Detection of repeated gonorrhea by a modified follow-up method.

The rate of reinfection after treatment was studied in four groups of patients. The first group of 100 patients were evaluated retrospectively after treatment with 1.0 g ampicillin twice followed by two re-examinations over a 2-week period during which time intercourse was prohibited. The second and third prospectively groups consisted of 100 and 200 patients respectively, treated with 1 g ampicillin twice and 1.4 g pivampicillin + probenecid respectively, with re-examinations at intervals of 1 week and 4 weeks after treatment. In these two groups sexual intercourse was allowed during the last 10 days of the follow-up period. The fourth study group consisted of all patients infected with gonococci having MIC greater than or equal to 0.3 micrograms/ml for ampicillin and/or benzylpenicillin, who were treated with 1 g ampicillin twice during the period of 1973-76. In the first group no positive cultures were obtained at re-examination. In groups two and three, 35 out of 300 (12%) were found to have positive cultures at re-examination. Some of these were probably treatment failures. The failure rate in group four was found to be 20%, indicating that the treatment regimen used left a narrow therapeutic margin. However, the risk of re-infection, in this urban clinic, seems to be higher than the risk of treatment failure which would have remained undetected had sexual intercourse been forbidden.

A dose response study with bacampicillin in uncomplicated gonorrhoea.

In a systematic study of dose-response relationship 883 patients with uncomplicated gonorrhoea were given single oral doses of 400, 800 or 1600 mg bacampicillin, with 1 g probenecid. A single dose of bacampicillin 800 mg plus probenecid was the minimum effective dose in patients with fully ampicillin-sensitive strains. In patients with gonococci showing reduced sensitivity to ampicillin, 1600 mg bacampicillin was required to reach a cure rate above 95%. Bacampicillin was well tolerated in all treatment groups. Side-effects were reported in 4.6% of the courses of treatment. The most frequent adverse reaction was loose stools (1.9%), which was noted more often after the 1600 mg dose but was considered to be of no or very little clinical importance.

Staphylococcus saprophyticus: a frequent cause of acute urinary tract infection among female outpatients.

The frequency of Staphylococcus saprophyticus, formerly Micrococcus subgroup 3, as the cause of bacteriuria is reported. Of 787 consecutive female outpatients with signs of bacteriuria, 173 (22.0%) yielded S. saprophyticus, predominantly in pure culture and in high counts. In the age group 16--25 years, this organism was demonstrated in no less than 42.3%. In hospitalized women and in men with signs of bacteriuria, on the other hand, S. saprophyticus was a rare finding (0.9% and 0.5%, respectively). The figures in female outpatients aged 15--30 years were similar over a three-year period, but higher during summer and fall as compared with those in winter and spring. The patients regularly had rather severe symptoms of acute urinary tract infections with dysuria and often loid pain. Hematuria and pyuria were common. All strains of S. saprophyticus had a fairly even and high susceptibility to antimicrobial agents except nalidixic acid. Recurrent infections were common. The origin of this infection is still obscure.

Hemolytic streptococci among infants in a maternity department. Report of an outbreak.

Reports of several streptococcal infections among babies after discharge from a maternity department initiated an epidemiologic study. Out of 100 infants in the 3 maternity wards 67% were colonized on the umbilicus with hemolytic streptococci group A. It was assumed that the spread had occurred from infant to infant in connection with the nursing. By means of new and strict hygienic routines, isolation and penicillin treatment of the colonized infants the spread was rapidly brought to an end. A retrospective study among the children delivered up to 6 weeks earlier showed that no less than 64% had had clinical signs of infection of possible streptococcal origin. Infections had also occurred among many family members. The observations emphasize the importance of strict hygienic routines and continuous bacteriologic surveillance in maternity departments, as well as close contact between maternity departments and health centers for children.

Culture diagnosis of gonorrhoea--a comparison between two standard laboratory methods and a commercial gonococcal culture kit (Kvadricult).

The efficiency of a commercial kit--Kvadricult--intended for the culture diagnosis of gonorrhoea and specially designed to simplify "bedside" inoculation, was compared in two laboratories with their standard laboratory gonococcal (GC) culture methods. The yields of specimens inoculated "bedside" were compared with those inoculated after transport for 4-18 hrs in a modified Stuart transport medium. The highest positive yield was obtained by "bedside" inoculation with approximately equal results for the conventional methods and the Kvadricult system. Compared with "bedside" inoculation, the loss of positive specimens after transport was less than 10% in one laboratory but more than 17% in the other, which was found to be due to inferiority of the GC medium used in this laboratory, the reasons for which are discussed. Prolonged transportation of specimens for 2 days increased the loss of positive specimens, rising to as much as 55% even at the laboratory with the more efficient GC medium. These losses can obviously be avoided by transport for less than 24 hours--or better still, by "bedside" inoculation. From this point of view we have found the Kvadricult system efficient and easy to handle.