Is Mycoplasma hominis a vaginal pathogen?

OBJECTIVE: To evaluate the role of Mycoplasma hominis as a vaginal pathogen. DESIGN: Prospective study comprising detailed history, clinical examination, sexually transmitted infection (STI) and bacterial vaginosis screen, vaginal swabs for mycoplasmas and other organisms, follow up of bacterial vaginosis patients, and analysis of results using SPSS package. SETTING: Genitourinary medicine clinic, Royal Liverpool University Hospital. PARTICIPANTS: 1200 consecutive unselected new patients who had not received an antimicrobial in the preceding 3 weeks, and seen by the principal author, between June 1987 and May 1995. MAIN OUTCOME MEASURES: Relation of M. hominis isolation rate and colony count to: (a) vaginal symptoms and with the number of polymorphonuclear leucocytes (PMN) per high power field in the Gram stained vaginal smear in patients with a single condition--that is, candidiasis, bacterial vaginosis, genital warts, chlamydial infection, or trichomoniasis, as well as in patients with no genital infection; (b) epidemiological characteristics of bacterial vaginosis. RESULTS: 1568 diagnoses were made (the numbers with single condition are in parenthesis). These included 291 (154) cases of candidiasis, 208 (123) cases of bacterial vaginosis, 240 (93) with genital warts, 140 (42) chlamydial infections, 54 (29) cases of trichomoniasis, and 249 women with no condition requiring treatment. M. hominis was found in the vagina in 341 women, but its isolation rates and colony counts among those with symptoms were not significantly different from those without symptoms in the single condition categories. There was no association between M. hominis and the number of PMN in Gram stained vaginal smears whether M. hominis was present alone or in combination with another single condition. M. hominis had no impact on epidemiological characteristics of bacterial vaginosis. CONCLUSION: This study shows no evidence that M. hominis is a vaginal pathogen in adults.

Comparison of an automated enzyme immunoassay with a direct fluorescent antibody test and polymerase chain reaction for the detection of Chlamydia trachomatis in diagnostic specimens from male patients.

Endourethral swabs and first-pass urine (FPU) samples from 148 male patients were tested for Chlamydia trachomatis by an automated enzyme immunoassay (EIA) (Vidas; bioMérieux, France), a direct fluorescent antibody (DFA) test (MicroTrak; Syva, USA) and two polymerase chain reaction (PCR) methods. Chlamydia trachomatis was considered present if a specimen was positive by at least two methods. This expanded criterion identified 27 patients (18%) as truly infected. One of the PCR methods was most sensitive for both types of specimen. When the recommended cut-off value of Vidas was reduced by 50%, its sensitivity on endourethral swabs was comparable to that of the DFA test, but the DFA test performed better with FPU. In general, FPU was suitable only for PCR.

The treatment of bacterial vaginosis with a 3 day course of 2% clindamycin cream: results of a multicentre, double blind, placebo controlled trial. B V Investigators Group.

OBJECTIVE: To evaluate the efficacy and safety of a 3 day course of intravaginal clindamycin 2% cream for the treatment of bacterial vaginosis. DESIGN: A prospective, randomised, double-blind placebo controlled study. SETTING: Departments of genitourinary medicine at Birmingham, Nottingham, Liverpool, Swansea, Leeds, Walsall, Stoke Mandeville, Southampton, Plymouth, Bishop's Stortford and Glasgow. SUBJECTS: Pre-menopausal women aged 18 years and over, who had symptomatic bacterial vaginosis were randomly allocated to receive either clindamycin 2% cream 5 grams (107 patients) or matching placebo cream (114 patients), daily for three days. Response to therapy was assessed at 7 days (Visit 2) and 28 days (Visit 3). RESULTS: 221 patients with symptomatic bacterial vaginosis were enrolled to the study and of these 141 (63.8%) completed the study. On the "intent-to-treat" (ITT) analysis, 75% of the clindamycin group were classified as "success" or "improved" at visit 2 compared with 13% of the placebo group (p < 0.001). At Visit 3, 41% of the clindamycin group were classified as either "success" or "improved" versus 4% in the placebo group (p < 0.001). Of the 80 patients who were recorded "success" or "improved" at visit 2, 20 (25%) were reported to have a "recurrence" of BV at Visit 3. The meta-analysis on those who were evaluable at Visit 2 and 3 also showed that clindamycin cream 2% was an effective treatment for bacterial vaginosis, and the differences between the clindamycin group and the placebo group were statistically significant. CONCLUSION: We conclude that a 3 day course of clindamycin 2% cream is an effective, and well tolerated treatment for bacterial vaginosis.

Treatment of bacterial vaginosis with a three day course of 2% clindamycin vaginal cream: a pilot study.

OBJECTIVE: To evaluate the efficacy and safety of a 3 day course of 2% clindamycin cream in the treatment of bacterial vaginosis. DESIGN: A prospective, randomised, double blind, placebo controlled study. SETTING: Department of Genitourinary Medicine, Royal Liverpool University Hospital. SUBJECTS: 55 female patients aged 18 years and over, and premenopausal, who spontaneously or after questioning complained of symptoms of bacterial vaginosis. RESULTS: 55 patients were enrolled. 44 patients were evaluable at Visit 1 when among the 23 who received clindamycin cream bacterial vaginosis was not present in 22 (95.6%) and only one failed treatment. Of the 21 patients in the placebo group only one (4.8%) patient was cured and 20 (95.2%) were failures. Of the 17 patients evaluable at Visit 2 in the clindamycin group, bacterial vaginosis was not present in 14 (82.4%) and had recurred in three. No serious adverse events were noted in either group. CONCLUSION: This pilot study provides encouraging evidence of the efficacy and safety of a 3 day course of 2% clindamycin cream in bacterial vaginosis.

Amyloid tumour of the urethra presenting as non-specific urethritis.

Amyloid tumour involving the urethra is a well recognised but rare occurrence. Chronic inflammation secondary to gonococcal urethritis is thought to be a possible predisposing factor. We report the case of a young man who presented with non-gonococcal urethritis and haematuria and was subsequently found to have primary amyloid of the urethra.

Incidence of Ureaplasma urealyticum in endourethral swabs compared with first voided urine from men.

The incidence of Ureaplasma urealyticum in endourethral swabs was compared with that in first voided urine specimens from 171 male patients. The organism was isolated from the urethras of 72 (42%) and from the urine of 66 (39%). The interval since last voiding urine did not significantly influence the incidence of infection or ureaplasma counts in either type of specimen. Urethritis was strongly associated with ureaplasma counts of greater than or equal to 5 x 10(5) colour changing units (ccu)/ml in the urethra and greater than or equal to 5 x 10(3) ccu/ml in urine.

Ciprofloxacin treatment of chlamydial infections of urogenital tracts of women.

Ciprofloxacin was evaluated in chlamydial infections of the urogenital tracts of women treated with a dosage regimen of 500 mg orally twice a day for seven days. Of the 40 women evaluated, 30 were infected with Chlamydia trachomatis only, two were infected with Neisseria gonorrhoeae only, and a further eight had combined gonococcal and chlamydial infections. Ten were found to be harbouring Chlamydia trachomatis in the urethra as well as the cervix. Neisseria gonorrhoeae was eradicated from all patients with or without concomitant chlamydial infection. The overall chlamydial reisolation rates were 14% (5/35) four weeks after treatment and 23% (6/26) 11 weeks after treatment. The organism was not reisolated from the urethra of any of the patients after treatment. Ciprofloxacin was effective against Mycoplasma hominis, but almost completely ineffective against Ureaplasma urealyticum.

Persistent urethritis due to Ureaplasma urealyticum in conjugal or stable partnerships.

A study of four conjugal partnerships is described in which the male partners presented with persistent or recurrent non-gonococcal, non-chlamydial, but ureaplasma positive urethritis. Resolution of symptoms and signs in the male partners was achieved only after treatment to eliminate Ureaplasma urealyticum from both partners.

Evaluation of a seven day course of oxytetracycline in women with chlamydial cervicitis.

In an urban clinic for sexually-transmitted diseases, 270 women with cervical swabs culture positive for Chlamydia trachomatis were treated with 250 mg oxytetracycline orally four times daily for 7 days. Chlamydial infection was found again in 17 of 220 (7.3%) women examined one month after treatment, and in 12 of 113 (9.7%) women reexamined three months after treatment. Even in cases where reinfection seemed unlikely, only 177 of 198 (89%) were cured. Most post-treatment infections were not clinically apparent, and laboratory follow-up was essential for evaluation of chemotherapy.

Evaluation of ciprofloxacin 500 mg twice daily for one week in treating uncomplicated gonococcal chlamydial, and non-specific urethritis in men.

Ciprofloxacin, a quinolone antibacterial, was evaluated in the treatment of gonococcal, chlamydial, gonococcal and chlamydial, and non-gonococcal non-chlamydial urethritis. The dosage regimen used was 500 mg orally twice a day for seven days. Of the 56 patients evaluated 22 had gonococcal infection only, 13 were infected with Chlamydia trachomatis only, seven had combined infection, and 14 were harbouring neither of these organisms. Neisseria gonorrhoeae was cleared in all the 29 patients with or without chlamydial infection. Of those who denied having sexual intercourse during the follow-up period, post gonococcal urethritis (PGU) developed in 12 (63%) out of 19, C trachomatis was isolated again from 11 (78%) out of 14, and urethritis recurred in five (55%) out of nine patients with non-gonococcal non-chlamydial infection. There was also evidence that the dosage regimen used was only partially effective against Ureaplasma urealyticum.

Early congenital syphilis still occurs.

Seven cases of early congenital syphilis have been recorded in the past 10 years in the Mersey Regional Health Authority. Antenatal serology was initially negative in five mothers, who were either incubating or acquired the infection later, and treatment had probably failed in two women given erythromycin for syphilis during pregnancy. Serology should be repeated later in pregnancy in those at high risk. Social factors that define this group include women who book for antenatal care late in pregnancy, have a past history of sexually transmitted disease, and have multiple consorts. Clinical signs in the infant such as failure to thrive, hepatosplenomegaly, symmetrical rash, rhinitis, and osteochondritis should alert the clinician to the possibility of congenital syphilis. Adequate management of mother and baby requires close liaison between the genitourinary physician, microbiologist, obstetrician, and paediatrician. Penicillin remains the treatment of choice.

Diagnosis of urethritis: role of polymorphonuclear leukocyte counts in gram-stained urethral smears.

Polymorphonuclear leukocytes (PMNs) in the gram-stained urethral smears of 236 consecutive sexually active men without gonorrhea were analyzed quantitatively. The frequency distribution of the highest count of PMNs per high-power field (hpf) showed a count of four PMNs to be the "cut-off" point separating men with urethritis from those without urethritis. This cut-off point correlated well with the presence of Chlamydia trachomatis as well as with turbid urine. However, the PMN count in the gram-stained urethral smear was found to be more sensitive than the appearance of the urine in the diagnosis of urethritis among those with minimal symptoms and signs and not harboring C. trachomatis. This study also demonstrated a close similarity as regards clinical features and PMN count in gram-stained urethral smears between those harboring Ureaplasma urealyticum and those with no organisms.