The potential effect on Neisseria gonorrhoeae of the use of clindamycin vaginal cream in the empirical treatment of vaginal discharge.

The minimum inhibitory concentrations (MIC) of clindamycin for 62 consecutive isolates of Neisseria gonorrhoeae were found to be 0.03-4 mg/L; the MIC50 and MIC90 were 0.125 and 2.0 mg/L respectively. Seven women treated with clindamycin vaginal cream had cervical mucus samples taken after seven days treatment. The concentrations of clindamycin achieved in the cervical mucus were 30-150 times higher (141-337 mg/L) than the highest MIC of the 62 N. gonorrhoeae isolates. Clindamycin vaginal cream is being used increasingly in Genitourinary Medicine clinics and General Practice for the treatment of bacterial vaginosis. This study shows that clindamycin vaginal cream achieves intra cervical concentrations that are high enough to inhibit N. gonorrhoeae. Empirical use of this therapy should be preceded by urethral and cervical swabs for N. gonorrhoeae in any woman at risk of gonorrhoeae.

Persistent episiotomy granulation polyps; a polysymptomatic clinical entity.

We describe a number of patients with persistent symptoms of vaginal discharge and discomfort, dyspareunia and postcoital bleeding. They presented 2-4 months following delivery with episiotomy. In these patients, the symptoms were associated with localised granulation tissue polyps, on the episiotomy site. Simple ablation resulted in rapid and effective relief of the symptoms. These lesions may be more common in clinical practice than is suggested by the lack of published reports. They should be looked for in women who may suffer from symptoms for several months after delivery.

A case cluster of possible tissue invasive gonorrhoea.

OBJECTIVE: To describe a cluster of patients presenting with severe symptoms and infected with an unusual strain of Neisseria gonorrhoeae. SETTING: A north London Department of Sexual Health. PATIENTS: Five patients were linked by reported sexual contact or other epidemiological evidence as part of a cluster of gonococcal infection. Cultured N gonorrhoea were subtyped by serological (serovar) and cultural (auxotype) methods and antibiotic sensitivities measured by minimum inhibitory concentration (MIC). RESULTS: Four of the patients had severe gonorrhoea-related systemic or extragenital symptoms: disseminated gonococcal infection with oligoarthritis (1 patient), acute pelvic inflammatory disease (1 patient, who was also chlamydia positive) and tender inguinal adenopathy (2 patients). The fifth patient was asymptomatic. N gonorrhoeae was isolated in four of the patients. All four organisms had identical MICs. Three of the organisms were subtyped and found to be the same rare strain (serovar 1A1, auxotype NR). CONCLUSION: This case cluster provides evidence for strain-related virulence in an uncommon gonococcal subtype.

Bartholin's abscess complicating food poisoning with Salmonella panama: a case report.

A patient is presented who developed an acute Bartholin's abscess four weeks after an attack of Salmonella panama enteritis. Aspirate from the abscess also grew Salmonella panama, indistinguishable from the gut isolate in serotype and antigenic structure (1 9, 12: 1, v: 1,5). Some aspects of the microbiology of Bartholin's abscess and its clinical management are discussed.

Sultamicillin in the treatment of gonorrhoea caused by penicillin sensitive and penicillinase producing strains of Neisseria gonorrhoeae.

A single oral dose of 2 g of sultamicillin and 1 g of probenecid was effective in the treatment of men with uncomplicated gonococcal urethritis caused by both penicillin sensitive strains of Neisseria gonorrhoeae and penicillinase producing strains of N gonorrhoeae (PPNG). Of 94 infected men who attended for at least one follow up examination, 91 (97%) were cured. The remaining three (3%) patients were still infected at follow up. Two of these patients had been re-exposed to an infected partner and were considered to be possible reinfections, while the third was deemed a treatment failure. Six of the 94 patients were infected with PPNG strains and all were successfully treated. Plasmid analysis of the PPNG strains showed Asian and African types both with and without transfer plasmid.

Aseptic meningitis and herpes simplex proctitis. A case report.

A male homosexual patient developed an aseptic meningitis during the course of acute ano-proctitis due to herpes simplex virus type 2 (HSV-2). Aseptic meningitis (sometimes proved to be due to HSV-2) has been associated with genital but not with anal herpes. This sexually transmissible virus should be considered when patients with aseptic meningitis are investigated.

Cervical cytology in genital infection.

Papanicolaou-stained cervical smears taken from 203 female patients with either gonorrhoea, trichomoniasis, or candidosis were examined for the degree of inflammatory change. The results from these patients were compared with the results of smears taken from women who had no evidence of sexually-acquired infection after full assessment in the clinic. Gonorrhoea and trichomoniasis were associated with inflammatory changes but these were less marked in patients with candidosis. It is concluded that, before cytological inflammatory changes are attributed to non-specific genital infection, it is important to exclude gonorrhoea, trichomoniasis, and, to a lesser extent, candidosis.