The prevalence of Chlamydia trachomatis in women with genitourinary symptoms.

Two studies were conducted to determine the prevalence of Chlamydia trachomatis in the urine and cervical exudates of women with genitourinary symptoms. In the first study, 873 women attending the World Health Organization-Sexually Transmitted Disease Center of the Alfred Fournier Institute, in Paris, were examined. In 7% of these women, culture results were positive for the presence of C trachomatis. Women with C trachomatis in the urethra had more polymorphonuclear cells in the urine than did those with C trachomatis in the cervix (P less than 0.001). The second study at the same center involved 180 women with vaginal or urethral signs and symptoms. Positive cultures for C trachomatis were found in 12% of the 140 women reporting vaginal problems and in 22% of the 40 women reporting urinary symptoms. Cell cultures from both the cervix and urethra were positive for C trachomatis in 1.4% of the women with vaginal signs and symptoms and in 2.5% of the women with urinary symptoms. These data support the value of urethral cultures for detecting C trachomatis in women with genitourinary symptoms.

Topical treatment of venereal warts: a comparative open study of podophyllotoxin cream versus solution.

Podophyllotoxin solution (0.5%) is licensed for use in the treatment of condylomata acuminata (genital warts) in men in a number of European countries. In some countries, approval also extends to treatment of genital warts in women. This controlled randomized prospective study evaluated the efficacy and safety of a cream formulation of podophyllotoxin at 2 concentrations (0.15% and 0.3%), using 0.5% podophyllotoxin solution as a reference treatment. Two separate studies were initiated, to assess the 3 treatment groups in (a) male patients, and (b) female patients. Statistical evaluation was based on a "response rate' calculated at each clinic visit. The mean "response rates' in the male patient study at 4 weeks were 75.1%, 79.0% and 85.6% in the 0.15% cream, 0.3% cream and 0.5% solution groups, respectively. The corresponding "response rates' for the female patient study were 86.2%, 92.6%, and 93.1%, respectively. The relapse rates for both male and female patients were 6.0% in the 0.15% cream group, 8.6% in the 0.3% cream group and 8.6% in the 0.5% solution group. The results show that there were no statistically significant differences between the 3 treatments with regard to both efficacy and safety. This was true for both the male and female patient groups.

[Present aspects of sexually transmitted diseases (STD) (author's transl)]. / Aspects actuels des maladies sexuellement transmissibles.

The emotional repercussion of STD remains very important. New present clinical aspects and new possibilities of diagnosis are pointed out. Concerning syphilis, the incubation period may be very long, cutaneo-mucous lesions of the secondary period very atypical . Concerning gonorrhea, the incubation period may be long (20 days); female or male asymptomatic forms are frequent: the existence of non-genital localizations is to be known. As to non-gonococcal infections, the frequence of Chlamydiae Tr. etiology is emphasized. Therefore an absolute priority must be given to the laboratory results which make the prescription of epidemiological treatment possible.

[Male genital lesions caused by papillomaviruses. Importance of colposcopy]. / Lésions génitales masculines à papillomavirus. Intérêt de la colposcopie.

Ten years after the description of cervical flat condyloma, it is now admitted that Human Papillomaviruses (HPVs) type 6 and 11 are responsible for condylomata acuminata and typical flat condyloma of the uterine cervix. HPV DNA type 16 and, less frequently, 18, 33 and other as yet uncharacterized HPV types (G. Orth, personal communication), are found in the majority of Cervical Intraepithelial Neoplasia (CIN), Vulvar Intraepithelial Neoplasia (VIN) and cervical and vulvar invasive cancers. Since HPVs are sexually transmissible, recent interest has focused on the "male factor". Clinically detectable lesions of male genitalia are condylomata acuminata, bowenoid papulosis and flat condyloma-like papules. The aim of our study was the colposcopical screening, recently suggested, of different groups of male patients in order to detect HPV-related lesions and the description of the colposcopical features of subclinical HPV-related lesions, since most of them have never been reported, to our knowledge, in the literature. A total of 114 men were examined. Among them, 18 presented clinically detected recalcitrant condylomata acuminata, 28 had been treated for the same pathology 1 to 5 days earlier and were clinically free of lesions, 46 were sexual partners of women with cervical atypia (flat condyloma and/or CIN) and 22 had a clinical diagnosis of genital infection without HPV-related lesions. A careful examination of external genitalia was performed. Then all patients underwent penile colposcopy before and after application of 5 p. 100 acetic acid. Selected biopsies were performed in all lesions which were clinically and colposcopically different from classic warts. Colpophotographs were taken in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Vaccination against nonspecific bacterial vaginosis. Double-blind study of Gynatren]. / Impfung gegen nichtspezifische bakterielle Vaginose. Doppelblinduntersuchung von Gynatren.

167 patients suffering from nonspecific bacterial vaginoses were vaccinated in a double-blind, randomized, placebo-controlled trial. It appeared, during the study period of 14 months, that the vaccination with Gynatren, a lactobacillus vaccine, was significantly better than the placebo as concerns its therapeutical effect, but mainly as concerns its preventive effect (less reinfections). The vaccine was very well tolerated. We conclude that vaccination with Gynatren is an effective measure to prevent recurrences of nonspecific vaginosis.

[Irradiated cell cultures applied to group A "chlamydiae" isolation (author's transl)]. / Application des cultures de cellules irradiées à l'isolement des Chlamydiae du groupe A.

The irradiated Mc Coy cell cultures method modified by Darougar et al. has been used to investigate the frequency of Chlamydiae in non-specific genital tract disease, in Reiter's disease and in patients suffering from conjonctivits associated with non-specific urethritis. Isolates were obtained from 104 men of the 660 suffering from acute urethritis, and from 18 men of the 67 suffering from conjonctivitis associated with urethritis. Fourteen female sexual contacts of these men were tested: Chlamydiae was isolated from 9. Seven patients suffering from acute Reiter's disease were tested: Chlamydiae was isolated from 4. These patients were tested by complement fixation and titers of 1/8 or more were only obtained in the 4 isolated positive cases, the three other cases remaining negative. Isolates of Chlamydiae were obtained from 10 women of the 67 women suffering from exocervicitis. No isolate was obtained, from 27 control patients.

"One-minute treatment" with thiamphenicol in 50,000 cases of gonorrhea: a 22-year study.

The results obtained with single-dose (2.5 g of thiamphenicol) therapy of gonorrhea in 50,000 patients are reported. Male patients included recent cases of acute or subacute urethritis and uncomplicated cases; all female patients had uncomplicated gonorrhea. Asymptomatic gonorrhea in both men and women was included in the therapy trial in all cases when "epidemiological" treatment was necessary. Tolerance of thiamphenicol was excellent; we observed only 62 cases of gastralgia or nausea and 12 cases of generalized pruritus reaction. No hematologic side effect was reported. The prescribed dose does not conceal incubating syphilis since 211 cases of recent syphilis were observed. Failures are reported year by year from 1961 to 1982 and, on the average, failure rates for men and women were 3.42% and 3.24%, respectively.

Enoxacin in the treatment of sexually transmitted diseases.

Enoxacin was evaluated in two double-blind comparative trials in a total of 200 male and female patients with urethral and/or endocervical gonorrhoea. Single 400-mg doses were effective in eradicating Neisseria gonorrhoeae (including penicillinase-producing strains) from patients. Enoxacin was as effective as the parenteral drugs approved for treatment. Adverse events occurred in 3% of patients. Enoxacin has been shown to be an effective well tolerated and convenient treatment for gonorrhoea.

[Male infertility and mycoplasma infections (author's transl)]. / Infertilité masculine et mycoplasmes

PIP: The frequency and pathogenic role of mycoplasmas in cases of male infertility were studied in 2 groups: in 69 subjects in whom the reduced fertility (most often called asthenozoospermia) could not be explained, 35 (50%) carried mycoplasmas. 120 other subjects suffering from subacute or persisting urethritis presented sperm anomalies the degree of which seemed to be proportional to the duration of the urethritis. The presence of mycoplasmas was demonstrated in 2 cases of repeated abortion. The disappearance of this microorganism after treatment resulted in satisfactory pregnancies in these cases. This work confirms the probable role of mycoplasmas in male infertility and their certain role in certain cases of repeated abortion.^ieng

Secnidazole. A 5-nitroimidazole derivative with a long half-life.

The therapeutic activity of a single 2 g dose of secnidazole was studied in patients with urogenital trichomoniasis. In 140 patients, 97% were cured and the drug was well tolerated. In the laboratory, tests on sensitivity were made and the minimal inhibitory concentration (MIC) and the minimal trichomonacidal concentration (MTC) were determined on cultures that had recently been isolated at the clinic, and the pharmacokinetic properties of secnidazole in man were compared with those of tinidazole. The therapeutic efficacy of all the metronidazole derivatives was reviewed and a single-dose treatment is recommended. Therapeutic and prophylactic treatment is achieved by products with a long half-life. Secnidazole, with a half-life of 14.3 +/- 1.3 h (women) and 20.2 +/- 3.1 h (men), is particularly suitable for this type of treatment.

Topical treatment of genital warts in men, an open study of podophyllotoxin cream compared with solution.

OBJECTIVE: To evaluate the clinical efficacy of a 0.15% and a 0.3% cream formulation of podophyllotoxin in comparison with the 0.5% solution in the treatment of condylomata acuminata and to compare the treatment modalities regarding side effects. DESIGN: The study was designed as an open randomised trial. Ninety male patients with signs of penile HPV infection, with either acuminate or papular lesions, were randomised into three parallel treatment groups. The study medication comprised 0.15% and 0.3% cream and 0.5% solution of podophyllotoxin. The patients treated themselves twice daily for three consecutive days and if total regression of the warts was not achieved after this first treatment cycle, further treatment cycles at 7-day intervals were to be repeated up to a maximum of four treatments. SETTING: The study was carried out in three outpatient clinics: two STD clinics, Department of Dermatology and Venereology, University Hospital (45 patients) and Institut Antoine Fournier, Paris (30 patients), and one military hospital, S1/FO 47/48, Sjukhusenheten, Enköping (15 patients). RESULTS: Statistical evaluation of the treatment effect was based on a "Response rate" calculation at each visit. The number of completely responding patients after the first, second, third and fourth cycle were 40 (44%), 61 (68%), 67 (74%) and 70 (78%), respectively. There was no statistically significant difference between the three treatments after four treatment cycles. However, the 0.15% cream had a significantly slower onset of efficacy as compared with the 0.3% cream and 0.5% solution. Adverse effects were less severe and less frequent with the 0.15% cream than with the other treatment modalities. Severe adverse effects were reported by 12 patients, of whom two were treated with 0.15% cream, five with 0.3% cream and five with 0.5% solution. Thirty-one patients were completely free from adverse effects. CONCLUSION: In this open randomised study with three parallel treatment groups, two cream formulations of 0.15% and 0.3% podophyllotoxin and a 0.5% solution of the same drug all showed an equally good response rate after four treatment cycles. Reported adverse effects were few and mild. The convenience of having different formulations to offer when prescribing treatment for condylomata must be considered.

[New "chlamydia" isolation methods applied to the current medical practice and epidemiology (author's transl)]. / Adaptation à la pratique médicale courante et à l'épidémiologie des nouvelles méthodes d'isolement des Chlamydia.

From 935 men attending a consultation for veneral diseases and 117 women suffering from vaginal discharge, 1 052 genito urinary tract specimens were inoculated on monolayers of McCoy cells which were irradiated or treated with either cytochalasin B or 5-iodo-2-deoxyuridine. The value of these technics was estimated in routine diagnostic procedures according to the number of positive cultures, regardless of the number of inclusions per culture and also by comparison of the number of inclusions seen in cells inoculated with reference strains of lymphogranuloma venereum, trachoma and human urethral Chlamydia. The best method seems to consist of the use of McCoy cells treated with cytochalasin B for routine isolation and of acridine orange for the staining of inclusions.

Microbiology of specimens obtained by laparoscopy from controls and from patients with pelvic inflammatory disease or infertility with tubal obstruction: Chlamydia trachomatis and Ureaplasma urealyticum.

We cultured for Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis and performed chlamydial serologic studies in 99 women undergoing laparoscopy. These women included patients with acute salpingitis, infertile women with and without mild pelvic inflammatory disease, and controls. C. trachomatis infection was significantly more common in patients than in controls. We also identified low-grade "silent" PID among women with infertility resulting from tubal obstruction and suggest this may be caused by chlamydiae.