Non-gonococcal Infections Research Articles

The prevalence of gonococcal and non-gonococcal infections in women referred to obstetrics and gynecology clinics.

Bacterial vaginosis is a condition caused by changes in the vaginal microbial ecosystem and increases the risk of preterm delivery, premature rupture of membranes, endometritis, and weight loss of the baby. This study aimed to evaluate the frequency of gonococcal and non-gonococcal genital infections in women referred to clinics in Ilam, Iran. Two swab samples were taken from each patient using a sterile swab, one swab was placed in a THB medium for the culture of Streptococcus agalactiae and the other in PBS buffer for PCR. PCR method was conducted for the identification of the other bacterial agents such as Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, and also S. agalactiae. Sampling was performed on 169 women with symptomatic vaginosis. The frequency of S. agalactiae by culture and PCR methods was 4.7% (8 samples) and 13.6% (23 samples) respectively. Also, 6.5% (11 samples), 3.5% (6 samples), 4.1% (7 samples), 1.2% (2 samples), and 0% of the samples were positive for N. gonorrhoeae, M. genitalium, M. hominis, U. urealyticum and C. trachomatis by PCR method. Except for a significant association between S. agalactiae colonization and abortion, there was no significant correlation between the prevalence of these bacteria and the patient's age, age of marriage, number of deliveries, and number of abortions. Overall, the prevalence of gonococcal and non-gonococcal infection in women referred to clinics in Ilam is similar to the other parts of Iran.

Nongonococcal cervicitis: The most common cause of fluor albus in female sex workers

Female sex workers have a high risk of suffering from sexual transmitted infections (STIs). If the female sex workers suffer from STIs, besides affecting themselves, they also have potential to transmit the disease to their clients. Fluor albus is one of the symptoms of STIs. The purpose of this research is to evaluate the type of STIs that the female sex workers suffer from. This research was conducted retrospectively on 100 female sex workers in Puskesmas Putat Surabaya in 2013-2014. The result of this research showed that from 100 female sex workers, 14 subjects (14%) suffered from gonococcal cervicitis, 51 subjects (51%) suffered from nongonococcal cervicitis, 10 subjects (10%) suffered from nongonococcal cervicitis accompanied by bacterial vaginosis, 9 subjects (9%) suffered from bacterial vaginosis, 1 subject (1%) suffered from trichomoniasis, and 14 subjects (14%) had no data. This research concluded that nongonococcal cervicitis is the most major cause of STIs suffered by female sex workers. Therefore, the vigilances to prevent transmission of nongonococcal infection to the clients is highly needed.

Bacteriological finding in the urethra in men with and without non-gonococcal urethritis

Non-gonococcal urethritis (NGU) is a very common sexually transmitted disease. The etiology of the disease is complex and not completely solved. The aim of this study was to determine the bacteriological finding in the urethra in men with and without non-gonococcal urethritis. The study group comprised 200 men with symptoms of urethritis. The control group consisted of 60 men without symptoms of urethritis. The diagnosis of nongonococcal infection was made by finding of an increased number of polymorphonuclear leukocytes (> or = 5) under the microscope in a sample of Gram-stain of urethral smear (x 1 000) and without evidence of Neisseria. gonorrhoeae in specimens (negative direct microscopy and cell culture). Bacteriological examination included: direct microscopy with the Gram-stained and methylblue-stained smears of urethral discharges, and cultivation of specimens under the aerobic/unaerobic conditions. In addition to standard bacterial examination and performinig direct imunofluorescence test to detect Chlamydia trachomatis (bioMerieux, France), urethral smears were also examined for the presence of Ureaplasma urealyticum and Mycoplasma hominis by commercially available Mycofast Evolution 2 test (International Microbio, France). The finding of mycoplasmas > or = 10(4) CCU/ml was positive. The data were statistically analyzed using Pearson chi2 and Student t test. C. trachomatis was predominant bacterial species found in urethra in men with nongonococcal urethritis. It was isolated alone and/or mixed with mycoplasmas and/or other bacteria in 86 (43.0%) of examinees. There was statistically significant difference in finding of C. trachomatis between the study group and the control group (p < 0.001). U. urealyticum was found in men with NGU: 30.2% were with C. trachomatis and 36.0% were without C. trachomatis (p > 0.05). In 16 (8.0%) men with NGU, C. trachomatis was isolated alone, while in 13.0% examinees it occurred with U. urealyticum. Staphylococcus saprophyticus was isolated in one subject with NGU, alone. Streptococcus agalactiae was found in 1.5% of men with urethritis. Anaerobic bacteria were found in 38 (19.0%) subjects with NGU and in 7 (11.7%) subjects from the control group. C. trachomatis was predominant bacterial species found in urethra in men with nongonococcal urthretitis. Mixed infections were frequent.

Usefulness of the Mycofast Test (MYCOFAST® Evolution 2) for the Diagnosis of Nongonococcal Genitourinary Infections

Purpose: We wanted to investigate the usefulness of Mycofast (MYCOFAST Evolution 2, International Microbio, France) for Ureaplasma urealyticum (U. urealyticum) and Mycoplasma hominis (M. hominis) in association with nongonococcal genitourinary infections. Materials and Methods: 530 patients visited our department for genitourinary infection symptoms or for the evaluation of sexually transmitted disease. The genital swabs were first vortexed in Mycofast transport broth. A volume of 100μl of liquid sample was innoculated to each well of the Mycofast broths and 0.5μl of liquid sample was innoculated to A7 agar culture media (International Microbio, France). The Mycofast broths were incubated at 35-37C for 36 hrs, and the A7 agar culture media was incubated for 4 days. We compaired Mycofast with A7 agar culture for the sensitivity, specificity, the positive and negative predictive values and the antibiotic susceptable profiles. Results: Of the 530 samples submitted, 165 samples were positive by the A7 agar culture and 162 samples were positive by Mycofast. 157 samples were positive by both methods. Of the 365 samples that were negative by the A7 agar culture, 360 samples were also negative by the Mycofast. In this study, Mycofast had a sensitivity and specificity of 95% and 98%, respectively, and a positive and negative predictive value of 96% and 97%, respectively. The Mycofast drug susceptibility tests indicate a high susceptibility to doxycyclin as follows: U. urealyticum: 86.3%; M. hominis: 85.0% and both organisms with simultaneous isolation: 75.8%. Conclusions: Mycofast was an easy test to perform and it proved to be a practical and reliable method for isolating the Mycoplasma and Ureaplasma species for making the diagnosis of nongonococcal genitourinary infections, and it showed the added benefit of determining the limited susceptibilities of the isolated strains. (Korean J Urol 2006;47:1117-1123) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Genital mycoplasmas, including Mycoplasma genitalium, as sexually transmitted agents.

Mycoplasmas are the smallest free-living organisms, widespread in nature. Several mycoplasma species have been isolated from humans. For 6 of them: Mycoplasma hominis, Ureaplasma urealyticum, M. primatum, M. genitalium, M. spermatophilum and M. penetrans, the genital tract is the main site of colonization. This review is concentrated on the role of mycoplasmas as sexually transmitted agents, with the emphasis to M. genitalium infections. M. hominis and U. urealyticum are isolated from the genital tract of healthy men and women with considerable frequency. The biological features (attachment properties, possible intracellular location) and experimental inoculation studies of M. genitalium indicate that this mycoplasma has pathogenic potential. Data from case-control studies, looking at men with non-gonococcal urethritis and women with cervicitis, have revealed that M. genitalium behave similarly to Chlamydia trachomatis and have revealed that carriage of M. genitalium and C. trachomatis is usually independent of one another. M. genitalium could be considered as a potential cause of sexually transmitted urethritis in men, including men with persistent or recurrent urethritis. More studies are expected to ascertain the role of M. genitalium in the female genital tract. Evidence-based data are needed to decide whether current non-gonococcal infection treatment principles are applicable or not for M. genitalium infections.

Azithromycin in the management of Chlamydia trachomatis infections.

The unique pharmacological profile of the azalide macrolide azithromycin, coupled with its in vitro activity against both Chlamydia trachomatis and the ureaplasmas, suggested that genital infections caused by these bacteria could be successfully treated with a single dose of the antibiotic. This has now been confirmed in worldwide clinical studies. A single oral dose of azithromycin 1 g eradicates C. trachomatis in almost 100% of cases of non-gonococcal urethritis and cervicitis. Unfortunately, there are no specific clinical signs for genital chlamydial infection. It is therefore necessary to use therapy effective against known and unknown pathogens for treating lower genital tract infection. Clinical cure rates for both chlamydial and non-chlamydial, non-gonococcal infections compare favourably with standard 7-day doxycycline therapy, being in excess of 85%. Side effects are few (< 20%) and essentially minor.

Diagnosing Non-Gonococcal Urethritis: The Gram-Stained Urethral Smear in Perspective

The value of microscopy of a Gram-stained urethral smear in the diagnosis of non-gonococcal urethritis and chlamydial urethral infection was assessed in 153 men attending a department of genitourinary medicine. A mean of more than 4 polymorphs in 5 fields (x1000) was considered to be abnormal. In the diagnosis of urethritis, the sensitivity (94%), specificity (91%), positive predictive value (93%) and negative predictive value (93%) were high. In the diagnosis of chlamydial infection, sensitivity (91%) and negative predictive value (96%) were high, but specificity (68%) and positive predictive value (46%) were low. In men with symptoms of genitourinary infection, the sensitivity (96.7%) and negative predictive value (97.4%) of the Gram-stained urethral smear in the diagnosis of chlamydial infection was comparable with modern chlamydial antigen detection tests.

Sexually Transmitted Arthritis Syndromes

Sexually transmitted infections may provoke a wide variety of rheumatic lesions. Disseminated N. gonorrhoeae infection leads to septic arthritis, which may be rapidly destructive but which responds promptly to appropriate antibiotic therapy. In contrast, both gonococcal and nongonococcal infections may lead to aseptic "reactive" arthritis or Reiter's syndrome. Inheritance of HLA B27 confers a relative risk of 30 to 50 times for the development of this condition. The demonstration of C. trachomatis antigen in joint material from a minority of patients suggests that direct interaction between microbial components and class I HLA antigens in the joint may be central to the pathogenesis of this disease. Arthralgia and arthritis occur in up to 50% of individuals in the prodrome of hepatitis B infection. Joint symptoms may be accompanied by urticarial or cutaneous vasculitic lesions, especially on the legs; both features resolve with the onset of jaundice. Hepatitis B infection is also a major cause of necrotizing vasculitis, which may or may not be associated with overt hepatitis. Seronegative arthritis, including Reiter's syndrome, psoriatic arthritis, and undifferentiated arthritis, a Sjögren's-like syndrome, vasculitis, and myopathies have been described in association with HIV infection. It is clear that synovitis occurs in those patients despite the fact that HIV is present in immune cells within the joint during inflammatory arthritis and that both antigen presentation and lymphocyte responsiveness within the joint are impaired. Nevertheless, synovitis may occur in the presence of marked CD4-positive lymphocyte depletion. Rheumatic syndromes, including arthralgia, inflammatory arthritis, and neuropathic arthritis, may occur during any stage of congenital or acquired syphilis. Syphilitic synovitis responds well to antibiotic therapy, but neuropathic lesions cannot be treated effectively. Septic arthritis has rarely been described as a complication of disseminated Mycoplasma or Urea-plasma infections, and joint lesions sometimes associated with erythema nodosum have also been reported in lymphogranuloma venereum and granuloma inguinale.

Prevalence of Chlamydia trachomatis in cases of genital non-gonococcal infection according to microbiological and serological investigations.

An investigation on the prevalence of Chlamydia trachomatis was carried out on 231 patients (115 men and 116 women, mean age 31.6 years) with genital non-gonococcal infection in order to study the role of this microorganism in infertility and/or sterility in the Italian population. One hundred and sixty-six apparently healthy subjects (108 men and 50 women, mean age 32.4) were also included as control for serological comparison only. Persons with gonococcal infection were excluded. ELISA method was chosen for the direct C. trachomatis examination of "scraping" samples. Serological investigations were carried out by means of the indirect immunofluorescence test for IgM and IgG determination as well as the immunoperoxidase assay for IgA antibodies. A direct C. trachomatis positive test was demonstrated in 27.8% of men vs. 11.2% in women (p less than 0.01) in the patient group. Anti-C. trachomatis IgG specific antibodies were present respectively at any serum dilution in 50.2% of patients vs. 47.6% of normal subjects respectively (p greater than 0.5). The low presence of C. trachomatis (19.5%) at the direct test contrasts with the higher percentage of anti-C. trachomatis positive patients (50.2%) in the same group suggesting that serological tests may be more useful than the direct test in demonstrating an active C. trachomatis infection provided that IgM, IgG and IgA specific antibodies be contemporaneously investigated.

Etiology and Outcome of Acute Pelvic Inflammatory Disease

BRUNHAM, R. C.; BINNS, B.; GUIJON, F.; DANFORTH, D.; KOSSEIM, M. L.; RAND, F.; MCDOWELL, J.; RAYNER, E. Author Information

Etiology and outcome of acute pelvic inflammatory disease.

We studied 71 women with the clinical diagnosis of acute pelvic inflammatory disease (PID) by laparoscopy and comprehensive microbiology in order to define the major etiologic determinants of poor fertility prognosis after tubal infection. Fifty women were found to have acute PID. Of the 50 women, 23 were pregnancy seeking and had a subsequent evaluation to determine fertility outcome. Seven of 13 women with non-gonococcal infection had an adverse reproductive outcome, compared with none of 10 women with gonococcal infection (P = .007). Two groups of causes for adverse reproductive outcome were found. Of the seven infertile women, four had initial tubal abscess, and three had evidence of Chlamydia trachomatis infection. This study directly documents the poor fertility prognosis for women with tubal abscess and suggests that women with culture and/or serological evidence of chlamydial infection also have a poor fertility prognosis.

Long-term complications of infection of the female genital tract by intracellular sexually-transmitted microorganisms: a review.

present in 18% of cases as against 3% of the controls. In 33% of the infertile group mechanical blockage could be demonstrated in the fallopian tubes. The sequelae of nongonococcal infection appeared to be worse than those of gonococcal infection; taking into consideration women who had had one attack only, the infertility rates were 17% (nongonococcal) and 12% (gonococcal), and the tubal occlusion rates were 13% (non

Evaluation of an advertising program on sexually transmitted diseases.

The Division of Venereal Disease Control in British Columbia undertook a three-year, $235,000 advertising campaign to increase demand for information on sexually transmitted disease, increase clinic attendance, and decrease the incidence of gonorrhea. As a result of the campaign, demand for information increased, and 150,000 calls were received on the recorded Venereal Disease Information Line. Annual attendance at the province's main clinic in Vancouver rose by 4,500 visits (a 25% increase), and the increase was significantly related to radio advertising. The number of reported cases of gonorrhea at the clinic dropped by 3.8%; the decrease was entirely within the female population. The campaign may have contributed to increased detection of nongonococcal infections, although lack of precampaign data does not permit full evaluation. The campaign was judged not be be cost-effective, and lack of integration with other services, especially expansion of clinic facilities and staff, led to early cancellation.

Erythromycin in chlamydial and mycoplasma genito-urinary infections: In vitro and in vivo activity

SummaryOf the non-gonococcal urethro-adnexitis infections, approximately 35% are due to Chlamydia trachomatis and 25% to mycoplasma, mainly Ureaplasma urealyticum. Chlamydia and ureaplasma are highly sensitive to erythromycin. Because of the frequency of re-infections, a 2 to 3-week treatment with 1 g erythromycin twice daily should be used for both these infectious agents and, in order to avoid re-infection by these sexually transmitted diseases, the partner should always be treated.

The Clinical Features and HLA Associations of Reactive Arthritis Associated with Non-Gonococcal Urethritis

Fifty-seven patients with arthritis associated with non-gonococcal genital infection have been studied. Synovitis characteristically affected one or a few joints, expecially the knee, ankle or metatarsophalangeal joints and was accompanied by tenosynovitis and enthesopathies--each in about one third of the patients. A quarter of the patients had ocular, cutaneous, or mucous membrane lesions (Reiter's syndrome). Although six patients developed a chronic or relapsing course, average duration of the acute episode in the majority was three to five months. Available evidence strongly suggests that infection following sexual intercourse, usually but not always with a new partner, was instrumental in the initiation of the disease. We have suggested the term 'sexually acquired reactive arthritis (SARA)' to emphasize the mode of acquisition of the disease, and note that similar syndromes are seen associated with gut infection. We consider that usage of the term Reiter's syndrome is correctly applied to only those cases which exhibited the characteristic triad of urethritis, arthritis and conjunctivitis with or without other cutaneous and mucous membrane lesions. Thirty-six of the 54 patients who were HLA typed (67 per cent) possessed the antigen HLA-B27. Of 30 who presented directly to a rheumatology unit 25 (82 per cent) were HLA-B27 positive. The other 24 patients initially attended a venereology clinic and only 11 (46 per cent) of these bore the antigen. This appears to reflect disease severity, HLA-B27 positive patients having a significantly longer duration of disease symptoms and a higher frequency of extra-articular manifestations, than those lacking this antigen.

Evaluation of Tetracycline or Penicillin and Ampicillin for Treatment of Acute Pelvic Inflammatory Disease

To evaluate guidelines for outpatient treatment of acute pelvic inflammatory disease recommended by the Center for Disease Control we studied 197 afflicted women. The women were treated either with tetracycline or with procaine penicillin and ampicillin, and 92% were subsequently seen at least once to assess efficacy of clinical and microbiologic treatment. Neisseria gonorrhoeae was isolated from the lower genital tract in 68% of these women, and although they had a quicker symptomatic response than those with nongonococcal infection (P less than 0.01), the two regimens were equally effective in producing clinical cure. However, subsequent identification of a pelvic abscess was 10 times more common in women from whom N. gonorrhoeae was not isolated. Therapy for pelvic inflammatory disease must be empirical since it is impossible to distinguish clinically between gonococcal and nongonococcal infection, and our data indicate that both regimens recommended by the Center for Disease Control are effective.

Gonorrhoea in 1972. A 1-year study of patients attending the VD Unit in Uppsala.

During 1972 a total of 2,090 men and 1,489 women were seen in the VD clinic in Uppsala, Sweden. The most frequent diagnosis among the men was non-gonococcal urethritis (38 per cent.) and among the women non-gonococcal vaginitis (34 per cent.), N. gonorrhoeae was found in 22 per cent. of the men and in 33 per cent. of the women, 68 per cent. of the men with gonorrhoea attended because of symptoms, but 67 per cent. of the men without gonococcal infections came for the same reason. 39 per cent. of the women with gonorrhoea attended after being told by their sexual partner; it was found that women coming because of symptoms were most likely to have non-gonococcal infection. Gonorrhoea without subjective symptoms was found in 23 per cent. of the men and 50 per cent. of the women. Gonorrhoea was found in association with scabies in 9 out of 18 men and in 3 out of 5 women. A rising incidence of pharyngeal gonococcal infections has been noticed at the clinic and the figures for 1972 were 6 per cent. of the men and 9 per cnet. of the women with gonorrhoea. The route of infection was usually oro-genital contact, but in some cases other routes had to be considered. It was not possible to define a promiscuous group of patients suitable for a planned study of prophylactic treatment, as only 2 per cent. of the men and 1 per cent. of the women had had nore than one gonococcal infection during the preceding year. The standard treatment for genital gonorrhoea (ampicillin 2 times 1 g. orally with a 5-hour interval) was very satisfactory and gave a 98 per cent. cure rate. This was possible because there were few gonococcal strains with decreased panicillin sensitivity. There were considerable problems in treating the pharyngeal infections, the standard treatment failing in 61 per cent.

Rifampicin (Rimactane) in the treatment of gonorrhoea.

The efficacy of a rifamycin derivative rifampicin (Rimactaine) administered orally in single 900 mg doses to 103 males for the treatment of gonorrhea was evaluated. In the 89 cases followed there were 20 nongonococcal infections 15 suspected reinfections and 10 suspected failures. 24.5% of the failures occurred in patients who had not eaten for 2 hours or more prior to treatment. The effectiveness of the drug compared favorably with findings in other studies assessing the effectiveness of single and injectable doses of antibiotics. It was concluded that the drug is well tolerated and comparable in effect with 1.2 MU of aqueous procaine penicillin.

Non-gonococcal infections of the female genitalia.

Non-gonococcal infections of the female genitalia.

Gonorrhoea and non-gonococcal infections.

Gonorrhoea and non-gonococcal infections.