Roselyn J. Rice

Maternal hypertension and associated pregnancy complications among African-American and other women in the United States.

Objective To characterize maternal hypertension and related pregnancy complications among African-American and other women in the United States. Methods Using data from the National Hospital Discharge Survey, we analyzed the incidence and clinical spectrum of maternal hypertension among African- American women who delivered in hospital during 1998–1992. Maternal hypertension consisted of pregnancy-induced hypertension and chronic hypertension preceding pregnancy, including pregnancy-aggravated hypertension. Pregnancy-induced hypertension included preeclampsia, eclampsia, and transient hypertension. Incidence rates (per 1000 deliveries) and 95% confidence intervals (CI) were calculated by type of hypertension and demographic characteristics. Risk ratios and 95% CIs for adverse pregnancy outcomes among women with hypertension were also calculated. Results The overall incidence of all causes of maternal hypertension was 64.2, and of chronic hypertension preceding pregnancy it was 25.0 per 1000 deliveries among African-American women, an excess of 15.6 and 14.5 cases per 1000 deliveries, respectively, compared with rates for other women. The risks of preterm delivery and inadaquate fetal growth were similarly increased for all hypertensive women, regardless of race. However, hypertensive African- American women were at a threefold greater risk of pregnancies complicated by antepartum hemorrhage, an association that was not observed in other women. Development of preeclampsia and eclampsia irrespective of race was about four times higher among women with chronic hypertension preceding pregnancy than among those without chronic hypertension. Conclusion The excess incidence of maternal hypertension, particularly chronic hypertension, may contribute to adverse maternal and fetal pregnancy outcome and the disparity in outcomes observed between African-American and other women in the U.S. These findings provide a specific focus further clinical research and assessment of prenatal management in African-American Women.

Transmission of Chlamydia trachomatis and Neisseria gonorrhoeae among Men with Urethritis and Their Female Sex Partners

Transmission of Chlamydia trachomatis and Neisseria gonorrhoeae among infected men and their female sex partners was examined using a design enhancing the likelihood that spread was directed from men to women. Chlamydia culture-negative specimens were examined using DNA amplification tests. Infection rates in women exposed to male sex partners with Chlamydia only were 65% (20/31) and with gonorrhea only were 73% (33/45). Infection of women by either agent was not influenced by the number of sexual exposures to or coinfection in men. There was a 98% (40/41) concordance of N. gonorrhoeae isolates among partners by auxotype and serovar. Chlamydia isolates were serotyped using ELISA and immunofluorescence testing and confirmed by nested polymerase chain reaction: 50% (6/12) of men and 57% (8/14) of women yielded mixed serovars. Sixty-four percent of pairs (9/14) were infected with identical serovars and an additional 28% shared at least one serovar. Multiple serovars of C. trachomatis, but not of N. gonorrhoeae, were common in sex partners and exchanged frequently.

Proposed criteria for interpretation of susceptibilities of strains of Neisseria gonorrhoeae to ciprofloxacin, ofloxacin, enoxacin, lomefloxacin, and norfloxacin.

The susceptibilities of 45 strains of Neisseria gonorrhoeae, including 25 strains susceptible to ciprofloxacin (MICs, < or = 0.06 microgram/ml) and 20 strains exhibiting decreased susceptibilities to ciprofloxacin (MICs, > or = 0.125 microgram/ml), to ciprofloxacin, ofloxacin, enoxacin, lomefloxacin, norfloxacin, and nalidixic acid were determined by agar dilution and disk diffusion. On the basis of theoretical calculations of predicted susceptibilities at which infections may fail therapy (supported by observed failures of infections to respond to the therapeutic doses of enoxacin and ciprofloxacin), the Centers for Disease Control and Prevention has adopted the following agar dilution breakpoints for interpretation of resistance to these agents: MICs of > or = 1.0 microgram of ciprofloxacin, enoxacin, and norfloxacin per ml and MICs of > or = 2.0 micrograms of ofloxacin and lomefloxacin per ml. The corresponding disk diffusion breakpoints for these agents were as follows: ciprofloxacin, < or = 29 mm; ofloxacin, < or = 24 mm; enoxacin, < or = 31 mm; lomefloxacin, < or = 26 mm; and norfloxacin, < or = 32 mm. The Centers for Disease Control and Prevention recommends two strains as interim quality control strains for susceptibility testing of ciprofloxacin and ofloxacin. These are N. gonorrhoeae CDC-10,328 (MIC of ciprofloxacin, 0.125 to 0.25 microgram/ml [inhibition zone diameter range, 30 to 34 mm]; MIC of ofloxacin, 0.5 microgram/ml [inhibition zone diameter range, 27 to 32 mm]) and N. gonorrhoeae CDC-10,329 (MIC of ciprofloxacin, 1.0 to 2.0 micrograms/ml [zone inhibition diameter range, 21 to 26 mm]; MIC of ofloxacin 2.0 micrograms/ml [inhibition zone diameter range, 18 to 21 mm]).

Susceptibilities of Chlamydia trachomatis isolates causing uncomplicated female genital tract infections and pelvic inflammatory disease

The in vitro susceptibilities of 45 recent clinical isolates of Chlamydia trachomatis obtained from women with asymptomatic genital tract infection, mucopurulent cervicitis, or pelvic inflammatory disease to doxycycline, azithromycin, ofloxacin, and clindamycin were determined. In addition, susceptibilities of 12 isolates to amoxicillin and trimethoprim-sulfamethoxazole were also determined. Isolates also were serotyped with a panel of monoclonal antibodies specific for chlamydial major outer membrane protein; 24 of 45 (53%) belonged to serovars Ia and E. For all isolates, the MIC range of doxycycline was 0.008 to 0.06 micrograms/ml, for trimethoprim-sulfamethoxazole it was 0.03 to 0.25 micrograms/ml, for azithromycin it was 0.125 to 2.0 micrograms/ml, for ofloxacin it was 0.5 to 1.0 micrograms/ml, for clindamycin it was 0.25 to 2.0 micrograms/ml, and for amoxicillin it was 0.25 to 4.0 microgram/ml. The ranges of minimum chlamydiacidal concentrations were generally 1 to 4 dilutions above the MICs of most agents, with a rank order similar to those of the MICs. Comparing the minimum chlamydiacidal concentrations for 90% of isolates tested, isolates causing asymptomatic infection belonged to a greater variety of serovars and were relatively more susceptible to doxycycline and azithromycin than isolates causing mucopurulent cervicitis or pelvic inflammatory disease; these differences in susceptibility were not detected among the other study agents. These data indicate that additional studies are needed to better define the apparent association of certain chlamydial serovars with the clinical severity of disease and the in vitro susceptibilities to certain antimicrobial agents.

Gonorrhea in the United States 1975-1984: is the giant only sleeping?

After a decade of increase, the number of cases of gonorrhea declined by 12% in the United States between 1975 and 1984. During the same period gonorrhea rates declined by 20%. We examined age-, sex-, and race-specific gonorrhea cases and rates to determine whether the national trend has been occurring in all population groups. The greatest percentage decline in rates was 22.6% among 25-44-year-old men of other-than-white race, and the only increase (0.5%) occurred among white teenaged women. To control gonorrhea and its complications more effectively, more focused screening of young women and more rapid treatment of their sexual partners are necessary.

Plasmid-mediated Antimicrobial Resistance in Neisseria gonorrhoeae in Kingston, Jamaica: 1990–1991

Background and Objectives Gonococcal infections caused by antimicrobial-resistant strains of Neisseria gonorrhoeae have spread into many geographic areas and have increased in prevalence since the mid 1970s. Surveillance of antimicrobial-resistant gonococcal strains in Jamaica from 1981 to 1983 indicated that fewer than 3% of strains produced (β-lactamase (penicillinase-producing Neisseria gonorrhoeae); approximately 4% of strains were resistant to penicillin, and 12% were resistant to tetracycline. Goal of this Study To measure the frequency and nature of antimicrobial resistance in Neisseria gonorrhoeae isolates in Kingston, Jamaica, from 1990 to 1991 and to assess the effectiveness of prescribed treatment regimens. Study Design Urethral isolates of Neisseria gonorrhoeae from 116 heterosexual men with uncomplicated gonorrhea, representing 7.1% (116/1633) men attending the STD Comprehensive Health Centre from October 1990 through March 1991 who had positive Gram-stained smears, were characterized by auxotype, serovar, presence of the TetM determinant, and plasmid content. Antimicrobial susceptibilities to penicillin, cefoxitin, ceftriaxone, ciprofloxacin, tetracycline, and spectinomycin were determined by an agar dilution method. Results A total of 80.2% (93/116) of the isolates exhibited plasmid-mediated resistance to penicillin, tetracycline, or both: penicillinase-producing Neisseria gonorrhoeae (13/116; 11.2%), tetracycline-resistant Neisseria gonorrhoeae (25/116; 21.6%), and penicillinase-producing/tetracycline-resistant Neisseria gonorrhoeae (55/116; 47.4%). Isolates with chromosomally mediated resistance to penicillin, tetracycline, or both, accounted for 5.2% (6/116) of the isolates. Penicillinase-producing Neisseria gonorrhoeae, tetracycline-resistant Neisseria gonorrhoeae, and penicillinase-producing/tetracycline-resistant Neisseria gonorrhoeae belonging to multiple auxotype/serovar classes were isolated repeatedly through the study period. Conclusions Infections caused by Neisseria gonorrhoeae exhibiting plasmid-mediated resistance to penicillin, tetracycline, or both, have become prevalent and endemic in Kingston, Jamaica. Therefore, all gonococcal infections should be treated with antimicrobial therapies known to be active against penicillin-resistant and tetracycline-resistant organisms to reduce gonorrhea transmission.

Diversity of isolates of penicillinase-producing Neisseria gonorrhoeae (PPNG) in Honolulu, Hawaii : 1982-1991

Background and Objectives Gonococcal infections caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) isolates have increased in geographic distribution and prevalence. It was postulated that PPNG strains would become endemic in Honolulu and that, in turn, this city would serve as a reservoir for the introduction of PPNG strains into the continental United States. Goal of this Study To assess the role of Honolulu as a reservoir for PPNG strains by assessing the diversity and persistence of PPNG strains between 1982 and 1991. Study Design A total of 432 PPNG strains were characterized by auxotype/serovar (A/S) class and plasmid content, and their distribution during the 10-year period was studied. Results Of 432 isolates, 373 (86.4%) possessed a 4.4-Mdal β-lactamase plasmid; 39 (9.0%) possessed a 3.2-Mdal β lactamase plasmid; and 20 (4.6%) possessed a 3.05-Mdal β-lac tamase plasmid. A total of 53 A/S classes were identified. Asian, African, and Toronto PPNG strains belonged to 49 (92.5%), 15 (28.3%), and 11 (20.7%) A/S classes, respectively. Though all Toronto PPNG strains possessed a 24.5-Mdal conjugative plasmid, these plasmids could not be transferred by conjugation. Although some apparent microepidemics of PPNG strains were identified, most strains were isolated sporadically. Conclusions A large number of different strains have been associated with PPNG infections in Honolulu, but there was no evidence that any strain persisted endemically during the study period. These observations have important implications for the design and assessment of community gonorrhea control strategies.