Women, children and STDs: addressing the other STD epidemic. Opinion.

PIP: Although considerable global attention and effort have been devoted to preventing and controlling the spread of HIV/AIDS, comparatively little focus has been given to controlling other sexually transmitted diseases (STD). However, since HIV, like other STDs, may be transmitted through unprotected sexual intercourse, measures implemented to check the spread of HIV through sexual contact also help to limit the transmission of other STDs. Gonorrhea, chlamydia, trichomoniasis, genital herpes, syphilis, and human papillomavirus infections cause infertility, cervical cancer, and adverse outcomes of pregnancy such as spontaneous abortion, prematurity, and stillbirth. Many people, however, remain unconvinced that STD infection has important adverse effects upon the health of women and their infants. There are enormous morbidity, mortality, and health care costs associated with these STDs. The author discusses how women are at increased risk relative to men, as well as primary, secondary, and tertiary prevention.^ieng

Adolescents and sexually transmitted diseases.

This paper presents a brief overview of sexually transmitted diseases (STDs), including acquired immunodeficiency syndrome (AIDS), in adolescent populations. Using the framework of a mathematical model (which considers how, why, and whether an infection spreads within a population), the epidemic of STDs among adolescent populations is considered. The unique aspects of adolescent behavior, adolescent biology, and the social context of adolescents' lives are highlighted.

Screening and treatment of sexually transmitted diseases: an important strategy for reducing the risk of HIV transmission.

The role of sexually transmitted diseases (STDs) in the spread of human immunodeficiency virus (HIV) infection is reviewed. The rationale for and approach to reducing STD prevalence in high-risk communities are presented. Given the asymptomatic nature of these infections and problems associated with delivering curative therapy, effective interventions will require the use of diagnostic tests for screening and the use of single-dose therapies in appropriate settings: Treatment of individuals with STDs will likely reduce individual risk, while reduction of STD prevalence in high-risk communities may curtail the epidemic spread of HIV.

Expression of paragloboside-like lipooligosaccharides may be a necessary component of gonococcal pathogenesis in men.

To learn how lipooligosaccharide (LOS) phase variations affect pathogenesis, we studied two male volunteers who were challenged intraurethrally with Neisseria gonorrhoeae that make a single LOS of 3,600 daltons and sequentially followed LOS expression by gonococci as urethritis developed. LOS variation occurred in vivo. Signs and symptoms of gonorrhea began with the appearance of variants making 4,700-dalton LOS that are immunochemically similar to glycosphingolipids of human hematopoietic cells (Mandrell, R.E., J.M. Griffiss, and B.A. Macher. 1989. J. Exp. Med. 168:107) and that have acceptors for sialic acid. A variant that appeared at the onset of leukorrhoea was shed by 34/36 men with naturally acquired gonorrhea at the time they sought medical attention; the other two shed the variant associated with dysuria. None shed the challenge variant. These data show that in vivo phase shifts to higher molecular mass LOS that mimic human cell membrane glycolipids are associated with the development of gonococcal leukorrhea.

Interaction of Neisseria gonorrhoeae with classical complement components, C1-inhibitor, and a monoclonal antibody directed against the Neisserial H.8 antigen.

Strains of Neisseria gonorrhoeae were used to evaluate bactericidal and opsonic properties of McAb 10 directed against the Neisserial outer membrane antigen, H.8. Gonococci were either serum resistant in the absence but serum sensitive in the presence, of McAb 10, or serum sensitive or serum resistant regardless of the presence of McAb 10. Strain JS3, which fell in the former category, was used in subsequent studies. C1 zymogen formed by reassociation of isolated C1 subunits was not directly activated by JS3 in the presence or absence of C1-inhibitor. JS3 thus was unable to directly activate the classical pathway independently of antibody. When purified classical pathway components were used to deposit C3 on JS3 in the absence of serum regulatory proteins or antibodies, added C1-inhibitor reduced C3 binding to background levels. When McAb 10 was present, C3 binding was unaffected by C1-inhibitor. Covalently bound, large molecular weight C3 alpha-chain-gonococcal complexes were disbanded by methylamine release of ester linkages. Released 125I-C3 migrated as C3b without degradation by gonococcal proteases. Purified classical components alone or McAb 10 alone facilitated JS3 killing by neutrophils; when combined, the two provided maximal killing. Levels of McAb 10 that only slightly increase C3 deposition on JS3 are bactericidal in serum and maximally opsonic in combination with purified classical pathway components.

The virulence-associated gonococcal H.8 gene encodes 14 tandemly repeated pentapeptides.

H.8 is a virulence-associated, surface-exposed immunogenic macromolecule composed of lipid and protein, common to Neisseria gonorrhoeae and Neisseria meningitidis. The H.8 DNA sequence predicted a 6.9 kD peptide comprising 14 tandemly repeated pentameric sequences. Ten were identical: Pro, Ala, Ala, Glu, Ala. Also predicted was a lipoprotein leader consensus sequence which probably specified acylation since the Escherichia coli-expressed protein was tightly associated with lipid. Lipid appeared to contribute significantly to H.8 antigen's electrophoretic mobility. This is the first description of a prokaryotic outer membrane protein composed solely of tandem repeats. Furthermore, DNA encoding this repeat appears to have been duplicated and translocated into another neisserial gene encoding an azurin.

Probing the surface of Neisseria gonorrhoeae: simultaneous localization of protein I and H.8 antigens.

Gonococcal outer membrane protein I and the neisserial antigen H.8 are being investigated for inclusion in a gonococcal vaccine. To determine the distribution of immunoaccessible protein I and H.8 molecules on the surface of viable gonococci and to approximate the accessibility of these antigens to vaccine-elicited antibodies, immunologic probes composed of protein I- and H.8-specific antibodies linked to gold spheres were developed. When whole gonococci were exposed to the protein I and H.8 immunologic probes and examined by transmission electron microscopy, gold spheres clearly marked the surface of some of the gonococci, but not the surface of other gonococci from the same culture. The immunologic accessibility of gonococcal protein I or neisserial H.8 varied among gonococci. This diversity may affect the efficacy of a vaccine composed of these surface antigens.

Analyses of the immunoaccessibility of H8 antigen and the functionality of H8 specific monoclonal antibody 10.

The immunoaccessibility of the H8 antigen was examined as was the functionality of H8 specific monoclonal antibody (McAb 10). Immunoaccessibility of H8 varied among individual gonococci grown in vitro; the overall degree of variability was strain dependent. The H8 antigen was detected on the surface of most but not all gonococci found in urine sediment from an infected volunteer. The H8 specific McAb 10 was not bactericidal for strains of serum resistant gonococci; in the serum sensitive strain, an increase of approximately .5 logs above the bactericidal activity of antibody depleted normal human serum was observed. It is possible that the apparent paradox of the common, immunogenic, antigenic surface constituent H8 may be resolved in part by variation in immunoaccessibility within and among gonococcal strains.

Isolation and preliminary biochemical characterization of the gonococcal H.8 antigen.

We have presented a method for the extraction and isolation of the gonococcal H.8 antigen. There was no evidence of contamination by other gonococcal proteins, phospholipids, or LPS. The purified H.8 antigen was subjected to preliminary analysis and appeared to be a proteolipid consisting of both protein and lipid components. The amino acid composition was unusual; the peptide portion of the antigen was an alanine and proline-rich molecule that lacked aromatic and sulfur-containing amino acids. The overall amino acid composition is hydrophobic. A lipid constituent was also identified; it was made up of at least two lipid components, which were unique to the H.8 molecule. The chemical nature of the association of the protein and lipid is presently unknown, but it is clearly a tenacious one.

A spontaneous mutant of Neisseria gonorrhoeae with decreased resistance to neutrophil granule proteins.

We examined the resistance of Neisseria gonorrhoeae to proteins prepared from the granules of human polymorphonuclear neutrophils (PMNs). We found that nearly isogenic strains differing in lipopolysaccharide subunit molecular weight also differed in levels of resistance to crude granule extracts. N. gonorrhoeae strain WS1 was at least 10-fold less resistant than the parental strain FA 102 to granule extracts. Surprisingly, strain WS1 did not differ from FA 102 in resistance to two isolated antimicrobial proteins obtained previously from extracts of human PMN granules. We used strain WS1 in assays that detected antimicrobial proteins in granule extracts, and we obtained at least two proteins with apparent molecular masses of 24-25.5 kilodaltons that exerted potent in vitro antigonococcal activity. We found that the ED50 (concentration of protein required to kill 50% of gonococci) against the strain WS1 was approximately 0.006 microgram of protein/ml, whereas the ED50 against the parental strain (FA 102) was approximately 0.4 microgram of protein/ml. Accordingly, alterations in lipopolysaccharide structure apparently caused a 66-fold decrease in gonococcal resistance to granule proteins. Our data suggest that gonococcal resistance to oxygen-independent antimicrobial systems of human PMNs may, in part, depend on the availability of certain lipopolysaccharide domains involved in recognition of the antimicrobial granule proteins described in this report.

Analyses of gonococcal H8 antigen. Surface location, inter- and intrastrain electrophoretic heterogeneity, and unusual two-dimensional electrophoretic characteristics.

The H8 protein is a surface-exposed antigen that is found, among members of the Neisseria genus, primarily on pathogenic species. In this study, the surface exposure of H8 was reassessed by four techniques. Results of slide agglutination, indirect fluorescent antibody binding, absorption of sera with whole gonococci, and immune electron microscopy all confirmed the presence of H8 in the outer membrane. The degree to which protein A-gold-labeled monoclonal antibodies bound to H8 was marked, and suggested that this antigen was present in abundant amounts in the outer membrane. Also in this study, the electrophoretic heterogeneity of this common surface antigen was examined. Because H8 stains poorly, electrophoretic mobility was assessed using polyclonal antibodies and a monoclonal antibody that recognizes a common H8 epitope. H8 was analyzed with respect to protein I, lipopolysaccharide (LPS), and pilus and opacity phenotypic variation; results confirmed that heterogeneity of Mr was the rule among strains (21 were examined), however, the variability in Mr was independent of protein I or LPS Mr. In one strain (FA1090), the heterogeneity of H8 was examined among 10 piliation/opacity variants; the H8 (and LPS) Mr was identical in all variants; similar data were generated in strains JS3 and JS1. The electrophoretic mobility of H8 was altered in serum-resistant and neutrophil enzyme-resistant gonococci compared to the sensitive gonococci. Some of the unusual electrophoretic migration characteristics of the antigen were also examined. H8 formed a unique mushroom-shaped band in one-dimensional gels; in a two-dimensional electrophoresis system, the antigen migrated aberrantly, very similarly to LPS. Also seen in the two-dimensional electrophoresis profile were multimers of the H8 antigen; in strain JS3 (Mr 23,500), these migrated at 43,600, 86,000, and greater than 150,000. In other strains, the Mr of the multimers differed depending upon the Mr of the monomer. The two-dimensional migration characteristics (as measured by antigenicity) were completely destroyed by proteinase K digestion. Activity of H8 polyclonal antibodies to the antigens in two-dimensional gels was completely removed by adsorption of formalin-fixed whole cells, but was not affected by adsorption with LPS. These electrophoretic characteristics may reflect the close association of some nonprotein constituent, perhaps lipid or carbohydrate or both.

Lipopolysaccharide variation in Coxiella burnetti: intrastrain heterogeneity in structure and antigenicity.

We isolated lipopolysaccharides (LPSs) from phase variants of Coxiella burnetii Nine Mile and compared the isolated LPS and C. burnetii cells by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting. The LPSs were found to be the predominant component which varied structurally and antigenically between virulent phase I and avirulent phase II. A comparison of techniques historically used to extract the phase I antigenic component revealed that the aqueous phase of phenol-water, trichloroacetic acid, and dimethyl sulfoxide extractions of phase I C. burnettii cells all contained phase I LPS, although the efficiency and specificity of extraction varied. Our studies provide additional evidence that phase variation in C. burnetii is analogous to the smooth-to-rough LPS variation of gram-negative enteric bacteria, with phase I LPS being equivalent to smooth LPS and phase II being equivalent to rough LPS. In addition, we identified a variant with a third LPS chemotype with appears to have a structural complexity intermediate to phase I and II LPSs. All three C. burnetii LPS contain a 2-keto-3-deoxyoctulosonic acid-like substance, heptose, and gel Limulus amoebocyte lysates in subnanogram amounts. The C. burnetii LPSs were nontoxic to chicken embryos at doses of over 80 micrograms per embryo, in contrast to Salmonella typhimurium smooth- and rough-type LPSs, which were toxic in nanogram amounts.

Morphology of three strains of contagious equine metritis organism.

Examination of recently isolated cultures of three strains of Contagious Equine Metritis Organism grown on specially formulated, serum-free, clear typing medium revealed the presence of numerous colonial opacity variants. These colonies were prepared by a number of fixation and staining techniques and examined by scanning and transmission electron microscopy. Opaque and transparent phenotypes produced copious amounts of extracellular material compared with intermediate-opacity phenotypes which produced little or none. Also unique to intermediate colonies were numerous thin intercellular strands, which may represent pili or polymers of extracellular material. The presence of an unusual fibrillar layer (with similar electron density to the extracellular material) on the outer leaf of the outer membrane also was confirmed. A number of other ultrastructural features also were noted, including an epilayer, a thin nonmembranous layer which covered colonies and adjacent agar.

Analyses of gonococcal lipopolysaccharide in whole-cell lysates by sodium dodecyl sulfate-polyacrylamide gel electrophoresis: stable association of lipopolysaccharide with the major outer membrane protein (protein I) of Neisseria gonorrhoeae.

The lipopolysaccharide (LPS) of Neisseria gonorrhoeae whole-cell lysates and proteinase K-digested lysates was examined and compared with purified homologous LPS by a method which preferentially stains LPS in polyacrylamide gels. The silver-stained profile of gonococcal LPS in the proteinase K-digested lysate was similar to that of homologous purified LPS; however, the LPS profile in whole-cell lysates was much smaller than that of digested lysates or purified LPS. Conditions of solubilization did not affect these differences. Since it is known that LPS migrates in a unique fashion in second-dimension electrophoresis, the location of LPS in the whole-cell lysates was probed by second-dimension sodium dodecyl sulfate-polyacrylamide gel electrophoresis with a variety of stains and radiolabels. Results from these experiments indicated a stable and reproducible association of LPS with proteins ranging between 23,000 to 36,000 in Mr, in particular major outer membrane protein I. In addition to staining with the silver method, which preferentially stains LPS, the putative LPS was resistant to digestion by proteinase K, did not stain with Coomassie brilliant blue, and was not labeled extrinsically with 125I (Iodogen method) or intrinsically with [35S]methionine. Analysis of two-dimensional gels by immunoblotting with rabbit antisera prepared from protein I bands removed from a polyacrylamide gel revealed the presence of antigens in the same area of the gel (below proteins that were 23,000 to 36,000 in Mr). Antibodies to constituents which migrated below the diagonal were essentially removed by adsorption of antisera with purified LPS, as were antibodies to homologous LPS and LPS in proteinase K-digested whole-cell lysates. Immunoblotting with a monoclonal antibody specific for LPS demonstrated reactivity of the antibody with LPS and with the protein I band. On the basis of these data, we conclude that protein I and perhaps other proteins in the whole-cell lysate are stably associated with LPS; this complex is resistant to dissociation in sodium dodecyl sulfate at high temperature (approximately 100 degrees C) but does, for unknown reasons, dissociate with electrophoresis in the second dimension. The association of LPS with protein antigens in sodium dodecyl sulfate-polyacrylamide gels adds another dimension of complexity to analysis of these antigens by immunoelectroblotting. Furthermore, the tight association of LPS with the major outer membrane protein I may alter the nature of the immune response generated by "purified" protein I vaccine antigens. The possible role of protein-LPS complexes in the pathogenesis of gonorrhea is discussed.

Arrangement of pili in colonies of Neisseria gonorrhoeae.

The morphology and arrangement of pili in the P++ colony phenotype of Neisseria gonorrhoeae were examined by a variety of electron microscopic techniques. The apparent structure and organization of gonococcal pili varied depending upon the method of specimen preparation. Pili as thin, individual, unbranched structures were demonstrated by negative staining and in sections of epoxy-embedded specimens. Pili forming thick structures which branch, subdivide, and rejoin to form an irregular lattice were demonstrated in specimens processed by the critical-point drying method and by rapid freezing and low temperature sublimination. We propose that in gonococcal colonies of the P++ phenotype, pili exist as individual threadlike structures only on the bacterial surfaces; as the pili leave the bacterial surfaces, they form thick bundles which branch, subdivide, and rejoin to form a supporting framework interconnecting the colony members. This arrangement of pili is usually disrupted by the commonly used method of negative staining and cannot be clearly detected within epoxy-embedded specimens. These data are summarized in a model depicting the organization of pili in the P++ colony phenotype of N. gonorrhoeae.

Monoclonal antibody against a genus-specific antigen of Chlamydia species: location of the epitope on chlamydial lipopolysaccharide.

Monoclonal antibodies were prepared by the fusion of murine myeloma NS1 cells with spleen cells of BALB/c mice immunized with Formalin-killed elementary bodies of the Chlamydia trachomatis L2 serovar. The specificity of these monoclonal antibodies was determined with a solid-phase immunoassay in which HeLa 229 cells infected with C. trachomatis serovars D, G, H, I, L2 and the Chlamydia psittaci meningopneumonitis strain Cal-10 were used. An immunoglobulin G3 monoclonal antibody (L2I-6) was identified that reacted with both C. trachomatis- and C. psittaci-infected HeLa cells. The immunoreactivity of the genus-specific epitope was heat resistant (100 degrees C, 10 min) but was destroyed by sodium metaperiodate treatment. Further characterization of the chlamydial specificity of monoclonal antibody L2I-6 by microimmunofluorescence showed that it was reactive with all 15 C. trachomatis serovars and seven C. psittaci strains isolated from five different animal species. We undertook studies to identify the biochemical nature of the chlamydial component on which the genus-specific epitope was located. The immunoreactive component was isolated by hot phenol-water extraction of dithiothreitol-reduced chlamydial elementary bodies. The component was positive in the Limulus amoebocyte lysate test (results of Limulus amoebocyte lysate assay were identical with those of Salmonella typhimurium LT2 SAI 377 Re lipopolysaccharide [LPS]), contained 8.8% 2-keto-3-deoxyoctulosonic acid, was resistant to proteinase K, and possessed electrophoretic mobility and silver-staining characteristics in sodium dodecyl sulfate-polyacrylamide gel electrophoresis consistent with a rough LPS or glycolipid. On the basis of these findings, we conclude that the genus-specific epitope recognized by monoclonal L2I-6 is located on chlamydial LPS. We further characterized the antigenic properties of the chlamydial LPS epitope by examining the immunoreactivity of monoclonal antibody L2I-6 by immunoblotting analyses against isolated LPSs extracted from Neisseria gonorrhoeae, S. typhimurium, and Escherichia coli. Monoclonal antibody L2I-6 did not bind LPS of these organisms, demonstrating that the chlamydial genus-specific LPS epitope is apparently not shared by these gram-negative bacteria. We were able, however, to show that the chlamydial LPS does share antigenic determinants with LPS of gram-negative organisms. Polyclonal rabbit antisera raised against S. typhimurium Re LPS or lipid A showed intense immunological cross-reactivity with chlamydial LPS by immunoblotting.(ABSTRACT TRUNCATED AT 400 WORDS)