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Query: UMLS:C0152447 (urethral discharge)
 296 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

For men with urethral discharge, a simple gram stained smear is 98% sensitive and over 99% specific in detecting gonococcal infection when compared to a single Thayer-Martin culture. The smear is less than 50% sensitive in asymptomatic urethritis. Neither Fluorescent antibody nor various serologic tests offer any diagnostic advantages over smears and/or cultures and they are not cost-effective. Treatment of gonococcal urethritis may be successfully accomplished with a variety of antibiotic regimens. Tetracycline hydrochloride (500 mg four times a day for 5 days) is highly effective, inexpensive, and is active against Chlamydia trachomatis; post gonococcal urethritis (PGU) is therefore uncommon. Aqueous Procaine Penicillin G (4.8 million units IM with 1 g of probenecid) has become the standard in the United States but suffers from higher cost, the need for refrigeration, occasional alarming toxic procaine reactions, and a high incidence of PGU. Spectinomycin 2 g IM remains expensive but is the regimen of choice for treatment failures and for Neisseria gonorrhoeae that produce penicillinase (PPNG). Other antibiotics active against PPNG are cotrimoxozole, cefoxitin, and cefuroxime. PNNG have now been reported from 27 countries throughout the world, but have attained significant prevalence in only a few areas of East Asia and West Africa. Because gonococcal patterns of antibiotic resistance are constantly changing, each region of the world needs to monitor treatment results and maintain some surveillance over sensitivity to antibiotics.
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PMID:Gonococcal urethritis--diagnosis and treatment. 16 Nov 60

Neisseria gonorrhoeae culture gave a positive result in 42 of 64 male adults with purulent urethral discharge. The majority of the infections were acquired outside Libya. Twenty-seven strains (64.3%) were non-penicillinase producing (NPPNG) and 15 (35.7%) were penicillinase producing (PPNG) by starch paper technique. Antimicrobial susceptibility of the strains to 5 antibiotics was carried out by agar-plate dilution technique. Twenty-three NPPNG strains (54.8%) were susceptible to penicillin with a minimum inhibitory concentration (MIC) of less than or equal to 0.5 micrograms/ml. In 4 strains (9.5%), a high resistance to penicillin (MIC greater than or equal to 16 micrograms/ml) appeared to be chromosomally-mediated (CMRNG). All PPNG strains were resistant to penicillin (MIC greater than or equal to 1 microgram/ml). While resistance to erythromycin (MIC greater than or equal to 1 microgram/ml) and tetracycline (MIC greater than or equal to 1 microgram/ml) was observed in 5 strains, resistance to kanamycin (MIC 32 micrograms/ml) and spectinomycin (MIC 64 micrograms/ml) was present in only one strain. Whereas no significant differences were recorded in MICs of erythromycin, tetracycline, kanamycin and spectinomycin between NPPNG and PPNG strains, one PPNG strain was found to be resistant in vitro to all 5 antibiotics.
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PMID:Antimicrobial susceptibility of non-penicillinase and penicillinase-producing Neisseria gonorrhoeae strains isolated in Tripoli, Libya. 215 9

In areas such as Los Angeles, California, where penicillin-resistant Neisseria gonorrhoeae accounts for 1% or more of all gonorrhea strains isolated, third-generation cephalosporin agents have replaced penicillin as standard therapy. Ceftriaxone, the agent recommended by CDC guidelines, or ceftizoxime, an alternative agent have excellent activity against all strains of N. gonorrhoeae. One hundred seventy-five male patients with clinically and microbiologically confirmed gonococcal urethritis were treated with single-dose ceftizoxime 250 mg IM (50 patients) or 500 mg IM (125 patients). Cure was demonstrated clinically by repeat cultures of urethral discharge in all patients, including those with infections from penicillinase-producing strains of bacteria. None of the patients experienced complications or allergic reactions to ceftizoxime. Given the lower unit-of-use cost of ceftizoxime, its routine in place of ceftriaxone could result in substantial cost savings in those institutions that treat large numbers of patients with uncomplicated gonococcal urethritis.
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PMID:Treatment of uncomplicated gonococcal urethritis with single-dose ceftizoxime. 226 6

We report a case of gonorrhea due to a penicillinase-producing strain of Neisseria gonorrhoeae resistant to spectinomycin in a 26-year-old man who had not been out of the United States for a year-and-a-half. His sexual contact also had no recent travel out of the United States. The genital and oropharyngeal infections were successfully treated with cefoxitin (1 g im) plus probenecid (1 g orally) and trimethoprim-sulfamethoxazole (80 mg of trimethoprim and 400 mg of sulfamethoxazole). The patient took nine of the latter tablets daily for five days. The organism was a serovar IB-3, proline-requiring auxotype. The patient's isolate contained both 2.6-megadalton and 4.4-megadalton plasmids. Measurement of minimal inhibitory concentrations (MICs) of antibiotics for the isolate confirmed the penicillin resistance and showed an MIC of spectinomycin of greater than 256 micrograms/ml. The epidemiologic investigation suggested that the source of the infection was a male contact with unusual clinical features, including bloody urethral discharge and a possible incubation period of 28 days.
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PMID:An unusual case of penicillinase-producing Neisseria gonorrhoeae resistant to spectinomycin in California. 293 64

One hundred and nine Neisseria gonorrhoeae strains were isolated from urethral discharge of male patients in a health centre in Addis Ababa, identified following conventional procedures, and tested for penicillin and tetracycline susceptibility by the agar dilution technique. World Health Organization reference strains were also tested as controls. Penicillinase producing N. gonorrhoeae (PPNG) were identified using Oxoid beta-lactamase detection papers. Minimal inhibitory concentration (MIC) values of penicillin varied between less than 0.01 mg l-1 and greater than 10.24 mg l-1 while those of tetracycline, between less than 0.25 mg l-1 and 4.0 mg l-1. About 64% of isolates were resistant to penicillin, requiring MICs of greater than or equal to 0.64 mg l-1: 26% were resistant to tetracycline, requiring greater than or equal to 2 mg l-1 for inhibition. The rate of simultaneous resistance to both antibiotics was 18%. PPNG comprised 49% of isolates, of which 23% were resistant also to tetracycline. Of 70 penicillin-resistant strains, 17 (24%) were non-PPNG.
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PMID:Penicillin and tetracycline susceptibility of gonococci from Addis Ababa and incidence of penicillinase-producing strains. 312 9

Unilateral conjunctivitis caused by penicillinase-producing Neisseria gonorrhoeae was diagnosed in a 21-year-old man. The conjunctivitis apparently resulted from autoinfection from the urethral discharge. The patient was satisfactorily treated with a single dose intramuscular of cefoxitin (2 g) and oral probenecid (1 g).
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PMID:Conjunctivitis caused by beta-lactamase-producing Neisseria gonorrhoeae. 392 8

The efficacy of a single 2.5-g dose of thiamphenicol against infection with penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) or non-penicillinase-producing strains (non-PPNG) was studied in a two-phase clinical trial in Nairobi. The first phase included men who had had a urethral discharge for less than seven days, were infected with either PPNG or non-PPNG, and had not received previous treatment. The second phase included men with PPNG infections that had not responded to treatment with penicillin. The overall cure rate (determined by follow-up examinations and cultures three and ten days after treatment) was 90.6% in the first phase of the study and 92.1% in the second phase. A second 2.5-g dose of thiamphenicol was administered to four of the six patients in the second phase whose cultures yielded gonococci after the initial dose; the infections of all four patients were cured. The results of disk diffusion tests of gonococcal isolates did not correlate well with the outcome of treatment.
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PMID:Treatment of gonorrhea with single-dose thiamphenicol in Kenya. 644 Dec 81

The study population comprised 276 patients who were either referred to a sexually transmitted diseases clinic or invited to attend through contact-tracing between October 1976 and December 1977. 156 (57%) were men and 120 (43%) women. 43% (119) of the patients were aged between 16 and 29 years. Urethral specimens were collected from all men who presented with urethral discharge using a sterile cotton-wool swab passed into the anterior urethra; the swab was plated directly on to plates of Thayer-Martin (Oxoid) and chocolate agar medium. In women, specimens were obtained with a swab from the cervical os and vaginal vault under direct vision with a Cusco's speculum and processed as above. A wet preparation of the genital discharge was examined for Trichomonas vaginalis, Candida albicans, and parasites, and specimens showing yeast cells were plated on Sabouraud's agar; C albicans was identified by the germ-tube test. Serum from each patient was tested by the Venereal Disease Research Laboratory test and Reiter protein complement fixation test. The most common diagnosis was non-specific genital infection, in 164 (59.4%) of the 276 patients. Gonorrhea was diagnosed in 53 (19.2%) patients and candidosis and trichomoniasis each in 29 (10.5%). Antitreponemal antibodies were detected in 1.4% of patients; all were cases of latent syphilis. Venereophobia, lymphogranuloma venereum, genital warts, and a miscellaneous group of conditions accounted for the remainder of cases. More than one diagnosis was confirmed in 6.5% of patients. Analysis of the source of infection showed that 34.1% of all patients contracted infection through casual partners whom the patients had met only once and could not name or trace; regular partners and prostitutes were the source of infection in 11.6% and 19.2%, respectively. Four strains of N gonorrhea had a minimum inhibitory concentration (MIC) of 0.075-0.3 mcg/ml and two strains an MIC of or= 0.6 mcg/ml. None of the six strains that were relatively resistant to penicillin produced beta-lactamase.
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PMID:Sexually transmitted diseases in clinic patients in Lagos. 689 89

A study was carried out in 2000/2001 in a rural district of Malawi among men presenting with urethral discharge, in order to (a) describe their health-seeking and sexual behaviour, (b) determine the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis, and (c) verify the antibiotic susceptibility of N. gonorrhoeae. A total of 114 patients were entered into the study; 61% reported having taken some form of medication before coming to the sexually transmitted infections clinic. The most frequent alternative source of care was traditional healers. Sixty-eight (60%) patients reported sexual encounters during the symptomatic period, the majority (84%) not using condoms. Using ligase chain reaction on urine, N. gonorrhoeae was detected in 91 (80%) and C. trachomatis in 2 (2%) urine specimens. Forty five of 47 N. gonorrhoeae isolates produced penicillinase, 89% showing multi-antimicrobial resistance. This study emphasizes the need to integrate alternative care providers and particularly traditional healers in control activities, and to encourage their role in promoting safer sexual behaviour. In patients presenting with urethral discharge in our rural setting, C. trachomatis was not found to be a major pathogen. Antimicrobial susceptibility surveillance of N. gonorrhoeae is essential in order to prevent treatment failures and control the spread of resistant strains.
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PMID:Behavioural characteristics, prevalence of Chlamydia trachomatis and antibiotic susceptibility of Neisseria gonorrhoeae in men with urethral discharge in Thyolo, Malawi. 1217 68

A 59-year-old Caucasian male presented with progressive dyspnea, arthralgias and fever for three days. A diastolic regurgitation murmur was detected in the aortic area. A transesophageal echocardiograph showed several vegetations and severe aortic regurgitation. Blood cultures yielded Neisseria gonorrhoeae beta-lactamase negative. The patient had not noticed any urogenital discomfort or urethral discharge. The patient successfully underwent surgery for septal abscess debridement. The patient received ceftriaxone 2 g bid for eight weeks and the clinical follow-up was uneventful. The review of the literature revealed a total of the 38 additional cases reported between 1980 and the present. The majority of the patients were young, male and with native valve involvement. There has been a clear tendency for left-sided valve involvement (especially in the aortic valve). All valve cultures were reported negative despite, in most cases, the marked tissue destruction. Polymerase chain reaction was performed in two patients and positive results were shown in both. Cultures of exudates from other locations were negative in most cases. One striking fact is the high proportion of patients who underwent surgery (72 %). Information regarding antibiotic sensitivity was available in 28 cases, with penicillin resistance reported in six patients (21 %) and intermediate sensitivity in four patients (14 %). Resistance to ciprofloxacin was reported in two cases (7 %). A rapid increase and distribution of isolates resistant to third generation cephalosporins have been recently detected. The mortality is high, particularly taking into account that most were young patients who had not presented previous heart disease.
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PMID:Gonococcal endocarditis: a case report and review of the literature. 2416 21


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