Paul J. Wiesner

Clinical spectrum of pharyngeal gonococcal infection.

Abstract Neisseria gonorrhoeae was isolated on selective medium from the pharynx of 150 patients, including 125 examined during a nine-month prospective study. The prevalence of neisseria species in 2,224 patients at a venereal-disease clinic was N. meningitidis, 17.2 per cent, N. gonorrhoeae, 5.6 per cent, and N. lactamicus, 1.9 per cent. Among patients with gonorrhea, gonococcal pharyngeal infection was found in 20.9 per cent of homosexual men, 10.3 per cent of women, and only 3.2 per cent of heterosexual men. Gonococcal pharyngeal infection was correlated with the practice of fellatio (p less than 0.001), and 4.2 per cent of patients who practiced fellatio had infection of the pharynx alone. Symptoms of pharyngitis were also correlated with practice of fellatio (p less than 0.0001), but not with gonococcal pharyngeal infection. However, N. gonorrhoeae did appear responsible for pharyngitis in selected patients, and pharyngeal gonococcal infection was the only apparent source of disseminated gonococcal ...

Low antibiotic resistance of gonococci causing disseminated infection.

DISSEMINATED gonococcal infection associated with the syndrome of gonococcal arthritis and dermatitis occurs in 1 to 3 per cent of patients with gonorrhea.1 , 2 Host factors that may predispose to ...

National gonorrhea therapy monitoring study: in vitro antibiotic susceptibility and its correlation with treatment results.

To monitor temporal trends and regional differences in antibiotic susceptibility, we measured the minimum inhibitory concentrations for penicillin G, ampicillin, tetracycline, and spectinomycin of 4405 pre-treatment gonococcal isolates from patients with uncomplicated gonorrhea. As compared to isolates studied in 1970-1971, recent United States isolates appeared equally sensitive to penicillin G and more sensitive to tetracycline. Relatively resistant strains were found throughout the country. We also studied 1974 patients, treated for uncomplicated gonorrhea according to the 1972 regimens recommended by the United States Public Health Service, to determine the relation between pretreatment minimum inhibitory concentrations and treatment results. For patients receiving the procaine penicillin-probenecid and ampicillin-probenecid regimens, minimum inhibitory concentrations to the treatment drugs were significantly higher in patients not cured than in those cured (P less than 0.01 fr penicillin and P less than 0.05 for ampicillin). In contrast, spectinomycin-treatment results appeared to be independent of the isolates susceptibility to spectinomycin and other antibiotics.

Using the essential services as a foundation for performance measurement and assessment of local public health systems.

Efforts are under way to develop a performance measurement monitoring system for state and local public health systems and to develop a strategic planning tool for local public health systems. The development of these measures is being based on the Essential Public Health Services. This article provides the rationale for why the Essential Services offer a good framework for identifying, analyzing, and evaluating public health activities. The article also reviews the history of local public health and the development and application of the Essential Public Health Services and their predecessor frameworks such as the core functions, the organizational practices, and the essential elements.

A trial of minocycline given after exposure to prevent gonorrhea.

In a prospective evaluation of antibiotic prophylaxis against gonorrhea, 1080 men were given 200 mg of oral minocycline or placebo after sexual intercourse with prostitutes in a Far Eastern port. Later, at sea, gonococcal infection was detected in 57 of 565 men given placebo and 24 of 515 men given minocycline (P less than 0.001). Minocycline prophylaxis completely prevented infection by gonococci susceptible to 0.75 microgram or less of tetracycline per milliliter, reduced the risk of infection or prolonged the incubation period in men exposed to gonococci susceptible to 1.0 to 2.0 micrograms per milliliter, but did not prevent infection or prolong incubation in men exposed to gonococci resistant to 2.0 micrograms. Minocycline did not increase the proportion of asymptomatic infections. Minocycline prophylaxis would probably have limited effectiveness as a public-health measure because of the tendency to select resistant gonococci.

National gonorrhea therapy monitoring study. Treatment results.

To monitor the efficacy of the 1972 United States Public Health Service recommended treatment regimens for uncomplicated gonorrhea, we studied 9008 patients who were randomly assigned either to aqueous procaine penicillin G, 4.8 million units intramuscularly plus 1 g of oral probenecid, or to one of the three other recommended regimens. Among the 3871 patients re-examined within three to seven days after therapy, the penicillin-probenecid regimen was successful in 96.8 per cent, whereas the cure rates of the ampicillin-probenecid, tetracycline, and spectinomycin regimens were 92.8, 96.2, and 94.8 per cent, respectively. In clinics comparing the regimens, penicillin G-probenecid was as effective as tetracycline, but more effective than ampicillin-probenecid (P less than 0.05) and spectinomycin (P less than 0.01). However, in patients re-examined three to 14 days after treatment, only the ampicillin-probenecid regimen was significantly less effective than penicillin probenecid (P less than 0.01). Despite these differences in results, all four regimens recommended by the Public Health Service provided effective therapy for uncomplicated gonorrhea.

Questionnaire survey of reported early congenital syphilis: problems in diagnosis, prevention, and treatment.

A retrospective questionnaire survey of a sample of 173 of the 360 cases of early congenital syphilis reported in 1972 revealed serious problems with diagnostic certainty, prevention, and treatment of congenital syphilis. Only 24 (13.9%) of the reported cases could be categorized as probable or definite cases based on criteria developed from a literature review. Forty percent of the mothers received no prenatal care and an additional 19% received no prenatal care until the third trimester. Initial and followup serologic testing was inadequate in those who received care. Eighty-three different penicillin treatment schedules were used in the treatment of 128 infants. Carefully reasoned diagnostic and therapeutic decision making about the management of congenital syphilis appears to be lacking.

Treatment of the Gonococcal Arthritis-Dermatitis Syndrome

Ninety-eight patients with the gonococcal arthritis-dermatitis syndrome were prospectively treated with penicillin G, at least 10 million units intravenously per day, followed by ampicillin, 2.0 g orally per day, to complete at least 10 days of treatment (33 patients); ampicillin, 3.5 g orally plus probenecid 1.0 g, followed by ampicillin, 2.0 g per day orally for at least 7 days (29 patients); lower doses of parenteral penicillin G (20 patients); oral tetracycline (6 patients); parenteral cephalosporins (5 patients); and other regimens (5 patients). The response to treatment was equally rapid and complete in each group. At least 90% of the patients in each group had subjective improvement and defervescence within 2 days, and all patients followed for at least 2 weeks achieved complete clinical and bacteriologic cure. Patients with purulent synovial effusions improved significantly more slowly than patients with nonpurulent effusions or with no effusions, regardless of which treatment was used.

Chloral Hydrate and Warfarin Interaction: Clinical Significance?

Abstract Chloral hydrate has been cited among the sedatives and hypnotics capable of altering the anticoagulant response to coumarin drugs. The clinical significance of any interaction between chlo...

Problems and approaches to the control and surveillance of sexually transmitted agents associated with pelvic inflammatory disease in the United States.

The national gonorrhea control program has expanded since its inception in 1972 and now reflects new information and program evaluations. Initial program objectives to reduce the incidence of disease and the resistance of gonococci to antibiotics have been expanded to reduce the occurrence of pelvic inflammatory disease and to limit the sequelae of PID. The changes since 1972 in the national venereal disease control program have increased the number of people helping control programs and have enhanced our ability to control other sexually transmitted diseases.