Comparison of culture and microscopy in the diagnosis of Gardnerella vaginalis infection.

A comparison was made between human blood agar containing amphotericin B, nalidixic acid and either gentamicin or colistin for the isolation of Gardnerella vaginalis from cases of non-specific vaginitis seen in a clinic for sexually transmitted diseases. The medium containing gentamicin was more inhibitory for non-Gardnerella species, but not sufficiently inhibitory to allow direct plating in the clinic without spreading for single colonies. The diffuse beta haemolysis produced by G vaginalis on human, but not on horse blood agar, proved very useful in differentiating it from other vaginal organisms and was not affected by the antibiotics used. This characteristic, together with Gram stain morphology, oxidase and catalase, provides a simple, reliable methods of identifying G vaginalis. Sixty women with symptoms of vaginitis, in whom no other pathogen was isolated, were examined by culture and microscopy. Gardnerella vaginalis was grown from 45 whereas only 31 had positive microscopy (clue cells or Gram-variable bacilli). There was no significant difference between the rate of isolation of G vaginalis in the group with positive microscopy (25/31) and that with negative microscopy (20/31).

Late endemic syphilis: case report of bejel with gummatous laryngitis.

An elderly Bedouin woman originally thought, on clinical and histological grounds, to have tuberculosis of the larynx was found to have gummatous laryngitis due to late endemic syphilis (bejel). This disease is highly prevalent in the Bedouin tribes of the Middle East. Doctors dealing with Arab patients, either in the Middle East or elsewhere, should be aware of this possibility.

Endemic non-venereal syphilis (bejel) in Saudi Arabia.

A total of 2515 people attending a large military hospital in Saudi Arabia was studied clinically, serologically, and (when appropriate) radiologically for evidence of treponematosis. The indications are that non-venereal endemic syphilis (bejel) is prevalent among the nomadic communities living in rural areas. In contrast, venereal syphilis is much less common, and is found almost exclusively in urban populations. Some of the high risk regions for bejel have been identified, and many people from these locations complained of persistent pain in the legs, which was often associated with radiological evidence of osteoperiostitis of the long bones. Bejel also seems to have become clinically "attenuated" within the last 30 years, with the majority of seroreactors having latent disease. A hypothesis suggesting a reason for this change is put forward, and ways of controlling the infection are outlined.

Treatment of herpes genitalis with carbenoxolone and cicloxolone creams: a double blind placebo controlled clinical trial.

preliminary results in vitro have indicated that carbenoxolone and analogues possessed activity against herpes viruses. We undertook a double blind clinical study to compare the efficacy of carbenoxolone and cicloxolone creams with placebo in initial and recurrent herpes genitalis. Seventy-nine patients (21 of whom were entered in the trial more than once) received 105 courses of treatment, 83 of which were suitable for life table analysis. There were significant differences in the time to disappearance of pain (p = 0.044) and the healing of lesions (p = 0.023) in favour of cicloxolone compared with placebo. Carbenoxolone showed some beneficial effect compared with placebo, but this was not significant. Results on day 5 were similar. The only adverse reaction was mild erythema with irritation in one patient in each treatment group. We conclude that further trials with more extensive virological investigation are indicated to confirm the beneficial effect of cicloxolone.

Effect of injections of small doses of human fibroblast interferon into genital warts. A pilot study.

Eleven male patients with genital warts were given injections of fibroblast interferon (300 u) and placebo into the bases of two similar warts. The changes in size of the treated warts compared with that of the controls suggested that interferon did inhibit the growth of the warts. The dose given was probably insufficient for a dramatic effect. In one patient, however, a wart on the penile shaft was injected with interferon and did disappear within two weeks whereas an untreated meatal wart increased in size.

Chlamydial, gonococcal, and herpes virus infections in neonates.

The incidence, type of lesions, portal of entry and treatment of chlamydial, gonococcal, and herpetic infections of neonates are briefly discussed. Herpes neonatorum is potentially the most serious of these conditions and major efforts in its prophylaxis are called for.

Treatment of nongonococcal urethritis with rifampicin as a means of defining the role of Ureaplasma urealyticum.

The results of a double-blind therapeutic trial on 217 men with nongonococcal urethritis (NGU) show that minocycline was more effective than rifampicin. Before treatment Chlamydia trachomatis was isolated from 43% of men, Ureaplasma urealyticum from 59%, and Mycoplasma hominis from 22%. Chlamydiae and ureaplasmas were isolated less frequently from men with a recent history of NGU. Minocycline was given to 94 patients, and after treatment chlamydiae were isolated from only one of 40 initially chlamydia-positive patients and ureaplasmas from only five of 57 initially ureaplasma-positive patients. Although most patients responded clinically, failure and partial recovery rather than complete recovery were observed more often among those who were infected with ureaplasmas. Rifampicin was given to 123 patients, after which chlamydiae were isolated from only one of 53 initially chlamydia-positive men whereas ureaplasmas, insensitive to the antibiotic in vitro, were isolated from 55 of 68 men who had initially positive results. Patients infected with ureaplasmas failed to respond to rifampicin treatment significantly more often than those who were not infected. This was also observed when only patients who had never had NGU or who had not had a recent episode were considered. Furthermore, 24 (44%) of the 55 men whose ureaplasmas persisted failed to recover whereas only one (7·7%) of 13 men whose ureaplasmas disappeared did not respond to treatment. These results suggested that ureaplasmas were a cause of urethritis in some of the men (an estimated 10% at least). In addition, Reiter's disease developed in two men treated with rifampicin from whom only ureaplasmas had been isolated initially. M. hominis did not seem to have an important pathogenic role in NGU and there was evidence that ureaplasmas were an unlikely cause of urethritis in some men since the organisms persisted despite complete clinical recovery.

Non-specific urethritis. A placebo-controlled trial of minocycline in conjunction with laboratory investigations.

The results of a double-blind therapeutic trial on 81 men suffering from non-specific urethritis (NSU) show that minocycline was more effective than a placebo. Before treatment Chlamydia trachomatis was isolated from 31 per cent. of the men, ureaplasmas from 58 per cent., and Mycoplasma hominis from 7-5 per cent. There is evidence that chlamydiae are a cause of urethritis. However, after minocycline therapy improvement in the clinical response of patients from whom only ureaplasmas were isolated was less significant, so that the evidence that these organisms are pathogenic is less convincing. Possible reasons for this are discussed, as are the implications of finding minocycline-resistant ureaplasmas in at least 6 per cent. of the patients who harboured these organisms. The symptoms and signs of patients from whom micro-organisms were not isolated also improved after minocycline therapy, implying that the aetiological agents in this group of patients are antibiotic-sensitive. However, the results do not exclude the possibility that a minocycline-resistant agent is the cause of urethritis in a minority of patients.

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.

Ureaplasma urealyticum and Mycoplasma hominis in chlamydial and non-chlamydial nongonococcal urethritis.

Urethral specimens from 726 patients with nongonococcal urethritis (NGU) were examined for Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis. Chlamydiae were isolated from 35.9% of ureaplasma-positive patients and from 36.5% of ureaplasma-negative patients. Ureaplasmas were isolated from 52.5% of chlamydia-positive patients and from 53.1% of chlamydia-negative patients, an observation which contrasts with that of some workers who have suggested that ureaplasmas are significantly associated with chlamydia-negative NGU. Furthermore, the numbers of ureaplasmas isolated from patients who did or did not harbour chlamydiae were not significantly different nor was there a particular association of ureaplasmas with chlamydia-negative NGU in patients experiencing their first episode of disease. In addition, M. hominis was not isolated more frequently from those from whom chlamydiae were or were not isolated. The only significant associations were the isolation of M. hominis from patients who were ureaplasma-positive and of ureaplasmas from those who were M. hominis-positive. These findings do not necessarily mitigate against ureaplasmas being responsible for some cases of chlamydia-negative NGU.