oral-throat wash specimens to detect the organism in heterosexual men with gonococcal and nongonococcal urethritis. In our cohort of 79 male patients with urethritis, oral throat wash specimens were collected after they had gargled with normal saline for approximately 30 to 60 s. Positive pharyngeal N. gonorrhoeae was defined as a positive result on the strand displacement amplification test for the specimen from the oral-throat wash. N. gonorrhoeae was detected in the oral-throat wash specimens of 13 (31.7%) of the 41 male patients with gonococcal urethritis. Oral-throat wash with a nucleic acid amplification test can detect pharyngeal N. gonorrhoeae easily and efficiently.     

Primary care management of sexually transmitted urethritis in adolescent males

PURPOSE: To describe current knowledge about diagnosis, screening, and treatment of sexually transmitted urethritis among adolescent and young adult males. DATA SOURCES: Current research, systematic reviews, consensus guidelines and the author's clinical experience. CONCLUSIONS: Urethritis, the most common sexually transmitted syndrome in young males, is most frequently caused by Chlamydia trachomatis and/or Neisseria gonorrhea. Symptoms include dysuria and penile discharge, although up to 50% of males are asymptomatic. Risky sexual behaviors and lack of access to healthcare increase incidence of this infection. Transmission to female partners can lead to pelvic inflammatory disease, infertility, and neonatal infection. IMPLICATIONS FOR PRACTICE: Young males with urethritis must be treated as soon as diagnosis is established. Consensus guidelines exist for diagnosis and treatment of gonococcal and non-gonococcal urethritis. Careful patient education is necessary to ensure successful treatment. Prevention of repeat infections requires partner treatment and detailed education about safer sexual practices. Improved access to preventive services for young males should be a healthcare priority.     

Update on the prevention and treatment of sexually transmitted diseases

The Centers for Disease Control and Prevention updated its guidelines for the treatment of sexually transmitted diseases. The guidelines include the following information: recommendations for hepatitis A immunization and expanded indications for hepatitis B vaccination; updated diagnostic criteria for pelvic inflammatory disease and parenteral treatment regimens; information on two additional antiviral agents for the treatment of genital herpes; a recommendation for use of a single 1-g dose of azithromycin (Zithromax) to treat urethritis and chlamydial cervicitis; information on the use of quinolones in the treatment of gonococcal infections; information on podofilox and imiquimod, which are both patient-applied medications, in the treatment of noncervical human papillomavirus infection; updated guidelines for the prevention and detection of congenital syphilis; and information on how to prevent the spread of sexually transmitted diseases by educating patients about the importance of changing their sexual behaviors. To have a significant impact on the current rate of transmission of sexually transmitted diseases, family physicians should develop a plan to integrate the guidelines into their practices.     

中医药外治法治疗盆腔炎性疾病后遗症研究进展

通过对中医外治法治疗盆腔炎性疾病后遗症研究成果的整理分析,从单一中医药外治法、联合中医药外治法、中药汤剂联合中医药外治法三方面来探寻中医外治法对盆腔炎性疾病后遗症的疗效,认为传统医学在治疗盆腔炎性疾病后遗症有着自身优势,但是未形成统一规范治疗体制,存在其自身局限性。     

Transvaginal sonography in the diagnosis of acute appendicitis.

OBJECTIVES: To evaluate transvaginal sonography with power Doppler capacity in the diagnosis of acute appendicitis and in discriminating appendicitis from pelvic inflammatory disease. PATIENTS AND METHODS: We describe transvaginal sonographic findings of six women with acute appendicitis selected from 31 women seen in an emergency room setting for clinically suspected pelvic inflammatory disease. The study population underwent gray-scale transvaginal sonography, and specific sonographic landmark findings for acute appendicitis and pelvic inflammatory disease were used. Hyperemia of any infectious complex was identified by power Doppler. Laparoscopy was performed after transvaginal sonography and was used as the gold standard. RESULTS: Laparoscopy showed acute appendicitis in six (19%) of the 31 patients. A thick walled non-compressible gas-containing tubular structure with a diameter exceeding 6 mm was seen by transvaginal sonography in four of the six cases, consistent with uncomplicated appendicitis. A heterogeneous complex with surrounding hyperechogenic soft tissue was seen in two cases with gangrenous appendicitis. Power Doppler detected hyperemia in all six cases. Normal adnexal structures were imaged next to the inflamed appendix. The sonographic criteria consistent with acute appendicitis were clearly different from those of acute pelvic inflammatory disease. CONCLUSIONS: Transvaginal sonography provides an opportunity to distinguish between appendicitis and acute pelvic inflammatory disease. Prospective trials are needed in order to evaluate the impact of transvaginal sonography in the diagnosis of acute appendicitis.