Spontaneous clearance of genital and extragenital Neisseria gonorrhoeae: data from GToG.

OBJECTIVES: Neisseria gonorrhoeae (NG) infection can resolve without antibiotic treatment, however the literature describing the frequency of clearance at individual sites, how rapidly it occurs and potential predictive factors is limited. In this analysis of a subpopulation identified from a large multicentre UK cohort, we describe the overall rate of spontaneous clearance of infection and explore factors associated with this. METHODS: Data from the Gentamicin compared with Ceftriaxone for the Treatment of Gonorrhoea randomised controlled trial consisting of 720 patients with NG were analysed. A subgroup of individuals had both a pretrial test sample and a trial enrolment sample taken. Those who had cleared NG between initial presentation and subsequent entry into the trial without antibiotic treatment were deemed to have spontaneously cleared. Sociodemographic characteristics, sexual history and sites of infection for those who spontaneously cleared infection were compared with that of those who did not. We also estimated the time interval to clearance. RESULTS: Overall, the proportion who had spontaneous clearance was 20.5% (83/405). Clearance of infection occurred over a median of 10 days (IQR 7-15 days). The cohort who spontaneously cleared were similar to those who did not in terms of age, gender, sexual orientation, HIV status and previous NG infection. Chlamydia coinfection was more frequent in the 'no spontaneous clearance group' (11.1% (9/83) cf 22.0% (69/322)) (p=0.029). Dysuria was reported more often in the 'no spontaneous clearance group' (4.8% (4/83) cf 13.0% (42/322)) (p=0.035). CONCLUSION: We present data from a large cohort of NG-infected individuals, of whom a significant proportion had spontaneous clearance of infection. This is consistent with previous smaller studies. If this is indicative of cure, point-of-care testing prior to treatment has the potential to reduce unnecessary exposure to antimicrobials. Further work to assess the importance of bacterial load, genotype and host immune response on spontaneous clearance of infection is required. TRIAL REGISTRATION NUMBER: ISRCTN51783227.

Neurobehavioural and neurotoxic effects of L-ascorbic acid and L-tryptophan in lead exposed rats.

BACKGROUND: Lead is an environmental toxicant, occupational and environmental exposures remain a serious problem in developing and industrializing countries. OBJECTIVE: This study is designed to investigate the effects of L-ascorbic acid and L-tryptophan on the neurotoxicity and neurobehavioural alterations in lead exposed male Sprague Dawley rats. METHODS: Experimental animals were exposed to oral doses of lead (Pb), L-ascorbic acid, and L-tryptophan at 75 mg/kg body weight, 40 mg/kg body weight, and 20 mg/kg body weight respectively, while control animals received 0.90% saline solution. Oral administration spanned for four weeks after which changes in neuro-behaviour, organ weight, blood deposition of Pb, brain serotonin, tryptophan and neuronal redox status were determined. Changes in organ weight, blood lead levels, neuro-behavioural characteristics, brain serotonin and tryptophan contents, and brain redox status were determined. RESULTS: The results indicated that Pb exposure increased blood lead, organ-weight index, and behavioural signs of anxiety and aggression. The sub-chronic exposure to Pb also decreased brain serotonin, while causing oxidative stress by decreasing reduced glutathione levels, antioxidant enzyme activity and increasing lipid peroxidation and brain protein contents. L-ascorbic acid attenuated both Pb induced neuronal oxidative stress, and abnormalities in behaviour. But L-tryptophan ameliorated Pb altered neurobehaviour with no significant effect on Pb induced oxidative stress in the brain. Co-administration of L-ascorbic acid and L-tryptophan on Pb exposed rats showed a reversal in all indices assessed towards the physiological state of control. CONCLUSION: This suggests that L-ascorbic and L-tryptophan can be used to compliment chelating therapy in lead neurotoxicity.