Cross-reactivity of Neisseria gonorrhoeae and Neisseria meningitidis and the nature of antigens involved in the bactericidal reaction.
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Biomedical subjects
Publications and source records attributed to E C Tramont.
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A latex agglutination test employing serogroup-specific meningococcal polysaccharides as the antigen has been developed. The test has been used to measure serological responses in patients with meningococcal disease, in meningococcal carriers, and in volunteers who received meningococcal vaccines. It has been shown to be a sensitive and highly specific test for the detection of group-specific meningococcal antibody. The advantages of standardized particles and antigens which are simple to prepare and stable make this assay feasible for many nonspecialized or small laboratories.
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Studies with 4 lots of group A meningococcal polysaccharides in 458 adult human volunteers showed that such vaccines are nontoxic and highly immunogenic. Comparisons of jet injection and subcutaneous (needle) methods of administration showed that both were equally immunogenic.
One hundred fourteen men with uncomplicated urethritis were randomized to receive 1 week of therapy with either doxycycline (100 mg twice daily) or ofloxacin (300 mg twice daily). Of the 109 men completing the post-treatment visit, 56 received ofloxacin and 52 (93%) were clinically cured. Forty four (83%) of the 53 men treated with doxycycline were cured. All 30 patients with gonorrhea (including three with penicillinase-producing Neisseria gonorrhoeae [PPNG] isolates) who were treated with ofloxacin became culture-negative, as compared with 32 of 34 patients receiving doxycycline. In contrast, three of 18 patients with Chlamydia trachomatis were microbiologic failures after ofloxacin therapy, while all ten treated with doxycycline were cured. Adverse effects of both treatment regimens were generally mild, and compliance was excellent except for one patient receiving doxycycline. These results show that ofloxacin, in a dosage of 300 mg taken orally twice daily for seven days, is an effective treatment for uncomplicated urethritis in men but may not reliably cure chlamydial infections.
Since syphilis and HIV infection are associated with each other at a higher rate than expected by chance, all HIV-infected persons and persons with syphilis should be tested for syphilis and vice versa. Because the immunological dysfunction of HIV-infected patients can interfere in clearing of T. pallidum, concomitant infection with T. pallidum requires that maximal doses of appropriate antibiotics be given (Table 2). Although falling nontreponemal titers, especially in early HIV stages, is evidence of adequate treatment, some appropriately treated HIV-infected persons will maintain a high persistent titer. If reinfection is ruled out, they require only one or two retreatments. Because some HIV-infected persons will inappropriately decrease their titer level, only adequate treatment (Table 2) gives the clinician confidence that the patient is cured.