Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:2.7.10.2 (focal adhesion kinase)
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The efficacy and safety of ofloxacin, 200 mg twice daily for 7 days, was compared with metronidazole, 400 mg twice daily for 7 days, for the treatment of bacterial vaginosis (BV). Diagnosis of BV was confirmed by at least 3 of the following 4 criteria: the presence of an abnormal vaginal discharge on examination, clue cells on microscopy of vaginal specimens, vaginal pH greater than 5.0 and a positive amine test. Vaginal specimens were examined for Mobiluncus spp, analysed for the succinate/lactate (S/L) ratio and cultured for Trichomonas vaginalis, Gardnerella vaginalis, Bacteroides spp. and Mycoplasma hominis. Patients were reviewed on completion of treatment (visit 2) and 14 days later (visit 3). The diagnosis of BV was accepted in 119 of 149 patients recruited, 60 of whom received treatment with ofloxacin and 59 received metronidazole. Sixty-two patients, 31 in each treatment group, completed the study. Diagnostic cure at visit 2 was significantly better in the metronidazole group with cure rates of 56% (metronidazole) vs 23% (ofloxacin) (P = 0.001); this was associated with higher eradication rates for G. vaginalis (100% vs 56%) and Bacteroides spp. (97% vs 49%). There were no significant differences between the two groups in clinical cure at either visit 2 or 3 or in diagnostic cure at visit 3. Both treatments were well tolerated. We conclude that metronidazole is likely to remain the first choice of treatment for BV but ofloxacin offers a safe and effective alternative.
Int J STD AIDS
PMID:Comparison of ofloxacin and metronidazole for the treatment of bacterial vaginosis. 161 67

The US guidelines for prevention and management of the difficult to diagnose symptomatic pelvic inflammatory disease (PID), which affects approximately 1 million every year, include microbial etiology and pathogenesis, the magnitude of the problem in terms of epidemiology and financial impact, risk assessment, prevention, diagnosis, treatment, and surveillance. The etiology of PID reveals multiple organisms, though mostly C. trachomatis and N. gonorrhoea. PID includes acute, silent, and atypical. C. trachomatis has been isolated in 20-40% of PID cases, while N. gonorrhoea in 27-80% of cervical cases. Other anaerobic bacteria isolated, which comprise 25-50% of acute cases, are Gardnerella vaginalis, Streptococcus species, Escherichia coli, and Hemophilus influenzae. PID results when organisms from the endocervix spread to the endometrium and fallopian tube mucosa. Contributing factors are IUD user's hormonal changes during menses (within 7 days of onset of menses), retrograde menses, and virulent characteristics of acute chlamydial and gonococcal PID. The estimated cost of PID for 1990 was $4.2 billion for 25 million in outpatient care and 275,000 hospitalized. Sexual practice related to the risk of PID are having sex with someone with STD, a young age at first intercourse, multiple sex partners, a high frequency of sexual intercourse and new partners within 30 days. Barrier methods (mechanical or chemical) decrease risk. Inconsistent risk is associated with oral contraceptive use and douching, but IUD's have an increased risk of adverse consequences and further transmission. Recommended action is community health promotion of education, as well as prompt and available clinical service, partner notification, training of health care providers, and routine screening. Individuals must self protect. Clinical diagnosis is difficult and imprecise. Minimum criteria for clinical diagnosis are lower abdominal pain, bilateral adnexal tenderness, cervical motion tenderness. Severe cases require oral temperature 38.3 Centigrade, abnormal cervical or vaginal discharge, elevated erythrocyte sedimentation rate and/or C-reactive protein, culture for N. gonorrhoea and non-cervical tests for C. trachomatis, and optionally endometrial biopsy, tubo-ovarian sonography, and laparoscopy. Failure to meet these criteria should not be withholding therapy. Sensitivity to the emotional needs and careful follow-up are necessary. Inpatient treatment recommendations are broad spectrum regimens such as: Cefoxitin plus doxycycline; for outpatients, cefoxitin plus doxycycline or tetracycline (erthyromycin may be substituted).
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PMID:Pelvic inflammatory disease: guidelines for prevention and management. 203 5

The relative value of a semiquantitative Gardnerella vaginalis culture for the diagnosis of bacterial vaginosis (BV) was studied in 113 women attending a STD clinic. The standard diagnosis of BV was based on the BV score, which is a 10-point grading system to evaluate gram-stained vaginal samples objectively and reproducibly. The sensitivity of G. vaginalis culture for the diagnosis of BV was 28%, while the specificity was 89%. The positive and the negative predictive values were 50% and 76% for G. vaginalis culture in our population. Our data suggest that G. vaginalis culture cannot be recommended for the routine diagnosis of BV. However, G. vaginalis culture will detect asymptomatic women with high vaginal colonization with G. vaginalis. Further studies are needed to find whether these women are at risk of developing BV.
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PMID:[The value of Gardnerella-vaginalis-culture in bacterial-vaginitis- score-confirmed bacterial vaginosis]. 205 65

Routine screening for sexually transmitted diseases in new patients attending the Genitourinary Clinic in Stoke-on-Trent includes a culture for Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU). A retrospective study was carried out on 400 female patients to ascertain whether there were any significant differences between the group positive for MH and UU and the negative control group. The positive group were found to be younger on average, but to have similar sexual histories to the negative control group. An association was found between the presence of genital mycoplasmas and Gardnerella vaginalis. An odourous vaginal discharge was more common in the positive group. Erythromycin was ineffective in eradicating the organisms in 62.5% of patients with MH, and 70% of those with UU. Continuing work is required to identify those women in whom the presence of MH or UU could have pathogenic effects. Treatment regimens for this group of women need to be carefully reassessed, in the light of increasing antibiotic resistance.
Int J STD AIDS 1990 May
PMID:Evaluation of the significance of Mycoplasma hominis and Ureaplasma urealyticum in female genital tract infection--a retrospective case note study. 208 93

Endocervical (120) and endourethral (104) swabs collected from patients attending the Gynaecological OPD and STD Clinic of a Hospital, in north India were subjected to the chlamydiazyme test to detect C. trachomatis antigen. This antigen was detected in 25 per cent (30 of 120) of cervical and 20.19 per cent (21 of 104) of urethral specimens. Of the 51 antigen positive cases, 30 (58.8%) presented with the clinical picture of cervicitis, 11 (21.5%) with urethritis, 6 (11.7%) were cases of primary infertility and 4 (7.8%) were healthy controls. The association of C. trachomatis and other sexually manifested microorganisms (Mycoplasma hominis, Ureaplasma urealyticum and Gardnerella vaginalis) was found more commonly in patients of cervicitis, especially those who were C. trachomatis antigen positive.
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PMID:Chlamydiazyme test for rapid detection of Chlamydia trachomatis. 266 22

The Gardnerella vaginalis-infection of the urogenital tract is of clinical importance in females and of epidemiological importance in males. Females suffer from Bacterial Vaginosis, with a foul-smelling grey vaginal discharge with a pH of 5.0-5.5 which contains "clue cells", and from Sepsis. The isolation and identification of G. vaginalis i necessary in man. If G. vaginalis-infection is suspected, simultaneous infections with further STD-agents such as N. gonorrhoeae, C. trachomatis etc should be excluded. Metronidazole (1 g/day for 5 days) is the drug of choice in G. vaginalis-infection.
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PMID:[Gardnerella vaginalis infection. Clinical aspects, diagnosis and therapy]. 331 83

An enzyme immunoassay (Chlamydiazyme) for detecting Chlamydia trachomatis was evaluated on genital specimens from 96 men and 272 women attending a clinic for sexually transmitted diseases (STD clinic). Compared with a direct immunofluorescence test for chlamydial elementary bodies, the enzyme immunoassay had a sensitivity of 58% on specimens from men, a specificity of 90%, a positive predictive value of 93%, and a negative predictive value of 88%; the assay had a sensitivity of 67% on specimens from women, a specificity of 89%, a positive predictive value of 63% and a negative predictive value of 90%. Immunofluorescence provided the most stringent test for the performance of the enzyme immunoassay as values were improved a little when a cell culture procedure was used for comparison. Further evidence for the lack of sensitivity was the detection of elementary bodies, sometimes in large numbers, in the enzyme immunoassay buffer of 13 of 19 specimens that had given a negative enzyme immunoassay result and the finding in comparative titrations of four laboratory strains that the enzyme immunoassay was at least 100-fold less able to detect chlamydiae than either immunofluorescence or the cell culture procedure. Lack of specificity may be associated with the finding that the enzyme immunoassay antibody reacted with strains of Acinetobacter calcoaceticus, Escherichia coli, Gardnerella vaginalis, Neisseria gonorrhoeae and group B streptococci. The enzyme immunoassay was not considered to be sufficiently sensitive, specific, or reproducible for routine use.
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PMID:Evaluation of enzyme immunoassay (Chlamydiazyme) for detecting Chlamydia trachomatis in genital tract specimens. 354 97

The Gardnerella vaginalis infection of the urogenital tract, an STD, is of clinical importance in females and of epidemiological importance in males. Females suffer from vulvovaginitis amine colpitis, with a bad-smelling grey vaginal discharge with a pH of 5.0-5.5, which contains "clue cells". The urethra of males is often asymptomatically infected. The identification of G. vaginalis is time-consuming and requires a lot of material. Isolation and identification of G. vaginalis can not yet be made in the routine examination of outpatients suffering from urogenital tract infections. If the diagnosis is based on signs such as bad-smelling grey discharge containing "clue cells", and the increase in pH about 20% false-positive and 20% false-negative results will be obtained. If G. vaginalis is isolated, simultaneous infections with further agents such as Chlamydia trachomatis, Neisseria gonorrhoeae etc., Trichomonas vaginalis, Candida species and HSV 2 should be excluded. Metronidazole (1 g/day for 5 days) is the drug of first choice in G. vaginalis infection.
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PMID:[Gardnerella vaginalis infection--another sexually transmitted disease]. 638 37

The office laboratory can be a tremendous resource for the physician. This is particularly true in the evaluation of STD, where many simple procedures may provide at least a preliminary diagnosis. Instead of waiting for more expensive culture results, the physician can make the diagnosis of Candida, Trichomonas or Gardnerella in the female and N. gonorrhoeae in the male, while the patient is in the office. Cultures for N. gonorrhoeae can be, with the use of the Phadebact or newer enzymatic sugar tests, completed in the office. This, however, is not recommended for an office which performs this test infrequently, because quality control procedures and known positives and negatives which should be incorporated into these procedures are often neither practical nor readily available. The wrong diagnosis in the area of STD leads not only to medical mismanagement but also to tremendous emotional and personal trauma. A good working relationship with a referral laboratory will augment the care and services you and your office laboratory can offer to the patient.
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PMID:Series: infectious diseases and the office laboratory. Office laboratory diagnosis of sexually transmitted diseases. 640 88

The aim of this study was to correlate the significance of vaginal microbiology, in particular its anaerobic component, to the presence of bacterial vaginosis (BV), and to review the clinical criteria used in the diagnosis of this condition. Ninety-two female patients who received routine STD screening were studied. After routine history, presence and character of vaginal discharge and vaginal pH were noted, an amine test performed, and a wet stain observed microscopically. Routine Gram stain smears and cultures were prepared. BV was diagnosed clinically in 28 (30%) of our sample, and Gardnerella vaginalis was cultured in 41 patients (45%). Both clue cells and anaerobes were closely associated with each other and both mutually exclusive with the presence of lactobacilli on Gram stain (P < 0.001). BV was found to be strongly associated with the presence of clue cells on the wet film, anaerobes and G. vaginalis. In conclusion, bacterial vaginosis is not only strongly associated with the presence of G. vaginalis in the vaginal flora, but more strongly with the presence of anaerobes. The study suggests that the microaerophile G. vaginalis is a commensal organism in a significant proportion of sexually active women. If the aerobic status of the healthy vagina is disrupted, anaerobes (including Gardnerella) will flourish, producing the clinical picture of bacterial vaginosis.
Int J STD AIDS
PMID:Bacterial vaginosis in a district genitourinary medicine department: significance of vaginal microbiology and anaerobes. 784 17


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