Pharyngeal gonorrhea screening in adolescents: is it necessary?

A prospective study was performed to examine the prevalence of pharyngeal gonorrhea in two urban female adolescent populations and to compare pharyngeal infection with a history of orogenital activity and concurrent genital gonorrhea. Group I was drawn from a children's hospital adolescent clinic and group II was drawn from a public health clinic for sexually transmitted diseases. None of the 240 adolescents in group I had a pharyngeal culture positive for Neisseria gonorrhoeae compared with 3.4% in group II. Only 2.5% of group I had genital gonorrhea, but 33% of group II had positive genital cultures. In only two of the 20 patients with pharyngeal gonococcal infection was the pharynx the only infected site. The addition of routine pharyngeal culturing for gonorrhea yielded only 1% additional gonorrhea cases. There was a significant relationship between concurrent genital and pharyngeal gonorrhea. These findings indicate that routine screening for pharyngeal gonorrhea is not productive in some adolescent populations. A more economic approach would be to use gonorrhea treatment that is effective against both genital and pharyngeal gonorrhea or to obtain pharyngeal cultures in those adolescents returning for test-of-cure cultures after antibiotic treatment for genital gonorrhea.

Establishing Chlamydia trachomatis isolation capability in a local laboratory.

A system for the culture and identification of Chlamydia trachomatis was established in a local health department laboratory. The McCoy cell-cycloheximide procedure was adopted with use of on-site monolayer production and iodine staining. Several procedural modifications were analyzed for sensitivity, including two-vial vs. one-vial inoculation, overnight refrigeration vs. immediate inoculation of the monolayer, and use of transport media with vancomycin (100 micrograms/ml) vs. transport media without vancomycin. Costs associated with establishing and maintaining this procedure over a one-year period were documented. Inoculation of two monolayers improved sensitivity only slightly (87/292 vs. 85/292). Loss in sensitivity following overnight refrigeration of the sample was approximately 7%; 42 of 45 positive cultures were detected. Addition of 100 micrograms of vancomycin/ml to the transport media increased apparent sensitivity from 27.4% to 29.6% among females with gonorrhea. The cost was $.06 per culture. On the basis of this information, cultures for isolation of C. trachomatis are now offered to our clinic for sexually transmitted diseases as well as to some private physicians and clinics. We are using one-vial inoculation of a specimen transported in sucrose-phosphate buffer containing 100 micrograms vancomycin/ml. The specimen is either cultured immediately or snap frozen at -77 C.

Comparison of cefuroxime and penicillin in the treatment of uncomplicated gonorrhea.

In a randomized double-blind trial, 216 men and 142 women infected with uncomplicated gonorrhea were treated with either 1.5 g of cefuroxime or 4.8 x 10(6) U of aqueous procaine penicillin G intramuscularly and 1.0 g of probenecid. The cure rates in the treatment groups were 96 and 95%, respectively. Intramuscularly administered cefuroxime was better tolerated than was procaine penicillin. Comparative antibiotic susceptibility studies revealed that cefuroxime and penicillin were about equally active and that both were more active than cefamandole or cefoxitin. Because cefuroxime is not degraded by the action of beta-lactamase enzymes, it has promise as an alternative to spectinomycin in the treatment of penicillinase-producing Neisseria gonorrhoeae infections.

The value of the cervical gram stain in the diagnosis and treatment of gonorrhea in women in a venereal disease clinic.

In a venereal disease clinic population of 8,537 women, 1,179 (70%) of 1,675 cases of gonorrhea were detected at the initial visit by the use of the cervical gram stain. The results of cervical cultures indicated that specificity of the gram stain was 97%. Use of the cervical gram stain, combined with epidemiologic treatment of potentially exposed patients, permitted treatment of 1,531 (91%) of 1,675 infected women at the initial clinic visit; this proportion represented an increase of 42% over treatment based solely upon epidemiologic grounds. Of the 124 patients who were not treated at the initial visit and who required treatment at a second visit, nine (7.3%) developed pelvic inflammatory disease during the interval between visits. Although a test of only moderate sensitivity, the cervical gram stain, used as an adjunct to the culture for Neisseria gonorrhoeae, provided the advantages of diagnosis at the initial visit and informed treatment, facilitated the case-finding process, and minimized treatment defaulter rates and the potential risks of sequelae and transmission of gonorrhea before results of cultures were known.

Accuracy of presumptive criteria for culture diagnosis of Neisseria gonorrhoeae in low-prevalence populations of women.

The accuracy of presumptive criteria for identification of Neisseria gonorrhoeae was assessed in two separate populations of women with a low prevalence of gonorrhea. Of the presumptively positive cervical isolates available for confirmation, 98.5% were identified as N. gonorrhoeae. Of 25 isolates that could not be confirmed, 20 failed to grow on subculture, and of the remaining 5, only 2 (0.6% of all viable recoveries) were identified as nongonococcal isolates (N. meningitidis). Our study confirms earlier findings that meningococcal isolates are rarely found in endocervical specimens. The benefits from early treatment and counselling of women for gonorrhea on the basis of presumptive criteria outweight the risks occasioned by the rarely encountered nongonococcal isolate.