Syphilis: where did it come from?
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Biomedical subjects
Publications and source records attributed to J D Oriel.
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Genital yeast infection was studied in 533 women seen in a department of venereology. Yeasts were recovered in culture from 138 patients (26% of the total). Candida albicans accounted for 112 (81%) of the isolates and Torulopsis glabrata for 22 (16%); other yeasts were uncommon. There was no evidence that the presence of yeasts was related to age. 32% of the women who were taking an oral contraceptive harboured yeasts, compared with 18% of those who were not.The symptoms and signs of the women with yeast infections were compared with those with vaginal trichomoniasis and those with no evidence of genital infection. It seems that a clinical diagnosis of vaginal mycosis cannot be made with accuracy and that positive identification of yeasts is necessary; for this, cultural methods are the most satisfactory.
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The activity of fluoroquinolones against Chlamydia trachomatis has been studied in vitro. Those agents with an MIC of less than 2.0 mg/L may be of clinical value, and clinical trials have been conducted with ciprofloxacin, ofloxacin, and fleroxacin. Ciprofloxacin has given variable results in the treatment of Chlamydia-positive urethritis in men; some studies have shown an unacceptably high reisolation of the organisms with prolonged posttreatment surveillance. Ofloxacin may be an effective drug for the treatment of lower genital tract infections with C. trachomatis in men and women, and there are indications that ofloxacin may also be of value in the treatment of chlamydial epididymitis and salpingitis. Early studies of fleroxacin suggest that this drug may also be an effective antichlamydial agent.
A group of men with uncomplicated gonococcal urethritis were treated with a single oral dose of rifampicin (900 mg) and erythromycin stearate (1 g). Neisseria gonorrhoeae was isolated from four of 108 men at the first follow-up examination, and from none of 68 who attended a second follow-up examination. It is concluded that this rifampicin-erythromycin combination may be useful for the therapy of gonorrhea. It may be of particular value in the treatment of infections due to penicillin-resistant N. gonorrhoeae, since in vitro studies showed that both rifampicin and erythromycin were active against 20 strains of beta-lactamase-producing N. gonorrhoeae. The effect of this rifampicin-erythromycin combination against associated infections with Chlamydia trachomatis was disappointing. This organism was isolated from five of nine patients who had yielded isolates of C. trachomatis before treatment.
A group of 50 men with uncomplicated gonococcal infections were treated with single, oral doses of 2.5 g of thiamphenicol. Reexamination, which included culture for Neisseria gonorrhoeae, was performed three to four days and seven days after treatment. Thirty-two (91%) of 35 men with urethral infections, 13 (87%) of 15 with rectal infections, and four (57%) of seven with pharyngeal infections were cured. None of the men from whom N. gonorrhoeae was reisolated admitted further sexual exposure. Treatment failure did not correlate with decreased sensitivity of the isolates to thiamphenicol in vitro. Three men had urethral infections with Chlamydia trachomatis before therapy, and the organism was reisolated after therapy in every case. No hematologic abnormalities occurred in any of the 50 patients treated with thiamphenicol, but 13 (26%) developed adverse gastrointestinal symptoms.
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Human papillomaviruses have not been propagated in tissue culture, so they cannot be studied by the procedures of classical virology. Recently, DNA hydridization techniques and restriction enzyme analysis have revealed that multiple strains of human papillomaviruses exist. It is now accepted that genital warts are a sexually transmitted disease; other routes of infection are possible, but unusual. An association between maternal warts during pregnancy and the development of vulval warts and laryngeal papillomatosis in infants and young children has been shown. The epidemiology of anal warts in homosexual men is not well understood. The flat condyloma, visible on colposcopy, is a human papillomavirus-containing lesion with a wart-like histology. It is a common condition which in the past may have been mistaken for dysplasia. Flat condylomas may regress spontaneously, or develop into condylomata acuminata. A link between these lesions and some cases of cervical carcinoma has been suggested.
The roles of Mycoplasma hominis and Ureaplasma urealyticum in the pathogenesis of nongonococcal urethritis (NGU) remain controversial. Isolation and serologic studies and results of antibiotic therapy do not provide good evidence that M. hominis causes NGU. The results of some studies of therapy and of some experiments in which humans were inoculated with U. urealyticum indicate that this organism may cause some cases of NGU. However, U. urealyticum is ubiquitous and apparently nonpathogenic at other genital sites; thus there are serious difficulties in deciding its role in NGU. Chronic prostatitis is a poorly defined clinical entity. At present there is no convincing evidence that either M. hominis or U. urealyticum is involved in its pathogenesis.