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1.  Letter: The future of venereology. 
PMCID: PMC1045259  PMID: 946949
2.  A sore throat with a difference. 
PMCID: PMC1045324  PMID: 827328
3.  Some aspects of sexually transmitted disease in Swaziland. 
A survey of sexually transmitted diseases was attempted in Swaziland. Time and the terms of reference limited its scope, but much interesting information was gathered. Neither the prevalence nor the relative frequency of the different diseases in the community could be ascertained, but there was evidence to support the local impression that the sexually transmitted diseases present an increasing problem in Swaziland. An important problem was that of case finding and two aspects of this are stressed: (1) A general lack of knowledge concerning the venereal diseases; (2) The large number of men infected by 'casual' girl friends who cannot easily be traced, and who form a reservoir of infection in the community.
PMCID: PMC1045322  PMID: 1036969
4.  Sensitivity of Trichomonas vaginalis to metronidazole, tinidazole, and nifuratel in vitro. 
Prompted by the sensitivity of trichomonads to metronidazole and nifuratel in clinical practice, a study was conducted in 1971-1972 of 63 consecutive strains of Trichomonas vaginalis isolated from women with clinically refractory vaginal discharge. Their susceptibility to metronidazole, tinidazole, and nifuratel was tested, using a serial tube dilution technique. The minimum concentrations which in 48 hrs caused immobilization and lysis of trichomonads cultured in Diamond's medium was assessed. No differences in drug potency could be determined. The median trichomonistatic and trichomonicidal concentrations were 0-1 and 0-6 mug/ml. respectively when using an inoculum of 10,000 organisms per ml. An inoculum of 100,000 per ml. resulted in inhibitory concentrations of 1-0 and killing concentrations of 3-3 mug./ml. These levels are readily attained in blood and vaginal tissue after oral ingestion of the two imidazole derivatives. Thus, metronidazole has maintained its efficacy since it was first introduced more than a decade ago. The few therapeutic failures with metronidazole and tinidazole are considered to have been caused by pharmacokinetic deficiencies in the patients, or by re-infection.
PMCID: PMC1045320  PMID: 1087577
5.  Isolation of Chlamydia trachomatis from women attending a clinic for sexually transmitted diseases. 
Attempts were made to isolate Chlamydia trachomatis from the cervix of 300 women attending a clinic for sexually transmitted diseases in Leeds. The women were divided into four groups; (1) 130 were consorts of men suffering from non-specific urethritis; (2) 66 were suffering from gonorrhoea, or were consorts of men suffering from this disease; (3) 56 were suffering from other sexually transmitted diseases; (4) 48 had no evidence of STD. The overall isolation rate of Chlamydia trachomatis was 20%. Positive results were obtained in 30%. of Group 1, in 27-3%. of Group 2, in 3-6%. of Group 3, and in 2-1%. of Group 4. No pathogenic sign or symptom of Chlamydia trachomatis infection of the cervix was detected.
PMCID: PMC1045318  PMID: 1009420
6.  Gonococcal urethral stricture and watering-can perineum. 
A total of sixteen patients with urethral stricture and/or perineal urinary fistulae (water-can perineum) complicating gonorrhoea were seen at the Special Treatment Clinic, University College Hospital, Ibadan, Nigeria. The patients were aged between 25 and 80 years, and the latent period between the time of original attack of gonococcal infection and the development of complications varied from 4 to 50 years. The rate of divorce or marital separation is high among these patients with late sequelae of gonorrhoea. The factors responsible for the present higher incidence of early and late complications of gonorrhoea among patients in Nigeria and other tropical countries compared with their counterparts in Europe and North American include: (a) Lack of medical facilities in most rural areas; (b) Inadequate treatment of veneral diseases, including the urban areas where self-medication is practised on a large scale by the general population; (c) Illiteracy and ignorance of venereal diseases. The cases of watering-can perineum reported here, and the subsequent chronic pyelonephritis and hypertension, reinforce the plea for early and energetic treatment of acute gonorrhoea in Africa as well as large-scale control measures by the health authorities.
PMCID: PMC1045316  PMID: 1009418
7.  Prevalence of multiple antibiotic resistance in Neisseria gonorrhoeae. 
The susceptibility of 100 strains of Neisseria gonorrhoeae to five antimicrobial agents (penicillin, streptomycin, oxytetracycline, sulphamethoxazole, and gentamicin) was examined. Three strains were resistant to each antimicrobial, fourteen exhibited resistance to three or four of the five compounds tested, and 49 were resistant to a single agent, or to pairs of the selected agents. 34 strains were found to be fully sensitive to all of the compounds tested. It is suggested that resistance to gentamicin and sulphamethoxazole may be determined by a multiple resistance gene. The overall frequency of penicillin resistance was found to be 26-5 per cent (MIC greater than 0-06 mug/ml.), suggesting a significant decrease in resistance since 1968.
PMCID: PMC1045315  PMID: 827327
8.  Prolonged survival of Neisseria gonorrhoeae in a new liquid medium. 
Despite substantial improvements in solid culture media for gonococci and the development of liquid media for the short-term growth of the organism, we know of no study of the long-term survival of Neisseria gonorrhoeae in liquid medium. A new liquid medium for N. gonorrhoeae formulated in this laboratory is simple, efficient, and promising. It will support growth and sustain inoculated colony types for periods of up to 3 weeks. Moreover, it has been used successfully for the primary isolation of gonococci from patients. From the evidence at present available, we believe that this medium will find a useful place in gonococcal research.
PMCID: PMC1045314  PMID: 827326
9.  Syphilitic aortic regurgitation. An appraisal of surgical treatment. 
During the 10 years from 1964 to 1973, fifteen patients with severe syphilitic aortic regurgitation were treated surgically at the National Heart Hospital. In thirteen the valve was replaced and in two it was repaired. In addition four had replacement of an aneurysmal ascending aorta with a Dacron graft and seven some form of plastic repair to the coronary ostia. Three patients died within 1 month of surgery and a further six during the follow-up period which varied from 1 to 55 months (mean 25-5). The six survivors have been followed-up for an average of 33 months. Factors contributing to this high mortality were analysed and it was found that the mean duration of effort dyspnoea was 22 months in the survivors compared with 48 months in those who had died. Similarly the average duration of nocturnal dyspnoea was 4 months in the survivors compared with a mean of 8 months in those who had died. Only six out of the fifteen patients had angina; this was present in two of the survivors and in four of the fatalities. The pulse pressure, heart size, and haemodynamic findings were similar in the two groups. The prognostic value of an elevated erythocyte sedimentation rate was also examined. It was concluded that preoperative investigations should include aortography, coronary arteriography, an assessment of left ventricular function, and whenever possible myocardial biopsy. These data were interpreted as suggesting that patients should be referred for surgery at an earlier stage in the disease--certainly before the onset of cardiac failure and--and that if this more aggresive attitude was adopted, as it has been in non-syphilitic cases of aortic valve disease, the present high mortality in this group would be reduced.
PMCID: PMC1045312  PMID: 1009417
10.  Editorial 
PMCID: PMC1045311
11.  Abstracts 
PMCID: PMC1045307
14.  Shigellosis. Another sexually transmitted disease? 
Following the clinical observation that there appeared to be an association between shigellosis and male homosexuality, the medical records of 113 patients at The New York Hospital were reviewed retrospectively. Of the 38 males studied who were between the ages 19 and 61, seventeen were homosexual (44-7 per cent.). Only one of the matched controls was homosexual. Of the men with shigellosis who had a history of foreign travel, 10 per cent. were homosexual; however, among the patients without a travel history, 57-1 per cent. were homosexual (P less than 0-05). For male patients with shigellosis who do not have an appropriate travel history, the physician should expand his epidemiological investigation to include sexual contacts. Men and women who perform rectal intercourse should be cautioned to abstain from this activity until their stool cultures are negative for shigella. If a male patient with shigellosis is homosexual, he should be screened for other sexually transmitted diseases such as syphilis, gonorrhoea, hepatitis B, and amoebiasis.
PMCID: PMC1045299  PMID: 1036464
15.  Drug misuse in a special clinic patient population in Glasgow. 
During the period October, 1970, to October, 1972, a sample of 295 patients attending Special Clinics in the City of Glasgow participated in an investigation into drug misuse. Results show that, of the 136 males and 159 females who took part--all within an age range of 16 to 24 years, 43 per cent. of the males and 36 per cent. of the females admitted to having experimented with drugs. These percentage figures on the prevalence of drug misuse compare with 36 per cent. of males and 24 per cent. of females obtained from other Glasgow-domiciled target groups, comprising a sample of 2,514 individuals. The principal drug of misuse is shown to be cannabis, followed by LSD and sleeping pills. Data on drug availability suggest that little difficulty is experienced in obtaining drugs illicitly from a variety of sources. Comparison between drug misusers and non-misusers on domestic, educational, and social variables revealed no very distinctive patterns. Results of screening for personality characteristics, using Eysenck's Psychoticism, Extraversion and Neuroticism Inventory generally confirmed previous findings related to atypical scores on the P, E, and N parameters. Even so, results obtained by means of the PEN Inventory and IPAT Anxiety Scale revealed a pattern in which drug misuse is shown to be related to even higher scores of psychoticism, neuroticism, and anxiety. The results of the investigation are discussed with particular reference to the nature of the appeal of drugs to the sexually permissive and promiscuous.
PMCID: PMC1045298  PMID: 990885
17.  Gonorrhoea in women and exposure to risk. 
Data are presented on the characteristics of women with newly diagnosed gonorrhoea who attended Lydia Clinic, St. Thomas' Hospital, during a 6-month period. Although gonorrhoea in women is largely asymptomatic, there was strong circumstantial evidence to suggest that some women had attended because they had been exposed to risk. The proportion of women thus motivated was largest among those women who had attended a clinic for sexually transmitted diseases before--in which up to 40 per cent. of women had apparently attended entirely of their own accord. Women born in the West Indies differed from their counterparts born in the United Kingdom in three respects: they were younger, recorded fewer contacts, and referred themselves less frequently to the clinic for a first visit. Implications for health education and for future research are discussed.
PMCID: PMC1045295  PMID: 1033015
18.  Activity in vitro of ten antimicrobial agents against Neisseria gonorrhoeae. A study of the correlation between the sensitivities. 
105 Belgian strains of Neisseria gonorrhoeae were tested for their sensitivity to penicillin, ampicillin, rifampicin, erythromycin, tetracycline, streptomycin, spectinomycin, sulphamethoxazole, trimethroprim, and a combination of sulphamethoxazole and trimethroprim in a 5:1 ratio. Distribution and median values of minimum inhibitory concentrations (MICs) are given and discussed. 42 per cent. of strains were relatively resistant to penicillin (MIC greater than or equal to 0-04 mug/ml.), but only 2 per cent. showed high-level resistance (MIC greater than or equal to 0-38 mug/ml.), which is comparable with the prevalence of decreased sensitivity found in other European countries. A significant positive correlation (P less than or equal to 0-01, rank correlation coefficient) is found between the sensitivities to penicillin, ampicillin, erythromycin, tetracycline, and streptomycin, except for the ampicillin-erythromycin and ampicillin-tetracycline pairs. Rifampicin is correlated with tetracycline. No correlation is found between the sensitivities to spectinomycin and any of the other drugs. The combination of sulphamethoxazole and trimethoprim in a 5:1 ratio also shows a significant positive correlation with penicillin and ampicillin and with sulphamethoxazole and trimethoprim separately.
PMCID: PMC1045294  PMID: 136290
19.  Diagnosis of gonorrhoea in women. 
250 consecutive female contacts of men with gonorrhoea were examined in Lydia Department of Genito-urinary Medicine, St Thomas' Hospital, London, and 165 (66 per cent.) were found to be positive for gonorrhoea. Over 99 per cent. of the positive results were found by the first two sets of genital investigations. These results are compared with earlier and more recent results from our own and other centres and it is postulated that the higher early diagnosis rate is due to the introduction of a highly selective but non-inhibitory culture medium (VCNT), combined with a new incubator which accurately regulates temperature, humidity, and CO2 content. Reasons for the negative findings in 35 per cent. of the female gonorrhoea contacts are discussed.
PMCID: PMC1045293  PMID: 990883
20.  Effects of laboratory maintenance on the nature of surface reactive antigens of Neisseria gonorrhoeae. 
The extensive in vitro cultivation methods used in propagating and maintaining gonococcal cells were found to affect their virulence, antigenicity, and ultrastructure. Adapting a laboratory-maintained strain of gonococci to animal virulence resulted in two lines of pilated cells with similar colonial morphologies. The animal-adapted cells, however, had a greater amount of extracellular pili and a more prominent peptidoglycan cell wall layer. They were also more resistant to the bactericidal effects of guinea-pig complement and more reactive in macroagglutination and bactericidal tests with strain-specific gonococcal antibody. In comparative guinea-pig protection trials, formalin-fixed cells of the animal-adapted cell line were 500 times more effective as immunogens than the laboratory-maintained cell line.
PMCID: PMC1045292  PMID: 825184
21.  The erythrocyte sedimentation rate in syphilis. 
The erythrocyte sedimentation rate was studied in 520 men and 202 women with syphilis. It was raised in 66-6 per cent. of sero-negative primary cases, 80 per cent. of sero-positive cases, 100 per cent. of secondary cases, 80 per cent. of early latent cases, and 73-9 per cent. of late latent cases. It was also raised in sixteen out of seventeen cases of neurosyphilis and in all eleven cases of cardiovascular syphilis. It was concluded that the ESR had little place in the management of syphilis in general, but could be helpful in the post-treatment follow-up of late syphilis.
PMCID: PMC1045290  PMID: 990882
23.  Editorial 
PMCID: PMC1045285
24.  Immunity in syphilis. Studies in active immunity. 
Support for the concept of the development of immunity during the course of syphilis is avaiable in the literature. In experimental syphilis in rabbits, some immunity is present approximately 3 weeks after infection with Treponema pallidum. Resistance to re-infection increases to a maximum at approximately 3 months after infection. Termination of this state by penicillin treatment within this 3-month period may enable re-infection to be accomplished. Attempts to reproduce this state of immunity experimentally by injection of T. pallidum itself, or protein derivatives, or ultrasonic disintegrates obtained from T. pallidum or non-pathogenic treponemes, have been unsuccessful. However, promising results in rabbits have resulted from injecting T. pallidum suspensions attenuated by storage at 4 degrees C, penicillin, or gamma irradiation, and also by suspensions preserved by glutaraldehyde. In the present study, partial resistance to intratesticular challenge in rabbits with T. pallidum has been obtained by immunization with a variety of non-pathogenic treponemes, as exemplified by the strains Nichols, Kazan 2, 4, 5, and 8, Treponema minutum, Treponema ambigua, Treponema refringens and Treponema microdentium. Success is attributed to the processing of immunizing antigens at 4 degrees C and storage until use at -20 degrees C. Attempts to attenuate T. pallidum by immunological means, namely, passage through a limited number of immunized rabbits, were unsuccessful.
PMCID: PMC1045289  PMID: 791454
25.  Abstracts 
PMCID: PMC1045282

Results 1-25 (117)