Disease prevalence in women attending the STD clinic in Mumbai (formerly Bombay), India

Our objectives were to determine the prevalence of Neisseria gonorrhoeae and its association with other STD causing organisms. Three hundred and thirty-six consecutive women (female sex workers (FSWs) and married contacts), attending a sexually transmitted disease (STD) clinic in Mumbai, were screened for N. gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. Per speculum examination was performed and clinical signs were recorded. Symptoms perceived by the women were also recorded. The mean age for married contacts, FSWs and gonorrhoea-positive women was 27.9, 29.7 and 27.5, respectively. 9.7% of the women were positive for N. gonorrhoeae, 23.2% were chlamydia-positive and 5.9% had trichomoniasis. N. gonorrhoeae was isolated more frequently from FSWs as compared to the married contacts. The prevalence of HIV was significantly higher among women with multiple sex partners (FSWs) (P<0.001). Gonococcal infection is significantly associated with the presence of HIV. A significant association between sexual habits and prevalence of gonorrhoea, trichomoniasis and HIV was observed. The prevalence of gonorrhoea over 1988 to 1996 remained approximately the same.

Association between auxotypes, serogroups, and antibiotic susceptibilities of Neisseria gonorrhoeae isolated from women in Mumbai (formerly Bombay), India

OBJECTIVES

Gonococcal isolates were differentiated based on susceptibility pattern, penicillinase production (PPNG or non-PPNG), serogroup, auxotype, protein, and plasmid profile. The association between serogroup and auxotype and PPNG was determined.

STUDY DESIGN

Women attending tertiary level health centers and the sexually transmitted disease (STD) clinic in Mumbai, India, were screened for Neisseria gonorrhoeae. Minimal inhibitory concentration testing was performed according to National Committee for Clinical Laboratory Standards (NCCLS) guidelines. Auxotypes, serogroups, protein profile, and plasmid content were also studied.

RESULTS

Of the 33 isolates, 16 (48.5%) were resistant to penicillin, and 28 (84.8%) showed a chromosomally mediated resistance to tetracycline. Five (15.2%) isolates showed resistance to ciprofloxacin, whereas 12 (36.4%) showed a reduced susceptibility. Twenty-seven (81.8%) isolates belonged to the WI serogroup, and 15 (46.7%) were penicillinase producers (PPNG). Seventeen (51.5%) isolates were of the nonrequiring auxotype, whereas seven (21.2%) were proline requiring. Fifteen (55.6%) of the isolates belonged to the nonrequiring-WI auxotype/serogroup (A/S) class. Ten of the PPNG isolates possessed the 4.4 MDa plasmid, whereas four had the 3.2 MDa plasmid. Increases in the molecular weight of the major outer membrane protein were observed.

CONCLUSION

A high prevalence of chromosomal resistance to penicillin and tetracycline was observed. The 4.4 MDa plasmid was the most prevalent among the PPNG isolates. We observed ciprofloxacin resistance, which has not been reported in previous studies in India. The nonrequiring auxotype was the most prevalent, followed by the proline requiring auxotype. WI serogroup was the most commonly observed among the isolates studied. The nonrequiring/WI A/S class was the most prevalent among the PPNG.

Superior sagittal sinus thrombosis in a child with nephrotic syndrome

A 3-year-old male with steroid-responsive nephrotic syndrome developed a rare complication, sagittal sinus thrombosis during an episode of gastroenteritis, while on steroid therapy. Anticoagulation, as assessed by partial thromboplastin time, was difficult to maintain, despite administering high doses of heparin, infusions of fresh-frozen plasma to provide antithrombin III, and, subsequently, maximum doses of warfarin (0.3 mg/kg per day). Despite these problems the child made a complete neurological recovery.