Female gonorrhea: its relation to abnormal uterine bleeding, urinary tract symptoms, and cervicitis.

Data are presented from an investigation of the assocation of presenting complaints with gonococcal infection in females seeking primary care in an urban emergency room. Over 27% of patients in the study had cultures positive for Neisseria gonorrhoeae (GC). The GC positivity rates which were significantly higher than expected were found in patients with abnormal uterine bleeding, urinary tract symptoms, and cervicitis, as well as acute PID. Clinical findings suggest an etiologic role for the gonococcus in the pathogenesis of these disorders. Where the incidence of gonorrhea is high, new approaches in the managment of patients with these presenting complaints are necessary in order to prevent the more serious complications of gonorrhea and further spread of the disease.

The impact of urban community hospital surveillance for gonorrhoea on the infection rate and complications in the female. A progress report.

This study substantiates a previous report concerning the importance of the urban community hospital, particularly its emergency room, in the detection of gonorrhoea in women. Pelvic inflammatory disease (PID), a major complication of gonorrhoea in women, significantly declined during a nine-year surveillance and control programme in the Memphis-Shelby County area. This suggests that the programme may have prevented PID developing in women through the early detection and treatment of asymptomatic infections.

PIP: The experience of a community surveillance program aimed at detecting gonorrhea in women in Memphis-Shelby County, Tennessee, is reported. This report, presenting data from 1975-76, updates an earlier report from the 1973-74 period. Data from both periods are compared in an attempt to determine the program's impact on the rate of women with gonorrhea and on the number of hospital admissions for pelvic inflammatory disease (PID), the most serious complication of gonorrhea. The total number of tests performed in the community increased from 113,063 in 1973-74 to 140,201 in 1975-76. The percentage of women with positive cultures was 5.1 in the earlier period and 5.0 in the latter period. The total number of positive cultures at the City of Memphis Hospital declined by 7.4% from 3097 in 1973-74 and 2868 in 1975-76. This decline is largely due to a reduction in the number of positive cultures identified in the emergency room. Despite this decline, the emergency room continued to provide the highest number of positive cultures (16.5% in 1975-76) and the highest ratio of positive cultures to number of tests. City of Memphis Hospital as a whole provided 40.6% of the positive cultures in only 31.5% of total tests. The number of cultures obtained from other community health services increased by 54.5% from 2709 to 4185 in the 2 study periods. This increase is largely attributed to the establishment of new family planning clinics in poor areas and increased participation in the surveillance program among private physicians in these areas. The 3 year moving average incidence of PID recorded in the City of Memphis Hospital discharge at diagnosis showed a dramatic decline between 1968 (the year the surveillance program was initiated) and 1976, suggesting that the program has effectively prevented much infection from progressing to PID. Moreover, the unchanged incidence of gonorrhea observed in the 2 study periods indicates that the infection rate has stabilized. This is in contrast to the continuous upward trend observed on a national level.

The role of the urban community hospital in gonorrhoea surveillance.

In a progressive surveillance programme designed to detect gonococcal infection in females, 113,063 women were screened for gonorrhoea in Memphis-Shelby County, Tennessee, during a 2-year period. The importance of including the urban community hospital in the surveillance programme is emphasized by the contribution of the City of Memphis Hospital where 53-3 per cent. of all positive cases of gonorrhoea were detected in only 34-2 per cent. of all tests done. The City of Memphis Hospital emergency room was an especially productive surveillance area, giving 29-0 per cent. of all positives with only 6-1 per cent. of all tests performed. The importance of taking routine cultures for gonococci from women presenting for prenatal care, delivery, or for genitourinary complaints in an urban hospital is stressed.

An outbreak of Legionnaires' disease associated with a contaminated air-conditioning cooling tower.

In August and September 1978, an outbreak of Legionnaires' disease occurred in Memphis, Tennessee. Of the 44 ill, 39 had been either patients, employees, visitors, or passers-by at one Memphis hospital (Hospital A) during the 10 days before. Assuming an incubation period of between two and 10 days, the onset of cases correlated precisely with the use of Hospital A's auxiliary air-conditioning cooling tower. L. pneumophila was recovered from two samples of water from the tower. Infection appeared to have occurred both outside and within the hospital. A significant association was demonstrated between acquisition of Legionnaires' disease and prior hospitalization in those areas of Hospital A that received ventilating air from air intakes near the auxiliary cooling tower. Tracer-smoke studies indicated that contaminated aerosols from the tower could easily reach these air intakes, as well as the street below, where four passers-by had been before they contracted Legionnaires' disease. This represents a common-source outbreak in which the source of L. pneumophila infection and airborne transmission were identified.

Selective screening of hospitalized patients for the presence of asymptomatic hepatitis B virus carriage: predictability based on census tract data.

Review of all hepatitis B surface antigen-positive patients reported to the county health department over the past 3 years showed that 60% of patients had been diagnosed at our hospital, which serves an inner city, predominantly black, indigent population. Sera from 524 adult patients admitted to the hospital were prospectively collected and tested for hepatitis B surface antigen, eight (1.5%) of which were antigen-positive. Census tract data allowed us to perform selective screening of sera from 95 other patients who were subsequently hospitalized and deemed "high risk" for hepatitis B infection. Nine of 95 (9.5%) selectively screened samples were positive for hepatitis B surface antigen, which represented a significantly higher rate of antigen carriage (P less than 0.0001) in hospitalized patients from "high risk" areas than that found in the general population screen. The methodology presented herein may be useful in providing a means of identifying hepatitis B surface antigen-positive patients from adult, urban, indigent care populations.

A multistate outbreak of infections caused by Yersinia enterocolitica transmitted by pasteurized milk.

In June and July 1982, a large interstate outbreak of Yersinia enterocolitica infections caused by an unusual serotype occurred in Tennessee, Arkansas, and Mississippi. Eighty-six percent of cases had enteritis characterized by fever, abdominal pain, and diarrhea. In three separate case-control studies, drinking milk pasteurized by plant A was statistically associated with illness. In a survey of randomly chosen households, 8.3% of persons who recalled having drunk milk from plant A during the suspect period experienced a yersiniosislike illness. Inspection of the plant and cultures of the available raw and pasteurized milk did not reveal the source or mechanism of contamination or a breach in normal pasteurizing technique. Although outbreaks of enteric disease caused by pasteurized milk are rare in the United States, the ability of Y enterocolitica to grow in milk at refrigeration temperatures makes pasteurized milk a possible vehicle for virulent Y enterocolitica. The extent to which milk is responsible for sporadic cases of yersiniosis is unknown.