During a period of 1 month all medical practitioners were invited to notify cases of gonorrhoea. 123 were obtained including 108 men, 10 women and 5 children. Of 25 hospital cases 23 were acute and 2 chronic; 23 were all infected by prostitutes. Intercourse took place in hotels in 17, in private houses in 6 and elsewhere in 2; introduction was made by taxi-drivers in 11, hotel staff in 3, friends in 3 and not stated 8; places of contact were-bars 16, cabaret 1, streets 2, not stated 6. The author thinks that supervision of prostitutes would help but that contact tracing would be a better long-term policy.
In this retrospective review of 16 children with vulvovaginitis due to Neisseria gonorrhoeae, the authors attempt to estimate the incidence of this infection and to ascertain the routes of transmission. From January 1977 to December 1982, 422 cases of gonococcal vulvovaginitis in women of all age groups were encountered at the University Hospital, Kuala Lumpur, Malaysia. Of these, 406 cases (96.2%) occurred in adults, and 16 cases (3.8%) occurred in children younger than 12 years of age. Penicillinase-producing N. gonorrhoeae (PPNG) strains were isolated from five (31%) of the 16 girls; all five cases were subsequently treated with cefuroxime and probenecid. The rest responded to intramuscular procaine penicillin. Although all patients appeared to be cured, only ten of 11 (two with PPNG) had test-of-cure cultures performed after treatment. Although interviewing the parents revealed no history of sexual contact in these children, nine of the girls were linked to culture-positive adult(s).
Genital discharge from patients unth. smear positive gonorrhoea was transported from the clinic to the laboratory in. Stuart's transport medium (Oxoid CM 111). Within. six hours of transit time the recovery rate of gonococci was 94%. When compared with "bedside" inoculation onto Modified Thayer Martin medium, there was no significant difference in recovery rates up to 6 hours of transportation in Stuart's transport medium, However, the rate of isolation of gonococci was significantly reduced after 20 to 30 hours of transportation. It is concluded that Stuart's transport medium is an acceptable transport medium for specimens containing gonococci when specimens reach the laboratory within 6 hours of collection.
Between 1992 and 1994, 253 tetracycline-resistant Neisseria gonorrhoeae (TRNG) strains were isolated and characterized by auxotype and serogroup (A/S) classes to study TRNG prevalence in different years. TRNG accounted for 28.1, 42.5, and 51.9% of the strains isolated in 1992, 1993, and 1994, respectively, showing a significant increase in each successive year (chi square = 26.7, P < 0.001). There was no significant increase in penicillinase-producing TRNG, which accounted for 53.1, 53.8, and 63.2% of the TRNG isolates. The 253 TRNG isolates belonged to 53 A/S classes. Eighteen A/S classes not observed in 1992 were detected in 1993, and 11 A/S classes not observed in 1992 and 1993 were isolated in 1994, indicating dissemination of the tetracycline resistance gene among the N. gonorrhoeae strains in Malaysia. Its emergence and subsequent rapid spread are alarming. The plasmid is capable of self-transfer (S.A. Morse, S.R. Johnson, J.W. Biddle, and M.C. Roberts, J. Infect. Dis. 155:819-822, 1987), allowing further dissemination of tetracycline resistance.
A 41 year-old Malay man had been treated by general practitioners for bilateral red eyes with profuse discharge of three weeks' duration with no improvement. He then presented to an ophthalmologist who noted profuse purulent discharge, bilateral corneal perforation, lid swelling and chemosis. Culture of the ocular discharge grew Neisseria gonorrhoeae. Treatment with systemic and topical antibiotics prevented microperforations in the right eye from progressing to overt perforation and was able to control disease in the left eye.
Acute infective sacro-iliitis is a rare condition. Though gonococcal arthritis is not uncommon, this organism does not appear to have been isolated from the sacro-iliac joint. The first proven case of gonococcal sacro-iliitis is reported here. Difficulties in correct diagnosis of infective sacro-iliitis are highlighted. Management of gonococcal sacro-iliitis is described. With the increase in number of gonococcal infections, a case can be made for routine culture of joint material N. Gonorrhoeae in cases of septic arthritis in patients at high risk.
One hundred and thirty-eight male patients presented unth. a total of 146 episodes of urethritis at a Kuala Lumpur STD clinic over a period of six months. Gonorrhoea accounted for almost 4 out of 5 cases of male urethritis. The incidence of betalactamase producing strains of Neisseria gonorrhoeae was 36 percent. Furthermore nearly 3 out of 10 cases of gonococcal urethritis developed post-gonococcal urethritis.
Screening by culture of endocervical specimens revealed four cases of gonorrhea among 744 pregnant women attending the prenatal clinic at the University Hospital in Kuala Lumpur, Malaysia. The observed prevalence of gonorrhea (0.54%) in pregnant women is similar to that in Great Britain (0.2-0.7%), but lower than the prevalences reported for North America (2.5-7.5%) and Thailand (11.9%). The results indicate that routine screening of pregnant women attending prenatal clinics in Malaysia would aid in the control of gonorrhea in that country.