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Brit. J. vener. Dis. (1971) 47, 57

AbstractsThis section of the JOURNAL is published itn collaboration with two abstracting Jfournals, ABSTRACTS OF WORLDMEDICINE and OPHTHALMIC LITERATURE, published by the British Medical Association. The abstracts are dividedinto the following sections:

Syphilis (Clinical, Therapy, Serology, Biological FalsePositive Phenomenon, Pathology, Experimental).

Gonorrhoea.Non-Gonococcal Urethritis and Allied Conditions.

Reiter's Disease and Allied Conditions.Antibiotics and Chemotherapy.Public Health and Social Aspects.Miscellaneous.

After each sub-section of abstracts follows a list of articles that have been noted but not abstracted.

Syphilis ClinicalRoot Compression caused byrabetic Spinal Arthropathy(Compressions radiculaires pararthropathies tabetiques du rachis)SERRE, H., GROS, C., SIMON, L.,BAUMELOU, H., and LAMBOLEY, C.(1970) Rev. Rhum., 37, 525 6 figs,41 refsFrom the Rheumatological Clinic ofthe University at Montpellier threecases are reported of severe lumbo-sacral root pains and loss of motorpower in one or both the lower limbsdue to compression of the caudaequina by spinal osteoarthropathy.The patients, two men and one womanaged from 58 to 62 years, had sufferedfrom tabes for many years. Two ofthem had received extensive anti-syphilitic treatment and in one, despitea history of lightning pains in bothlegs for at least 12 years and otherunequivocal symptoms of tabes, thenature of the complaint had not beenrecognized. Serological tests for syphi-lis were strongly positive in the bloodof two of the patients and negative inone who was known to have had tabesfor over three decades. The cerebro-spinal fluid, apart from a moderateincrease in protein (70 mg./100 ml.) inone case, was normal. The extent ofbone and joint destruction was deter-mined by tomography and the levelsof root compression were establishedby myelography and radiculography.Laminectomy at the appropriate levelsrelieved the patients from root painsand restored motor power completelyin one case and partially in the othertwo.

Neurological signs caused by spinalosteoarthropathy in long-standingtabes are relatively frequent. Of a totalof 57 patients described in the four-

teen reports published by French andEnglish authors between 1933 and1967, two had compression of thespine at the cervical or thoracic leveland 36 had compression of either asingle root in an intervertebral fora-men or several roots of the caudaequina in the spinal canal. The threepatients described in this paper fallinto the last category. L. Z. Oller

Follow-up Studies on theProgression of General Paralysisof the Insane up to Old Age(Katamnestiche Beobachtungen zurEntwicklung der progressivenParalyse bis ins hohe alter) MULLER,C. (1970) Arch. Psychiat. Nervenkr.,213, 149 52 refsOf 326 patients born between theyears 1872 and 1897 who had beenadmitted to the Psychiatric Clinic atthe University of Lausanne withgeneral paralysis of the insane (GPI),only 22 were still alive in 1963.Twenty ofthese patients, thirteen menand seven women, were studied. Theinterval between their first admissionto hospital and their re-examinationfor the purpose of this study averaged21-5 years. Nineteen patients hadreceived adequate treatment (arsphen-amine combined with fever therapy orwith penicillin), whereas less than halfof those who had died earlier had beenadequately treated. Ten patients hadbecome ill before and ten after the ageof 50 years. Among the former ten,five were cured, three showed somemental defect, and two had pareticdementia; among the latter ten, twowere cured, four showed some defect,and four had paretic dementia. Noneof the twenty patients, of whom four-teen were septuagenarians and one inthe late eighties, showed signs ofsenile dementia. It is concluded that

GPI does not predispose to thedevelopment of senile atrophy of thebrain. The author refers in a post-script to a recent similar study con-ceming 32 patients with GPI aged 65years and over which has confirmedhis findings. L. Z. OllerSTORM-MATHISEN, A. (1969) Acta psychiat.

scand., 45, 118

Morbidity and ClinicalManifestations of CongenitalSyphilis in Infancy (Morbiditat undklinische Symptomatik der konnatalenLues im Sauglingsalter)WECHSELBERG, W., and SCHNEIDER,J. D. (1970) Dtsch. med. Wschr., 39,1976 2 figs, 24 refsThe authors describe the clinical find-ings in 127 infants with congenitalsyphilis seen at the Children's Clinicof the University of Cologne between1948 and 1968. The incidence of thedisease as seen at the Clinic fell froman average of more than twenty casesa year in 1948-50 to one a year in1957-6C, but rose again slightly in the1960s.

In 84 per cent. of cases the firstsymptoms of congenital syphilis ap-peared within the first 2 months oflife. The earliest manifestation was aserous or purulent nasal discharge in27 per cent., skin lesions in 23 percent., and non-specific symptoms suchas infections, fever, vomiting, ordyspepsia in 17 per cent. The mostimportant single sign of the diseasewas a serous or purulent rhinitis,which occurred in 72 per cent. ofcases; enlargement of the liver wasfound in 65 per cent., anaemia in 56per cent., splenomegaly in 55 percent., a maculopapular rash in 44 percent., periostitis in 39 per cent., andosteochondritis in 33 per cent. Skinand bone changes have been less

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58 British Journal of Venereal Diseases

frequent during the past 10 years,possibly because of earlier treatment.Parrot's pseudoparalysis was found in20 per cent. of cases, but only onepatient showed neurological abnor-malities.

[This is an important paper as itanalyses in detail the clinical findingsin an unusually large series of cases ofcongenital syphilis in infants and dis-cusses them with reference to thosereported in the literature. As thiscondition becomes rarer, it is increas-ingly difficult for any one clinician toobtain adequate experience in thediagnosis and management of thedisease, and well-documented andclear accounts of the clinical mani-festations are very valuable.]

R. D. Catterall

Subacute InflammatoryRheumatism in SecondarySyphilis (Le rhumatismeinflammatoire subaigu de la syphilissecondaire) KAHN, M.-F., BAILLET,F., AMOUROUX, J., and SEZE, S. DE(1970) Rev. Rhum., 37, 431 2 figs,5 refs

Does Syphilis cause SpinalErosion? (La syphilis erode-t-elleencore le rachis?) BALEDENT, M.,LAUDE, M., DELMAIRE, M., andLIENARD, J. (1970) Sem. H8p.Paris, 46, 2354 3 figs, 8 refs

Three Cases of Syphilitic Gummaof the Brain (La gommesyphilitique cerebrale) OBLu, N.,STANCIU, A., SANDULESCU, G., andGOSTACHESCU, G. (1970)Neuro-chirurgie, 16, 249 10 figs,15 refs

A Case of SymmetricalSyphilitic Gumma of the FrontalLobes. Clinical and PathologicalObservations (Gomme leutichesimmetriche dei lobi frontali)LECHI, A. (1970) Acta neurol.(Napoli), 25, 542 3 figs, 2 refs

Gumma of the Lung - A Caseconfirmed by Thoracotomy andBiopsy WEAVER, P. C., andBRANFOOT, A. C. (1970) Brit. .Dis. Chest, 64, 238 9 figs, 24 refs

Syphilitic Aortic Insufficiency:Its Increased Incidence in theElderly PREWITT, T. A. (1970)

J. Amer. med. Ass., 211, 637 1 fig.,16 refs

Secondary Syphilitic Hepatitis(Clinical and PathogeneticFeatures and Presentation of aCase) (L'epatite luetica secondaria.Considerazioni cliniche epatogenetiche e presentazione di uncaso) ALBERTAZZI, F., STRANI,G. F., and SARTORIS, S. (1970)G. ital. Derm., 111, 440 21 refs.

Syphilis TherapyTreatment of Syphilis with a NewPenicillin: Clemizole-penicillin(Traitement de la syphilis par unenouvelle penicilline: la clemizole-penicilline) DELZANT, 0. (1970)Rev. int. Serv. Sante Armdes, 43, 233Clemizole-penicillin (Bellocillin) is amixture of one part penicillin G andfour parts clemizole-penicillin, clemi-zole delaying the release of penicillinand having antihistaminic properties.After a single injection (dose notstated, but presumably 1 mega unit)blood levels of 0 35 unit after 24 hrsand 0 05 unit after 96 hrs are pro-duced; the data on which theseresults are based are not given.

161 patients were treated with thispreparation at the Saint-Louis Hos-pital, Paris. These included twelvewith sero-negative primary, 34 withsero-positive primary, 44 with secon-dary, and 71 with latent syphilis.Untreated early or early latent in-fections were treated with fifteendaily injections of 1 mega unit. 37patients who had been treated in thepast, and presumably presented assero-positive latent cases, were re-treated with a total of 10 mega unitsgiven at the rate of three injections aweek.The rate of disappearance of tre-

ponemes from lesions, the healing ofsurface lesions, and the serologicalresponse were comparable to thosefound with other penicillin prepar-ations. Clemizole-penicillin appearedto produce less pain and local reactionthan other slow-release penicillins.Urticarial reactions with intense itch-ing occurred in two patients withsecondary and in four with latentsyphilis. These included two patientswith a history of similar reactions topenicillin and treatment with clemi-

zole-penicillin had to be stopped.This incidence ofgeneralized reactionsis considerably less than the figure of8 to 10 per cent. which the authorquotes as the experience with otherslow-release penicillins.

A. E. Wilkinson[Reprinted from Abstracts on Hygiene bypermission of the Editor.]

Treatment of Early Syphilis inthe Past 21 Years at theWiesbaden DermatologicalClinic (Die Therapie derFruh-Syphilis in den letzten 21Jahren in der WiesbadenerDermatologischen Klinik) NEMEC,F. (1970) Z. Haut-u. Geschl.-Kr.,45, 561 4 figs, 71 refs

Treatment of Syphilis inPenicillin-Sensitive Patients(Syphilis-Behandlung beiPenicillin-Unvertrdglichkeit)LANDES, E., and METZ, B. (1970)Z. Haut-u. Geschl.-Kr., 45, 79335 refs

Syphilis SerologyImmunoglubulin Class of NaturalHuman Antibodies Reactive withTreponema pallidum JULIAN,A. J., LOGAN, L. C., NORINS, L.C., andCOHEN, I. R. (1970) Infection andImmunity, 1, 555In these studies at the CommunicableDisease Center, Atlanta, Ga., serafrom 36 presumed normal adultswhich gave negative reactions in theVDRL, TPI, and FTA-ABS testswere examined in an indirect fluores-cence test against Treponema pallidumwith monospecific conjugated antiseraagainst IgG, IgM, and IgA globulins.Quantitative tests on uninactivatedsera diluted in buffered saline showedthat all contained IgG antibodies attitres of 5 to 2560, 58 per cent. hadIgM antibodies at titres of 5 to 20, and20 per cent. had IgA antibodies at atitre of 5. The mean titres of the threeclasses were: IgG, 640; IgM and IgA,5. In similar tests on pools of un-heated sera from twenty normalmothers and of cord blood from theirinfants, the maternal titres were: IgG,40; IgM, 20; IgA, 5. The cord serumIgG titre was 20 but tests for IgM andIgA were negative.The wide difference between the

IgG titres of the maternal serum pool



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and that of the 36 normal adults is notdiscussed.When 1 in 5 dilutions of the normal

adult sera in buffered saline wereheated for 1 hr at 56°C, the reactivityof the immunoglobulins against T.pallidum was not altered. Heatingsimilar specimens for 1 hr at 65°Cdepressed the IgG reactivity from 100per cent. ofthe sera to 31 per cent. andabolished reactivity of IgM and IgAcompletely.Cohn fractions II and IIIL from

three commercial sources were foundto contain mainly IgG antibody re-active with T. pallidum. IgM reactivityat dilutions above 1 in 5 were foundonly in Fraction IIIi. IgA activity wasfound in only one preparation ofFraction II.


Fluorescent Antibody Tests forSyphilis using CerebrospinalFluid: Clinical Correlation in 150Cases ESCOBAR, M. R., DALTON, H. P.,and ALLISON, M. J. (1970) Amer. J.clin. Path., 53, 886This report presents an analysis of theresults of tests on serum and cerebro-spinaJ fluid from 150 patients examinedat the Medical College of Virginia.VDRL and FTA-ABS tests were doneon both specimens and spinal fluid wasalso examined undiluted and diluted1 in 5 by the FTA test withoutabsorption.

49 patients were classed as syphili-tic, including eighteen with neuro-syphilis. Serum VDRL tests werereactive in 78 per cent. and FTA-ABStests in 98 per cent. Cerebrospinalfluids from these patients showedreactivity in the VDRL in six, in theFTA test in thirty, and in the FTA-ABS test in eleven. These tests werereactive in four, sixteen, and fourrespectively of the patients withneurosyphilis, but only two of thesewere reactive in both the VDRL andFTA-ABS tests. 32 patients with avariety ofdisorders were not suspectedclinically of having syphilis, but FTA-ABS tests were found to be positive ontheir sera. VDRL tests on cerebro-spinal fluid from these patients wereall negative; the FTA test showedreactivity in 21, and the FTA-ABStest in three. VDRL and FTA-ABS

tests on spinal fluid from 67 patientswho did not have syphilis were allnegative, but the unabsorbed FTA testshowed some reactivity in six.Although the authors express some

reservations about the specificity oftheunabsorbed FTA test on cerebrospinalfluid, they recommend its use as ascreening procedure, VDRL andFTA-ABS tests being carried outwhen the first is found positive.[No data are given about the cell and

protein contents of the cerebrospinalfluids examined, nor whether anywhich gave unexpected results in theunabsorbed FTA tests were contamin-ated with blood; this might giveerroneous results with such a sensitivetest.]


Early Diagnosis of NeonatalSyphilis MAMUNES, P., CAVE, V. G.,BUDELL, J. W., ANDERSEN, J. A., andSTEWARD, R. E. (1970) Amer. J7. Dis.Child., 120, 1768 infants whose cord blood had givenreactive VDRL tests were investi-gated at the New Jersey College ofMedicine. Quantitative VDRL testswere performed and the sera screenedat a dilution of 1 in 5 in buffered salinein an indirect fluorescence test againstTreponema pallidum with an anti-human IgM conjugate; when it waspositive, titrations were done. SerumIgM levels were estimated by an im-munodiffusion method. When pos-sible, treatment was withheld unlessthere was clinical evidence of infectionor a sustained rise in the VDRL titre.

37 infants were observed longenough without treatment to allowassessment. In fourteen cases (includ-ing six with inadequate follow-up) theIgM FTA test was reactive at titres of5 to 1280. In four of these, clinicalevidence of infection was present ordeveloped later, and in six others activedisease was suspected. The sera of sixbabies gave initial weak reactions inthe FTA test although there was noclinical evidence to suggest activity;possible explanations of this are dis-cussed. 28 bablies whose FTA testswere initially negative showed a fall inVDRL reactivity to negative withouttreatment and had no clinically appar-ent disease.

Estimations of serum IgM levelswere not found to be helpful indeciding whether the children hadbeen infected. Detection of IgM anti-treponemal antibody by the FTA testis thought to offer a sensitive methodof determining this. Better standardi-zation of the conjugate and furtherprospective studies are desirable be-fore the method is used for routinescreening purposes.


Post-treatment Disappearanceof Reactivity to Treponemal andLipoidal Tests in Early Syphilis[In English] LASSUS, A.,JOHANSSON, E., and FORSTROM, L.(1970) Acta derm.-venereol.(Stockh.), 50, 148 1 fig., 6 refsTo compare the persistence aftertreatment of FTA-ABS reactivitywith that of lipoidal (Kahn, VDRLslide, and Kolmer) tests and of Reiterprotein complement-fixation (RPCF)tests with the pretreatment levels ofthese tests and with duration ofsyphilis at the time of treatment, theauthors, at the University CentralHospital, Helsinki, studied 56 patients(44 male, 12 female, age not stated)suffering from early syphilis with aknown date of infection; nineteen hadprimary and 37 secondary syphilis.They were first given a test dose of100,000 u. penicillin to bring to lightthe possibility of a Herxheimerreaction, and then treated with600,000 u. procaine penicillin intra-muscularly daily for 12 days. Beforetreatment the FTA-ABS test waspositive in all cases, the RPCF in 51,the Kahn in 53, and the VDRL orKolmer in 54. Patients were asked toattend for follow-up 1, 3, 6, and 12months after treatment for repeat tests.

In thirty patients treated within 3months of acquiring their infection,the results of most of the tests soonbecame negative, but of seventeenpatients still available for follow-up at12 months the FTA-ABS test wasstill positive in five, the Kolmer andRPCF in two, the VDRL in one, andthe Kahn in none.

In the remaining 26 patients, whosetreatment had been started more than3 months after infection, the results oftests showed little change at the 3-



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month follow-up; twenty patientswere still available for follow-up at 12months, when the FTA-ABS test wasstill positive in nineteen, the VDRL,Kolmer, and RPCF in over half, andthe Kahn in five.The authors consider that the

lipoidal tests are better indicators ofthe success of treatment in earlysyphilis than are the RPCF and FTA-ABS tests, but the latter is best fordetecting syphilis even when it hasbeen treated in its course.

Eric Dunlop

The Positive WassermannReaction: Investigation andInterpretation WILKINSON, A. E.(1970) Brit. J7. Hosp. Med., 4, 4773 refs

IgG Immunoglobulins in theCerebrospinal Fluid in Syphilis(Immunoglobuline IgG im Liquorcerebrospinalis bei Lues)HEITMANN, H. J. (1970) Hautarzt,21, 477. 4 refs

Study and Characterization ofAntibodies against TreponemalSoluble Protein Antigens in theSerum of Syphilitic Subjects(Ricerca e tipizzazione di anticorpicontro l'antigene treponemicoproteico solubile nei sieri di soggettisifilitici) MEIATTINI, F., andPIAzzI, S. E. (1970) Ann. Sclavo,12, 121 12 figs, 40 refs

Complement-binding Antibodiesin Cardiolipin-stimulatedLymphocyte Cultures fromPatients with Syphilis(Entstehung komplementbindenderAntikorper in mitKardiolipinstimuliertenLymphocytenkulturenSyphilis-Kranker) HUNYADI, J.,DOBOZy, A., and SIMON, N. (1970)Arch. klin. exp. Derm., 239, 2822 figs, 21 refs

Congenital SyphiliticMacroglobulinaemia. Report of aCase (Macroglobulinaemia lueticaconnatale. Descrizione di un caso)FORMENTIN, P. A.,GRAVINA-SANVITALE, G., andGRAVINA, E. (1970) Acta paediat.lat. (Reggio Emilia), 23, 147 5 figs,28 refs

Evaluation of Serologic Tests forSyphilis using Drops of Bloodfrom Puncture of the FingerCHACKO, C. W., and GOPALAN, K. N.(1970) Indian J. Derm. Venereol.,36, 105 3 refs

Sampling of Blood fromFinger-Puncture in BlottingPaper Discs (Rondelles) forFluorescent TreponemalAntibody Tests forTreponematoses CHACKO, C. W.,and GOPALAN, K. N. (1970) IndianJ. Derm. Venereol., 36, 135 2 refs

Statistical Approach to theProblem of Cure of Syphilis inRelation to SerologicalEvaluation (In riferimento allavalutazione sierologica approcciostatistico al problema dellaguarigione della sifilide) FLARER, F.(1970) Arch. belges Derm., 26, 289

Treponemal Serology of WestAfricans working in France(Immunofluorescence and KlineFlocculation Tests on 1,000 Sera)(Serologie treponemique destravailleurs de l'Ouest Africaintransplantes (a propos de 1,000examens en immunofluorescence eten floculation de Kline)) NIEL, G.,and GENTILINI, M. (1970) Bull.Soc. Path. exot., 63, 180 20 refsQuantitative FTA Test carriedout with Fluorescent FractionalAntigammaglobulins. II.Syphilitic Sera (FTA testquantitativo eseguito medianteanti-gamma-globuline frazionatefluorescenti. II. Lue sierologica)SARTORIS, S., STRANI, G. F., andPIPPIoNE, M. (1969) G. ital. Derm.,110, 18 43 refs

Syphilis Biologicalfalsepositive phenomenonSyphilis and Biological FalsePositive Reactors among LeprosyPatients SCOTTI, A. T., MACKEY,D. M., and TRAUTMAN, J. R. (1970)Arch. Derm., 101, 328This study from the CommunicableDisease Center, Atlanta, Ga., reportsthe results of tests on 206 sera frompatients with leprosy. VDRL and RPRtests were performed on all and serareactive with either were furtherexamined by FTA-ABS and TPI tests.

82 sera (40 per cent.) were reactivewith one or other of the screeningtests, 58 were reactive in the VDRLonly, and 24 in both. Of these 82sera, 33 were reactive in the FTA-ABS and/or TPI tests, suggestingthat 16 per cent. of the patientshad treponemal disease while 24 percent. had given BFP reactions with thetests for reagin. The FTA-ABS testwas rather more sensitive than theTPI, the numbers of reactive serabeing 31 and 26 respectively. The RPRtest was less sensitive than the VDRL;of the 33 sera reactive in one or boththe treponemal tests, the RPR wasreactive in 23 and the VDRL in all 33.However, the specificity of the RPRwas considerably higher, as it gaveonly one reactive result which was notconfirmed by reactivity in one or otherof the treponemal tests in comparisonwith 33 such results with the VDRLtest.

[It would have added to the interestof this study if the treponemal testshad been performed on the wholegroup of sera. No information is givenabout the type of leprosy from whichthe patients were suffering; it isthought that the lepromatous formgives more BFP reactions than thetuberculoid type of the disease.]


Chronic Biological FalsePositive Reactions to SerologicalTests for Syphilis in BloodDonors GARNER, M. F., andBACKHOUSE, J. L. (1970) J7. clin. Path.,23, 478The results of verification tests on 375sera from blood donors sent to theInstitute of Clinical Pathology andMedical Research, Sydney, becausescreening tests for syphilis had beenfound positive are analysed. Cardio-lipin WR, VDRL slide, Reiter proteincomplement-fixation, TPI, and FTA-AIBS tests were performed.

187 sera were found negative in alltests, suggesting that the originalscreening tests were at fault. 108 serahad reactive TPI and FTA-ABS tests,indicating past or present syphilis.Eighty sera gave negative results withthese two tests, suggesting that theresults of the other tests were non-specific. Sera from 67 of these donors



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were again examined after intervals of6 months to 2 years; all except one stillshowed the same pattern, so that thesewere reactions of the chronic BFPtype. 64 of these were from personswho had given many donations andonly two were found at the firstdonation. Reactive screening tests on32 donors were first found at the 2nddonation in four, at the 3rd in one, atthe 4th to 8th in three each, at the 10thin one, at the 19th in three, at the 20thand 22nd in two each, and at the 24thin four.[The preponderance of the chronic

type of BFP reaction is surprising; it isnot stated whether blood from thesedonors was used for transfusion.]

A. E. Wilkinson

Fluorescent TreponemalAntibody-absorption TestReactions in LupusErythematosus. Atypical BeadingPattern and Probable False-positive Reactions KRAUs, s. J.,HASERICK, J. R., and LANTZ, M. A. (1970)New Engl. J3. Med., 282, 1287 22 refsRecent reports have suggested thatfalse positive FTA-ABS results mayoccur in patients with certain diseasesoften associated with globulin abnor-malities. Futhermore, sera from somepatients with lupus erythematosus(LE) have shown an atypical patternof treponemal fluorescence with thistest.To study this problem the authors

of this paper from the National Com-municable Diseases Center, Atlanta,Georgia, examined sera from 150patients (143 female, 7 male, age 13-80 yrs) with LE by the FTA-ABS testand also by the VDRL and TPI tests.Control sera were obtained from 75premarital blood samples.Ofthe 150 patients, 23 showed some

degree of fluorescence in the FTA-ABS test: four were reactive (includingthe only patient who gave a positiveTPI test), eight gave borderlinefluorescence, and the remaining elevengave an atypical 'beading' fluorescenceunlike the homogeneous pattern usual-ly seen in FTA-ABS reactive sera.VDRL tests were reactive in 24patients; none of the control sera waspositive in any of the tests. Thefrequency of reactive VDRL tests, ofatypical 'beading' fluorescence in theFTA-ABS test, and of typical homo-

geneous fluorescence (combinedborderline-reactive results) in theFTA-ABS test was significantlygreater in the LE group than in thecontrol group (P < 0 001, < 0-05, and<0-05 for each test respectively). Itwas shown by statistical analysis thatVDRL reactivity and FTA-ABSfluorescence in the LE group wereindependent variables.As the LE and control groups were

matched for variables known to affectthe incidence of syphilis it is unlikelythat this infection would account forthe differences in the VDRL andFTA-ABS test results; this is sup-ported by the failure to find clinical orepidemiological evidence of syphiliticinfection.The explanation for 'beaded' FTA-

ABS fluorescence is unknown, as is itsspecificity for LE serum.

Gordon Scrimgeour

Syphilis PathologyAn Electron Microscopic Study ofa Syphilitic Chancre. Engulfmentof Treponema pallidum byPlasma Celis AzAR, H. A.,PHAM, T. D., and KURBAN, A. K.(1970) Arch. Path., 90, 143Thin sections from a penile chancrewere examined by electron micro-scopy. The general picture was one ofproliferating small vessels surroundedby treponemes and inflammatory cells,including plasma cells. The organismswere seen between the capillaryendothelium and the surroundingperivascular connective tissue. Theappearances suggested that these werethe sites of proliferation.

Segments of treponemes were seenwithin spaces bounded by membranesin the cytoplasm of endothelial orperivascular connective tissue cellsand within plasma cells and poly-morphs. The close proximity of thetreponeme segment within its vacuoleto structures such as mitochondria,Golgi apparatus, or the endoplasmicreticulum of plasma cells suggestedthat the treponemes were lying deepwithin the cytoplasm of the host cells.Besides plasma cells of typical mor-phology, three variant forms aredescribed and illustrated. It is sug-gested that these may reflect abnormal

injury to the cells or an interferencewith the secretion ofimmunoglobulins.


GonorrhoeaSingle-dose AntibioticTreatment of AsymptomaticGonorrhea in HospitalizedWomen JOHNSON, D. W., KVALE,P. A., AFABLE, V. L., STEWART, S. D.,HALVERSON, C. W., and HOLMES,K. K. (1970) New Engl. J7. Med.,283, 1 3 figs, 13 refsA co-operative study has been carriedout by the United States NavalPreventive Medicine Unit No. 6,Pearl Harbour, Hawaii, and the localhealth authorities in which ninedifferent single-dose regimens for thetreatment of gonorrhoea were com-pared in a group of asymptomaticFilipino hostesses who were chroniccarriers of Neisseria gonorrhoeae. Ofthe 422 studied, 396 had positiveendocervical cultures and 26 negativecultures, the latter serving as controls.The women were confined to hospitalfor 6 days during and after treatmentto allow daily endocervical cultures tobe made for gonococci during thattime, and also to avoid re-infection.

Single injections of combined pro-caine and crystalline benzylpenicillinin a 3: 1 ratio were given intra-muscularly in four different dosages.After 2 m.u. treatment failure occurredin four of nine cases, after 3 m.u. innine of 26, after 6 m.u. in three of 24,and after 6 m.u. preceded 1 hr earlierby 1 g. probenecid by mouth therewere no failures in eighty cases.

Ampicillin (3-5 g.) was given bymouth to 108 women (preceded byprobenecid in 74 cases); there wereno treatment failures. Three schedulesof tetracycline were used: after 0-25 g.oxytetracycline intramuscularly treat-ment failure occurred in four of 25cases and after 0-5 g. in two of 35cases; there were no failures after 2-5g. of tetracycline by mouth in elevencases.Treatment with oxytetracyline was

tolerated least well. It is noted that, inspite of the fact that peak serumconcentrations of ampicillin alonewere considerably lower than thoseachieved when ampicillin was com-



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bined with probenecid, there were notreatment failures. This may havebeen because the drug had not beenused before in this population, but itis noted that the hostesses treated withampicillin were small in stature, withan average weight of only 45 kg. Whenthe same dose was given to theirconsorts there was a 24 per cent.failure rate. The authors advise there-fore that probenecid be given withampicillin or with penicillin for thetreatment of asymptomatic femalecarriers of N. gonorrhoeae.

[The results are of considerableinterest. It is possible that moretreatment failures might have beenreported if symptomatic patients hadbeen treated, or if rectal cultures hadbeen made.] Eric Dunlop

Gonorrhoea with Skin and JointManifestations WOLFF, C. B.,GOODMAN, H. V., and VAHRMAN, J.(1970) Brit. med. J7., 2, 2713 figs, 19 refsA benign form of metastatic gonor-rhoea with pyrexia and lesions of skinand joints has been reported, but inthe United Kingdom it is regarded asvery rare. This report of four casesseen in London (St. Mary Abbots, St.Stephen's, and Western Hospitals)during 1969 is therefore of consider-able interest.The condition is found most often

in women (three of the authors'patients were female). The clinicalpattern is that of a mild systemicreaction, with fever, arthritis whichtends to be migratory, and skinpapules with scanty peripheral distri-bution, developing into pustules someof which become haemorrhagic. Eachskin lesion is surrounded by anerythematous area. The gonococcuswas isolated from cervix and blood inthe first case, from a shoulder jointand the urethra in the second, fromthe blood in the third, and from cervixand blood in the fourth. The firstthree patients responded well to intra-muscular injections of crystallinepenicillin (0 5-1F0 m.u.), reinforced inthe second case by 0 5 m.u. phenoxy-methyl penicillin by mouth 6-hrly. Inthe fourth the outcome is not known.The authors stress the importance

of these findings, especially in womenin whom genital gonorrhoea may beasymptomatic. The condition has to

be differentiated from Reiter's diseasein which there is no response topenicillin, meningococcal septicaemia,and low-grade staphylococcal septi-caemia. A. J. King

Treatment of Gonorrhoea withSulmycin (Gonorrhoe-Behandlung mit Sulmycin)HANTSCHKE, D., and MAUSS, j. (1970)Z. Haut-u. Geschl.-Kr., 45, 407 12 refsNine men and fourteen women withmicroscopical and cultural evidence ofgonorrhoea were treated with Sulmy-cin (gentamycin sulphate). An in-jection of 80 mg. was given intra-muscularly twice daily to men andthrice daily to women. Eight men andthree women were treated as out-patients and the others were admittedto hospital (Dermatological Clinic atthe University of Essen). All weretested by smear and culture on the 2ndand 3rd day of treatment, and in onlyone case were gonococci cultured fromthe cervix.The persistence of gonococci in this

case was attributed to the fact that thewoman douched the vagina with waterfour to five times daily which isthought to have diluted the concen-tration of gentamycin below theeffective level. No other follow-uptests were carried out apart fromserological tests for syphilis some 7weeks later. Side-effects did notoccur. Sulmycin is recommended asan alternative to penicillin for thetreatment of gonorrhoea, particularlyin cases of mixed infection withpenicillinase-producing Staph. aureusand where masking of syphilis shouldbe avoided.

[Disappearance of gonococci duringthe course of treatment does notpreclude a relapse, and is not thereforea sufficient criterion of cure.]

L. Z. Oller

Preliminary Report on a MassProgram for Detection ofGonorrhea KACKLER, J.,BROLNITSKY, O., and ORBACH, H. (1970)Publ. Hlth Rep. (Wash.), 85, 6811 fig., 3 refsThe number of cases of gonorrhoeareported annually in Chicago has risensteadily in recent years, from 21,260 in1962 to 41,306 in 1969. In an attemptto reduce the size of the reservoir ofundetected infection in females a mass

screening programme was undertakenby the staff of the Chicago Board ofHealth among women and girls attend-ing 22 health facilities, mainly ante-natal and family planning clinics,serving the lower socio-economicareas of the city. Cervical specimenswere taken and examined by cultureonly, Thayer-Martin selective mediumbeing used. Most of the persons testedhad no symptoms or signs of gonor-rhoea.

In the first 12 months (July 1968-June 1969) 32,470 females (59 per cent.family planning and 41 per cent.antenatal patients) were examined and1,782 (5 5 per cent.) were found to beinfected with Neisseria gonorrhoeae.Analysis by 5-yr age groups showedthe highest incidence (6-9 per cent.) tobe in the 9,637 girls aged 15-19, whilein the largest group, 11,366 aged 20-24, the incidence was 6-4 per cent.Most of the patients found to be

infected were treated with a singledose of 3 m.u. procaine penicillin inoil with aluminium monostearate(PAM), 1-5 m.u. being injected intoeach buttock. (Those claiming to besensitive to pencillin usually received250 mg. tetracycline by mouth fourtimes a day for 3 days (total 3 g.) or 1 g.streptomycin intramuscularly). Testsof cure were made on every 25thpatient; of the first 200 so assessed,only four had failed to respond to thedose of PAM given and three ofthese responded to a second dose.

Future plans of the Chicago Boardof Health include the screening of anadditional 59,000 females by thismethod and of 2,500 others using analtests also, while 1,000 asymptomaticmales are to be screened for gonorrhoeaby the platinum loop technique.

R. R. Willcox

Identification of Different ClonalTypes ofN. gonorrhoeae inInfected and apparentlyUninfected Women (Identifi-cazione di differenti tipi clonali diN. gonorrhoeae in donne ammalate oaparentemente noninfette.)MARINELLI, P., and MELLINO, M. (1969)Igiene mod., 62, 1035

Growth ofNeisseria gonorrhoeaeon Unenriched Nutrient AgarHANSMAN, D. (1970) J. med.Microbiol., 3, 359 7 refs



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The Disc and Plate DilutionMethods in Determination of theSensitivity ofNeisseriagonorrhoeae to Penicillin G,Ampicillin, and DoxycyclineJOKIPII, A. M. M., and RENKONEN, O.-V.(1970) Chemotherapy (Basel), 15,317 1 fig., 8 refs

Primary Isolation ofNeisseriagonorrhoeae on Hemoglobin-FreeThayer-Martin Medium PARISER,D. M., and PITTARD, W. B. (1970)Publ. Hlth Rep. (Wash.), 85, 5325 refs

Trimethoprim as an AdditionalSelective Agent in Media for theIsolation of N. gonorrhoeaeRIDDELL, R. H., and BUCK, A. C. (1970)J. clin. Path., 23, 481 5 refs

Method for Preparing N.gonorrhoeae FluorescentAntibody Conjugate PEACOCK,W. L. (1970) Publ. Hlth Rep. (Wash.),85, 733 21 refs

Investigations on the Reduction ofNitrate and Nitrite by N.gonorrhoeae and N. meningitidis(Untersuchungen zur Reduktion vonNitrat und Nitrit durch Neisseriagonorrhoeae und Neisseriameningitidis) BERGER, U. (1970)Z. med. Mikrobiol. Immunol., 156, 868 refs

Treatment of Gonorrhoea withReference to Loss of PenicillinSensitivity by Certain Strains ofGonococcus(Derzeitiger Stand der Gonorrhoe-Behandlung unter besondererBerucksichtigung der Penicillin-sensibilitatseinbussen bestimmterGonokokkenstamme)MEYER-ROHN, J. (1970) Z. Haut-u.Geschl.-Kr., 45, 533

Penicillin and the GonococcusPLATTS, W. M. (1970) N.Z. med. J3.,71, 351 2 figs, 19 refs

Ampicillin in the Treatment ofGonorrhoea in Girls inInstitutions SULLIVAN, J. F. (1970)Med. J7. Aust., 2, 785 4 refs

'Trobicin Hydrochloride' in theTreatment of GonorrhoeaPLATTS, W. M. (1970) Med. J7. Aust.,2, 500 5 refs

The Problem of GonorrhoeaCATTERALL, R. D. (1970) Brit. J7.Hosp. Med., 3, 55 1 fig., 74 refs

Gonococcal Endocarditis withSevere Aortic Regurgitation:Early Valve Replacement VOIGT,G. C., BENDER, H. W., BUCKELS, L. J.,MEESTER, T. R. De, and MACDONALD, W.(1970) Jtohns Hopk. med. J3., 126, 3056 figs, 16 refs

Kanamycin as Treatment ofAcute Gonorrhea in FemalesSHAPIRO, L. H., and LENTZ, J. W. (1970)Obstet. and Gynec., 35, 794 7 refs

Non-gonococcal urethritisand allied conditionsAcquisition of Mycoplasmataand T-Strains during InfancyFoy, H. M., KENNY, G. E.,LEVINSOHN, E. M., and GRAYSTON,J. T. (1970) J. infect. Dis., 121, 57920 refsOne hundred neonates, 47 female and53 male, born in hospital were testedfor the presence of large-colonymycoplasmata and T-strains. Speci-mens from the throat, genitals, um-bilical stump, urine, and conjunctivawere taken on the 1st or 2nd day afterbirth and cultured. Further specimenswere collected at home on six oc-casions during the 1st year and oncemore at 2 years. 74 infants were avail-able for follow-up cultures at the endof the 1st year and 47 at 2 years.T-strains were isolated from 38 percent. of the female and 6 per cent. ofthe male infants, usually directly afterbirth, and the rate of isolation declinedsharply after 3 months. The vaginawas the main site from which theorganisms were grown. M. hominiswas isolated at birth from the vaginaof three female infants and from theconjunctiva of one male. Neither ofthese two organisms was recovered at2 years. Other mycoplasmata (M.salivarum and M. pharyngis) werecultured from the throats of a fewinfants (3 and 4 per cent. respectively),but not before 1 year of age. No ill-effects were associated with thepresence of Mycoplasma species orT-strains.

The results of this study suggestthat various reports of abortion,pathological delivery, and neonatalconjunctivitis attributed to infectionof genital strains of these organisms(M. hominis and T-strains) must beinterpreted cautiously. As to theirpathogenicity in later life, studies ofolder subjects would be necessary.

L. Z. Oller

Mycoplasma Species in theVagina and Their Relation toVaginitis MENDEL, E. B., ROWAN,D. F., MELTON GRAHAM, J. H., andDELLINGER, D. (1970) Obstet.Gynec., 35, 104 9 refsThis investigation from the BaylorUniversity Medical Centre reportsthe incidence of Mycoplasma inrelation to the common vaginal agentsin 88 gynaecological and 32 obstetricpatients.The methods of preparing the

media used and the processing ofspecimens is described in detail. Theonly Mycoplasma species isolated inthe vaginal cultures was M. hominisType 1.

In gynaecological patients Myco-plasma were grown from 21 of 43patients with Trichomonas vaginalis,eleven of 24 with Haemophilus vagin-alis, eleven of 36 with monilialvaginitis, and four of fourteen withnon-specific vaginitis. It was grownfrom one of two patients with gonor-rhoea.

In the obstetric group Mycoplasmawere found in four of seven patientswith Trichomonas vaginalis, three ofsix with Haemophilus vaginalis, threeof sixteen with monilial vaginitis, andtwo of seven with non-specificvaginitis.Mycoplasma hominis was thus found

in a high proportion of patients havingTrichomonas vaginalis, Haemophilusvaginalis, or non-specific vaginitis,but no specific correlation could beshown as Mycoplasma were also foundwith these agents in asymptomaticpatients.The authors found no connection

between the occurrence of Myco-plasma and abortion or other obstetriccomplications. They conclude thatMycoplasma may be a commensal ora parasite of low virulence.

C. S. Ratnatunga



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Mycoplasma Recovery from theMale Genitourinary Tract:Voided Urine versus the UrethralSwab GREGORY, J. E., andCUNDY, K. R. (1970) Appl.Microbiol., 19, 268The value of culturing voided urinespecimens in order to establish myco-plasmal infection of the genitourinarytract of males is in some dispute. Theauthors, working at the TempleUniversity School of Medicine, Phila-delphia, took voided urine specimensand material by urethral swab fromfifty male patients attending a venerealdisease clinic and cultured these forMycoplasma spp. Of the fifty patientsexamined, 43 were suffering fromurethral discharge and dysuria, fivegave a history of contact with aninfected female, and two had penilerashes. The media used were PPLOagar and broth (Difco) with addedhorse serum (10 per cent.), yeastextract, urea, and penicillin.M. hominis type 1 was isolated alone

from fifteen specimens of voided urineand T-strains from seven, and the twoorganisms were found together in afurther seven specimens; the corres-ponding figures for isolations by theurethral swab technique were eigh-teen, five, and twelve respectively. Sothat in all Mycoplasma spp. wereisolated from 35 patients (70 per cent.)by the urethral swab technique andfrom 29 patients (58 per cent.) byculturing voided urine. The resultsobtained from the two techniques didnot differ significantly (X2 ,95 = 1-56).

Gordon Scrimgeour

Isolation ofMycoplasma hominisT-strains, and Cytomegalovirusfrom the Cervix of PregnantWomen Foy, H. M., KENNY,G. E., WENTWORTH, B. B.,JOHNSON, W. L., and GRAYSTON,J. T. (1970) Amer. J. Obstet.Gynec., 106, 635 27 refs[From the Department of PreventiveMedicine, and Department of Obstet-rics and Gynecology, University ofWashington School of Medicine.]Mycoplasma hominis was isolated from37 of 199 cervical cultures fromwomen attending the prenatal clinicat the University Hospital in Seattle.The isolation rate was higher amongNegroes (32 per cent.) than amongCaucasians (16 per cent.). T-strains

were isolated from 56 per cent. of thepregnant Caucasian women and 75per cent. of the pregnant Negrowomen. Nearly all (92 per cent.) ofthose who carried M. hominis alsocarried T-strains. No adverse effect onpregnancy or on the infant from thepresence of either M. hominis or T-strains was observed. Both organismswere transmitted to infants of positivemothers (M. hominis to two of elevensuch infants and T-strains to four offifteen such infants). Cytomegaloviruswas isolated from cervical cultures offive of 140 pregnant women. Congeni-tal cytomegalovirus disease or trans-mission to the infant was not seen inany of these five patients. On the otherhand, the presence of CMV in thecervix was associated with lower thanaverage birth weight

Authors' summary

Mycoplasma in the UterineCervix GREGORY, J. E., andPAYNE, F. E. (1970) Amer. J.Obstet. Gynec., 107, 220 1 fig.,25 refs[From the Department of Epidemio-logy, School of Public Health, Uni-versity of Michigan.] A study ofMycoplasma in the uterine cervix wasmade on 150 women attending avenereal disease clinic, and 150women visiting a family planningclinic. Ages ranged from 16 to 61years in the venereal disease group and15 to 45 in the family planning group.Both groups were from lower incomefamily units and of similar ethnicbackground. The prevalence of Myco-plasma in the cervix was 92 per cent.in the venereal disease group, as com-pared to 38 per cent. in the familyplanning group. Mycoplasma hoministype 1 was the predominant species ofMycoplasma isolated from both groups.Within both groups, age, phase of themenstrual cycle, type of contraception,or non-Mycoplasma genito-urinarytract infections were not significantlyrelated to the prevalence of cervicalMycoplasma. Nor were Mycoplasmaisolations related to cytological evi-dence of premalignant or malignantalteration of cervical cells in eithergroup. Coccoid bodies associated withthe cytoplasm of squamous cells werepresent in cervical smears from about50 per cent. of women yielding M.hominis as opposed to about 10 per

cent. of women not yielding Myco-plasma. Authors' summary

Occurrence of Candida in OralLeukoplakias RENSTRUP, G. (1970)Acta path. microbiol. scand., 78B, 4213 figs, 6 refs

Serum Fluorescent Antibodyand ImmunoglobulinEstimations in CandidosisLEHNER, T. (1970) J. med.Microbiol., 3, 475 1 fig., 12 refs

Epidemiology of Trichomoniasisand the Role of this Infection inthe Development of Carcinomaof the Cervix BERTINI, B., andHORNSTEIN, M. (1970) Acta cytol.(Philad.), 14, 325 9 figs, 23 refs

Antibiotics andchemotherapyClinical Diagnosis of PenicillinAllergy [In English.] PEDERSEN-BJERGAARD, J. (1970) Acta allerg.(Kbh.), 25, 89 1 fig., bibl.[From Rigshospitalet, Copenhagen] aclinical study of 116 patients with arelevant history of penicillin allergy issubmitted. This series included 31patients with suspected anaphylacticreactions and nineteen with occu-pational exposure to penicillin. Thediagnosis of penicillin allergy was con-firmed in 53 patients, while 63tolerated penicillin in a therapeuticdose.

Patients with proven penicillin al-lergy had a significantly increasedincidence of asthma in their familiesand personal histories of asthma,vasomotor rhinitis, hay fever, andangioneurotic oedema. It is probable,though not proved, that a geneticrelationship exists between penicillinallergy and the atopic diseases. Themost relevant information indicatingpenicillin allergy was a history ofprevious anaphylactic reactions, ofseveral clinical symptoms and signs atthe same time, or of repeated allergicreactions upon contact with penicillin.

Intracutaneous tests using benzyl-penicillin, and read for an immediate-type reaction, were done on all 116patients with a history suggestingpenicillin allergy. The tests werepositive in nineteen patients, all ofwhom had manifest penicillin allergy.



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One patient reacted to 10-5 u. penicil-lin and one to 10-4 U. Intracutaneoustests with benzylpenicillin read forimmediate-type reaction were done on120 patients without a history ofpenicillin allergy and were negative inall. Cutaneous tests with benzyl-penicillin read for delayed-type re-action were positive in 25 out of 116patients with a history suggestingpenicillin allergy. In subsequentprovocation tests sixteen proved tohave manifest penicillin allergy, whilenine tolerated penicillin in therapeuticdoses without complaints.

Intracutaneous tests with peni-cilloyl-polylysine, read for immediate-type reaction, were positive in ten outof 41 patients with a history suggestingpenicillin allergy. One of these tenpatients tolerated penicillin in atherapeutic dose, whereas eight provedto have manifest penicillin allergy.Three out of 120 control patientswithout a history of penicillin allergyalso showed positive cutaneous re-action to penicilloyl-polylysine; allthree tolerated penicillin in a thera-peutic dose without complaints.

Provocation tests with penicillinwere done on 75 patients with ahistory suggesting penicillin allergyand entirely negative cutaneous re-actions to penicillin. On this provo-cation, twenty developed definiteallergic symptoms, including sevenwith anaphylactic reactions.

Complicating allergic reactions oc-curred on intracutaneous testing withbenzylpenicillin in eighteen out of 116patients with a history suggestingpenicillin allergy despite great cautionin the testing. On intracutaneoustesting with penicilloyl-polylysinethree out of 41 patients developedcomplicating allergic reactions.The results indicate that cutaneous

tests as used in the present studycannot predict penicillin allergy withsufficient certainty for use in clinicalpractice. It was found probable thatintracutaneous tests and provocationtests with penicillin as performed,might entail a 'rush hyposensitization'of the patients to penicillin.At the end of 2-6 yrs nine of the

penicillin allergics were retested, andseven still exhibited manifest penicillinallergy. Author's summary

Serological Diagnosis ofPenicillin Allergy [In English]PEDERSEN-BJERGAARD, J. (1970)Acta allerg. (Kbh.), 25, 131 3 figs,bibl.[From Rigshospitalet and the FinsenInstitute, Copenhagen.]

Agglutinating antibodies to pH 6-1penicillin-sensitized erythrocytes weredemonstrated in 25 out of 53 sera frompenicillin allergics, in five out oftwelve sera from patients with allegednot confirmed penicillin allergy, and ineight out of 120 sera from patientswithout a history of penicillin allergy.Titre values ranged from 1:1 to1:4,096. The occurrence of agglutinat-ing antibody was significantly morecommon in penicillin allergy, but nottantamount to such allergy.

Sensitization of erythrocytes bypenicillin at pH 9 0 increased thesensitivity ofthe agglutination reactionto sera with low titre values butreduced the specificity of the methodfor predicting clinical penicillin allergybecause of the many reactions amongpatients without a history of penicillinallergy. It was not possible to increasethe sensitivity of the agglutinationreaction by using Coombs' anti-human globulin sera.

Inhibition of the agglutinationreaction to penicillin-sensitized eryth-rocytes was possible in all cases bypreceding incubation of the test serumwith benzylpenicillin. For sera withagglutinating as well as skin-sensitiz-ing antibodies there was a correlationbetween the agglutinin titre and thepenicillin concentration needed fortotal inhibition of the agglutination. Inthe inhibition experiments usingpenicillin it proved possible, to someextent, to distinguish between serafrom patients with and without mani-fest penicillin allergy and betweenagglutinating sera with and withoutsimultaneous presence of skin-sen-sitizing antibodies.

Inhibition of the agglutinationreaction to penicillin-sensitized ery-throcytes proved possible in somecases by preceding incubation of serawith 2-mercaptoethanol, but theresults were not reproducible for allthe sera. However, the investigationsuggested that the separation of seraby inhibition experiments with peni-cillin could be explained from the

occurrence of mainly IgG antibody insera from non-penicillin allergics with-out skin-sensitizing antibodies, and ofIgM antibody in sera from penicillinallergics with skin-sensitizing anti-bodies.The results of the agglutination

tests were compared with previouslypublished determinations of skin-sensitizing antibodies and clinicalinvestigations on the same group ofpatients. This showed a significantcorrelation between the occurrence ofagglutinating antibody and penicilloyl-specific skin-sensitizing antibody aswell as between a positive immediate-type intracutaneous reaction to peni-cillin and demonstrable skin-sensitiz-ing antibodies.

Serological investigations with de-termination of agglutinating and skin-sensitizing antibodies rendered itpossible to make an assumed diagnosisof penicillin allergy in only 37 out of53 patients with manifest penicillinallergy. Author's summary

Ampicillin Eruptions CROW, K. D.(1970) Trans. St John's Hosp. derm.Soc. (Lond.), 56, 35 5 refsThe administration of ampicillinapparently produces a high incidenceof drug eruption, which consists of awidespread multiform erythema witha predilection for the limbs. Theeruption is presumably not producedby histamine release and the incidenceappears to be related to the dosageused and to the type of infection forwhich it is given; for example, it hasbeen recorded in almost 100 per cent.of cases in which ampicillin was givenfor infectious mononucleosis.

In order to further investigate thisphenomenon, a series of twelvepatients (2 male, 10 female, age range7-48 yrs) who had had typical am-picillin eruptions was studied at thePrincess Margaret Hospital, Swindon,Wiltshire. At an interval after thedisappearance of the rash which variedfrom 2 wks to 1 yr (mean 5 mths)the patients were given a test dose of250 or 500 mg. ampicillin and noneexperienced an adverse reaction.Subsequently four of the patientswere given 500 mg., followed by250 mg. three times daily for 7 days.Three of these had no skin reaction,but a boy aged 7 developed a fainterythema after 1 day of treatment and



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66 British J7ournal of Venereal Diseases

refused to take any more. None of thepatients had positive agglutinationtests for infectious mononucleosis.

Benjamin Schwartz

Public health and socialaspectsReaction of Patients towardsV.D. Infection SETH, T. R. (1970)Indian J7. Derm. Venereol., 36, 122

Venereal Disease in ScotlandSCHOFIELD, C. B. S., and McNEIL, N.(1970) Hlth Bull. (Edinb.), 28, 19

Yaws Eradication in Indonesia:Dr. Raden Kodijat's ContributionHACKETT, C. J. (1970) Trans. roy.Soc. trop. Med. Hyg., 64, 615 2 figs,bibl

Biological and MedicolegalAspects of the Diagnosis ofGonococcal and TrichomonalInfections (Aspects biologiques etmedico-1egaux du diagnostic degonococcie et de trichomonase)FROGE, E., DENIs, F., andBOILLEAU, Y. (1970) Mid. lIg., 3,229 30 refs

MiscellaneousNuclear Inclusion Bodies inVaginal Smears from Patientswith Vaginal DischargeCEDERQVIST, L., ELIASSON, G.,LINDALL, L., and STORMBY, K.(1970) Acta obstet. gynec. scand.,49, 13 2 figs, 14 refs100 women with acute vaginal dis-charge were selected at random fromamong those attending the Depart-

ment of Gynaecology, Malmo GeneralHospital, Sweden. Vaginal and cer-vical smears were examined for cyto-logical changes due to herpes simplexinfection and tissue cultures wereinoculated.Of these 100 women with clinically

copious discharge, cytological evid-ence of herpes was found in elevenand the virus was grown in five, allamong the eleven with cytologicalchanges. Gynaecological examinationshowed signs of herpes in only threewomen, all of whom had cytologicalevidence of this, the virus being grownin two. Infections with the gonococcusand trichomonas were present in 21and 24 per cent. respectively of theentire series, but they were foundalmost twice as often in those with thecytological changes [the numbers aretoo small to be statistically significant].The frequency of cytological changessuggestive of herpes in an unselectedseries of 68,000 vaginal smears in theauthors' laboratory was 0 04 per cent.

P. Rodin

Immunopathology of OralLeukoplakia LEHNER, T. (1970)Brit. J7. Cancer, 24, 442 1 fig.,15 refs

One-Stage Management ofPeriurethral Abscesscomplicating Urethral StrictureMEHAN, D. J., and BERSON, J. (1970)Sth. med. J7. (Bgham, Ala.), 63, 11794 figs, 3 refs

Strictured Urethra TURNER-WARWICK, R., and WORTH, P. H. L.(1970) Brit. J7. Hosp. Med., 3, 86010 figs, 12 refs

Resection of Urethral Strictureand End-to-End AnastomosisJESSEN, C. (1970) Scand. J3. Urol.Nephrol., 4, 87 2 figs, 19 refs

Venereal Disease LEADINGARTICLE (1970) Lancet, 2, 250

Urogenital TuberculosisMANGELSON, N. L., SAUNDERS, J. C.,and BROSMAN, S. A. (1970) J. Urol.(Baltimore), 104, 309 13 figs,15 refs

Genito-urinary Tuberculosis inan Area with a Large AsianImmigrant PopulationCARRUTHERS, R. K., and LONG, S. V.(1970) Brit. J3. Urol., 42, 535 2 refs

Granulomatous Orchitis: AReport ofTwo Cases CHANG,A. R., and PENMAN, H. G. (1970)Aust. N.Z. J7. Surg., 40, 79 7 figs,7 refs

Simplified Treatment forDisease of Bartholin's GlandGOLDBERG, J. E. (1970) Obstet. andGynec., 35, 109 2 refs

Herpes Genitalis as a VenerealDisease. HUTFIELD, D. C. (1970)Brit. J3. Hosp. Med., 3, 881

Herpes Viruses-Structural]Glycoproteins and ClassificationROIZMAN, B., KELLER, J. M., andSPEAR, P. G. (1970) Nature (Lond.),227, 1253 2 figs, 29 refs

Current Therapy of Gonorrheaand Syphilis KIND, A. C. (1970)Wis. med. J., 69, 218 7 refs

It is regretted that most of the French translations of the Summaries of Articles in this issue were delayed bythe Post Office Strike and have had to be omitted from this issue. Furthermore, six articles by foreign contri-

butors have had to be held over until April.

Correction In the paper by J. W. Lentz and L. Nicholas entitled 'Penicilloyl-polylysine intradermal testing for penicillin hypersensitivity',which appeared in the December, 1970, issue, p. 458, col. 1, line 11 from the bottom, and on p. 459, col. 2, lines 8 and 16:

for 3-5 please read 0-35



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