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In a preliminary study of the transmission rate of Ureaplasma urealyticum, Mycoplasma species, Gardnerella vaginalis, B-Streptococci, Candida species and Chlamydia trachomatis from the mother to the newborn, swabs were taken from 45 parturients and their neonates and cultured by suitable methods. Out of 30 parturients with a positive culture, 8 harboured more than one microorganism investigated. U. urealyticum was found in 11 newborn and all of them had a positive mother. Candida spp. were found in 4 newborn, but 3 of these had a negative mother. G. vaginalis was detected in only 1 infant and the mother was negative. C. trachomatis was not isolated from any mother but was present in 2 newborn infants. Thus only U. urealyticum showed clear evidence of transmission from mother to baby.

The serovares D-K of Chlamydia trachomatis (CT) are associated with inclusion conjunctivits, non-gonoccoccal urethritis (NGU), post-gonoccoccal urethritis (PGU), epididymitis, and ensuing male infertility. CT can be isolated from testicular tissue, in sexually acquired reactive arthritis (SARA) and in proctitis. Female partner infection primarily involves the cervix with ascending infection and ensuing infertility. Asymptomatic CT infection of the urogenital tract does not only present epidemiological problems, but also calls for smear examination in the asympotomatic partner. Double infection with CT and Neisseria gonorrhoeae is not necessarily followed by PGU. Incomplete detection of CT must be taken into account especially after application of penicillin and in the isolation procedures from sperm. The serovares L1-L3 are the infectious agents in venereal lymphogranuloma. Tetracyclines and erythromycin are usually recommended as the therapy of choice in CT infection. Sulfonamides should be applied with caution, since resistent CT isolates have been made known. There is still further clinical study required regarding the efficacy of quinolines in urogenital infections with chlamydiae.

Gardnerella vaginalis, a sexually transmittable organism, is regarded as the indicator of the so-called "non-specific vaginitis". The isolation rate of G. vaginalis from 72 women attending our out-patient department during one year because of urogenital complaints was higher in pretreated than in untreated patients. In genital swabs taken from untreated patients, G. vaginalis could be isolated only in 17%, whereas this was observed in 38% of the specimens from women pretreated with various antimicrobial agents. In 9% of the women without vaginal discharge G. vaginalis was isolated. In specimens obtained from 53% of the women positive for G. vaginalis further organisms such as Chlamydia trachomatis, Trichomonas vaginalis, Candida albicans, Ureaplasma urealyticum, Mycoplasma spp. and B-Streptococci could be isolated. Asymptomatic infections with Neisseria gonorrhoeae (1) and C. trachomatis (4) were also observed. The present study clearly demonstrates that a broad microbiological examination is essential for specific therapy in vaginitis. Even if unspecific vaginitis is diagnosed by the presence of clue-cells, increased vaginal pH and fishy odour, a combined infection by further sexually transmittable organisms, especially N. gonorrhoeae, is to be excluded.

In 589 males, 169 with and 420 without urethritis, urethral swabs were taken and assessed semiquantitatively for the sexually transmittable infectious agents Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Trichomonas vaginalis and Candida species. The organisms were isolated in patients with and without urethritis as follows: N. gonorrhoeae with urethritis 19.5%, without 0.0%; C. trachomatis with urethritis 16.0%, without 2.9%; U. urealyticum (high cfu-counts) with urethritis 27.2%, without 11.7%; M. hominis (high cfu) with 4.7%, without 2.9%. Combined infections were more frequent in males with urethritis (20.8%) than in those without (5.4%). None of the investigated pathogenic microorganisms could be demonstrated in 37.9% of males with and in 71.2% of males without urethritis. Using loglinear analysis, a significant coincidence of infections with N. gonorrhoeae and U. urealyticum and of infections with U. urealyticum and M. hominis was found. It is concluded that an asymptomatic infection of the male urethra with sexually transmittable organisms is to be expected in partner's control examinations and in patients presenting for other STD like venereal warts or genital herpes. Therefore in these men, even if they are asymptomatic, a comprehensive microbiological examination is strongly recommended.

Urethral swabs from 322 men without urethritis, 73 of whom had venereal warts (condylomata acuminata, CA) and 249 who had none, were investigated between 1981 and 1984 by microscope and culture for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma species, Trichomonas vaginalis, Garderella vaginalis, B streptococci, aerobic pathogenic bacteria and Candida species. The isolation frequencies in patients with and without CA were as follows: N. gonorrhoea: with CA 0%, without 0.4%; C. trachomatis: with CA 6%, without 4.4%; U. urealyticum in high CFU: with CA 15%, without 17.7%; Mycoplasma spp. in high CFU: with CA 6%, without 4%; T. vaginalis: with CA 0%, without 0.4%; G. vaginalis: with CA 4%, without 5%; B streptococci: with CA 4%, without 6%; Candida spp. only in low CFU: with CA 3%, without 2.4%.--The results indicate that as far as the isolation frequencies of sexually transmittable pathogens in the urethra are concerned, there are no significant differences between patients with CA and asymptomatic patients presenting to an STD department. However, N. gonorrhoeae was significantly less frequently isolated and C. trachomatis and U. urealyticum significantly more frequently isolated in our patients than has been reported in previous studies.

In a prospective study, urethral swabs were taken from 544 men presented to an STD clinic, 118 with and 426 without urethritis, and examined by microscope and/or culture for G. vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum, Mycoplasma hominis, Candida species and Trichomonas vaginalis. G. vaginalis was isolated from 4.2% of the males with urethritis and from 6.3% of those without urethritis. Using loglinear analysis, the following associations were significant (p less than 0.05): three-way: G. vaginalis, U. urealyticum, C. trachomatis; two-way: G. vaginalis, U. urealyticum and G. vaginalis, M. hominis and U. urealyticum, M. hominis. It is concluded that G. vaginalis is associated with genital mycoplasmas not only in the female, but also in the male urogenital tract.

The Gardnerella vaginalis infection of the urogenital tract, an STD, is of clinical importance in females and of epidemiological importance in males. Females suffer from vulvovaginitis amine colpitis, with a bad-smelling grey vaginal discharge with a pH of 5.0-5.5, which contains "clue cells". The urethra of males is often asymptomatically infected. The identification of G. vaginalis is time-consuming and requires a lot of material. Isolation and identification of G. vaginalis can not yet be made in the routine examination of outpatients suffering from urogenital tract infections. If the diagnosis is based on signs such as bad-smelling grey discharge containing "clue cells", and the increase in pH about 20% false-positive and 20% false-negative results will be obtained. If G. vaginalis is isolated, simultaneous infections with further agents such as Chlamydia trachomatis, Neisseria gonorrhoeae etc., Trichomonas vaginalis, Candida species and HSV 2 should be excluded. Metronidazole (1 g/day for 5 days) is the drug of first choice in G. vaginalis infection.