CYP2C9 polymorphism studies in the Saudi population.

OBJECTIVE: To determine the prevalence of CYP2C9 polymorphism in normal Saudis (controls), in Saudi patients with venous thrombosis, in patients requiring low dose warfarin (study group) for anticoagulation, and to compare our results to those from other populations. METHODS: Blood from the control and study groups was collected from November 2001 to November 2008. The DNA was extracted, stored at -70°C and later tested for the CYP2C9 polymorphism using established methods. Clinical data were collected through direct interview, chart review, and the Saudi Thrombosis and Familial Thrombophilia Registry. All individuals consented. RESULTS: The prevalence of CYP2C9 polymorphisms in the Saudi population was similar to Caucasians and higher than Asian and African. The control (n=670) and patients with venous thrombosis (n=110) groups showed similar prevalence of the normal wild type CYP2C9 and the 2 polymorphisms tested (CYP2C9*2 and CYP2C9*3). The group that required low dose warfarin (n=25) showed significantly higher CYP2C9 polymorphism, required 40% less warfarin and had a higher rate of bleeding (5% versus 1.8%). CONCLUSION: The prevalence of the abnormal polymorphism in the Saudi population of 35.5% is similar to that in Caucasians. Patients with the CYP2C9 polymorphism required 40% less warfarin and had more serious bleeds.

The potential effect on Neisseria gonorrhoeae of the use of clindamycin vaginal cream in the empirical treatment of vaginal discharge.

The minimum inhibitory concentrations (MIC) of clindamycin for 62 consecutive isolates of Neisseria gonorrhoeae were found to be 0.03-4 mg/L; the MIC50 and MIC90 were 0.125 and 2.0 mg/L respectively. Seven women treated with clindamycin vaginal cream had cervical mucus samples taken after seven days treatment. The concentrations of clindamycin achieved in the cervical mucus were 30-150 times higher (141-337 mg/L) than the highest MIC of the 62 N. gonorrhoeae isolates. Clindamycin vaginal cream is being used increasingly in Genitourinary Medicine clinics and General Practice for the treatment of bacterial vaginosis. This study shows that clindamycin vaginal cream achieves intra cervical concentrations that are high enough to inhibit N. gonorrhoeae. Empirical use of this therapy should be preceded by urethral and cervical swabs for N. gonorrhoeae in any woman at risk of gonorrhoeae.

Persistent episiotomy granulation polyps; a polysymptomatic clinical entity.

We describe a number of patients with persistent symptoms of vaginal discharge and discomfort, dyspareunia and postcoital bleeding. They presented 2-4 months following delivery with episiotomy. In these patients, the symptoms were associated with localised granulation tissue polyps, on the episiotomy site. Simple ablation resulted in rapid and effective relief of the symptoms. These lesions may be more common in clinical practice than is suggested by the lack of published reports. They should be looked for in women who may suffer from symptoms for several months after delivery.

A case cluster of possible tissue invasive gonorrhoea.

OBJECTIVE: To describe a cluster of patients presenting with severe symptoms and infected with an unusual strain of Neisseria gonorrhoeae. SETTING: A north London Department of Sexual Health. PATIENTS: Five patients were linked by reported sexual contact or other epidemiological evidence as part of a cluster of gonococcal infection. Cultured N gonorrhoea were subtyped by serological (serovar) and cultural (auxotype) methods and antibiotic sensitivities measured by minimum inhibitory concentration (MIC). RESULTS: Four of the patients had severe gonorrhoea-related systemic or extragenital symptoms: disseminated gonococcal infection with oligoarthritis (1 patient), acute pelvic inflammatory disease (1 patient, who was also chlamydia positive) and tender inguinal adenopathy (2 patients). The fifth patient was asymptomatic. N gonorrhoeae was isolated in four of the patients. All four organisms had identical MICs. Three of the organisms were subtyped and found to be the same rare strain (serovar 1A1, auxotype NR). CONCLUSION: This case cluster provides evidence for strain-related virulence in an uncommon gonococcal subtype.

Bartholin's abscess complicating food poisoning with Salmonella panama: a case report.

A patient is presented who developed an acute Bartholin's abscess four weeks after an attack of Salmonella panama enteritis. Aspirate from the abscess also grew Salmonella panama, indistinguishable from the gut isolate in serotype and antigenic structure (1 9, 12: 1, v: 1,5). Some aspects of the microbiology of Bartholin's abscess and its clinical management are discussed.

Acute urethritis due to Neisseria meningitidis group A acquired by orogenital contact: case report.

A case of heterosexual transmission of Neisseria meningitidis group A by fellatio, which resulted in acute purulent urethritis in the male partner, is presented. The emotional impact of a mistaken diagnosis of gonococcal infection and the need to treat asymptomatic throat carriage in sexual contacts makes early recognition of meningococcal infection important in this unusual circumstance.

Psychosexual trauma of an abnormal cervical smear.

The psychosexual sequelae of diagnosis and treatment of pre-invasive cervical atypia were assessed in three groups of women. The first group included 30 women referred to a colposcopy clinic with an abnormal cervical smear indicating cervical intraepithelial neoplasia (CIN), the second comprised 50 women who were traced as sexual partners of men with penile human papillomavirus (HPV) infection; 26 of them had histologically proven cervical atypia and 24 had no such evidence. The third group included 25 women traced as partners of men with non-specific urethritis and who did not have cervical disease. Before and after questionnaires assessed six aspects of sexual behaviour and responses before diagnosis and 6 months after treatment in women with cervical atypia. These were compared with answers given by women investigated and treated, if necessary, as partners of men with sexually transmitted disease (control group). There were statistically significant adverse psychosexual sequelae associated with diagnosis and treatment of pre-invasive cervical epithelial disease.

Sultamicillin in the treatment of gonorrhoea caused by penicillin sensitive and penicillinase producing strains of Neisseria gonorrhoeae.

A single oral dose of 2 g of sultamicillin and 1 g of probenecid was effective in the treatment of men with uncomplicated gonococcal urethritis caused by both penicillin sensitive strains of Neisseria gonorrhoeae and penicillinase producing strains of N gonorrhoeae (PPNG). Of 94 infected men who attended for at least one follow up examination, 91 (97%) were cured. The remaining three (3%) patients were still infected at follow up. Two of these patients had been re-exposed to an infected partner and were considered to be possible reinfections, while the third was deemed a treatment failure. Six of the 94 patients were infected with PPNG strains and all were successfully treated. Plasmid analysis of the PPNG strains showed Asian and African types both with and without transfer plasmid.

Provision of a chlamydial culture service to a sexually transmitted diseases clinic.

Urethral specimens from 215 men were inoculated on to McCoy cell cultures, both at the local laboratory and at a central reference laboratory, Chlamydia trachomatis was isolated from 58 (28%) patients; 12 of these isolates were, however, obtained only at the local laboratory. The results show the feasibility and convenience of a central laboratory supplying a peripheral laboratory with uninoculated prepared cell cultures. Such a service is not only more cost effective but obviates the problems of transporting specimens to a central laboratory.

Aseptic meningitis and herpes simplex proctitis. A case report.

A male homosexual patient developed an aseptic meningitis during the course of acute ano-proctitis due to herpes simplex virus type 2 (HSV-2). Aseptic meningitis (sometimes proved to be due to HSV-2) has been associated with genital but not with anal herpes. This sexually transmissible virus should be considered when patients with aseptic meningitis are investigated.

Cervical cytology in genital infection.

Papanicolaou-stained cervical smears taken from 203 female patients with either gonorrhoea, trichomoniasis, or candidosis were examined for the degree of inflammatory change. The results from these patients were compared with the results of smears taken from women who had no evidence of sexually-acquired infection after full assessment in the clinic. Gonorrhoea and trichomoniasis were associated with inflammatory changes but these were less marked in patients with candidosis. It is concluded that, before cytological inflammatory changes are attributed to non-specific genital infection, it is important to exclude gonorrhoea, trichomoniasis, and, to a lesser extent, candidosis.

Value of Papanicolaou-stained smears in the diagnosis of trichomoniasis, candidiasis, and cervical herpes simplex virus infection in women.

In the diagnosis of trichomoniasis Papanicolaou-stained cervical smears gave marginally better results than cultures of vaginal secretion; stained cervical smears and wet films of vaginal material gave similar results. Culture of vaginal secretion on Sabouraud's medium gave the best results in the diagnosis of candidiasis; Papanicolaou-stained smears gave significantly fewer positive results than either cultures or Gram-stained vaginal smears. Papanicolaou-stained smears were reported as positive in only two of five patients with cervical herpes simplex virus infection. It is concluded that Papanicolaou smears are as good as wet films or cultures in the diagnosis of trichomoniasis but cannot be relied on for the diagnosis of candidiasis, or for detecting herpes simplex virus infection.