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ABSTRACT: During 1995-1997, an outbreak of 66 cases of gonorrhea caused by an erythromycin-resistant (Ery(r); MIC >/=1.0 microgram/mL) prototrophic (proto) auxotype IB-1 serovar of Neisseria gonorrhoeae occurred in King County, Washington; 65 cases involved men who have sex with men (MSM), which accounted for approximately 37% of infections among MSM during this period. Isolates from 19 of these 65 cases of infection were analyzed by DNA sequencing of the polymerase chain reaction-amplified promoter region of the mtrR gene and by pulsed-field gel electrophoresis (PFGE) analysis of genomic DNA after NheI and SpeI digestion. Eighteen of the 19 isolates had a 1-bp A/T deletion in a 13-bp inverted repeat of the mtrR promoter region and shared a single PFGE type. Among MSM who provided data about sexual behavior, 37 (64%) of 58 MSM infected by the proto/IB-1 Ery(r) strain reported having >2 sex partners during the past 60 days, compared with 32 (30%) of 106 MSM infected by other strains (P<.001). This clonal outbreak of gonorrhea illustrates the ongoing need for behavioral preventive interventions among MSM.
The Journal of Infectious Diseases 07/2000; 181(6):2080-2. · 6.41 Impact Factor
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ABSTRACT: Two Neisseria gonorrhoeae isolates from Seattle and two isolates from Uruguay were resistant to erythromycin (MIC, 4 to 16 microg/ml) and had reduced susceptibility to azithromycin (MIC, 1 to 4 microg/ml) due to the presence of the self-mobile rRNA methylase gene(s) ermF or ermB and ermF. The two Seattle isolates and one isolate from Uruguay were multiresistant, carrying either the 25.2-MDa tetM-containing plasmid (Seattle) or a beta-lactamase plasmid (Uruguay). Sixteen commensal Neisseria isolates (10 Neisseria perflava-N. sicca, 2 N. flava, and 4 N. mucosa) for which erythromycin MICs were 4 to 16 microg/ml were shown to carry one or more known rRNA methylase genes, including ermB, ermC, and/or ermF. Many of these isolates also were multiresistant and carried the tetM gene. This is the first time that a complete transposon or a complete conjugative transposon carrying an antibiotic resistance gene has been described for the genus Neisseria.
Antimicrobial Agents and Chemotherapy 07/1999; 43(6):1367-72. · 4.84 Impact Factor
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Sex Transm Dis 04/1999; 26(3):157-9. · 2.87 Impact Factor
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ABSTRACT: To assess low abdominal pain, yellow vaginal discharge, other symptoms and signs, and demographic and behavioural variables as predictors for cervical or vaginal infection.
A cross sectional study of women attending gynaecology and family planning clinics in Lima, Peru was undertaken. 630 consecutive eligible female patients with chief or elicited complaints of yellow vaginal discharge, low abdominal pain, or both were interviewed and examined, together with a comparable reference group without these complaints. Vaginal specimens were tested for trichomoniasis and bacterial vaginosis. Endocervical specimens were tested for Neisseria gonorrhoeae and Chlamydia trachomatis using the ligase chain reaction.
Infections found included chlamydial infection in 69 women (10.9%), gonorrhoea in 10 (1.6%), and either infection in 77 (12.2%); trichomoniasis in 46 (7.3%), bacterial vaginosis in 189 (30%), and either infection in 209 (33.2%). Cervical infection with C trachomatis and/or N gonorrhoeae was independently associated with history of a new sex partner within the last 3 months, more than one sex partner within the last year, use of condoms never or in less than 50% of sex acts, history of sex partner with STD within the last year; with symptoms of persistent low abdominal pain and of yellow vaginal discharge; and with signs of profuse and yellow vaginal discharge, cervical ectopy, easily induced endocervical bleeding, or brown cervical secretion. Using these findings, an algorithm was created that had a positive predictive value (PPV) of 36% for cervical infection among women reporting chief or elicited complaint of this abnormal vaginal discharge and a PPV of 25% among those without a complaint. A chief complaint of yellow vaginal discharge had a PPV of 50% for trichomoniasis or bacterial vaginosis. Among women without a chief complaint of yellow vaginal discharge, clinical findings of yellow vaginal discharge had a PPV of 55%.
Where economic and technical constraints preclude testing, clinical findings and risk assessment are helpful in detecting vaginal and cervical infections. Several demographic, behavioural, clinical, and laboratory variables were predictive of infection in this population.
Sexually Transmitted Infections 07/1998; 74 Suppl 1:S85-94. · 2.85 Impact Factor
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C A Ryan,
A Zidouh,
L E Manhart,
R Selka, M Xia,
M Moloney-Kitts,
J Mahjour,
M Krone,
B N Courtois,
G Dallabetta,
K K Holmes
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ABSTRACT: To determine where and with what symptoms women seek care for reproductive tract infections (RTI) in Morocco and to guide allocation of resources for training and treatment for RTIs.
A primary healthcare centre (PHC), a family planning centre (FPC), and a specialty dermatovenereology clinic (SC) were selected in each of three urban areas. Women with symptoms of vaginal discharge, lower abdominal or pelvic pain, or genital lesions (genital ulcer or warts) underwent interviews, physical examinations, serological testing for human immunodeficiency virus (HIV) and syphilis, and collection of vaginal fluid for microscopic examination, and urine for detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) by ligase chain reaction (LCR).
Over 8 months, 1238 women enrolled, including 61.8% at PHCs, 34.8% at FPCs, and 3.4% at SCs. Overall, 54% complained of vaginal discharge, of whom 8.8% had GC or CT infection and 30.1% had trichomoniasis (TV) or bacterial vaginosis (BV); 24.9% complained of lower abdominal pain with or without vaginal discharge, of whom 7.3% had GC or CT and 22.6% had TV or BV. GC or CT infections were found in 10.1% of PHC and 5.4% of FPC patients; while TV and/or BV infections were found in 28.7% and 22.8%, respectively. GC or CT infection was associated with perceived risk behaviours of the male partner (for example, belief partner is unfaithful) more often than with reported risk behaviours of the women themselves. For vaginal infections, a modified World Health Organisation (WHO) test algorithm for vaginal discharge involving risk assessment plus speculum and bimanual examination was 98.0% sensitive at PHCs and 90.8% at FPCs, with positive predictive value (PPV) of 33.4% at PHCs and 26.8% at FPCs. For GC or CT infections this algorithm was 60.6% sensitive at PHCs and 85.7% sensitive at FPCs; but PPV was only 9.9% and 9.0% respectively, little higher than the background prevalence of these infections. An RTI algorithm (Morocco specific) had comparable sensitivity and PPV for vaginal infection, and for cervical infection was less sensitive but had much higher PPV (26.9% for PHCs and 26.7% for FPCs).
Women with complaints of vaginal discharge and/or lower abdominal pain presented to PHC and FP clinics, not to SCs. PHCs and FPCs should therefore receive resources for management of vaginal discharge. Both the test algorithm and the new RTI algorithm were useful in allocating treatment for vaginal infection, but only the RTI algorithm discriminated in selecting women with cervical infection. Even with the RTI algorithm, which limited treatment for cervical infection to risk assessment positive patients with signs of cervical infection or PID, the PPV for cervical infection was low, potentially resulting in frequent overtreatment and problems of partner notification.
Sexually Transmitted Infections 07/1998; 74 Suppl 1:S95-105. · 2.85 Impact Factor
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ABSTRACT: Patients and gonococcal isolates (n = 783) from five sexually transmitted disease clinics in Ohio and western Pennsylvania were studied to investigate the spread of gonococci with decreased fluoroquinolone susceptibility. Among patients with gonorrhea, rates of infection with strains with decreased fluoroquinolone susceptibility (MIC of 0.125-0.25 microg ciprofloxacin/mL) were 20% for Cleveland, 9% for Akron, 7% for Columbus, 1% for Toledo, and 0.5% for Pittsburgh. Persons infected with strains with decreased susceptibility were more likely than those with susceptible strains to be male and older; no significant differences in sex behaviors, residence of sex partners, or recent antibiotic use were detected. Prevalence of decreased susceptibility was not correlated with reported levels of community fluoroquinolone use. The Pro/IB-3 auxotype/serovar class accounted for 80% (44/55) of isolates with decreased susceptibility. Pro/IB-3 isolates from three cities had indistinguishable pulsed-field gel electrophoresis patterns, suggesting intercity spread of a clone.
The Journal of Infectious Diseases 04/1998; 177(3):677-82. · 6.41 Impact Factor
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ABSTRACT: Isolates of Neisseria gonorrhoeae requiring arginine, hypoxanthine, and uracil (AHU) appeared in Denmark in 1946, were preponderant in Seattle during the 1970s, were associated with disseminated gonococcal infections (DGI), and were primarily of the IA-1,2 serovar.
To investigate the disappearance of the AHU/IA-1,2 phenotype and to examine by pulsed-field gel electrophoresis (PFGE) the genomic homogeneity of this unique phenotype isolated from Seattle-King County during the past decade.
This retrospective study used data extracted from previous publications for the period 1971 through 1984, and from existing records at the Neisseria Reference Laboratory, University of Washington for the period 1985 through 1996. Samples (n = 68) of AHU/IA-1,2 isolates from 1984 to 1985 and 1988 to 1993 were analyzed using endonucleases NheI and XbaI. For comparison, 10 AHU/IB isolates were included in the study.
AHU isolates, predominantly IA-1,2 strains accounted for 52% of the gonococcal isolates for the period 1971 through 1974, 40% for 1974 through 1976, 16% for 1984, and then declined from 7% in 1986 to 0% for each of the last 3 years, 1994 through 1996. Isolates with < or = 1 band difference after digestion with either NheI or XbaI were considered to belong to a single closely related pattern. Pulsed-field gel electrophoresis (PFGE) type designation was made from the combination of NheI and XbaI patterns. These criteria yielded 5 NheI and 8 XbaI PFGE patterns, and 11 PFGE types based on the combination of NheI and XbaI pattern. The most frequently occurring NheI and XbaI patterns accounted for 74% and 57% of isolates, respectively. One type persisted throughout the decade and accounted for 54% of the 68 isolates. Analysis of the 10 AHU/IB isolates yielded 7 NheI and 8 XbaI patterns that gave 9 types that were distinct from the types found in the AHU/IA-1,2 strains.
The AHU/IA-1,2 phenotype first documented 50 years ago in Denmark still shows a high degree of genomic homogeneity during the past decade in Seattle. The implementation of screening, decreased rates of sexual exposure in the acquired immune deficiency syndrome era, or other factors may explain its apparent elimination in Seattle-King County.
Sex Transm Dis 12/1997; 24(10):561-6. · 2.87 Impact Factor
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Antimicrobial Agents and Chemotherapy 11/1996; 40(10):2439-40. · 4.84 Impact Factor
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Journal of Antimicrobial Chemotherapy 05/1996; 37(4):839-41. · 5.07 Impact Factor
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ABSTRACT: Forty-four Neisseria gonorrhoeae, 12 N. meningitidis, four Kingella denitrificans and one Eikenella corrodens carrying 25.2 MDa Tet M plasmids were analysed using polymerase chain reaction (PCR) to the downstream region of the incomplete Tet M transposon. From each isolate, one of two different PCR fragments of approximately 700 or 1600 bp were obtained. The two different sized PCR fragments had > or = 90% DNA sequence identity with Ureaplasma urealyticum Tet M downstream sequences. The difference between the large PCR fragment and the smaller PCR fragment was a deletion of over 800 bp in the smaller fragment. Both PCR fragments were found in plasmids isolated from N. gonorrhoeae and K. denitrificans. The smaller PCR fragment was found in N. meningitidis plasmids and the larger PCR fragment was found in the E. corrodens plasmid.
Molecular and Cellular Probes 11/1995; 9(5):327-32. · 2.08 Impact Factor
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ABSTRACT: Pulsed-field gel electrophoresis (PFGE) is a technique for analyzing large DNA fragments. PFGE was compared to auxotyping and Por serovar (A/S) classification to determine its utility in the study of gonococcal infection, subtyping A/S classes, and clone identification. PFGE patterns were stable in vitro after 2 isolates were passaged 50 times, and those from sex partners were indistinguishable with both enzymes. Fourteen proline-requiring IA-6 isolates from Kenya produced 8 NheI and 7 XbaI patterns; these included 6 Tet M-carrying isolates, all producing the same NheI pattern. PFGE patterns of 14 arginine-, hypoxanthine-, and uracil-requiring IA-1,2 isolates, from the US Pacific Northwest and Hawaii in 1993, were less diverse with both enzymes. PFGE analysis represents a potentially useful addition to the current gonococcal classification system.
The Journal of Infectious Diseases 03/1995; 171(2):455-8. · 6.41 Impact Factor
