Specimens were taken, using carbon-impregnated swabs, from the cervix, urethra and rectum of 945 Cape Coloured gynaecological patients, and from the cervix only of 1 276 pregnant Cape Coloured women. These specimens were submitted to the laboratory in a modified Stuart transport medium and cultured on Thayer-Martin medium. Neisseria gonorrhoeae was cultured in 5,3% of the specimens from the gynaecological patients and in 5,3% of specimens from the pregnant women. All cultures showed type I or 11 colony pattern. No strains showed resistance to any of the antibiotics tested.S. Afr. Med. J., 48, 259 (1974)

Brede, H.D.

Finlayson, M.H.

Gibbs, B.

English

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13 February 1974 S.A. MEDICAL JOURNAL(Supplement-South African Journal of Laboratory and Clinical Medicine)259LCM JlDiagnosis and Incidence of Neisseria gonorrhoeaein Cape Coloured Females in the Western CapeLABORATORY ASPECTSM. H. FINLAYSON, B. GIBBS, H. D. BREDEMETHODS10 g20 g2 g8 g2 g10924g1 litrewaterSUMMARYSpecimens were taken, using carbon-impregnated swabs,from the cervix, urethra and rectum of 945 Cape Colouredgynaecological patients, and from the cervix only of 1 276pregnant Cape Coloured women. These specimens weresubmitted to the laboratory in a modified Stuart transportmedium and cultured on Thayer-Martin medium. Neisseriagonorrhoeae was cultured in 5,3% of the specimens fromthe gynaecological patients and in 5,3% of specimensfrom the pregnant women. All cultures showed typeI or 11 colony pattern. No strains showed resistance to anyof the antibiotics tested.S. Afr. Med. J., 48, 259 (1974).Although Leistikow first cultured Neisseria gonorrhoeaein 1882, this organism was for many years isolated onlywith difficulty on artificial culture media. Growth wasrarely obtained unless the infected material was culturedimmediately after the specimen was taken from th<.;patient, and in the case of specimens taken from femalepatients, particularly, the additional problem of over-growth by other organisms was frequently encountered..According to Kraus and Yen' these methods detectedonly about 16% of suspected cases. After the use ofselective antibiotics incorporated in the medium, and inparticular the use of the medium devised by Thayer andMartin' in 1964, these difficulties were largely overcome.and Wende3 was able to obtain 92% positive culturesfrom patients with clinical gonorrhoea. The problem ofobtaining a growth of the gonococcus when delay hadoccurred between the taking of the specimen and theinoculation of the culture medium was overcome by theuse of charcoal-impregnated swabs as recommended byStokes: and Stuart transport medium: or by the use ofMartin and Lester's Transgrow medium in which thegonococcus was not only transported but also grewduring transportation.The adoption of these techniques has revolutionised thelaboratory diagnosis of gonorrhoea. During the past 18Department of Medical Microbiology, University of SteUen-bosch and Tygerberg Hospital, Tiervlei, CPM. H. FINLAYSONB. GIBBSH. D. BREDEDate received: 1 August 1973.months, we have used some of these methods in theTygerberg Hospital and the results are described here.Patients from whom positive cultures were obtained havebeen treated, and follow-up cultures have been done.Charcoal-impregnated swabs, prepared as described byStokes: were used. Three swabs, one each from the cervix,urethra and rectum of all gynaecological cases, weretaken. In the case of obstetric patients, swabs were takenonly from the cervix. The swabs, rolled on wooden sticks,were contained in glass test-tubes and immediately afterthe specimens were taken, plunged deeply into Stuarttransport medium (Oxoid) which was contained to adepth of 4 - 5 cm in identical glass test-tubes.After varying intervals, but usually within 6 hoursafter the specimen was taken, the swabs were plated outon a modified Thayer-Martin medium, the compositionof which is as follows:1. Base mediumTryptone (Diteo)Proteose peptone (Oxoid)Soluble starch (BDH)K,HPO.KH,PO.NaCIAgar No. 3 (Oxoid)Distilled water2. Haemoglobin (Difco) 2% in distilled3. Supplements A and B (Difco)4. VCN inhibitor."The medium was prepared by adding 250 ml of (2),2,5 ml each of supplements A and B (3), and 5,0 ml of(4) to 250 ml of melted base (1).Incubation was carried out in an atmosphere containingapproximately 3% CO, (candle flame), for 48 hours at35°C. After incuba,tion the plates were examined and ifsuspicious colonies were present, these were tested withoxidase reagent (tetramethyl paraphenylenediamine).Colonies of N. gonorrhoeae were replated onto Thayer-Martin plates.Pure cultures were tested for fermentation propertiesusing sugars in cystine trypicase agar (BBL). Antibioticsensitivity tests using the methods described by Garrodand Waterhouse' were carried out with the followingantibiotics: penicillin, ampicillin, streptomycin, tetracycline,260LKW 12S.-A. MEDIESE TYDSKRIF(Byvoegsel-SlIid-Afrikaanse Tydskrif vir Laboratorillm- en Kliniekwerk)13 Februarie 1974erythromycin, lincomycin, gentamicin, cephalosporin,Nicene, carbenicillin, and trimethoprim-sulphamethoxa-zole. The antibiotic discs were placed on the surface ofcultures grown on Wellcotest lysed blood agar. The anti-biotic concentrations were those recommended by Garrodand Waterhouse.' Ticene was tested at a concentration of25 p.gjml and trimethoprim-sulphamethoxazole at a con-centration of 25 p.gjml.All strains of Neisseria isolated, fermented glucoseonly, after incubation for 72 hours.RESULTSSwabs from 945 patients admitted to the gynaecologicalwards and from 1 276 obstetric patients were cultured.The results are shown in Table I.TABLE I. N. GONORRHOEAE ISOLATIONSDECEMBER 1972 TO JUNE 1973Total Total PercentageDepartment investigations isolation isolationGynaecology -urethral, cervical andrectal swabs ... 945 50 5,3Obstetrics -cervical swabs 1 276 68 5,3Total 2221 118 5,3It will be seen that from 5,3°~ of both the gynaecologicaland the obstetric patients, N. gonorrhoeae was cultured.All cultures showed colony types I or II, as described byKellog et al: and Jephcott and Reyn"Sensitivity tests, according to the paper disc methodas described by Garrod and Waterhouse,' were carried outon all strains. None of the strains showed resistance toany of the 11 chemotherapeutic substances tested.An attempt was made to follow up the patients fromwhom N. gonorrhoeae were isolated. These patients weretreated as described by Hayward and after an interval of5 - 16 weeks repeat swabs from 42 patients were examined.In each case swabs were taken from the cervix, urethra,rectum and throat. From 2 of the patients N. gonorrhoeaewas isolated from the cervical swabs only.DISCUSSIONIt is of interest that our findings are in agreement withthose of Kraus and Yen,' who examined cervical culturesfrom 1 309 antepartum patients in Cleveland, Ohio, USA,and discovered an incidence of N. gonorrhoeae of 5,73%.Of the patients examined 93~~ were non-White and none ofthem' showed symptoms of gonorrhoea. The presence ofN. gonorrhoeae in symptomless females was also reportedby Harris et al.,10 who took cultures from 213 femaleprisoners, and using a delayed fluorescent antibody method,detected N. gonorrhoeae in 20,6% who had no symptomsof N. gonorrhoeae infection.The sensitivity tests carried out by us showed no strainsof N. gonorrhoeae resistant to penicillin, streptomycin orany of the other 9 chemotherapeutic substances tested.This is at variance with the findings of Arya et al.'1 andMasawe et al." in Uganda, the former finding 18% andthe latter 20 - 30% of the local strains of N. gonorrhoeaeresistant to penicillin in vitro. In many countries in Europeand also in the USA an increased resistance of N. gonorr-hoeae to penicillin has been reported, while in SwedenBergman and Tarnvick13 have also reported an increasein resistance to streptomycin. In the USSR, Lurie andKvassnayaH have reported increased resistance to tetra-cycline.We thank Professor W. A. van Niekerk and his staff forproviding the clinical material.This investigation was partly supported by a grant forcurrent expenses from the South African Medical ResearchCouncil.REFERE CES1. Kraus, G. W. and Yen, S. S. C. (1967): Obstet. and Gynec., 30,258.2. Thayer, J. D. and Martin, J. E. jun. (1964): Pub!. Hlth Rep. (Wash.),79, 49.3. Wende, R. D. (1964): Publ. H1th Lab., 22, 104.4. Stokes, J. (1968): Cli"ical Bacieriology, p. 319. London: EdwardArnold.5. Stuart, R. D. (1959): Pub!. Hlth Rep. (Wash.), 75, 431.6. Blair, J. E., Lenriette, E. H. and Truant, J. P. (1970): Man"al 0/Clinical Microbiology, p. 84. Betbesda, Md.: American Society forMicrobiology.7. Garrod, L. P. and Waterhouse, P. M. (1971): J. Chn. Path., 24, 774.8. Kellog, D. S. jun., Peacock, W. L. jun., Brown, L. and Pirkle, C. L.(1963): J. Bact., 85, 1274.9. Jephcott, A. E. and Reyn, A. (1971): Acta path. microbio!. scand.,79, 609.10. Harris, A., Deacon, W. E., Tiedemann, 1. and Peacock, W. L. (1961):Pub!. HUh, Rep. (Wash.), 76, 93.11. Arya, O. P., Rao, S. K. and Knochiri, E. (1971): Brit. J. Yener.Dis., 47, 184.12. Ma awe, E. J. (1970): E. Afr. Med. J., 47, 673.13. Bergman, S. and Tarnvick, A. (1970): Acta derrn-venereo!. (Stockh.),50, 317.14. Lurie, S. S. and Kvassnaya, N. I. (1969): Yestn. Derrn. Yener., 43,46.

Diagnosis and incidence of neisseria gonorrhoeae in Cape coloured females in the Western Cape

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Diagnosis and incidence of neisseria gonorrhoeae in Cape coloured females in the Western Cape

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