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Herpes zoster is common in the elderly. Persons over the age of 50 years have an attack rate double that of patients less than 50 years old. In the very aged, this rate nearly doubles again. The loss of cell‐mediated immunity for the VZ virus appears to be the primary factor in the disruption of the dynamic containment process responsible for VZ virus latency within the sensory ganglion. Humoral immunity may play a role in the maintenance of latency, but the degree is unproven, except in the case of dissemination where loss of detectable antibodies seems to correlate with extradermatomal dissemination. Severe forms of the disease and its complications, e.g., postherpetic neuralgia, are likely among the elderly. Direct im‐munofluorescent staining or cytologic examination is useful for early diagnosis, and serologic changes can document the confusing clinical entity of zoster sine herpete.

There were 50 patients with acute epididymitis who were evaluated prospectively by history, examination and microbiologic studies, including cultures for aerobes, anaerobes, Neisseria gonorrhoeae, Chlamydia trachomatis and Ureaplasma urealyticum. Escherichia coli was the predominant pathogen isolated from the urine of men more than 35 years old, while Chlamydia trachomatis and Neisseria gonorrhoeae were the predominant pathogens isolated from the urethra of men less than 35 years old. The etiologic role of Escherichia coli and Chlamydia trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine or urethral cultures for these agents. Chlamydia trachomatis epididymitis accounted for two-thirds of idiopathic epididymitis in young men and often was associated with oligospermia. Of 9 female sexual partners of men with Chlamydia trachomatis infection 6 had antibody to Chlamydia trachomatis, of whom 2 had positive cervical cultures for this organism and 2 others had non-gonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with Chlamydia trachomatis epididymitis and should be offered to the female sex partners

In a case-control study of matched pairs, the risk of acute pelvic inflammatory disease (PID) was 4.4 times higher in intrauterine contraceptive device (IUD) users than in nonusers (p < 0.001). Of approximately 500,000 cases of acute PID occurring annually in the United States, an estimated 110,000 are attributable to IUD's, costing over forty-four million dollars per year. PID was attributable to the IUD in 77 per cent of IUD users. No particular type of IUD was implicated. The relative risk of acute PID in IUD users over nonusers was higher in nulligravid women than in previously pregnant women and was directly related to socioeconomic status (SES), but the total annual risk of PID in IUD users appear inversely related to SES. IUD use significantly increased the risk of nongonococcal PID. Fever occurred in 13 (21 per cent) of 61 IUD users and 59 (41 per cent) of 143 nonusers (p < 0.025). Among women with nongonococcal PID, and adnexal mass ≥ 6 cm. was noted in 14 (40 per cent) of 35 IUD users and in only 12 (15 per cent) of 78 nonusers (p < 0.01). An increased risk of gonococcal PID was found among non-Caucasians and women not using contraception, while the risk of nongonococcal PID was increased among women with a past history of gonorrhea. Oral contraceptive use may protect women with gonorrhea from developing PID. Menstruation precipitates the onset of symptoms of gonococcal PID.

SEATTLE-KING County has experienced an outbreak of diphtheria since 1972.1 It has been characterized mainly by cutaneous diphtheria among alcohol-using indigent adults in Seattle's Skid Road area. During this period, 749 cases and carriers of diphtheria were identified, and one, described here, was an unusual case of chronic intermittent cutaneous diphtheria.MethodsFor three years the patient was often seen at one of five health facilities: Harborview Medical Center (HMC), Seattle-King County Health Department Communicable Disease Control Clinic, Seattle City Jail, Seattle Indian Health Clinic, and Pioneer Square Neighborhood Health Center. There, the patient's skin lesions were swabbed with a sterile cotton-tipped applicator, and the material was either directly inoculated onto blood agar, tellurite, and Loeffler's blood culture media, or, in several of the facilities, Amies transport medium without charcoal was used initially. Nasopharyngeal and throat cultures were also obtained when the patient was examined at the Health Department.

The prevalence rates of serum hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs) were 5.6% and 34% in 144 homosexual men in Seattle. Prevalence rates were only 0.9% and 3.6% in 111 heterosexual male venereal disease clinic patients with nongonococcal urethritis, and also 0.9% and 3.6% in 111 healthy men undergoing routine physical examinations. Thus, previous exposure to hepatitis B virus (HBV) was estimated to be 8.8 times greater for homosexual men than for heterosexual men. Four of four HBsAg positive sera from homosexual men were subtyped as "ad," whereas subtype "ay" is preponderant in intravenous drug abusers. Future public health measures to control HBV infection should address the prevention of sexually transmitted HBV infection among homosexual men.(JAMA 238:2625-2626, 1977)

Between 1972 and 1982 Seattle experienced a diphtheria outbreak involving 1,100 cases, primarily adults with cutaneous lesions. Biotyping revealed three consecutive overlapping outbreaks including 433 toxinogenic intermedius cases. Isolates from each quarter year were examined for DNA restriction fragment patterns and hybridization patterns with three DNA probes. All intermedius outbreak isolates appeared identical in all analyses and most stock cultures had the outbreak DNA fragment pattern, but DNA probes detected six patterns within 11 intermedius stock cultures. The mitis outbreak was heterogeneous, involving at least five restriction fragment patterns. In contrast, DNA restriction fragment analyses indicated that 22 of 25 gravis outbreak isolates belonged to a single strain, whereas there were seven strains within eight gravis stock cultures. DNA probe analyses of gravis outbreak isolates detected seven different patterns, five involving copy numbers of the toxB fragment and attB sites that presumably reflected lysogenic events that occurred during the outbreak.

Among men and women treated in Seattle for uncomplicated gonorrhea with single doses of 2.4 and 4.8 million units, respectively of aqueous procaine penicillin G, treatment failure was noted within one week in 15.4% of men and in 10.4% of women. Failure rates were reduced significantly to 1.8% of men and 3.7% of women when 1.0 g of oral probenenicid was given simultaneously with the penicillin injections. The risk of failure was dependent on the resistance to penicillin of Neisseria gonorrhoeae isolated before treatment. Failure rates, which can be expected when penicillin is used without probenecid, have been calculated for each level of gonococcal resistance to penicillin and can be used in other regions to predict the efficacy of these doses of penicillin.