Search

Background Emerging antimicrobial resistance (AMR) challenges gonorrhoea treatment and requires surveillance. Aim This observational study describes the genetic diversity of Neisseria gonorrhoeae isolates in Germany from 2014 to 2017 and identifies N. gonorrhoeae multi-antigen sequence typing (NG-MAST) genogroups associated with AMR or some patient demographics. Methods 1,220 gonococcal isolates underwent AMR testing and NG-MAST. Associations between genogroups and AMR or sex/age of patients were statistically assessed. Results Patients’ median age was 32 years (interquartile range: 25–44); 1,078 isolates (88.4%) originated from men. In total, 432 NG-MAST sequence types including 156 novel ones were identified, resulting in 17 major genogroups covering 59.1% (721/1,220) of all isolates. Genogroups G1407 and G10557 (G7072) were significantly associated with decreased susceptibility to cefixime (Kruskal–Wallis chi-squared: 549.3442, df: 16, p

In February 2019, the fourth expert meeting on rapid diagnostic tests (RDTs) for sexually transmitted infections (STI) was held at the Robert Koch Institute (RKI) in Berlin. Novel technical developments and new aspects of RDT applications were discussed by representatives from the German STI Society (DSTIG); RKI; the Paul Ehrlich Institute; national reference centers for HIV, HBV, and HCV; and reference laboratories for Chlamydia, gonococci, and Treponema pallidum.As a result of this meeting, we present a revision of the joint statement on STI diagnostics with RDTs from 2017. The Regulation (EU) 2017/746 of the European Parliament and of the Council on in vitro diagnostic medical devices became effective in May 2017 and includes more stringent regulatory requirements for RDTs, mainly concerning conformity of manufacturing processes and performance characteristics of class D in vitro diagnostics (detection of HIV, HBV, HCV, and T. pallidum). Some RDTs for HIV, HCV, and T. pallidum have been evaluated in clinical studies and/or were WHO prequalified and may be used in low-threshold services. Among them are some HIV RDTs available and approved for self-testing. In addition, some HBV RDTs based on detection of HBs antigen (HBsAg) received WHO prequalification. However, false negative results may occur in samples with low HBsAg levels, as for instance in HIV-coinfected patients receiving antiretroviral therapy. For Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), antigen-based RDTs still do not allow reliable detection of infection. Only PCR-based CT/NG RDTs possess sufficient diagnostic accuracy to be used as point-of-care tests. Rapid PCR tests for NG, however, do not provide any information about antimicrobial resistance.

Background German national guidelines recommend ceftriaxone combined with azithromycin for Neisseria gonorrhoeae (NG) treatment since 2014. The Gonococcal-Resistance-Network (GORENET) monitors gonococcal antimicrobial resistance (AMR) in Germany. The aim is to assess whether national guidelines are still effective in Germany and which factors affect higher minimum inhibitory concentrations (MICs). Methods GORENET laboratories sent NG isolates to the conciliar laboratory for centralized retesting of AMR using E-test. We included infection year, sex, age, infection site and clinical service type in the analysis. Geometric means were calculated for MICs for infection year. The effects of infection year, sex, age, infection site and clinical service type on MICs for ceftriaxone, cefixime, and azithromycin were investigated by multiple linear regression. Results Overall, 278 (2014), 303 (2015), 438 (2016) and 409 (2017) isolates were analysed. Of these, 90% of isolates came from men. Median age was 33 years (IQR: 25–44). Cumulative geometric means of MICs 2014–2017 were 0.006 µg/ml for ceftriaxone, 0.022 µg/ml for cefixime, and 0.185 µg/ml for azithromycin. In adjusted analysis, MICs decreased for ceftriaxone, cefixime and azithromycin by 0.74 (CI-95% 0.70–0.79), 0.89 (CI-95% 0.87–0.92) and 0.79 (CI-95% 0.75–0.83) per year, respectively. For ceftriaxone, isolates from urology (1.40; 95%-CI 1.15–1.69) and other service types (1.39; 95%-CI 1.10–1.77) compared to internal medicine, and from women (1.58; 95%-CI 1.14–2.18) were associated with increased MICs. Regarding cefixime isolates collected from urology (1.14; 95%-CI 1.02–1.28) compared to internal medicine, and from women (1.41; 95%-CI 1.18–1.69) were associated with increased MICs. For azithromycin, isolates from urology (0.82; 95%-CI 0.70–0.97) compared to internal medicine, and from women (0.77; 95%-CI 0.59–1.00) were associated with decreased MICs. Conclusion Treatment options as recommended by German national guidelines are still applicable. The lower MICs after 2014 may be due to the change of national treatment guidelines in 2014. Differences in MICs regarding service types and sex need to be further investigated. Disclosure No significant relationships.

Background The widespread antimicrobial resistance (AMR) of Neisseria gonorrhoeae (NG) is a serious problem for the treatment of gonorrhoea. Because NG infections are not reportable in Germany, only limited data on disease epidemiology and antimicrobial susceptibility patterns are available. The Gonococcal Resistance Network (GORENET) monitors trends of NG AMR in Germany and links this to epidemiological data and NG multiantigen sequence typing (NG-MAST) data to guide treatment algorithms and target future prevention strategies. Methods Between April 2014 and December 2018, NG isolates and data on patient-related information were collected from laboratories nationwide and centralized susceptibility testing using E-test was performed. Susceptibility results for cefixime, ceftriaxone, azithromycin, ciprofloxacin and penicillin were defined according to EUCAST 4.0 standards. Results Of 2115 isolates, 91.6% of isolates were from men. The most frequently tested materials among men were urethral (92.4%) and rectal swabs (3.8%), and among women mainly endocervical swabs (80.9%). Resistance to ceftriaxone (MIC ≥0.125 mg/L) occurred only sporadically (0–0.3%) during the entire observation period (2015 and 2018), while 1.0–2.1% of isolates were resistant to cefixime (MIC ≥0.125 mg/L). Proportion of isolates resistant to azithromycin (MIC ≥ 0.5 mg/L) was 11.4% (2014), 11.3% (2015), 4.3% (2016), 3.7% (2017), 9.4% (2018). 53.4–71.7% were resistant to ciprofloxacin, and 14.2–24.3.1% were resistant to penicillin. Conclusion Resistance to ceftriaxone and to cefixime was low, whereas azithromycin resistance showed a discontinuous presentation with partly high levels during the observation period. Rates of ciprofloxacin and penicillin resistance were very high. According to the current national guidelines, ceftriaxone 1-2g IV and azithromycin 1,5g orally are usually used in dual therapy. Shortly revised national guidelines will state that use of azithromycin should be avoided if possible if a test of cure can be guaranteed and a susceptibility test is available. Continued surveillance of NG AMR remains relevant to ensure efficient disease management. Disclosure No significant relationships.

Background Neisseria gonorrhoeae (NG) infections are not reportable in Germany. The Gonococcal Resistance Network (GORENET) is a laboratory network to monitor antimicrobial resistance (AMR) in Germany, linking data from sequence typing to epidemiological data. We described prevalence of gonococcal sequence types in Germany and associations to AMR to improve future treatment and prevention strategies. Methods NG isolates collected between April 2014 and December 2017 were tested by E-test and sequence typed by NG multiantigen sequence typing (NG-MAST). For sequence typing, DNA was extracted and internal fragments of porB and tbpB were amplified by polymerase chain reaction. Fragments were sequenced by Sanger sequencing and evaluated using a global database (www.ng-mast.net). Genogroups were assigned to sequence types which shared one allele and exhibited ≥99% homogeneity in the other allele. Results 1220 isolates were sequence typed (106 in 2014, 96 in 2015, 525 in 2016, and 495 in 2017). In total, we detected 422 different sequence types that grouped into 17 genogroups. Among the most prevalent genogroups were G2400 (6.8%), G1407 (6.8%), G5441 (6.2%), G25 (5.6%), G2992 (5.5%) and G10557 (5.3%). The multi-resistant G1407 and G2400 were most prevalent in 2014 (12.4% and 10.5%, respectively) and declined to 6.1% and 7.3% in 2017. Two new genogroups, G11461 (3.6%) and G17420 (2.1%), emerged showing high prevalence in 2017 and no association to extended-spectrum cephalosporin resistance. Furthermore, a novel genogroup-association with cefixime resistance and reduced cephalosporin susceptibility was identified. Conclusion From 2014 to 2017 prevalence of G1407 declined and two novel extended-spectrum cephalosporin sensitive clones G11461 and G17420 seem to have replaced the multi-drug resistance clone G1407. To verify these results, continuous testing with an increased number of isolates should be performed. Disclosure No significant relationships.

Bakterielle sexuell ubertragbare Infektionen (STI) zeigen seit Jahren weltweit eine deutliche Zunahme. In Deutschland wird diese Tatsache durch steigende Meldezahlen fur Syphilis bestatigt. Auch fur die nicht meldepflichtigen STI Gonorrhoe, Chlamydia-trachomatis- und Mycoplasma-genitalium-Infektionen wird eine zunehmende Inzidenz beobachtet. Entscheidend fur die Weiterverbreitung ist, dass das breite klinische Spektrum, welches neben Urogenitalsitus auch Pharynx und Rektum einbezieht, durch eine hohe Zahl asymptomatischer Verlaufe erganzt wird. Neue Real-Time-Multiplex-Diagnostikverfahren ermoglichen einen schnellen und gezielten Nachweis von STI-Erregern. Die haufigste bakterielle STI ist die urogenitale Chlamydieninfektion mit den Serovaren D-K, die besonders bei jungen Erwachsenen auftritt. Einer Chlamydien-Proktitis kann eine Infektion mit L-Serovaren und damit eine Lymphogranuloma-venereum (LGV)-Infektion zugrunde liegen. Neisseria (N.) gonorrhoeae zeigte in den letzten Jahren eine starke Resistenzentwicklung mit Ausbildung von Einzel- und Multiresistenzen gegenuber bisher gangigen Antibiotika. Daher ist fur N. gonorrhoeae zusatzlich zum nucleic acid amplification test (NAAT) eine kulturelle Empfindlichkeitstestung durchzufuhren. Auch fur Mycoplasma genitalium sind Resistenzentwicklungen bekannt, die eine Therapie erschweren konnen.

Worldwide, the incidence of bacterial sexually transmitted infections (STIs) has shown a significant increase in recent years. In Germany, this circumstance is reflected by a rise in the number of reported syphilis cases. There has also been an uptick in the incidence of non-notifiable STIs such as gonorrhea and infections caused by Chlamydia trachomatis and Mycoplasma genitalium. A key factor in the spread of these infections is their varied clinical presentation, which includes urogenital, pharyngeal and rectal involvement as well as a large number of asymptomatic cases. New real-time multiplex PCR methods allow for rapid and targeted detection of STI pathogens. The most common bacterial STI is urogenital chlamydial infection caused by serovars D-K, which affects young adults in particular. Lymphogranuloma venereum (LGV) caused by L serovars often presents as chlamydial proctitis. In recent years, Neisseria (N.) gonorrhoeae has shown a significant development of resistance, with high-level monoresistance and multiresistance to antibiotics commonly used for treatment. It is therefore imperative that sensitivity testing of N. gonorrhoeae be performed in addition to nucleic acid amplification tests (NAATs). Increased drug resistance has also been observed for Mycoplasma genitalium, a fact that complicates treatment.

Weltweit sind zunehmende Antibiotikaresistenzen (AMR) bei Infektionen mit Neisseria gonorrhoeae (NG) zu beobachten. Aufgrund der fehlenden Meldepflicht in Deutschland stehen kaum epidemiologische und bevolkerungsbezogene Daten zur Verbreitung von NG-Infektionen und deren AMR zur Verfugung. Ziel der hier vorgestellten Erhebung war die Erfassung der NG-Diagnostikmethoden und AMR-Testungen von Laboren in Deutschland. Zwischen Juni und August 2013 wurde eine Querschnittserhebung in Deutschland uber einen Online-Fragebogen durchgefuhrt. Labore mit NG-Diagnostik wurden identifiziert, um sie hinsichtlich der Diagnostikmethoden, des Probenumfangs, der getesteten Antibiotika, der beobachteten AMR sowie mit Blick auf allgemeine Laborangaben zu charakterisieren. Insgesamt fuhrten 188 von 521 teilnehmenden Laboren eine NG-Diagnostik durch. Ihre Angaben waren somit Grundlage fur die weiteren statistischen Auswertungen. 92,6 % der Labore fuhrten einen Kulturnachweis durch. Im Median wurden 60 Proben pro Quartal (PpQ) (IQR 15–270) getestet. Der Positivenanteil unter Mannern lag bei 4,1 % sowie 6,9 %. Die Mehrzahl (82,1 %) der 151 Labore mit Kulturnachweis fuhrte eine AMR-Testung durch. Die hier am haufigsten getesteten Antibiotika waren Ciprofloxacin (94,8 %), Penicillin (93,1 %), Doxycyclin (70,0 %) und Ceftriaxon (67,2 %). Die Antibiotika gegen die am haufigsten jemals Resistenzen beobachtet wurden waren Ciprofloxacin (87,1 %), Penicillin (78,3 %), Doxycyclin (56,6 %) und Azithromycin (35,1 %; alle Angaben als Protzentsatz der Labore). Es wurden unterschiedliche AMR-Ablesestandards verwendet. Die weltweite Resistenzentwicklung weist darauf hin, dass eine regelmasige Uberwachung von AMR bei NG-Infektionen erforderlich ist. Die im Rahmen der Studie erhobenen Daten zur deutschen Laborlandschaft bei der NG-Diagnostik bieten hierfur eine wichtige Voraussetzung.

Die Urethritis, mit typischen Symptomen wie Dysurie und Fluor, wird durch Bakterien, Pilze, Protozoen und Viren verursacht, die oft sexuell ubertragen werden. Aufsteigende Entzundungen konnen zu Sterilitat und schweren Krankheitsbildern fuhren. Erregereigenschaften und patientenspezifische Faktoren bestimmen den Verlauf. Bei Nachweis einer sexuell ubertragbaren Infektion (STI) ist immer die Untersuchung auf weitere STIs zu fordern. Die Gonorrhoe manifestiert sich an Schleimhauten des Urogenital- und Analtrakts, des Rachens und der Konjunktiven. Besorgniserregend ist die Entwicklung von Einzel- und Multiresistenzen. Derzeit wird die duale Therapie mit Ceftriaxon und Azithromycin empfohlen. Die urogenitale Chlamydien-Infektion (Serovare D–K) gehort zu den haufigsten STIs. Bei einer Proktitis sollte auch an eine LGV-Infektion gedacht werden. Zur Behandlung eignen sich Doxycyclin oder Azithromycin. Genitale Mykoplasmeninfektionen bestehen oft bei persistierender oder rezidivierender Urethritis. Zunehmend treten Resistenzen auf. Zur Behandlung wird Azithromycin empfohlen. Die Trichomoniasis gilt als STI mit der hochsten Pravalenz. Mittel der Wahl ist Metronidazol.

Diese venerischen Erkrankungen (STI) sind in Europa selten. Das Lymphogranuloma venereum (LGV), verursacht durch L-Serovare von Chlamydia trachomatis, verlauft in Stadien mit genitoanalen Ulzerationen und wird zunehmend bei MSM (men who have sex with men) mit HIV-Infektion angetroffen. Therapie der Wahl ist Doxycyclin. Im Spatstadium sind chirurgische Masnahmen erforderlich. Ulcus molle, hervorgerufen durch Haemophilus ducreyi, ist in den Tropen verbreitet. Klinisch findet sich ein dolentes Ulkus mit Lymphangitis. Therapeutisch wird Azithromycin eingesetzt. Bei HIV-Infektion kann es zu Therapieversagen kommen. Die Donovanosis, durch Klebsiella granulomatis verursacht, ist durch Ulzerationen und destruierende Granulome im Genitoanalbereich gekennzeichnet. Mittel der Wahl ist Azithromycin. Die Verbreitung des Zika-Virus erfolgt uber die Aedes-Mucke. Auch eine sexuelle Ubertragung ist moglich. Die Infektion kann beim Fotus zur Mikrozephalie fuhren. Eine Therapie gibt es nicht. Praventiv werden Muckenschutz und Gebrauch von Kondomen empfohlen.

Nazi anti-Semitism had a considerable impact on dermatology during the period 1933 to 1945. Before World War II, dermatology in German-speaking lands was at the forefront of medicine, and about 25% of the dermatologists were Jewish. Many perished during the Holocaust; others emigrated from Germany and played a major role in advancing dermatology in their new homes, especially in the United States. Erich Langer (1891–1957) was almost unique, because he survived the entire period in Berlin. Langer had been chief of dermatology at Berlin-Britz, a large city hospital, before 1933 but was discharged almost immediately after the Nazi takeover because of his Jewish roots. In June 1945 he returned to his old department and resumed charge. He became one of the key figures in rebuilding German dermatology in the immediate postwar years. He served as first chair of dermatology at the new Free University in Berlin, started two journals, and wrote several books. Until recently, very little was known about Erich Langer's mysterious tale of survival and how he evaded Nazi roundups. Fortunately, we have discovered considerable archival material that has allowed us to piece together, for the first time, a detailed account of Langer's courageous and remarkable story as the last Jewish dermatologist in Nazi Berlin.

Sexuell ubertragbare Infektionen (STI) sind ubiquitar verbreitet. Durch die zunehmende Globalisierung breiten sich Erreger mit den jeweiligen Resistenzen rasch kontinentubergreifend aus. Derzeit lassen sich dramatische Resistenzentwicklungen bei Gonokokken beobachten. Es besteht die Gefahr der Entwicklung multiresistenter Neisseria-gonorrhoeae-Stamme. Aus diesem Grund mussten die Therapieempfehlungen weltweit uberarbeitet werden. Bei der Syphilis ist ein deutlicher Anstieg der Erkrankungsfalle in Deutschland zu beobachten. Die Behandlung mit Penicillin ist unverandert wirksam, jedoch werden Resistenzen gegen Makrolide zunehmend problematisch. Fur Chlamydieninfektionen bestehen gut etablierte diagnostische und therapeutische Richtlinien. Besondere Beachtung findet ein Ausbruch von Lymphogranuloma venereum (LGV) in Europa unter MSM (men who have sex with men) mit gleichzeitiger HIV-Infektion.

Nachdem die Gonorrho mikrobiologisch nachgewiesen ist, lasst sie sich mit einer gezielten antibiotischen Therapie in der Regel gut heilen. Die Zunahme der Resistenz gegenuber mehreren verschiedenen Substanzklassen in den letzten Jahren erschwert jedoch die Behandlung

Background In most gonococcal populations, penicillin-resistant strains have increased dramatically and penicillin can no longer be recommended for the treatment of gonorrhoea. Cefixime is the first oral third generation cephalosporin and represents an alternative therapeutical approach. Objective To evaluate the in vitro activity of cefixime against a gonococcal population in Germany. Material 203 Neisseria gonorrhoeae strains, isolated in the area of Heidelberg between 1986 and 1990, including 14 penicillinase-producing Neisseria gonorrhoeae (PPNG) strains and five strains with chromosomally mediated penicillin resistance (CMPR). Methods Determination of minimal inhibitory concentration (MIC) of cefixime was performed by standard agar dilution technique. Auxotype/serovar (A/S) classification was performed by using Neisseria defined agar and 12 gonococcal outer membrane porin specific monoclonal antibodies in a coagglutination assay. Results The MIC range reached from ≤ 0.00025 μg/ml to 0.125 μg/ml cefixime. For both penicillin sensitive- and penicillin-resistant strains, the geometric mean MIC was 0.0048 μg/ml, MIC 50 0.002 μg/ml and MIC 90 0.008 μg/ml. Among gonococcal strains with an MIC of ≤ 0.001 μg/ml cefixime strains belonging to A/S class (P)AH(U)/IA-1/2 were significantly more frequent ( p 0.001 μg/ml. Conclusion Cefixime showed very high antimicrobial activity against Neisseria gonorrhoeae . All tested gonococcal strains were susceptible to cefixime. The A/S class composition of a tested gonococcal population influences very strongly the range of MICs.

Mycoplasmas are the smallest free-living organisms, widespread in nature. Several mycoplasma species have been isolated from humans. For 6 of them: Mycoplasma hominis, Ureaplasma urealyticum, M. primatum, M. genitalium, M. spermatophilum and M. penetrans, the genital tract is the main site of colonization. This review is concentrated on the role of mycoplasmas as sexually transmitted agents, with the emphasis to M. genitalium infections. M. hominis and U. urealyticum are isolated from the genital tract of healthy men and women with considerable frequency. The biological features (attachment properties, possible intracellular location) and experimental inoculation studies of M. genitalium indicate that this mycoplasma has pathogenic potential. Data from case-control studies, looking at men with non-gonococcal urethritis and women with cervicitis, have revealed that M. genitalium behave similarly to Chlamydia trachomatis and have revealed that carriage of M. genitalium and C. trachomatis is usually independent of one another. M. genitalium could be considered as a potential cause of sexually transmitted urethritis in men, including men with persistent or recurrent urethritis. More studies are expected to ascertain the role of M. genitalium in the female genital tract. Evidence-based data are needed to decide whether current non-gonococcal infection treatment principles are applicable or not for M. genitalium infections.

Background Cutaneous lymphadenoma is a recently recognized unusual tumor. It presents as an indistinct solitary non-ulcerating dermal nodule occuring mostly in the head and neck region of middle aged persons. Its histogenetic definition is controversial and recently it has been proposed that it might represent an unusual inflammatory basal cell carcinoma. We present clinical, histological and immunohistochemistry data of two cases. For the first time lectin-immunohistochemistry of cutaneous lymphadenoma is reported on. Observations One tumor was located on the eyebrow of a 37 years old, the other on the nose of a 75 years old male patient. Slow growth over years occured. Histology showed biphasic pattern of elongated and angulated lobules with peripheral rim of basaloid cells and central network of lymphohistiocytic cells with preponderance of protein S 100-positive cells. Peanut agglutinin (PNA) did not show peripheral staining around tumor lobules as seen in basal cell carcinoma. Conclusions Clinical and histological features as well as absence of peanut agglutinin staining argue in favor of the distinction of cutaneous lymphadenoma from inflammatory basal cell carcinoma. The former probably represents a benign growth of adnexal origin.

Protein I has become the basis of serotyping of N. gonorrhoeae. A panel of 12 anti-protein I monoclonal antibodies is supplied by Syva Company, Palo Alto, CA, through distributors for research purposes only. These distributors are responsible for storing the monoclonal antibodies, supplying research groups and training new users, particularly in the interpretation of coagglutination reactions. A European Workshop was held in Heidelberg, Federal Republic of Germany in July 1988 to discuss serotyping with these antibodies. The current uses of serotyping of N. gonorrhoeae include epidemiological studies, clinical purposes and surveillance of antibiotic resistance and plasmid carriage. Predominant serovars may be subtyped either by additional antibodies or with the use of another technique, such as auxotyping, determination of antibiotic sensitivities, plasmid analysis or genetic fingerprinting. Conversely, there is growing evidence that it may be appropriate to group certain serovars together. Data collected during prevalence studies could be combined with clinical information and an international data bank set up. This supposes a close future collaboration of all groups involved in the epidemiology of N. gonorrhoeae.

In dealing with sexually transmitted diseases (STDs) in childhood, the physician carries a special responsibility involving questions of jurisdiction and professional laws. Taking into consideration the age of the child, the sexually transmittable agent, and the localization of the infection helps in assessing the possibility of sexual abuse.

Seit Einfuhrung der hochaktiven antiretroviralen Therapie (HAART) in die Behandlung der HIV-Infektion und der damit verbundenen zeitweiligen Therapierbarkeit dieser todlich verlaufenden sexuell ubertragbaren Krankheit (STD), scheint trotz aller staatlicher Praventionsmasnahmen ein eher unbekummerter Umgang und ein mehr und mehr schwindendes Bewusstsein in der Bevolkerung fur STDs zu bestehen. Kennzeichnend fur diese Entwicklung ist das gehaufte Wiederauftreten der Syphilis in Teilen Europas und den USA. Daher kommt dem Facharzt fur Dermatologie und Venerologie eine zentrale Rolle nicht nur in Diagnostik und Therapie von STDs, sondern auch im Rahmen der Aufklarung seiner Patienten und der Sekundarpravention zu.

The German Registry of Adamantiades-Behcet’s disease founded 1990 in Berlin provides current data on the epidemiology, the clinical manifestations and the course of the disease in Germany on a continuous basis. A total number of 265 patients, including 106 German and 119 Turkish patients, has been reported to the German Registry until December 1998. Two hundred thirty-four patients fulfilled the criteria of the Behcet’s Disease Classification Tree. The prevalence of the disease evaluated in Berlin-West was 1.68/100,000 in 1989 and had risen to 2.26/100,000 in 1994. The median age of onset was 25 years (range 4 months to 72 years; German-Turks, ns). Juvenile disease was recorded in 6.3% of the patients. The complete clinical picture according to the criteria of the International Study Group of Behcet’s disease developed in 13 months. The interval between onset of the disease and diagnosis was 32 months, which was significantly longer than the duration of the development of the complete clinical picture (p

Die folgenden Empfehlungen beschranken sich auf die Abklarung von sexuell ubertragbaren Krankheiten im Kindesalter. Die psychosozialen Aspekte eines sexuellen Missbrauchs von Kindern sind wichtig, konnen aber hier nicht abgehandelt werden.

Eine sexuell erworbene mannliche Urethritis kann durch eine Reihe verschiedener Erreger verursacht werden. Die urethralen Beschwerden sind im allgemeinen zu unspezifisch, um daraus auf die Art des Erregers schliesen zu konnen. Deswegen ist die atiologische Einordnung einer Urethritis die entscheidende Voraussetzung fur ihre erfolgreiche Behandlung [1].

Six months after the occurrence of pyoderma gangrenosum, subcorneal pustular dermatosis developed in a 60-year-old woman. The patient's serum was found to contain an IgA-lambda paraprotein. Although similar cases have been reported, this case is unique in that a distinct episode of pyoderma gangrenosum was followed by subcorneal pustular dermatosis.

Seven monoclonal antibodies have been used for the serotyping of one hundred Neisseria gonorrhoeae wild strains, randomly selected from nine U.S. cities, and seven serotype reference strains by the co-agglutination method. As determined by gel-immunoradioassay, the monoclonal antibodies recognized the protein I trimer of a single or a limited subset of serotype reference strains. All but three strains were typable by one or two of the antibodies. The most common serotypes were 1.3 (26%), 1 (20%), 5 (17%), 5.7 (11%) and 9 (10%). To correlate typing results with ability for killing of these antibodies, susceptibility of typed and non-typed strains to killing was studied. Susceptibility was significantly associated with typing by the serotype 7 (p = 0.011) and serotype 9 (p = 0.033) specific monoclonal antibodies. Reaction of antibodies recognizing epitopes on the protein IB molecule with a given strain predicted in an average of 43% of strains (49% of strains of serotype 5, 62% of serotype 7, 29% of serotype 8, and 33% of serotype 9) its susceptibility to killing by the typing antibodies. In contrast, only 15% of the strains (15% of strains of serotype 1 and 15% of serotype 3) were killed by their typing antibodies, recognizing epitopes on the protein IA molecule. These monoclonal antibodies might prove to be important for the isolation and structural characterization of epitopes responsible for susceptibility of the gonococcus to killing and thus for the development of a vaccine against invasive gonococcal disease.

179 gonococcal strains isolated from prostitutes with single or multiple uncomplicated cervical infections in 1982–84 were analysed for presence of chromosomally mediated resistance to penicillin or tetracycline and were characterized according to auxotype and serovar. As a control group, 41 cervical isolates from non-prostitute females with uncomplicated cervical infection isolated in the same time period were examined. We found 54 different auxotype/serovar classes among prostitutes. Eight classes contained 58% (103/179) of the isolates. 43 classes were represented by only one to three isolates. Resistance to penicillin (MIC ≧ 1 µg/ml) was present in 2% (4/179) and resistance to tetracycline (MIC ≧ 1 µg/ml) in 29% (51/179) of the prostitute isolates. There was no difference in the distribution of auxotype/serovar classes and of antibiotic resistance between prostitutes with single and with multiple infections.

Summary A biotinylated DNA probe combined with a streptavidin-peroxidase complex for the identification of culture isolates of N. gonorrhoeae (Ortho diagnostic systems, Neckargemund, FRG) was compared with the conventional carbohydrate utilisation test as reference. All 118 strains identified by the reference method as N. gonorrhoeae also gave positive reactions with the DNA hybridisation assay. However, with this test 2 of 23 non-gonococcal Neisseria or Branhamella species were identified as N. gonorrhoeae as well. The study shows that the DNA hybridisation technique can principially be used for the confirmatory identification of N. gonorrhoeae , but since specificity is particularly essential for confirmatory identification, the DNA hybridisation assay evaluated cannot be recommended for routine diagnosis.

Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP). To investigate the reasons for this development, we-on behalf of the DGP-sent a questionnaire to 120 German Departments of Dermatology in autumn 2012. In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments. Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available., Hintergrund Venenleiden sind eine Volkskrankheit und haben eine enorme sozioökonomische Bedeutung. Dennoch scheint der Anteil der phlebologisch tätigen Dermatologen entsprechend den Zahlen der Deutschen Gesellschaft für Phlebologie (DGP) abzunehmen. Methoden Um die Ursachen dieser Entwicklung zu untersuchen, führten wir im Herbst 2012 im Auftrag der DGP eine Befragungsstudie zur Phlebologie an 120 deutschen Hautkliniken durch. Ergebnisse In 76 antwortenden Klinien gab es im Mittel 1,5 Phlebologen und 0,9 Ärzte mit Voraussetzungen zur Weiterbildungsermächtigung Phlebologie. In 71,1 % der Kliniken gab es einen Phlebologen, in 73,7 % eine phlebologische Sprechstunde. Zur Diagnostik wurden besonders die Doppler- (89,5 %) und Duplexsonographie (86,8 %) eingesetzt. In der Therapie führte die Kompressionstherapie (94,7 %), gefolgt von Sklerosierungstherapien (flüssig 78,9 %, Schaum 63,2 %, Katheter 18,4 %), den endoluminalen thermischen Verfahren (Radiowelle 28,9 %, Laser 17,1 %) und den operativen Eingriffen (vor allem Cross- und Saphenektomie 67,1 %, Seitenastexhairese 75 %). Die durchschnittlichen Behandlungszahlen waren sehr heterogen. Schlussfolgerung Die Phlebologie spielt in der Dermatologie weiterhin eine wichtige Rolle. Mehrheitlich sind in den Kliniken die Möglichkeiten zur Weiterbildung Phlebologie gegeben. Es wird ein breites Spektrum an phlebologischen Techniken zur Diagnostik und Therapie angeboten.

The German Registry of Adamantiades-Behcet's disease was founded in 1990 in Berlin and it provides current data on the epidemiology, the clinical manifestations and the course of the disease in Germany on a continuous basis. A total of 218 patients, including 89 German and 100 Turkish patients, had been reported to the German Registry until October 1997. One hundred and ninety-six patients fulfilled the criteria of the Behcet's disease classification tree. The prevalence of the disease evaluated in Berlin-West was 1.68/100,000 in 1989 and had risen to 2.26/100,000 by 1994. The median age of onset was 25 years (range 5 to 66 years; German-Turks, ns). Juvenile disease was recorded in 6.9% of patients. The complete clinical picture according to the criteria of the International Study Group of Behcet's Disease developed in 15.5 months. The interval between onset of the disease and diagnosis was 35 months, which was significantly longer than the duration of the development of the complete clinical picture (p < 0.0001). The disease was diagnosed later in German (48.5 months) than in Turkish patients (25.5 months, p = 0.003). While German patients presented an equal male-to-female ratio, a male predominance was shown in Turkish patients (M:F 2.1:1, p = 0.022). Familial occurrence was detected in 2.0% of German and 15.9% of Turkish patients (p = 0.013). The frequencies of major clinical manifestations were: oral ulcers 99%, skin lesions 76%, genital ulcers 75%, ocular manifestations 59%, arthritis 59%, and positive pathergy test 52%. Clinical differences between German and Turkish patients were only found in the frequency of ocular lesions (48% vs. 66%, p = 0.025). Oral ulcers were with 72% the most common onset symptom of the disease followed by erythema nodosum (9%), uveitis (7%), arthritis (7%), genital ulcers (3%), superficial thrombophlebitis (2%) and papules/sterile pustules (2%). Uveitis and erythema nodosum as onset symptoms shortened the median interval to diagnosis to 1.5 and 15 months, respectively, while arthritis delayed diagnosis (43.5 months; p = 0.029). A severe course developed in 25% of the patients; irreversible retinal vasculitis to blindness in 15%, sterile meningoencephalitis in 8%, severe arthritis in 5%, hemoptysis in 2%, lethal outcome in 2% and bowel perforation in 1%. The relative risk of HLA-B5 positive German natives developing the disease. HLA-B5 was confirmed as a marker of severe prognosis. Cardiolipin autoantibodies were associated with cutaneous vasculitis and superficial thrombophlebitis was correlated with systemic vessel involvement.