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.

[Clinical studies of Chlamydia trachomatis in male urethritis].

From January through December 1986, the urethral smear specimens from 132 male urethritis patients were examined by using Chlamydia trachomatis direct specimen test (Micro Trak). C. trachomatis was detected in 59 (44.7%) out of 132 male urethritis patients, 8 (30.8%) out of 26 patients with gonococcal urethritis (GU), and 51 (48.1%) out of 106 patients with non-gonococcal urethritis (NGU). In 5 (31.3%) out of 16 cases, already treated in other hospitals, infection of C. trachomatis was revealed. The age distribution of the patients with chlamydial urethritis (NGU-C) was between 19 and 52 years old, and the average was 30.9 years old. The peak incubation periods of GU and NGU-C were seen within 7 days and between 8 and 14 days, respectively. In NGU-C patients, 70.6% of them showed WBC less than or equal to 9/hpf in first voided urine sediment. The source of infection was a non-prostitute in 22.2% and a prostitute in 72.2% of GU, while in NGU-C 23.5% was infected from a non-prostitute, and 62.7% from a prostitute. Ofloxacin (OFLX) was administered in a daily dosage of 600 mg (in 3 divided oral doses) for 5 to 14 days in 38 NGU-C patients, and C. trachomatis was eliminated in all cases after the treatment.

Mucopurulent cervicitis: a clinical entity?

Of 297 women attending a sexually transmitted disease clinic who were examined for the presence of mucopurulent cervicitis, 96 (32%) satisfied the diagnostic criteria. Mucopurulent cervicitis was strongly associated with the isolation of Chlamydia trachomatis and Neisseria gonorrhoeae. It was also associated with bacterial vaginosis, the use of oral contraceptives, and sexual contact with men who had non-gonococcal urethritis. Conversely, the presence of opaque cervical secretions did not show these associations, and the results indicated no difference in genital infections in women with clear cervical secretions whether or not more than 10 polymorphonuclear leucocytes per field (at a magnification of x 1000) were present. The findings support the suggestion that mucopurulent cervicitis is a definite clinical entity that requires investigation and treatment.

Isolation of Chlamydia trachomatis from endometriums of women with and without symptoms.

Chlamydia trachomatis was isolated from the endometrial cavities of three out of 19 women with positive cervical cultures, who were all symptomless sexual contacts of men with non-gonococcal urethritis (NGU). C trachomatis was recovered from the endometrial cavities of four out of 14 women with pelvic inflammatory disease (PID), three of whom had positive cervical cultures. Although endometrial biopsy is probably not justifiable as a routine procedure, it may be a useful adjunct to endocervical investigations for managing women with PID.

[Chlamydia trachomatis infection among sexual partners of the patients with non-gonococcal urethritis].

During the past 3 years, 30 sexual partners including 18 married couples and 12 extramarital sexual pairs whose male partners were diagnosed as having non-gonococcal urethritis were examined for Chlamydia trachomatis infection. Twenty-three of the 30 couples (76.7%) had identical results either positive or negative for Chlamydia trachomatis infection. All 3 male partners of the 3 pairs who had the non-identical results for Chlamydia trachomatis infection, male negative and female positive, had history of urethritis or prostatitis. Fourteen of the 17 female partners (82.4%) who were positive for Chlamydia trachomatis, had no subjective complaints. The above findings suggest the necessity of treating the female sexual partners of the non-gonococcal urethritis patients irrespective of their symptom.

[Urethro-adnexitis of the male and sexually transmissible pathogens. A report of experiences of the Giessen study group]. / Urethro-Adnexitis des Mannes und sexuell übertragbare Erreger. Ein Erfahrungsbericht der Giessener Arbeitsgruppe.

In recent years, the improvement in microbiological diagnostic methods has caused the spectrum of infectious agents causing male urethroadnexitis to expand considerably. In addition to the well-known urinogenic enterobacteriae and enterococci and the sexually transmitted gonococci and trichomonads, Chlamydia trachomatis and Ureaplasma urealyticum must now be considered particularly important etiologic agents that are sexually transmitted. Their cell biology and epidemiology, our diagnostic procedures, and the criteria of etiologic classification of male urethroadnexitis are described in detail. The recently developed quinolone derivates offer new and promising therapeutic perspectives.

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.

Epidemiological treatment of sexual contacts prevents recurrence of non-gonococcal urethritis.

Of 98 male patients with non-gonococcal urethritis (NGU) who had regular female consorts who received concurrent epidemiological treatment, NGU recurred in four (16%) men whose treated partners were initially chlamydia positive and 20 (27%) men whose treated partners were initially chlamydia negative. Of 32 men whose regular female sexual partners refused to attend, 26 (77%) men suffered a recurrence of NGU. All study patients were selected because they were in monogamous relationships and returned to the clinic either because of a recurrence of NGU or for unrelated reasons at least 12 months after treatment. We recommend the routine epidemiological treatment of all sexual contacts of men with NGU.

Suboptimal efficacy of erythromycin and tetracycline against vaginal Ureaplasma urealyticum.

Female sexual contacts of men with nongonococcal urethritis (NGU) are often treated with either tetracycline or erythromycin because these antimicrobial agents are active in vitro against most strains of both Chlamydia trachomatis and Ureaplasma urealyticum, the major identified causes of NGU. Both drugs are known to be active against genital C. trachomatis infections in women. In this study, tetracycline and erythromycin base were evaluated for efficacy against U. urealyticum in the vagina. U. urealyticum was isolated from 400 (85%) of 473 women. Among women whose cultures for U. urealyticum were initially positive, cultures were negative at follow-up for one (1%) of 95 receiving no treatment, four (6%) of 71 receiving erythromycin base (250 mg four times daily for seven to ten days), and 59 (42%) of 142 receiving tetracycline (500 mg four times daily for five to ten days). Thus, none of the regimens is reliable for eradication of U. urealyticum from the vagina.

[Condylomata acuminata-associated STD infections of the urethra of the male. A comparative epidemiologic study]. / Condylomata-acuminata-assoziierte STD-Infektionen der Urethra des Mannes. Eine vergleichende epidemiologische Studie.

Urethral swabs from 322 men without urethritis, 73 of whom had venereal warts (condylomata acuminata, CA) and 249 who had none, were investigated between 1981 and 1984 by microscope and culture for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma species, Trichomonas vaginalis, Garderella vaginalis, B streptococci, aerobic pathogenic bacteria and Candida species. The isolation frequencies in patients with and without CA were as follows: N. gonorrhoea: with CA 0%, without 0.4%; C. trachomatis: with CA 6%, without 4.4%; U. urealyticum in high CFU: with CA 15%, without 17.7%; Mycoplasma spp. in high CFU: with CA 6%, without 4%; T. vaginalis: with CA 0%, without 0.4%; G. vaginalis: with CA 4%, without 5%; B streptococci: with CA 4%, without 6%; Candida spp. only in low CFU: with CA 3%, without 2.4%.--The results indicate that as far as the isolation frequencies of sexually transmittable pathogens in the urethra are concerned, there are no significant differences between patients with CA and asymptomatic patients presenting to an STD department. However, N. gonorrhoeae was significantly less frequently isolated and C. trachomatis and U. urealyticum significantly more frequently isolated in our patients than has been reported in previous studies.

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.

Clinical and microbiological investigation of women with acute salpingitis and their consorts.

To determine the microbiological causes of pelvic inflammatory disease, 43 women with acute salpingitis (AS) and 160 controls were studied. Amongst AS women there were significantly higher endocervical isolation rates of Neisseria gonorrhoeae (54% vs 6%), Chlamydia trachomatis (40% vs 13%), Mycoplasma hominis (60% vs 19%), enterobacteria (26% vs 11%) and anaerobic bacteria (58% vs 29%). A polymicrobial pathogenic endocervical flora was present in both gonococcal and non-gonococcal AS. Laparoscopic sampling of the fallopian tubes rarely provided useful microbiological data but did reveal the inaccuracy of clinical diagnosis of AS. Thirty-four male consorts of AS women were investigated; 20 had gonorrhoea and 27 had non-gonococcal urethritis (NGU). A high proportion of infected men had asymptomatic gonorrhoea (35%) and/or asymptomatic NGU (56%). These findings had implications for the management of AS.

Clinical approach to urethritis, mucocutaneous lesions, and inguinal lymphadenopathy in homosexual men.

The spectrum of sexually transmitted diseases observed among homosexual men is diverse, but in general includes the same infections observed among heterosexuals. A systematic approach to the diagnosis of these diseases, incorporating sexual history, predominant symptoms, findings from physical examination, and office laboratory evaluation will frequently yield a specific diagnosis. Prompt diagnosis and treatment of patients, and when appropriate, of contacts are of critical importance to the prevention of unnecessary morbidity and further transmission of disease.

Sexually transmitted disease in men.

As sexual mores have changed, the primary care physician is increasingly challenged by patient sexually transmitted diseases. In this article, the authors attempt to aid in the proper diagnosis and management of men with sexually transmitted disease. Clinical understanding, approaches, and tables to direct management are emphasized.

Reiter's syndrome--a possible consequence of artificial insemination?

Artificial insemination by donor (AID) has been complicated by the transmission of several genital infections. We describe the case of a man with Reiter's syndrome whose illness followed AID treatment of his wife.

[Clinical observation of non-gonococcal urethritis].

Sixty-one male urethritis cases, 28 gonococcal urethritis and 33 nongonococcal urethritis (NGU), were out-patients at the Department of Urology, Asahi General Hospital, during the 4 months, Oct. 1, 1984-Jan. 31, 1985. Thirteen of the 33 NGU patients (39.4%) were infected with C. trachomatis (CT). The efficacy of Doxycycline and the route of infection was studied in the cases of CT-positive CT-negative-NGU. CT infection from prostitutes was not so frequent as in the other pathogen infection of NGU. The efficacy of Doxycycline (100 mg b.i.d. for 2 weeks) against CT infection was excellent in the disappearance of subjective complaints and that of white blood cells in the urethral discharge in the CT positive-NGU group (13/13), in comparison with CT negative-NGU group (7/18). The efficacy of Doxycycline against CT was also confirmed from the follow-up study by the isolation of CT and by detection of CT antigen from urethral swabs using FITC conjugated monoclonal antibody against CT antigen.