[Laboratory practices: diagnostics and antibiotics resistance testing of Neisseria gonorrhoeae in Germany]. / Die deutsche Laborlandschaft zu Diagnostik und Antibiotikaresistenztestung bei Neisseria gonorrhoeae.

Recent years have seen a world-wide increase in antimicrobial resistance (AMR) in cases of infection with Neisseria gonorrhoeae (NG). NG infection is not notifiable in Germany and there is a lack of information available about the spread and AMR of NG infections. The objective of the study was to provide information on diagnostic methods and AMR testing in cases of NG infections in German laboratories. A cross-sectional survey was undertaken in Germany between June and August 2013 using an online questionnaire. Laboratories performing NG diagnostics were identified and described with regard to the diagnostic methods used, the number of tests performed, the antibiotics tested and the AMR observed, in addition to general laboratory information. In total, 188 of the 521 participating laboratories performed NG diagnostics; these were included in the further statistical analysis. 92.6 % of the 188 laboratories performed culture. A median of 60 (IQR 15-270) samples per quarter (SPQ) were tested, with an overall positivity rate of 4.1 and 6.9 % among men. Most (82.1 %) of the 151 laboratories performing NG culture tested for AMR as well. The most frequently tested antibiotics were ciprofloxacin (94.8 %), penicillin (93.1 %), doxycycline (70.0 %) and ceftriaxone (67.2 %). The most frequently observed AMR ever were those against ciprofloxacin (87.1 %), penicillin (78.3 %), doxycycline (56.6 %) and azithromycin (35.1 %; all percentages refer to laboratories). The laboratories used different standards regarding susceptibility criteria. The emergence and spread of AMR shows that it is crucial to assess and monitor the scope and trends of multidrug-resistant gonorrhea. The data collected on diagnostic methods and AMR testing in cases of NG infections in German laboratories constitute an important basis for future monitoring.

[Gonorrhea]. / Gonorrhoe.

Infection with Neisseria gonorrhoeae is a frequent occurrence. It is almost always transmitted via sexual intercourse and the risk of infection is markedly higher for women than for men. Purulent secretion characterizes the clinical picture. After an incubation period of 2-6 days, for the most part urethritis, cervicitis, proctitis, pharyngitis, or conjunctivitis usually develops. Condoms offer good protection against gonococcal infection. The treatment of choice in Central Europe is a single dose of Cefixime.

[The 100 years since discovery of Spirochaeta pallida]. / 100 Jahre Entdeckung der Spirochaeta pallida.

On 3 March 1905, Fritz Schaudinn, Erich Hoffmann and Fred Neufeld, working in the women's ward of the Department of Dermatology at the Charite Hospital in Berlin, became the first people in the world to observe the causative agent of syphilis, Treponema pallidum. The pathogen's etiological significance was subsequently demonstrated by Schaudinn and Hoffmann and other scientists. The detection of Treponema pallidum was the first decisive step towards the development of diagnostic and therapeutic procedures in subsequent years.

[CD8-positive, CD30-negative cutaneous T-cell lymphoma simulating pyoderma gangrenosum]. / CD8-positives, CD30-negatives kutanes T-Zell-Lymphom unter dem klinischen Bild eines Pyoderma gangraenosum.

Ulcerated primary cutaneous lymphomas are not rare, but the clinical manifestation as a pyoderma gangrenosum look-alike is extraordinary. CD8-positive lymphomas are rare, unclassifiable tumours with variable prognosis. We report on a 49-year-old patient with a large ulcerated primary cutaneous lymphoma on the left chest wall presenting as pyoderma gangrenosum. With immunohistochemical staining, most lymphocytes were shown to be CD8-positive. The CD30 antigen was not expressed. After radiotherapy with complete skin irradiation, the lymphoma regressed completely. The patient has been free of relapse for 28 months so far.

Sexually transmitted diseases in children. A practical approach.

Basically, all sexually transmitted diseases occurring in adults can be transmitted to children. Patterns of transmission are as follows: intrauterine, perinatal, by sexual abuse, by voluntary sexual contact, by accidental autoinoculation or heterinoculation, or indirect transmission. In children between 2 and 10 years of age, sexual abuse is first in possible ways of transmission. Taking into consideration the age of the child, the sexually transmittable agent and the localization of the infection helps in assessing the possibility of sexual abuse.

Epidemiological features of Adamantiades-Behçet's disease in Germany and in Europe.

The German Registry of Adamantiades-Behçet's disease was founded in 1990 in Berlin and it provides current data on the epidemiology, the clinical manifestations and the course of the disease in Germany on a continuous basis. A total of 218 patients, including 89 German and 100 Turkish patients, had been reported to the German Registry until October 1997. One hundred and ninety-six patients fulfilled the criteria of the Behçet's disease classification tree. The prevalence of the disease evaluated in Berlin-West was 1.68/100,000 in 1989 and had risen to 2.26/100,000 by 1994. The median age of onset was 25 years (range 5 to 66 years; German-Turks, ns). Juvenile disease was recorded in 6.9% of patients. The complete clinical picture according to the criteria of the International Study Group of Behçet's Disease developed in 15.5 months. The interval between onset of the disease and diagnosis was 35 months, which was significantly longer than the duration of the development of the complete clinical picture (p < 0.0001). The disease was diagnosed later in German (48.5 months) than in Turkish patients (25.5 months, p = 0.003). While German patients presented an equal male-to-female ratio, a male predominance was shown in Turkish patients (M:F 2.1:1, p = 0.022). Familial occurrence was detected in 2.0% of German and 15.9% of Turkish patients (p = 0.013). The frequencies of major clinical manifestations were: oral ulcers 99%, skin lesions 76%, genital ulcers 75%, ocular manifestations 59%, arthritis 59%, and positive pathergy test 52%. Clinical differences between German and Turkish patients were only found in the frequency of ocular lesions (48% vs. 66%, p = 0.025). Oral ulcers were with 72% the most common onset symptom of the disease followed by erythema nodosum (9%), uveitis (7%), arthritis (7%), genital ulcers (3%), superficial thrombophlebitis (2%) and papules/sterile pustules (2%). Uveitis and erythema nodosum as onset symptoms shortened the median interval to diagnosis to 1.5 and 15 months, respectively, while arthritis delayed diagnosis (43.5 months; p = 0.029). A severe course developed in 25% of the patients; irreversible retinal vasculitis to blindness in 15%, sterile meningoencephalitis in 8%, severe arthritis in 5%, hemoptysis in 2%, lethal outcome in 2% and bowel perforation in 1%. The relative risk of HLA-B5 positive German natives developing the disease. HLA-B5 was confirmed as a marker of severe prognosis. Cardiolipin autoantibodies were associated with cutaneous vasculitis and superficial thrombophlebitis was correlated with systemic vessel involvement.

[Molecular epidemiology of Neisseria gonorrhoeae: effect of sex and sexual orientation on the distribution of gonococcal types]. / Molekulare Epidemiologie von Neisseria gonorrhoeae: Einfluss von Geschlecht und sexueller Orientierung auf die Verteilung der Gonokokkentypen.

Auxotype/serovar (A/S) classification enables precise characterisation of Neisseria gonorrhoeae. In the present study we evaluated whether sex and sexual preference of the patient influence the auxotype/serovar class of the infecting gonococcal strain. In male patients prototrophic/IB-3 was the most frequently isolated A/S class. By contrast, in female patients the A/S class (P)AH(U)/IA-1/2 was significantly (p < 0.005) more frequently isolated than in male patients. Analysis of our data according to sexual preference of the patients showed that in heterosexual patients the two mentioned A/S classes were leading, whereas in homo- and bisexual patients A/S classes prototrophic/IB-2 (p < 0.0001) and Pro/IB-2/16 (p < 0.0001) were isolated significantly more often. Our data are a strong indication that the host environment is also responsible for the selection of N. gonorrhoeae strains with certain typing characteristics.

Epidemiology of sexually transmitted diseases. What does it tell us?

Incidence numbers of Neisseria gonorrhoeae, Treponema pallidum and Chlamydia trachomatis differ substantially in different countries at different times. In European countries, the incidence of gonorrhea and of primary and secondary syphilis currently is extremely low. In North American countries gonorrhea incidence declined at a very slow annual rate and syphilis incidence increased. Chlamydial infections show a profile that seems to be delayed by two decades from infections with Neisseria gonorrhoeae. Our efforts in the future should be directed to prevent the resurgence of gonorrhea and syphilis and to achieve the same success with chlamydial infections. Poor populations in developed and developing countries, which have similar demographic, social and economic characteristics, represent one important target group for control programs. Education of young and poor people represent the challenge of the future for sexually transmitted diseases control strategies. Combined strategies also will have an effect on incurable viral STD.

[Molecular epidemiology of Neisseria gonorrhoeae: typing with combined auxotype/serovar classification]. / Molekulare Epidemiologie von Neisseria gonorrhoeae: Typisierung mit Hilfe der kombinierten Auxotyp/Serovar-Klassifikation.

Auxotyping or determination of serovars of N. gonorrhoeae used separately can be for a limited differentiation of strains only. Combined auxotype/serovar (A/S)-classification was examined for its discriminatory ability on 360 gonococcal strains isolated over 9 years in the area of Heidelberg. The prototrophic, prolin requiring and (P)AH(U)-auxotype were the 3 most frequent auxotypes. 33 different serovars were identified. Protein-IB-serovars dominated by 75%. IB-3, IB-2 and IA-1/2 were the most frequent serovars. The (P)AH(U) auxotype is statistically significant associated with serovar IA-1/2, the PA(U) auxotype with serovar IB-2/16 and the prolin requiring auxotype with serovar IB-1. Combined typing resulted in 68 different A/S classes. The 3 most frequent classes were Proto/IB-3, (P)AH(U)/IA-1/2 and Proto/IB-2/16. The number of the A/S classes identified per year rose generally with the number of the isolated strains. Our data show the heterogeneity and dynamics of a gonococcal population. A/S classification permits the epidemiological differentiation of a gonococcal population in endemic, transient and microepidemic strains.

[Local and systemic humoral immune response to protein I of Neisseria gonorrhoeae]. / Lokale und systemische humorale Immunantwort gegen Protein I von Neisseria gonorrhoeae.

Knowledge of the immune response to natural infection with Neisseria gonorrhoeae is presupposition for the development of a gonococcal vaccine. Pili and protein I have gained importance for a subunite vaccine. A pilus vaccine proved to be ineffective in a field trial due to extensive pilus variability. According to an alternative strategy protein I may represent an important vaccine candidate for a gonococcal vaccine. To study the local and systemic, humoral immune response to N. gonorrhoeae cervical secretion, vaginal fluid and serum from prostitutes and family planning patients were compared by the use of a protein I ELISA. In local secretions and in serum patients in the study group showed significantly higher anti-protein-I-IgA-levels than patients in the control group. In cervical secretion immune response to an acute gonococcal infection consisted of a short lived, significant increase of anti-protein-I-IgA, while anti-protein-I-IgG showed a lower, but longer lasting significant increase. The course of the immune response in vaginal fluid reflected the immune response of cervical secretion at a lower level. In serum antigenic stimulus of a local gonococcal infection resulted in a significant but short lived protein I specific IgG immune response. In local infection with N. gonorrhoeae protein I represents a target antigen of the local and systemic immune response. Clear differences exist between local and systemic humoral immune response in the protein I reactive immunoglobulin class and in the course of reactivity. In the future it may be possible to define epitopes on protein I which induce protective immunity.

Pyoderma gangrenosum followed by subcorneal pustular dermatosis in a patient with IgA paraproteinemia.

Six months after the occurrence of pyoderma gangrenosum, subcorneal pustular dermatosis developed in a 60-year-old woman. The patient's serum was found to contain an IgA-lambda paraprotein. Although similar cases have been reported, this case is unique in that a distinct episode of pyoderma gangrenosum was followed by subcorneal pustular dermatosis.