Evaluation of Syndromic Management in Women with Vaginal Discharge in China / 中华皮肤科杂志

ObjectiveToevaluateourrevisedsyndromicalgorithmforthemanagementinpatientswithvaginaldischargeanddetermineitssensitivity,specificity,andpositivepredictivevalue(PPV).MethodsPatientswithvaginaldischargesyndromewereselectedintheirfirstvisitstotwoSTDclinicsinShanghaiandSichuan.Theyweremanagedaccordingtorevisedsyndromicflowcharts.Theetiologyofthesyndromewasdetectedbylaboratorytesting.ThedatawereanalyzedusingEPIINFOV5.0software.ResultsTherewere27(8.1%)patientswithgonorrhea,57(17.1%)withchlamydialinfection,and18(5.4%)withbothinfectionsin334patientswithvaginaldischarge.Thesensitivitywas70.6%,specificity54.7%,PPV40.7%,andnegativepredictivevalue(NPV)80.9%forthediagnosisofgonorrheaand/orchlamydialinfectionbysyndromicapproach.ConclusionThespecificityandPPVforsyndromicmanagementofvaginaldischargearenotsatisfied.Furthervalidationandrevisionareneededforsyndromicapproachesofvaginaldischarge.

Correlation between Fluoroquinolone Resistance and Mutations of Neisseria gonorrhoeae gyrA and parCgenes / 中华皮肤科杂志

ObjectiveToevaluatethecorrelationbetweenfluoroquinoloneresistanceinNeisseriagonor-rhoeaeandmutationsingyrAandparCgenes.Methods①Thesusceptibilities58clinicalisolatesofN.gonorrhoeaeto5fluoroquinolonesweretestedbydiscdiffusionmethod.②Theminimuminhibitoryconcentration(MIC)ofciprofloxacinwasdeterminedbyE-test.③Thefragmentsincludingthequinoloneresistance-determiningregion(QRDR)wereamplifiedbyPCRingyrAgeneof18strains,andparCgeneof8strains,andtheirrelativefragmentsweredirectlysequenced.Results①Thenumbersofstrainssimultaneouslysensitive,intermediateandresistanttociprofloxacin,ofloxacin,lomefloxacin,fleroxacinandenoxacinwere2,4and39,respectively.②TherangeofciprofloxacinMICwas0.004～12.0?g/mLin58strains.Thenumbersofstrainssensitive,intermediateandresistanttociprofloracinwere2,17and39,respectively.③ThestrainswithciprofloxacinMICfrom0.004～0.016?g/mLhadnomutationingyrAandparCgenes.ThestrainswithMICfrom0.064to0.094?g/mLcarriedasinglepointmutationingyrAgene,whilethestrainswithMIC≥0.25?g/mLcontainedtwomutationsingyrAgene.Inaddition,thestrainswithMIC≤0.25?g/mLhadnomutationinparCgeneandthestrainswithMIC≥1.0?g/mLexhibitedasinglepointmutationinparCgeneandtwomutationsingyrAgene.④Of16strainscontainingmutationingyrAgene,15strainsexhibitedsubstitutionofSer91(TCC)→Phe(TTC).Conclusions①MutationswithingyrAgenemediatelowandmoderatelevelsfluoroquinoloneresistancewhilemutationswithinparCgeneparticipateinhighlevelfluoro-quinoloneresistanceinN.gonorrhoeae.②SubstitutionofSer91→PheingyrAgeneisthepivotalmutationresultinginfluoroquinoloneresistanceinN.gonorrhoeae.