No abstract

The efficacy of single-dose azithromycin therapy in the treatment of cervical Chlamydia trachomatis infections was compared to that of a standard seven-day course of treatment with doxycycline. Cervical samples from 60 patients reacted positively in an enzyme immunoassay for detection of Chlamydia trachomatis. In 31 patients Chlamydia trachomatis was isolated from the sample taken before treatment. Fourteen of the 31 patients were treated with doxycycline and 17 with azithromycin. All cultures of samples taken one and four weeks after the start of therapy were negative. All 31 isolates showed a similar pattern of MICs for the seven antibiotics tested, including azithromycin and doxycycline. No differences were observed between isolates of different serovars. In samples from four patients chlamydial DNA could be detected by PCR one week after the start of the therapy and in two patients also after four weeks. No difference in microbiological parameters could be observed between the two treatment groups. It is concluded that single-dose azithromycin is as effective as a seven-day course of doxycycline in the therapy of cervical Chlamydia trachomatis infections.

From patients with bacterial vaginosis motile, anaerobic, comma-shaped bacteria can be isolated, which have recently been placed into the new genus Mobiluncus. In this study, electron microscopy was used to examine the in situ adherence of these motile curved rods to detached epithelial cells (comma cells) in vaginal fluid from two patients with bacterial vaginosis. Thin sections showed that the curved rods attached both directly to the epithelial cell surface and at various distances from it. It is concluded that after initial attachment these motile bacteria can grow at the epithelial cell surface in sessile microcolonies. Ruthenium red staining demonstrated a coating of precipitated glycocalyx material both on the surface of the curved rods and on their flagella. This may indicate that in situ the adherent curved rods were enclosed in a very hydrated matrix of exopolysaccharides. Conspicuous was the ability of the curved rods to attach to the epithelial cell surface via their cell tips. However, in situ no specialized bacteria cell surface structures were seen that might explain this polar attachment. Electron microscopy of pure cultures demonstrated that both Mobiluncus curtisii subsp. curtisii and Mobiluncus mulieris can produce a glycocalyx in vitro.

The cervical and high vaginal flora of 76 patients with cervicitis were studied before and after therapy with Ornidazol by quantitative culture methods. Lactobacilli were the predominant organisms, but Peptostreptococci, Bacteroides and Trichomonas were encountered in 17, respectively 32 and 81% of all specimens. During and after therapy Trichomonas disappeared completely, the bacterial flora normalized and became comparable to that of healthy women with incidences for Bacteroides of 8–13% and Peptostreptococci of 4–5%. The in vitro susceptibility (MIC and MBC) of 50 strains of Bacteroides to Ornidazol was determined by a broth dilution method and an agar plate technique. The MIC varied from 0.07 to 10 μg/ml. All strains were susceptible to 10 μg/ml. There was a slight variation in resistance between the various species tested. B.fragilis was less susceptible to Ornidazol than other Bacteroides species. Within the species B. fragilis the subspecies thetaiotaomicron and ‘other’ were most susceptible, spp. fragilis and spp. distasonis least.

Summary. A total of 369 women with clinical and mycological evidence of vaginal candidiasis received treatment, after random allocation, with either a single oral 150‐mg dose of fluconazole (188 women) or 200 mg of intravaginal clotrimazole given daily for 3 consecutive days (181 women). They were assessed at 5–16 days and again at 27–62 days after treatment. Candida species were completely eradicated from the vagina in 72% of the fluconazole group and in 62% of the clotrimazole group at the long‐term assessment (P=0·07). Favourable clinical responses were obtained in 99% of the fluconazole group and in 97% of the clotrimazole group at the short‐term assessment and in 93% and 84% respectively at the long‐term assessment when there was a significant advantage for fluconazole treatment (P=0·02). Symptoms in patients receiving fluconazole were relieved more rapidly (P<0·001). Treatment‐related side‐effects were few and minor in both groups. It is concluded that treatment of vaginal candidiasis with fluconazole, as a single oral dose, was more effective in the long term, relieved symptoms more rapidly, and was as safe as treatment with intravaginal clotrimazole.