The British Journal of Venereal Diseases最新文献

In a large multicentre study of 429 patients with the usual signs and symptoms of non-specific vaginitis (NSV), we studied the effect of different doses of metronidazole. The patients were divided into five treatment groups as follows: group A was given 400 mg metronidazole three times daily for seven days, group B 2000 mg as a single dose, group C 2000 mg on days 1 and 2, group D 2000 mg on days 1 and 3, and group E was given 1200 mg metronidazole once daily for five days. At follow up examination four weeks from the start of treatment, patients in groups D and E showed the best clinical results with cure rates of 94.0% and 93.6% respectively. In addition the rate of reisolation of Gardnerella vaginalis was lowest in group D. We therefore recommend metronidazole 2000 mg on days 1 and 3 as routine treatment for non-specific or vaginitis associated with gardnerella.

Serum from 74 female and 170 male patients with gonorrhoea and from 72 male and 123 female controls was tested for its ability to induce in gonococci resistance to complement mediated killing by human serum. We confirmed two findings of a previous survey: firstly, a higher percentage of serum samples from women suffering their first infection than from female controls induced high resistance; secondly, no serum sample taken from infected women with complications (mainly salpingitis) induced high resistance. The number of serum samples from female patients with repeat infection was too small for conclusions to be drawn. In men, however, there were no significant differences between patients and controls, or between patients with first or repeat infection, in the percentage whose serum induced high resistance. The pattern of these results on the induction of resistance to serum correlates with the general clinical aspects of gonococcal infections; namely, wide clinical differences in symptoms in women contrasting with a more uniform pattern in men.

Thymus derived lymphocytes (T cells) were counted in the peripheral blood of 30 patients with genital warts and in 20 healthy controls. The control group was made up of 10 healthy patients with no history of warts and 10 who had been cured of warts for at least 12 months. We found that patients with genital warts had a significantly lower number of T cells despite an adequate number of circulating lymphocytes in the peripheral blood. We therefore suggest that a functional defect of lymphocytes ("dyslymphocytosis") could be the cause of genital warts either in their primary or recurrent form. These abnormal lymphocytes return to their normal function after the disappearance of genital warts.

A single blind study of 103 women with vaginal candidosis was undertaken to compare treatment with conventional topical clotrimazole and oral ketoconazole. Both treatment regimens were equally effective in terms of clinical symptoms, negative results on culture for Candida albicans, and relapse rates. As treatment for vaginal candidosis takes several days, patient compliance is important and the success of a treatment regimen may depend on its acceptability to patients. Those in this study who had previously been treated for vaginal candidosis were asked to compare their current and previous treatments. Significantly more (p less than 0.001) of those treated with ketoconazole than those treated with clotrimazole found it more acceptable than previous treatment. This indicated a strong preference for oral treatment, and oral antifungal agents may be the treatment of choice for vaginal candidosis in the future.

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.

We studied 192 men with acute gonococcal urethritis, 97 of whom received two oral doses of Augmentin (amoxycillin 3 g and clavulanic acid 250 mg) separated by a four hour interval; the remaining 95 received 2 g kanamycin in a single intramuscular injection. Of the patients treated with Augmentin, 93 (95.9%) were cured, which was significantly more than the 83 (87.4%) patients treated with kanamycin. Augmentin was equally effective in the treatment of penicillinase producing Neisseria gonorrhoeae (PPNG) and non-PPNG infections, the cure rates for which were 96.6% and 95.6% respectively.

Of 1031 consecutive isolates of Neisseria gonorrhoeae examined before 31 July 1982, 30 strains showed beta-lactamase activity. All the penicillinase producing N gonorrhoeae (PPNG) strains were imported, 23 of them from South East Asia. One PPNG strain was identified as coming from Antigua and one from Chile, the first PPNG strains to be reported from these two countries. In 28 strains, the minimum inhibitory concentration (MIC) of penicillin was greater than or equal to 4.0 mg/l, and 15 strains were insensitive to tetracycline (MIC greater than or equal to 2.0 mg/l). Four strains were less sensitive to spectinomycin (MIC = 30 mg/l), while the remaining 26 were highly sensitive to this antibiotic. The African plasmid was found in only one strain (that originating from Antigua), and all other PPNG strains contained the Asian plasmid. Twenty PPNG strains contained the resistance plasmid together with the transfer plasmid. Auxotype determination showed that 18 PPNG strains were prototrophic whereas 11 were proline requiring.

We carried out auxanographic typing and plasmid identification on 1380 isolates of penicillinase producing Neisseria gonorrhoeae (PPNG) isolated in the Netherlands in 1982 and found four plasmid patterns and 24 auxotypes with noticeable local or regional variations. Among 756 strains harbouring the 3 X 2 megadalton (Mdal) resistance plasmid ("African" type), with or without the 24 Mdal transfer plasmid, 667 (88%) were non-requiring and inhibited by phenylalanine. This type was endemic in most of the cities or regions we studied. Twenty methionine requiring PPNG strains were found, all harbouring the 3.2 and 24 Mdal plasmid; virtually all of them were isolated or contracted in the region of Groningen. The predominant (443 (71%) auxotype among the 624 PPNG strains containing the 4.5 Mdal plasmid ("Asian" type) (with or without the 24 Mdal plasmid) was proline requiring. This auxotype (with the 4.5 Mdal and 24 Mdal plasmid) caused an outbreak in Amsterdam, and in Groningen replaced the local methionine requiring auxotype which had the 3.2 Mdal and 24 Mdal plasmids. Many auxotypes with the 4.5 Mdal plasmid, and requiring proline only, or proline and isoleucine, circulated in the Hague. Spread of imported strains by prostitution played an important part in the epidemiology of infection with PPNG strains.

A group of 25 controls and 30 women with lesions of the cervix associated with papillomavirus were studied prospectively by colposcopy and cytology for up to two years to investigate the relation between human papillomavirus (HPV) infection of the cervix and resolution or progression of cervical intraepithelial neoplasia (CIN). We found that the viral changes were transient and that active infection, as judged by repeated colposcopic and cytological examination, resolved in 83% of the patients. Resolution or persistence of the viral infection did not appear to affect the development of the CIN lesion. The proportion of CIN lesions that resolved and persisted were the same for the study group and the controls. Possible reactivation of latent papillomavirus was noted in three control group patients. Our findings indicate that changes in the cervix associated with papillomavirus should not influence the clinical management or follow up of patients with CIN.