Of 101 fertile women (15-50 years of age) consulting in general practice due to vaginal discharge and/or genital malodor, bacterial vaginosis was diagnosed in 34% and vaginal candidiasis in 23%. The presence of Chlamydia trachomatis, Trichomonas vaginalis, genital herpes virus and Neisseria gonorrhoeae was demonstrated in 15%, 9%, 7%, and 1% of cases, respectively. No specific genital tract pathogens were found in 25 patients, where the clinical diagnosis was psychological factors (n = 5), intra-uterine device-associated discharge (n = 5), cytolytic vaginosis (n = 5), urinary tract infection (n = 3), or other/unknown causes (n = 7). In most cases diagnosis of bacterial vaginosis, vaginal candidiasis or trichomoniasis was established by clinical examination and simple office tests (pH indicator paper, amine test, microscopy of wet smear, yeast culture kit). C. trachomatis and N. gonorrhoeae were diagnosed by means of culture, cervicitis being diagnosed clinically in five of 15 cases with culture-confirmed chlamydial infection, while gonorrhoea was suspected from findings in a stained cervical smear. Sexually transmitted micro-organisms were detected in 16% of women with bacterial vaginosis or candidiasis. Of 29 women with sexually transmitted agents, 14% harbored more than one such organism.
Women, 15-45 years of age, with symptoms of lower urinary tract infection (UTI) were randomly treated with nalidixic acid (1 g X 3) or pivmecillinam (200-400 mg X 3) for three or seven days, respectively. Therapeutic failure, relapse, or reinfection occurred among 18% of 82 women, even though the isolated strains of gram-negative rods in these patients were susceptible in vitro to the antibiotics used. Therapeutic failure, i.e. no effect or at best only a minor effect on the symptoms, was registered in 10 of 13 cases of UTI caused by Staphylococcus saprophyticus and treated with nalidixic acid, which was consistent with the high minimum inhibitory concentrations (MIC) (128-512 micrograms/ml) of this antibiotic. S. saprophyticus was isolated in 9 of 12 patients during treatment with nalidixic acid. On the other hand, pivmecillinam therapy was clinically effective in 16 of 18 patients with UTI caused by S. saprophyticus, even though the MIC of mecillinam to these strains was considerably higher (8-64 micrograms/ml) than that vis-à-vis gram-negative rods. Thus the clinical effect of pivmecillinam was significantly better than that of nalidixic acid in cases of UTI caused by S. saprophyticus. The organism was not isolated from 14 patients receiving pivmecillinam therapy.
Bacteria in excess of 10(4) colony-forming units per ml (CFU/ml), were isolated from voided urine specimens from 127 (79%) of 160 women, 15-45 years of age, consulting in general practice due to frequency and dysuria. Escherichia coli was the species most frequently isolated, followed by Staphylococcus saprophyticus. Chlamydia trachomatis was isolated from 8 (5%) patients, in 6 of whom greater than 10(4) CFU/ml urine were isolated. A 2-fold titre increase in micro-immunofluorescence antibodies to C. trachomatis was demonstrated in 8 cases, the organism itself being isolated in 1 case only. No viruses were isolated in any of 18 women with negative urine cultures. Proteinuria and/or haematuria was found more frequently in patients with S. saprophyticus than in patients with gram-negative rods. Tests for nitrite indicated bacteriuria in only 58% of the patients with greater than 10(4) CFU/ml urine, which can be partly explained by the fact that S. saprophyticus only occasionally reduces nitrate. Cocci were noted in urine sediment in 75% of patients in whom S. saprophyticus was isolated.
Of 101 women, 15-50 years of age, presenting with vaginal discharge, 34 had bacterial vaginosis and were randomly assigned to a seven-day course of oral treatment with either erythromycin (0.5 g b i d . ) or metronidazole (0.4 g b.i.d.) in a single-blind, cross-over study. Treatment failure (?three clinical signs of bacterial vaginosis) occurred in 13 (81%) of 16 patients given erythromycin, as compared with three (17%) of 18 women treated with metronidazole QJ < 0.001). Persistence of Gardnerella vaginalis, Mobiluncus species and/or Mycoplasma hominis was found in 14 of 16 patients treated with erythromycin, and in four of 16 patients treated with metronidazole. Treatment with metronidazole was successful ( 2 two clinical signs of bacterial vaginosis) in eight of 10 cases of erythromycin treatment failure. Neither of two cases of metronidazole treatment failure was cured with erythromycin. At three-month follow-up of 3 1 women, persistence or recurrence of bacterial vaginosis was diagnosed in 11 cases (36%)).
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