淋菌性感染症の疫学的・治療学的研究(1) --持続性アモキシシリン(L-AMPC)による検討--

Abstract

1981年10月～1982年2月の間の札幌での淋菌性感染症178例(男158例, 女20例)につき, 疫学的, 治療学的に研究した.男158例は全例急性尿道炎で, 最年少は15歳で, 10歳代が20.3%であった.男子例の感染源は, 10代では, ほとんどがディスコなどでpick upしたかりそめの女友達であるが, 20歳代はトルコ, バーなどの接客婦がふえ, 25歳以上ではそれが半数以上となる.最近ふえ続けるトルコ風呂接客婦の占める割合が多くなっている.女子20例中1例は1歳の腟外性器炎を除き子宮頸管炎で, 16～19歳が半数を占めた.潜伏期がはっきりしている男141例で中, 5日以内83例, 6～10日39例, 11～20日13例, 21～30日4例, 30日以上2例と潜伏期の長いものが増えつつある.また菌量106 cells/ml接種で, MIC 1.56 μg/ml以上の12株はβ-lactcmase産生株であった.このβ-lactamase産生株は同時にDoxycyclin (DOXY)のMICはすべて1.56 μg/ml以上で, AMPCとDOXYとの耐性獲得機序の相関性を示した.男133例, 女15例に持続性アモキシシリン(L-AMPC) 1 g/日(500 mg×2)を原則とし7日間投与し, L-AMPCによる淋菌性感染症の治療プランを提唱した

During the period from October of 1981 through March of 1982, our research group in Sapporo treated 178 patients (158 males and 20 females) for gonorrheal infections. We performed epidemiological and therapeutic studies on these patients. The youngest of the 158 male patients with acute gonorrheal urethritis was 15 years old. The age distribution was 32 patients (20.3%) under 20 years, 46 patients (29.1%) aged 20 to 24, 34 patients (21.5%) aged 25 to 29, 22 patients (13.9%) aged 30 to 34, 10 patients (6.3%) aged 35 to 39, and 14 patients (8.9%) aged 40 to 54. The fact that 20% of gonorrheal urethritis occurred in youths under 20 years of age, is especially noteworthy. The infection in the teenage boys was found to be picked up mostly from girls met at discos , etc., On the other hand, the patients in their 20s, were infected more frequently by contact with hostesses at massage parlors and bars, these sources making up the majority of male patients who were 25 years or older. These findings are quite interesting because they reflect the socio-economic status of the patients. In addition, the fact that hostesses working at massage parlors are a frequent source of gonorrheal urethritis infections can represent a considerable problem in terms of public hygiene. The 20 female patients with gonorrheal infections were all found to be cases of cervicitis, except for a 1-year-old girl with gonorrheal infection of external genitals. The fact that about half of these female patients were teenagers, aged 16 to 19 years is worth special note. The duration of the latent period was less than 5 days in 83 male patients (58.9%) with urethritis, 6 approximately 10 days in 39 patients (27.7%), 11 approximately 20 days in 13 patients (9.2%), 21 approximately 30 days in 4 patients (2.8%), and over 30 days in 2 patients (1.4%), It can thus be said that the number of cases showing a long incubation period is increasing. The MICs of 154 gonococci strains isolated from the urethral or vaginal discharge were determined. Thirteen (8.4%) of these clinically isolated strains were found to be beta-lactamase producers. When a bacterial inoculation level of 10(6) cells/ml was used in the in vitro MIC determination, the MIC was 1.56 micrograms/ml or higher for 12 of these beta-lactamase-producing strains; the MIC of the 13th strain was 0.78 microgram/ml. At the same time, the MICs of these beta-lactamase-producing strains to doxycycline were also high; 1.56 micrograms/ml or higher.(ABSTRACT TRUNCATED AT 400 WORDS)