SUMMARY Fourteen of 194 (7-2Vo) consecutive unselected men had positive culture results from genital swabs for Gardnerella vaginalis. A higher yield of isolates was obtained from preputial (93%) than from urethral swabs (647o). Of the 14 men, two had no detectable genital abnormality, eight non-gonococcal urethritis, and nine balanoposthitis. The urethral isolation rates for G vaginalis in men with and without non-gonococcal urethritis were not significantly different, but preputial isolation rates were significantly higher (P<0-001) in men with balanoposthitis than in those without. The prevalence rate for G vaginalis in men with non-candidal balanoposthitis was 31%qo.In a second study, concomitant Bacteroides species were isolated in preputial swabs from nine of 12 (750%o) men with G vaginalis-associated balanoposthitis and may play a role in its pathogenesis.
Ofloxacin was used to treat patients with gonorrhoea and/or Chlamydia trachomatis infection. Gonorrhoea was treated with a single 400 mg dose and chlamydial infection with a seven day course (200 mg bd). Fifty of 84 patients with gonorrhoea (60 men and 24 women) returned for two follow-up examinations 7 and 14 days after treatment, 17 patients returned for only one follow-up examination and 17 defaulted. Neisseria gonorrhoeae was re-isolated from three patients who had probably become re-infected. Treatment was successful in 64 patients, 58 of whom were assessed after a single 400 mg dose of ofloxacin. Chlamydial infection was identified in 30 patients with gonorrhoea (13 men and 17 women) and in 35 other patients (17 men and 18 women). C. trachomatis was not recovered from any of the 49 patients who returned for two follow-up examinations, or from the ten patients who attended for one follow-up visit only. Sixteen patients did not return for follow-up examination. Our results suggest a seven day course of ofloxacin would eradicate N. gonorrhoeae and C. trachomatis in patients infected with both organisms. Such treatment may be advisable in patients with gonorrhoea if microbiological tests for C. trachomatis are not available.
F our days after a Caribbean vacation, a 31-year-old woman presents to her family physician with fever, rash and myalgia. On examination, she appears well. Her blood pressure is 116/90 mm Hg, her heart rate is 95 beats/min, and her temperature is 38.6°C. She has a diffuse, faint macular rash. Laboratory investigations show a leukocyte count of 2.5 (normal 4.0-11.0) × 10 9 /L and normal hemoglobin and platelets levels. Three thick and thin blood films performed 12 hours apart show no evidence of malarial parasites, and blood cultures yielded negative results. What is the most likely diagnosis?The patient's presentation is highly suggestive of dengue, the most common cause of fever in travellers who have recently returned from Latin America, including the Caribbean.1 Dengue is an acute viral illness transmitted by Aedes mosquitoes throughout the tropics and subtropics, mainly in urban and periurban areas. 2Dengue infection rates have increased dramatically in the past 50 years, 3 with current worldwide incidence approaching 390 million cases per year.2 In North Americans returning from the Caribbean, South America, South-East Asia and South-Central Asia, dengue is a major cause of febrile illness and occurs more often than malaria.1,3 Popular tourist destinations for Canadians, including Cuba, the Dominican Republic, Martinique, Mexico and Hawaii, have experienced recent dengue outbreaks. 4,5 Physicians should consider dengue in febrile patients presenting within two weeks of return from an endemic area, although a shorter incubation period of five to seven days is most typical. Common concurrent symptoms during the initial febrile phase include retro-orbital headache, myalgia, vomiting and an early, nonspecific macular rash. 3 In the immediate period around defervescence, known as the critical phase, patients are at risk of hemorrhage and complications related to increased vascular permeability. A distinct rash characterized by diffuse erythema with islands of sparing (areas of uninvolved skin) typically appears just before recovery. Leukopenia, thrombocytopenia and transaminitis frequently occur. Combined symptoms and laboratory findings are more highly predictive of dengue infection, which is 71 times more likely in travellers with both fever and rash and 230 times more likely in those with fever, rash and leukopenia. What diagnostic tests should be performed?In any returning traveller who is ill, it is essential to initially rule out severe and potentially lifethreatening infections requiring specific treatment, including malaria, typhoid fever, bacterial sepsis, influenza and rickettsial disease.3 Chikungunya virus has been isolated recently in the Caribbean and should also be considered in returning travellers with fever.4 Serologic testing for dengue lacks sensitivity in the acute setting, with only 50% of patients having detectable IgM antibodies on day 4 of illness.5 A fourfold rise in convalescent IgG titres measured more than 14 days after symptom onset retroactively confirms dengue infection but rarel...
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