Journal of the American Venereal Disease Association最新文献

Thirteen cases of anorectal Herpesivirus hominis infection in male homosexuals are described. Symptoms included pruitus ani in 11 cases, while 7 noticed intense and pain. Change of bowel habits and anal discharge were not presenting symptoms in the majority. None had generalized complications. Inguinal lymphadenopathy, a vesicular eruption, and superficial ulceration around the anal margin were commonly found. Some developed vesicular spread to the natal cleft. Treatment with cotrimoxazole to prevent masking of possible coexistent syphilis, though satisfactory in preventing secondary infection seemed to have little effect on early resolution of the lesions. Relapse occurred in over one third of the patients. Infection with Herpesvirus hominis seems an uncommon but increasingly recognized hazard for the passive homosexual and should be included in the differential diagnosis of lesions presenting at the anus.

The English literature on the treatment of late benign syphilis with penicillin was reviewed. To date there have been no controlled randomized therapeutic trials to support the efficacy of this therapy. This disease responds rapidly to all antisyphilitic drugs including arsphenamine and heavy metals. There are ample case reports and 2 major therapy studies which demonstrate the safety and beneficial effects of penicillin in individual patients. Although the exact dosage and duration of therapy are open to speculation, it is wise to treat patients with late benign syphilis with doses of penicillin judged to be effective for concomitant neuro-or cardiovascular syphilis.

The English literature on the treatment of cardiovascular syphilis with penicillin was reviewed. To date there have been no controlled randomized clinical trials to demonstrate that penicillin therapy prolongs life expectancy, alleviates symptoms, or arrests the disease process. In spite of many shortcomings in the published data, penicillin is safe and free of severe reactions. Most authors agree that significant subjective improvement in the patient's status occurs following penicillin treatment. Once the patient has become symptomatic penicillin may have little efficacy. The optimal dosage and duration of therapy have never been established. Because of its low cost, ease of administration, and lack of toxicity, it should be given to all patients with cardiovascular syphilis in hope of arresting the effects of the disease on the heart and great vessels.

Only penicillin has been adequately studied in treating syphilis during pregnancy. It is safe for the fetus and highly effective in doses currently recommended by the USPHS. Since these schedules appear to represent a minimal effective dose, smaller amounts should never be used. Whether higher doses would produce higher cure rates is not known. Penicillin is the drug of choice and the standard against which all others must be measured. Tetracyclines in any dose or form should not be used because of toxicity to both mother and child. Erythromycin (except the estolate) and cephalosporins are promising because of low toxicity, but their efficacy has not been established.

Endocervical cultures for Neisseria gonorrhoeae were taken from 4,285 new patients attending the emergency room and outpatient clinics at Women's Hospital, Los Angeles County-University of Southern California Medical Center. Of these, 144 (3.4%) were positive. Clinic-specific rates were: emergency room 9.0%, family planning clinic 2.3%, therapeutic abortion clinic 2.2%, and prenatal clinic 1.0%. An additional 70 return patients were cultured because of history, symptoms, or signs suggestive of gonorrhea; 14% of these "nonscreen" cultures were positive. Rates for the emergency room and nonscreen category were significantly greater than rates from the clinics. A questionnaire was used to determine patient characteristics in an attempt to identify a high-risk population. Variables of age, race, marital status, history of previous veneral disease or pelvic infection, number of sexual partners, and suspicion of venereal disease were significantly related to the incidence of positive cultures. Obstetrical history and symptoms of cramping or discharge were not related.

The response to phagocytic stimuli was tested for polymorphonuclear (PMN) cells from gonorrhea repeaters, first-time infected patients, and never-infected controls. PMN function was assessed by measuring quantitative leukocyte iodination, glucose-1-C oxidation, and phagocytosis and killing of Staphylococcus aureus 502A. No significant differences in PMN function were noted for the three groups studied. However, white patients had significantly greater leukocyte iodination than black patients (p less than 0.05) and males tended to have greater leukocyte iodination than females (p less than 0.02). It is concluded that PMN cells from gonorrhea repeaters, first-time infected patients, and never-infected controls respond equally well to in vitro phagocytic stimuli. This implies that a significant defect in PMN cell function should not be implicated as a reason for the apparent susceptibility of gonorrhea repeaters to multiple genital gonococcal infections.

In an effort to evaluate the effectiveness of a mass screening program for gonorrhea, a retrospective study was carried out on patients admitted to the hospital with the diagnosis of acute and chronic salpingitis. This study was done at the Confederate Memorial Medical Center in Shreveport, Louisiana. Admissions were reviewed for the year prior to the screening program, and compared to the numbers that were admitted after 2 years of screening. A 70% increase was found to have occurred despite extensive efforts to identify and treat asymptomatic women with gonorrhea, and their male contacts. This finding contrasts dramatically with the experience of others who have reported success in reducing the spread of gonorrhea by such a screening program.

Although penicillin remains the drug of choice for congenital syphilis, the optimal regimen has not been established. The published clinical trials were completed before the development of repository preparations such as benzathine penicillin. Consequently, current therapy must be derived from available clinical and pharmacologic data.