[The venereological profile in Godthab District Venereal Clinic, Nuuk, Grønland. A 3-month study in 1991]. / Den venerologiske profil i Godthåb Distrikts Venereaklinik, Nuuk, Grønland. En tre måneders undersøgelse i 1991.

A total of 803 patients participated in a consecutive review of the disease pattern concerning venereal diseases. The investigation took place in the Clinic for Venereal Diseases in Nuuk/Godthåb during a period of three months. Less than half of the contacts were on account of symptoms of genital infection. One fifth of the patients had been summoned for partner control. A corresponding proportion felt well and had not been exposed to any known risk of infection. Chlamydia trachomatis was demonstrated in 19% and gonorrhoea in 10%. Among the asymptomatic persons, 16% were found to be Chlamydia positive and 0.6% gonococcal positive. Syphilis was demonstrated in one man and one woman. One man was known to be HIV-positive and two contacts of this patient were found to be negative but seroconversion occurred subsequently in both cases. Vaginitis and bacterial vaginosis were found in 38% of the women. In over one third (39%), no clinical or microbiological evidence of genital infection was found. Early diagnosis, treatment, information and tracing of contacts are still the cardinal principles in the combat of venereal diseases in Greenland.

Systemic interferon alpha-2b increases the cure rate in laser treated patients with multiple persistent genital warts: a placebo-controlled study.

Systemic treatment modalities for eradication of multiple therapy resistant genital warts are so far not available. In this study laser treated patients with multiple genital warts received postoperatively either interferon alpha-2b subcutaneously (s.c.) 5 x 10(6) IU or matching placebo three times weekly for four weeks. At the conclusion of the study, 6-8 weeks after discontinuation of therapy, a significantly higher cure rate was found in the group of interferon-treated patients (14 of 27 (52%) patients cured) than among placebo treated patients (5 of 22 (23%) patients cured) (p less than 0.05). The side effects of fever, chills, myalgia, headache and leukopenia occurred more commonly in the interferon treated group than in the placebo group. However, only three of 32 patients discontinued interferon therapy because of side effects. We conclude that the addition of s.c. administered interferon alpha-2b to laser treated patients with chronic therapy resistant genital warts is fairly well tolerated and that it significantly enhances the chance of eliminating the disease.

Survival of chlamydiae in human semen prepared for artificial insemination by donor.

Semen specimens from 21 men with urethral infection with Chlamydia trachomatis were tested for the presence of the organism before and after cryopreservation for 3 weeks of storage at -196 degrees C. Five specimens were chlamydia-positive before preservation and four of them were still positive after storage when examined by enzyme immunoassay (Chlamydiazyme). When examined by cell culture, four proved chlamydia- positive before storage and two afterwards. The results indicate that testing for C. trachomatis has to be performed from the urethra of all donors of semen used for artificial insemination before the inoculation takes place.

[The incidence of gonorrhea as an indicator for prevention of AIDS in Greenland]. / Gonoréincidensen som mål for AIDS-forebyggelsen i Grønland.

The first case of HIV infection in Greenland was demonstrated towards the end of 1985 and, since then, a general informative campaign was instituted and teaching material about AIDS and HIV infection were prepared for use in schools. This activity was particularly great in 1987 and 1988. The main messages were 1) use of condoms and 2) reduction in the number of sexual partners. The incidence of gonorrhoea has been very high for many years in Greenland and the incidence of gonorrhoea was employed as indicator for the effect of the prophylactic campaign. Investigation revealed a decrease of 67% during the period 1985-1988. The decrease was particularly great in 1988 (58%). There appears to be a direct connection between this observation and the two main messages of the campaign as the employment of condoms increased tenfold during the period 1986-1988 end contact investigations revealed a decrease in the number of unknown sexual partners. On the other hand, no definite decrease in the total number of sexual partners was reported by patients attending the clinic for Venereal Diseases in Godthåb. It is emphasized that the incidence of gonorrhoea has decreased markedly but it is still considerably higher than the incidence in Denmark. Continued and active prophylactic efforts are still required.

Occurrence of Ureaplasma urealyticus and Mycoplasma hominis in non-gonococcal urethritis before and after treatment in a double-blind trial of ofloxacin versus erythromycin.

The efficacy of ofloxacin, a new quinolone derivate, was tested against that of erythromycin in a prospective double-blind trial in patients with non-gonococcal urethritis (NGU) with special reference to the occurrence of Mycoplasma hominis and Ureaplasma urealyticum. 188 male NGU patients were randomized to treatment with either ofloxacin 200 mg b.i.d. or erythromycin 500 mg b.i.d. for seven days. Before treatment eight (4.3%) patients, five in the erythromycin group and three in the ofloxacin group, were M. hominis positive. At follow-up day 8 and 15 after start of treatment all five in the erythromycin group and two in the ofloxacin group were still positive. U. urealyticum was recovered in 16 patients (8.5%) before treatment. One patient was still positive in the erythromycin group when examined day 15, whereas all patients were negative in the ofloxacin group at both follow-up controls. Clinically, the efficacy of treatment day 15 was 77.4% in the erythromycin group and 84.3% in the ofloxacin group. The difference was not significant. Side-effects occurred in 38.5% in the erythromycin group and in 21.3% in the ofloxacin group. This difference is significant. Ofloxacin is effective in the treatment of NGU in males and is an alternative to conventional antibiotic treatment.

[Demonstration of urogenital Chlamydia infection by means of the Chlamydiazyme test]. / Påvisning af urogenital Chlamydia-infektion ved hjaelp af Chlamydiazyme-testen.

Abbott's recently introduced Chlamydiazyme test which is based on the Elisa principal and cell culture technique was employed with the object of demonstrating urogenital infection with Chlamydia trachomatis in 150 persons. Neither of the methods were optimal. The Chlamydiazyme test had a lower sensitivity and specificity than the cell culture method.

Treatment of nongonococcal urethritis: comparison of ofloxacin and erythromycin.

Ofloxacin, a new quinolone carboxylic acid derivative, has been reported to be effective and safe in the treatment of nongonococcal urethritis (NGU). In the present investigation 188 male outpatients with NGU were randomized to double-blind treatment with either erythromycin (500 mg twice a day) or ofloxacin (200 mg twice a day) for seven days. Before therapy Chlamydia trachomatis was isolated from 43.6% of the patients. One relapse and one reinfection occurred in the erythromycin-treated group, whereas all patients in the group given ofloxacin were culture-negative at follow-up. Among the C. trachomatis-positive group of patients, the clinical efficacy of ofloxacin was 83.7%, and that of erythromycin, 77.4% at the final follow-up. In the C. trachomatis-negative group, the efficacy of ofloxacin was 93%, and that of erythromycin, 84.3%. The differences are not significant. No serious adverse effects were demonstrated. The results indicate that ofloxacin might be a valuable alternative for the treatment of NGU in men.

Treating genitourinary and pharyngeal gonorrhoea with single dose ceftriaxone.

The efficacy of ceftriaxone 250 mg given as a single intramuscular dose to treat genitourinary and pharyngeal gonorrhoea is compared with the outcome of the Danish standard treatment for uncomplicated genitourinary gonorrhoea, pivampicillin 1.4 g and probenecid 1 g, both given by mouth. The study comprised 327 patients for whom the diagnosis of gonorrhoea was made by microscopy of a methylene blue stained smear at their first visit to the clinic and for whom the diagnosis was later confirmed by culture of Neisseria gonorrhoeae. One hundred and seventy patients with genitourinary gonorrhoea (18 with and 152 without concomitant pharyngeal infection) were treated with ceftriaxone. One hundred and fifty seven (17 with and 140 without concomitant pharyngeal infection) were treated with pivampicillin. One week after treatment N gonorrhoeae was isolated from none of 18, 1/152, (1%), 11/17 (65%), and 6/140 (4%) patients, respectively. At a second attendance two weeks after treatment no further treatment failure was found. During the study period, a further 52 patients with pharyngeal infection (with or without concomitant genitourinary infection) that was shown by culture only were treated with a single intramuscular injection of 250 mg ceftriaxone. No treatment failure was observed in this group. Only minor adverse drug reactions were seen. Ceftriaxone 250 mg as a single intramuscular injection is therefore safe and effective in treating gonorrhoea, including pharyngeal infection.

Pivampicillin compared with erythromycin for treating women with genital Chlamydia trachomatis infection.

In a randomised single blind study, pivampicillin was compared with erythromycin in women with urogenital Chlamydia trachomatis infections. The pivampicillin dosage was 700 mg twice a day and the erythromycin dosage 500 mg twice a day for seven days. Follow up took place on days 7 and 14 after the start of treatment. All 26 women treated with pivampicillin were culture negative for chlamydiae at the first and second follow up visits. All 23 women who received erythromycin were culture negative at the first follow up visit, but one was culture positive at the second follow up visit. Gastrointestinal side effects were recorded in five patients receiving pivampicillin and in nine receiving erythromycin. Two patients receiving erythromycin were withdrawn from treatment because of gastrointestinal disturbances, compared with none receiving pivampicillin.

Pivampicillin in treating genital infection with Chlamydia trachomatis.

Pivampicillin was used to treat urogenital colonisation with Chlamydia trachomatis in 41 women and 24 men who yielded chlamydiae but not gonococci. They were treated for 10 days. All but one patient gave negative chlamydia cultures 10 days after the start of treatment, and all 65 patients gave negative results at the second examination seven days later. Ten days of treatment with pivampicillin seems to be the optimum to eradicate C trachomatis from the lower genital tract in man.

In vitro secretion of immunoglobulin in early syphilis evaluated with the plaque forming cell assay.

We have studied the secretion of immunoglobulin in vitro from blood lymphocytes in twenty-one patients with primary or secondary syphilis before and after treatment of their disease. Polyclonal activation of B lymphocytes with pokeweed mitogen is dependent upon T lymphocytes. Using the inversed haemolytic plaque cell assay we found a normal secretion in vitro of immunoglobulin in both primary and secondary syphilis. Our results indicate that patients with syphilis retain a normal immune regulation of B lymphocyte immunoglobulin secretion in vitro.

Chlamydia, mycoplasmas, ureaplasmas, and yeasts in the lower genital tract of females. Comparison between a group attending a venereal disease clinic and a control group.

162 women were investigated. Group I consisted of 85 women, who were partners to men with non-gonococcal urethritis (NGU) or presented macroscopic signs of cervicitis; patients who had harbored Neisseria gonorrhoeae were excluded from the study. Group II was a control group of 77 women without any complaints from the urogenital tract and with normal findings at pelvic examination. All the women were tested for infection with Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, and Candida albicans. In group I, chlamydiae and mycoplasmas were recovered in 44% and 36%, respectively, the corresponding figures for the control group (group II) being 5% and 19%. The difference is highly significant. No such difference between the two groups was found for ureaplasmas. Sixteen percent of the patients in group I were positive for C. albicans; 12% were positive in group II. Fifty per cent of asymptomatic NGU-partners were chlamydia-positive, and about one-third of patients with either dysuria or vaginal discharge harbored the organism. No difference in the isolation frequency of mycoplasmas was observed between asymptomatic partners to male NGU carriers and women with increased vaginal discharge, whereas the organism was isolated more frequently from patients with dysuria. Fifty-nine per cent of patients with cervicitis were chlamydia-positive, compared with 30% of patients with normal cervical appearance and normal vaginal discharge. Samples obtained from the cervix were more often positive than samples from the urethra. In conclusion, if samples can be taken from only one of the two sites in patients with lower genital tract infection, the cervix is the optimal sampling site.

Biological false positives to serological tests for syphilis in herpes genitalis.

A survey was made of 17 patients (4 females and 13 males) with herpes genitalis who, during period 1971-84, developed biological false positive serological tests for syphilis. Of 121 patients with herpes genitalis diagnosed by herpes culture in 1982-84, 4.1% developed biologically false positive reaction. Duration of symptoms before biologically false positive reaction was 12 days. Duration of false positive reaction was on average 32 days. Eight had borderline reactions, 7 uneven positive titers and 2 serological patterns simulating secondary syphilis.