Declining rates of gonorrhoea and syphilis in Strasbourg, France: a 20-year study.

OBJECTIVE: To report the epidemiology of gonorrhoea and syphilis during the years 1973-1992 in the Strasbourg STD clinic and to discuss the data in the light of changes in STD rates in western countries. DESIGN: Retrospective analysis of gonorrhoea and syphilis cases recorded annually, total number of consultations, HIV serology, STD among prostitutes. SETTING: Strasbourg, Bas-Rhin, FRANCE. SUBJECTS: Patients attending the public STD clinic in Strasbourg. RESULTS: From 1973 to 1992 79,786 consultations were recorded. Since 1984, a regular fall has been noted, from more than 4500 consultations a year in the 1970s, to 1519 consultations in 1992. A major decline in gonorrhoea was observed, especially since 1984. There were 457 new cases in 1973 (15.3% of all patients) whereas only seven new cases in 1992 (0.8% of all patients). Syphilis has been declining regularly since 1979, with a reinforcement in this decline since 1984: 168 cases were recorded in 1972 (6.4% of all patients), and only two cases in 1992 (0.2% of all patients). Positive HIV tests were found in 14% and 12% of patients in 1985-86, and the positivity rate has regularly decreased to reach 0.6% in 1992. Prostitutes represented 9.2% of all patients in 1980, and only 0.8% of patients in 1992. Since 1987, syphilis and gonorrhoea have been rarely recorded among prostitutes. CONCLUSIONS: A dramatic decline in both gonorrhoea and syphilis has been observed in Strasbourg, especially since 1984, with a parallel diminution in the STD clinic frequentation. A comparable trend in gonorrhoea rates was noted in many western countries, but syphilis rates are more heterogeneous among geographic areas. Changes in sexual behaviour due to the AIDS epidemic are probably responsible in part for this decline, but nevertheless the rarity of gonorrhoea and syphilis in Strasbourg in 1992 is not clearly explained.

What can be expected from the cytologic examination of cervicovaginal smears for the diagnosis of Chlamydia trachomatis infections?

The value of Papanicolaou-stained smears for the diagnosis of chlamydial infections is still disputed. A comparative examination of smears from infected and uninfected women has allowed the proposal of a new scheme for the interpretation of the cytologic abnormalities associated with chlamydial infection. In particular, the appearances of metaplastic cells were classified, and two smear types were found to have the highest sensitivities and positive predictive values: smears in which the metaplastic cells had (1) intracytoplasmic vacuoles containing polymorphonuclear leukocytes or (2) numerous small intracytoplasmic vacuoles containing a central eosinophilic granule. The sensitivity of this method is low, however; cytology cannot replace bacteriologic identification for the diagnosis of chlamydial infections. Nevertheless, the examination of Papanicolaou-stained smears could be considered as a screening tool in low-risk populations; provided that all of the cytologic features were considered, presumptive diagnoses of chlamydial infections could be obtained.

Somatostatin treatment of psoriasis.

Somatostatin treatment was administered to 20 psoriatic patients according to the following protocol: Continuous infusion (250 micrograms/h) for at least 2 days followed either by short infusions (1 h) at 8 A.M. and 8 P.M. (12 cases) or by repeating the initial 2-day infusion (eight patients). Before treatment (day 0) and on day 6, biopsy specimens were taken for routine examination (12 patients) and for ultrastructure (seven patients). In vitro immunological studies were carried out on peripheral blood lymphocytes (six patients) on day 0 and day 8. In two patients, somatostatin was stopped because of serious side effects. Thus, clinical results were evaluated in 18 patients, on day 30. In ten of them no improvement whatsoever occurred, two had a partial clearing and an almost complete remission was achieved in six others. Ultrastructural studies showed, on day 6, enlargement of the intercellular spaces with deposits of granular material of glucidic composition, associated with features of cellular damage. Percentages of T and B cells were unmodified but a significant depression of mitogenic stimulation by PHA and ConA was clearly observed on day 8. Even if somatostatin treatment may have a beneficial effect in some patients it seems much less valid than other well-known therapies for psoriasis.

[Value of cefotaxime in the treatment of female asymptomatic N. gonorrhoeae carriers (author's transl)]. / Intérêt du céfotaxime dans le traitement du portage asymptomatique de gonocoque chez la femme.

Thirty women with asymptomatic genital gonococcal contamination were cured with one single i.m. injection of 1 g cefotaxime. Seven hours after treatment, the antibiotic level in cervical fluid was found equivalent to the minimal bactericidal concentration for gonococcus strains. But cefotaxime does not appear useful in the prevention of meningococcal pharyngeal carriage.

[Lymphoedema of penis and scrotum: two observations (author's transl)]. / Le lymphcedème péno-scrotal : 2 observations.

Two cases of lymphoedema of penis and scrotum are reported: lymphanogiography is useful to distinguish between primary or secondary lymphoedema. In the first case, this is a primary tarda lymphoedema of penis and scrotum with hypoplastic lymphatics of the right leg. In the second case the lymphoedema follows repeated infection and paraphimosis. This infection may have worsened an already compromised lymphatic circulation. These genital elephantiasis are quite different from penile venereal edema, which disappears quickly after sexual abstinence. The operative treatment of lymphoedema is lymphangiectomy.

[Survey of gonococcal and meningococcal infections. Results from a systematic study of patients from an urban dispensary and sexual partners (author's transl)]. / Bilan d'une recherche systématique de gonocoque et de méningocoque dans un dispensaire antivénérien. Résultats fournis par les prélèvements effectués chez les partenaires.

Over a period of 28 months, 605 strains of gonococci and 302 strains of meningococci have been isolated in an urban dispensary. The study was particularly concerned with the identification of gonococcal and meningococcal strains isolated from the patients sexual partners and with epidemiological distribution of the two species. There was only little seasonal variations in the occurrence of gonococcal infections. The frequency of meningococcal infections (which are only poorly transmitted, by the nasopharyngeal route) varied inconsistently during the period covered.