Yhu-Hsiung Lee

The Genital Mycoplasmas

IT has been seven years since human infections with genital mycoplasmas were reviewed in these pages.1 Interest in these organisms has increased considerably with a corresponding increase in our kn...

Chorioamnionitis and Colonization of the Newborn Infant with Genital Mycoplasmas

To study the role of Mycoplasma hominis and T-mycoplasmas (Ureaplasma urealyticum) in chorioamnionitis, we obtained culture from 249 puerperal women and their babies. The placentas were examined histologically. Infants whose placentas showed inflammation (chorioamnionitis) had cultures positive for T-mycoplasmas more frequently (37.5 per cent) than those with normal placentas (19.0 per cent) (P = 0.021). Colonization with M. hominis was found in 16.0 per cent of the babies and was not significantly associated with chorioamnionitis. Material colonization with mycoplasmas was more frequent (73.4 per cent) and was not correlated with placental inflammation. We conclude that a substantial proportion of cases of chorioamnionitis may be caused by prenatal infection with T-mycoplasmas. The fact that these organisms are not highly virulent could explain the frequent finding of inflammed placentas from otherwise normal pregnacies. No adverse clinical effects of the placental lesions or of mycoplasmal colonization could be detected in this small study.

Sexual experience and urethral colonization with genital mycoplasmas. A study in normal men.

Cultures for genital mycoplasmas and anonymous questionnaires on sexual experience were obtained from 191 normal male college students. Men who had not had sexual intercourse were virtually free of mycoplasmas whereas more than 26% of those who had had intercourse with 2 partners and 56.3% of those who had had intercourse with more than 14 partners were colonized with T-strain mycoplasmas. Mycoplasma hominis was less prevalent but followed the same general pattern. These data indicate that colonization with T-mycoplasmas is related to sexual experience and T-mycoplasmas are part of the urethral flora of many normal sexually active men. Moreover the rates of colonization among the more sexually active normal men are similar to those that have been reported for patients with nongonococcal urethritis. This raises some questions about the proposed causative role for T-mycoplasmas in this disorder. (authors)

Acute pelvic inflammatory disease: characteristics of patients with gonococcal and nongonococcal infection and evaluation of their response to treatment with aqueous procaine penicillin G and spectinomycin hydrochloride.

We studied 41 women with acute gonococcal pelvic inflammatory disease and 42 women with acute nongonococcal pelvic inflammatory disease. Women with gonococcal pelvic inflammatory disease were more likely to have become ill during the first 10 days of their menstrual cycle (P < 0.05), presented themselves for treatment sooner (P < 0.05), and were more severely ill than patients with nongonococcal pelvic inflammatory disease (P < 0.05). Patients were treated with aqueous procaine penicillin G or with spectinomycin hydro-chloride for five days. Most of the patients with gonococcal disease responded to treatment. Neither drug, in the dosage employed in this study, was highly effective in the treatment of acute nongonococcal pelvic inflammatory disease. In all, 10 of 21 women with nongonococcal pelvic inflammatory disease and only one of 19 women with gonococcal pelvic inflammatory disease required retreatment for pelvic inflammatory disease within 28 days (P < 0.05). Reexamination an average of 17 months following treatment showed that women who had been treated for nongonococcal pelvic inflammatory disease were more likely to develop recurrent pelvic inflammatory disease if the episode of pelvic inflammatory disease treated in the study was not their first. Women treated for nongonococcal pelvic inflammatory disease were also less likely to become pregnant (P < 0.05). These data, which show that gonococcal and nongonococcal pelvic inflammatory disease differ in initial clinical severity, response to treatment, and long-term complications, support the concept that gonococcal pelvic inflammatory disease and nongonococcal pelvic inflammatory disease are separate clinical entities.

ISOLATION OF GENITAL MYCOPLASMAS FROM BLOOD OBTAINED SHORTLY AFTER VAGINAL DELIVERY

Blood obtained from three hundred and twenty-seven women within a few minutes of vaginal delivery was cultured for genital mycoplasmas (Mycoplasma hominis and T mycoplasmas). Twenty-six (8%) of the women had genital mycoplasmas isolated from their blood. Ten women had blood-cultures which contained M. hominis. Fifteen women had blood-cultures which contained T mycoplasmas. Both M. hominis and T mycoplasmas were isolated from the blood of one woman. Only one of two hundred and seventy-three blood-cultures obtained 1 or more days after delivery contained mycoplasmas. The isolation of M. hominis, but not of T mycoplasmas, from the blood was associated with vaginal colonisation and a serological response to the homologous isolate. Two of ten women whose blood contained M. hominis gave birth to stillborn infants. In contrast, there were only four (1.3%) stillbirths among the infants born to the three hundred and one women whose blood did not contain mycoplasmas. This difference is statistically significant.

MINOCYCLINE: POSSIBLE VESTIBULAR SIDE-EFFECTS

Abstract 17 (89%) of 19 persons taking minocycline for the treatment of bacteriuria or for prophylaxis of meningococcal disease developed nausea, vomiting, weakness, ataxia, vertigo, or dizziness, 24-48 hours after the initiation of therapy. These symptoms usually occurred in combination, were often acute and severe, and disappeared shortly after therapy was discontinued. The side-effects were not elicited when tetracycline was administered to some of the same patients, nor was there a history of similar symptoms among household or work contacts. The data suggest that minocycline has a propensity for producing reversible vestibular side-effects.

Microbiological investigation of Bartholin's gland abscesses and cysts.

Percutaneous aspirates from intact Bartholins gland cysts (12) and abscesses (34) were examined for bacteria and genital mycoplasmas. Aspirates from 10 of the 12 patients with Bartholins gland cysts were sterile. Aspirates from the other two cysts contained organisms that are part of the vaginal microbial flora. Of the 34 abscesses, 24 (70.6 per cent) contained bacteria. Eight abscesses contained gram-negative rods in pure culture and four contained gonococci in pure culture. Twelve abscesses contained one or more vaginal organisms including anaerobic gram-negative rods (eight isolates), anaerobic gram-positive cocci (eight), Staphylococcus epidermidis (four), and microaerophilic streptococci (three). Although most of the patients had genital mycoplasmas isolated from vaginal cultures, Mycoplasma hominis was isolated from only one and Ureaplasma urealyticum from none of the aspirates.

Localization of genital mycoplasmas in women

Abstract Cultures for T-mycoplasmas and Mycoplasma hominis were obtained from the urethra, vagina, cervix, and posterior fornix of 132 women. Vaginal cultures resulted in the most isolations of both species. As a measure of the reproducibility of this method, 4 separate vaginal cultures were obtained from 52 additional women. A single vaginal culture detected from 77.3 to 88.6 per cent of women shown to be positive for T-mycoplasmas and from 91.3 to 95.7 per cent of women shown to be positive for M. hominis.

Comparison of Spectinomycin Hydrochloride and Aqueous Procaine Penicillin G in the Treatment of Uncomplicated Gonorrhea

Men and women with uncomplicated gonorrhea were randomly assigned to receive aqueous procaine penicillin G (2,400,000 U for men; 2,400,000 U daily for 2 days for women) or spectinomycin hydrochloride (2.0 g for men; 4.0 g for women). Among men who returned for post-treatment evaluation within 10 days, treatment failures were noted among 16 (20.3%) of 79 men who received penicillin and 8 (9.5%) of 84 men who received spectinomycin (P < 0.1). Similarly, 6 (13.3%) of 45 women who received penicillin and 3 (6.5%) of 46 women who received spectinomycin had positive endocervical cultures for Neisseria gonorrhoeae at the time of the post-treatment examination (P = not significant).

366 FAMILIAL AGGREGATION OF BLOOD PRESSURE IN NEWBORN INFANTS

The blood pressures and pulse rates of 398 normal full term sleeping infants and their mothers were measured two to four days after birth using an ultrasound Doppler device with a print out recorder. The mean systolic and diastolic (K4 & K5) blood pressure were 72.3 ± 10.1, 52.4 ± 8.4 and 49.0 ± 8.3 mm Hg respectively. Birth weight was correlated with systolic and muffle (K4) blood pressure (p<0.001 & <0.05 respectively), but not with disappearance (K5) blood pressure. The pulse rates of black infants were significantly higher than those of white infants (p = 0.006), but were not correlated with blood pressure. Sex, race, body length and type of feeding did not influence infants blood pressure. Maternal systolic and diastolic (K5) blood pressure correlated weakly with infants systolic and diastolic (K5) blood pressure (regression coefficient 0.123, p <0.05 and 0.113, p <0.05 respectively). Significant correlation was also found for maternal against infants diastolic blood pressure at one month home visit (K4 = 0.302, p< 0.001, K5 = 0.264, p <0.01). Thus a familial effect on blood pressure can be detected as early as the first few days of life.