[Etiology of erysipelas]. / Zur Atiologie des Erysipels.

Bacterial cultures were taken from 31 patients by scarification from the dermal compartment of recent erysipelas foci. Pathogenic organisms were isolated from the dermis while cultures from the skin surface remained sterile in 5 patients; Streptococcus pyogenes was cultured in 2 of these patients and Staphylococcus aureus in the other 3 patients. Our findings indicate that staphylococcal erysipelas does exist and we suppose that Staphylococcus aureus is able to induce erysipelas, above all in the presence of dysfunction of lymph vessels. When treatment with penicillin G is not successful, erysipelas caused by staphylococci has to be considered. In these cases treatment has to be changed to penicillinase-resistant penicillin.

[Herpes simplex infection as a sexually transmitted disease]. / Herpes-simplex-Infektion als "Sexually transmitted disease".

Genital herpes simplex virus (HSV-)infection is a disease of growing importance in sexually transmitted diseases. It is the most common cause of genital ulcerations throughout the industrialized nations. It is caused by either herpes simplex virus type 1 or 2. Genital herpes displays variable clinical manifestations in a primary or recurrent form. Various seroepidemiologic studies suggest that asymptomatic infection is common. Primary infection causes severe genital lesions and has a relatively high incidence of neurologic and extragenital manifestations. Recurrent episodes are, in contrast, of much milder expression. To exclude the diagnosis of other possible causes of genital ulcers, laboratory confirmation of the diagnosis of genital HSV-infections has to be established, before antiviral therapy is introduced. HSV can be cultivated in cell culture. Rapid diagnostic techniques such as immunofluorescence, cytologic examination and electronmicroscopy are also available. The most promising antiviral drug seems to be acyclovir. It is effective in reducing some of the manifestations of genital HSV infections. However, the most important problems like the prevention of recurrent infections in patients with genital herpes and the transmission of the disease to newborns or to sexual partners, have not yet been solved.

[Aztreonam, a new approach in the therapy of gonorrhea]. / Aztreonam, eine neue Möglichkeit in der Gonorrhoe-Therapie.

The isolated gonococcal strains cultured from 99 patients (64 men and 35 women) with uncomplicated genital gonorrhoea were tested with regard to their susceptibility to aztreonam. No resistant strain was found. The bacteriological evaluation of 50 of these strains showed a minimum inhibitory concentration (MIC) of 0.0075 to 3.906 mcg/ml. Four of the tested strains were penicillinase-producing strains of N. gonorrhoeae. 95 patients (95.9%) were cured after administration of a single dose of 1 g aztreonam by intramuscular injection. It was not possible to exclude reinfection of the 4 remaining patients. No side effects were reported.

[Chlamydia trachomatis in patients with genital contact infections in Austria--studies of 3,367 patients]. / Chlamydia trachomatis bei Patienten mit genitalen Kontaktinfektionen in Wien--Untersuchungen an 3367 Patienten.

In order to evaluate the epidemiological importance of Chlamydia trachomatis (C. trachomatis) as a genital microorganism, data were obtained from 3,367 patients with sexually transmitted diseases in Vienna and analyzed by computer-assisted methods. C. trachomatis was cultured in 26.1% of 2,594 patients investigated for the first time. The microorganism was found more often in male patients (31.3%) than in female patients (21%). 32.2% of positive Chlamydia cultures were obtained from patients with non-gonococcal urethritis (NGU) and 64% from postgonococcal urethritis (PGU) patients. A high coincidence with Neisseria gonorrhoeae (N. gonorrhoeae) was detected in males (31.2%) and females (43.5%). Data on Mycoplasma hominis (M. hominis), and Ureaplasma urealyticum (U. urealyticum) show that, in contrast to the low incidence of M. hominis and U. urealyticum in males, the organisms were found predominantly in females.

[Incidence of Chlamydia trachomatis infections in pregnant patients in Vienna]. / Häufigkeit von Chlamydia-trachomatis-Infektionen bei Graviden in Wien.

Pregnant women were examined for chlamydia trachomatis-infection on a routine basis during a multicentric study in Vienna. Samples were taken from the cervix and fornix between the 30th and 34th week pregnancy. FTIC-conjugated monoclonal antibodies and immunofluorescence techniques were used to verify chlamydia trachomatis. Out of 1238 pregnant women, 101 (8.16%) were positive for chlamydia trachomatis. Since chlamydia infections can result in severe local or generalized complications and also spread to the newborn baby, screening investigations should be regularly performed during pregnancy and, if indicated, adequate treatment undertaken.

[Genital Chlamydia infections in female patients at risk of having sexually transmitted diseases]. / Genitale Chlamydieninfektionen bei STD- (= Sexually transmitted diseases-) Risikopatientinnen.

Investigations for Chlamydia infections of the genital tract were performed in 270 Viennese registered, as well as in 51 non-registered prostitutes. The results were compared with findings obtained in 56 female patients attending an out-patient STD clinic and 48 pregnant women seeking antenatal care in a department of obstetrics. Diagnosis of Chlamydia infection was the organisms on cultured McCoy cells after treatment with cycloheximide. The highest infection rate (31%) was found in non-licensed prostitutes. In registered prostitutes, 20.4% of the cervical smears proved to be positive for Chlamydia. The control groups showed lower infection rates of 9% and 4%, respectively. These results indicate that women who frequently change their sexual partners are considerably more at risk of contracting Chlamydia infections. Hence, this group of persons should be more regularly investigated and--if necessary--given appropriate treatment in order to prevent further spread of the disease.

[Nonspecific urethritis]. / Die unspezifische Urethritis.

The multiple etiology of non-gonorrhoic urethritis has been extensively investigated in the last few years. It has thus become possible to diagnose the separate forms and consequently treat them with a greater degree of accuracy and specificity. For exact diagnosis multiple and time consuming examinations are often necessary. Sometimes this can only be done in highly specialized laboratories. Among the agents triggering such an infection Chlamydia (30.9% of the cases of non-gonorrhoic urethritis), as well as mycoplasma, ureaplasma, anaerobic bacteria and herpes simplex viruses have gained particular significance. Whereas these infections very rarely lead to complications by ascension in men they can result in unpleasant and severe disease in women (salpingitis, infertility, newborn infection).

[Atypical herpetic manifestations]. / Atypische herpetische Manifestationen.

Herpetic lesions may be readily identified by modern virological techniques. In immunocompromised patients, the herpetic lesions are often atypical and even completely different from conventional forms; in these patients, the course of herpes virus infections may be life-threatening. Therefore, early diagnosis of herpetic infections is essential in order to begin with acyclovir treatment in time.

[Acyclovir-corticosteroid therapy in herpes zoster]. / Aciclovir-Kortikosteroidtherapie beim Herpes zoster.

Thirty patients between 60 and 86 years of age (average 73.6 years) [8, 9, 11] with high risk of having the disease for an extraordinarily long time or of developing neuritis were treated for 5 days with 4-5 mg acyclovir per kilogram body weight. They were not immunocompromised and received the drug intravenously at 8-h intervals. Of this group, 20 patients received daily 40-80 mg methylprednisolone simultaneously. All patients were hospitalized because of extensive, hemorrhagic lesions, which in 8 cases were necrotizing. The primary site of the disease was the head in 13 patients (43.3%), the neck or trunk in 15 (50%) and the extremities in 2 (6.7%). In addition, 8 (26.7%) showed generalized lesions. The duration of the disease could be reduced by one-third by acyclovir treatment, as compared with reference groups, and the methylprednisolone group had even better results. Individual pain was more promptly resolved by the combined treatment than by acyclovir alone. No persistent neuritis was observed in the methylprednisolone-acyclovir group, but occurred in two out of ten patients who had received acyclovir alone. No side effects were reported. The antiviral effect of acyclovir obviously reduces the risk of possible generalization during corticosteroid treatment to negligible amounts. Because of the possible selection of resistant strains, acyclovir should usually only be given to high-risk zoster patients beyond the age of 60. Administration must be initiated in the early phase of the disease, since no effect can be expected after viral shedding has been terminated.

Chlamydia trachomatis and pregnancy: a cross-sectional study in pregnant Viennese women.

To identify the epidemiologic role of Chlamydia trachomatis in Vienna and its incidence in the first and third trimesters of pregnancy, 1116 pregnant women (age range 16-43 years, medium age 26) were screened. Of 459 women applying for legal abortion in the first trimester of pregnancy, Chlamydia trachomatis was detected from the cervices of 24 (5.2%). Chlamydial detection was also performed in 657 women during the thirty-fourth week of pregnancy. The infection rate was found to be very similar to that of the other group (5.9%). The diagnosis was established by the direct immunofluorescence test. The number of elementary bodies did not differ between the two groups, indicating that pregnancy itself may not influence shedding of Chlamydia trachomatis from the cervix.

Therapeutic aspects of herpes genitalis. A short review.

The treatment of manifestations of infection by herpes simplex hominis virus must be aimed at both the local eruptions and the mechanism of recurrence. Recently, some success has been achieved with the use of vaccines and other agents to stimulate a cell-mediated immunity in patients with recurrent herpes infection.

[Virostatic treatment of herpes simplex infections of variable severity]. / Virustatische Behandlung von Herpes simplex-Infektionen unterschiedlicher Verlaufsschwere.

Aciclovir (ACV) is the most effective drug for the virostatic management of herpes simplex virus (HSV) infections, and the rate of side-effects is low. ACV resistance is rare, occurring only in highly immunocompromised patients (so far about 30 cases have been reported). Dosages and modes of application of ACV in different HSV infections are indicated and discussed.

Medical health care for Viennese prostitutes.

In Vienna, legalized prostitution is tightly controlled by the advisory board of the Viennese Public Health Service. Registered prostitutes are routinely screened for all important STDs, such as syphilis, HIV, gonorrhea, chlamydial- and yeast-infections, and Trichomonas vaginalis. Furthermore, cytological smears are obtained from the cervix and chest X-rays are performed at least once a year. In all pathological findings, an appropriate therapy is implemented. Presenting data of 1989, out of the 713 weekly controlled registered prostitutes, Neisseria gonorrhoeae was detected in 0.3% of all examinations (110/35,368). In non-registered prostitutes, the infection rate of N. gonorrhoeae was 6.9% (27/354), and so far, 20 times higher than in registered ones. The infection rate of Chlamydia trachomatis, which has been routinely diagnosed in registered prostitutes for several years, has decreased from 20.4% in 1980 to 2.2% in 1989 compared with 31.4% and 10.9% in non-registered prostitutes. In registered prostitutes, the prevalence of genital infections, such as C. trachomatis, T. vaginalis, and yeasts was shown to be 4.9%. The corresponding data in non-registered prostitutes were much higher (18.8%). Due to examinations for cervical malignancy the incidence of Papanicolaou stain IV and V has decreased from 3.1% in 1988 to 1.6% in 1989. There was no serologic evidence for syphilis and HIV infection in both special risk groups. The data demonstrate, that due to a good health surveillance of STD-risk groups, a good information service, and free treatment, the prevalence of STDs can be reduced in prostitutes.

Culture versus direct specimen test: comparative study of infections with Chlamydia trachomatis in Viennese prostitutes.

To evaluate the sensitivity and specificity of the direct specimen test with monoclonal antibody conjugated with fluorescein isothiocyanate (FITC), cervical smears from 700 Viennese prostitutes were investigated by immunofluorescence microscopy and compared with the results of cultures for Chlamydia trachomatis in McCoy cells. Inclusion bodies in cell culture and elementary bodies on the smear slide were counted and evaluated in four categories. Cultures were obtained from 12.6% (88) of all women investigated, whereas the direct specimen test gave positive results in 10.4% (73). The results indicate that in asymptomatic people with only few inclusion bodies and latent infections, culture on McCoy cells is the more adequate method of identifying Chlamydia trachomatis.

Netilmicin: new approach to treating gonorrhoea.

Resistance and side effects to antibiotics or other chemotherapeutic agents are the main limiting factors in the treatment of gonorrhoea. As no such side effects have been reported with a new aminoglycoside, netilmicin, the therapeutic efficiency of this substance was evaluated in 1200 patients (690 women, 510 men) with uncomplicated gonorrhoea, who each received a single dose of 300 mg netilmicin by intramuscular injection. Efficacy of treatment was assessed by smear microscopy and culture, which gave results in all 1200 patients. No serious side effects were reported. These results indicate that netilmicin is an extraordinarily safe and efficient agent for treating uncomplicated gonorrhoea.

Evaluation of a radioactive rRNA:cDNA-hybridisation assay for the direct detection of Chlamydia trachomatis in urogenital specimens.

A radioactive cDNA probe complementary to chlamydial ribosomal RNA was used to detect C trachomatis in urogenital specimens. Of 37 specimens positive with cell culture 31 were confirmed by the rRNA:cDNA hybridisation test, the sensitivity being 83.8%. The specificity of the hybridisation test was 94.4%, as 186 of 197 specimens that were negative by cell culture were also negative when assessed by the hybridisation method. Given a prevalence of 15.8% the predictive values for positive and negative results were 73.8% and 96.9%, respectively. In additional experiments the possible role of microorganisms added to the specimen collection medium was investigated. However, no indication for crosshybridisation was found; at high concentrations microorganisms interfered with the test procedure.

Quinolones as an alternative treatment of chlamydial, mycoplasma and gonococcal urogenital infections.

We report the results of several trials aimed at evaluating the quinolones in urogenital infections. In Chlamydia trachomatis infections, ofloxacin (200 mg b.i.d. for 10 days) gave a cure rate of 98% (n = 66), and fleroxacin (400 mg s.i.d. for 7 days) provided a cure rate of 89% (n = 19). A double-blind study comparing fleroxacin (600 mg s.i.d.) to doxycycline (100 mg b.i.d.) for 7 days showed similar high cure rates for both regimens (100%; n = 23). In Mycoplasma hominis infections, ofloxacin (200 mg b.i.d. for 10 days) yielded a cure rate of 86% (n = 50) for M. hominis and 55% (n = 43) for Ureaplasma urealyticum. Gonococcal infections (n = 122) were all cured by a single dose of 200 mg ofloxacin. Both ofloxacin and fleroxacin were well tolerated and may be recommended for patients with chlamydial or uncomplicated gonococcal infections, although 600 mg fleroxacin showed a higher incidence of adverse events compared to doxycycline.

Effect of different preparation procedures on the ultrastructure of gonococci.

Culture samples of Neisseria gonorrhoeae and Escherichia coli were studied by transmission and electron microscopy to evaluate the effect of different preparation procedures on the pilation of these organisms. Unfixed as well as fixed bacteria showed only few, long, filamentous appendages when investigated in ultrathin sections, negatively stained specimens, or critical-point dried preparations. Snap-frozen specimens of E. coli showed many short and thin pili after being shadowed with carbon and platinum whereas those of N. gonorrhoeae showed only some type-C-like pili. Thus, the number and morphological appearance of pili appear to be greatly influenced by the preparation techniques used for study by electronmicroscopy. Conclusions as to the type and the infectivity of a bacterial strain can, therefore, not be based on purely morphological criteria.