Journal of the American Venereal Disease Association最新文献

Reactions related to treatment of syphilis may be due to treponemal infection, therapy, or to the interaction of these. In this review I discuss the Jarisch-Herxheimer (J-H) reaction and the therapeutic paradox. Antibiotic side effects are not unique among patients treated for syphilis; therefore, readers are referred elsewhere for reviews of major antibiotic side effects. J-H reactions are acute, transient episodes with manifestations occurring both systemically and at local sites of treponemal concentration. These reactions are related to the rapid destruction of treponemes by various therapeutic agents. In this review, I suggest that J-H reactions may be significant only in syphilitic paresis, pregnancy complicated by syphilis, and when local inflammation can cause serious functional compromise, as with second or eighth cranial nerve involvement. Many workers use prednisone in conjunction with penicillin in some or all of these situations. However, the efficacy of corticosteroids has not been evaluated for such problems in clinical trials. Therefore, the use of prednisone can be supported only in very selected situations and for short duration (ie, 2 days). Therapeutic paradox, which is clinical worsening despite cure of infection, is said to result from scar formation after rapid treponemal destruction by therapeutic agents. The therapeutic paradox does not appear of great significance. Futhermore, no methods to prevent such reactions are generally advocated.

Reports in the English language of the treatment of primary syphilis are reviewed. Except for benzathine penicillin, the efficacy of the currently recommended dosage schedules are documented only by Schroeter et al. Although these investigators reported generally acceptable failure rates, further study is necessary to determine: (1) if differences in efficacy exist among regimes; (2) if the current schedules are equally effective in both primary and secondary syphilis; and (3) if increased dosages reduce failure rates.

The studies in the English language of the treatment of latent syphillis suffer from a variety of problems. Investigators have failed to define cases adequately and, in some instances, have combined results of several treatment regimens, and have not followed patients for an adequate period of time. It may be wisest to recommend that regimens considered effective for asymptomatic neurosyphilis also be used for latent syphilis.

This case report describes a laboratory-acquired infection with Treponema pallidum, Nichols strain. The specific details of the accidental exposure are presented, along with a description of the clinical observations. This infection indicates that the rabbit adapted Nichols strain of T pallidum retains its capability to infect humans. In addition, aerosols of concentrated preparations of these organisms, generated within the laboratory, represent a definite biohazard.

Pathways of entry of pathogenic organisms into the prostate may include hematogenous dissemination from distant foci of infection, extension via lymphatics, transmission via infected urine from kidneys, or retrograde entry via the urethra. The last route of entry seems to account for most episodes of prostatitis. Indirect evidence from studies of patients with prostatitis points to retrograde entry of bacteria via the urethra following oral, anal, or genital intercourse or masturbatory practices as a major means of induction of prostatitis. Evidence is based upon similarity of organisms recovered from various orifices to those in the prostate, apparent low incidence of prostatitis in asexual males, and appearance in the prostate of bacteria which reside in the distal urethra. Definitive studies are necessary to prove this hypothesis; emphasis must be placed on correct diagnosis of prostatitis.

A clinical trial was performed to test a loading dose regimen of tetracycline (1.5 gm po sTAT and 0.5 mg po quid for 4 days) against a no-loading dose (0.5 gm po quid for 4 1/2 days) in the treatment of 477 cases of uncomplicated male urogenital gonorrhea. The regimens were equivalent, with an overall cure rate of 96%. A crossover pharmacokinetic study in 10 healthy volunteers demonstrated higher blood levels during the first day on the loading regimen, but equivalence thereafter. Tetracycline, in a total dose of 9.5 gm, is highly effective treatment, and a loading dose is not necessary.

Minimum inhibitory concentrations (MIC) of penicillin in units per milliliter were determined for 2.241 gonococcal isolates submitted to the SEATO Medical Research Laboratory between January 1, 1972, and December 31, 1974. Isolates were separated into 3 groups, determined by the calender year in which they were submitted. The mean penicillin MIC+/-2 standard errors was calculated for each of the 3 groups. These values were 0.58+/-0.02 units/ml in 1972, 0.72+/-0.04 units/ml in 1973, and 1.05+/-0.04 units/ml in 1974. These means were found to be significantly different (p less than 0.0001).

T-mycoplasmas have been associated with nongonococcal urethritis (NGU) in studies in which these organisms were found to be more prevalent among men with NGU than among control groups of men. In none of these studies were the groups matched for sexual experience, a variable which we have shown to be an important determinant of colonization with T-mycoplasmas. We obtained urethral cultures for genital mycoplasmas from men presenting to the Boston City Hospital with gonococcal urethritis and with NGU, and from men of comparable sexual experience who did not have urethritis. Colonization with T-mycoplasmas was no more prevalent among men who had NGU than among the men who did not have urethritis. These data raise some serious questions about the role of T-mycoplasmas in nongonococcal urethritis.

This study compared repeat gonorrhea patients with nonrepeat patients and control patients not having venereal disease. Focus was given to current intellectual and personality attributes as well as a broad spectrum of background factors in social, familial, educational, and sexual history. One-tailed t-tests were computed on the myriad permutations of patient group and the multiple derived scores from the personality and intellectual assessments. The results show no significant differences between the patients having their first infection of VD and the patients with repeat VD; however, when these 2 groups are pooled and compared with the controls, the VD patients are significantly higher on the depression, schizophrenia, psychasthenia, hysteria, and psychopathic scales. A similar pattern exists on reasoning ability and internal versus external locus of control. The VD patients are seen to perceive themselves as much more externally controlled than do the controls. It is concluded that the VD patients might profit from psychologic treatment; such treatment resources might aid not only in the control of repeat infections but in the general social integration of the patients.

In a group of 184 women infected with Corynebacterium vaginale (Haemophilus vaginalis), 34% over age 30 were divorced or separated and 8% gave a history of induced abortion. Fifty-one percent were taking an oral contraceptive drug, as compared to 36% of 140 women in a control group. Various sexually transmitted diseases were diagnosed either concomitantly or at another time in 52% of women in the study group and 38% of those in the control group. The rate of cervical neoplasia (invasive carcinoma, carcinoma in situ, and dysplasia) was 13.6% in the study group and 5.7% in the control group, the rate in the study group being several times that in the general population. These and other available epidemiologic data support the conclusion that C vainale is transmitted sexually.