Infection with multiple sexually transmitted agents.

A patient named as a contact by an individual with gonorrhea and syphilis was found to be an asymptomatic carrier of seven organisms known to be transmitted sexually. Cultures were positive for Neisseria gonorrhoeae, Chlamydia trachomatis, Gardnerella vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, and Herpes simplex virus. Trichomonas vaginalis was detected by a wet preparation and the Papanicolaou smear. The cervix was found to have an ulcer on the posterior lip that yielded Herpes simplex on culture. Although the venereal disease reaction level (VDRL) and the fluorescent treponemal antibody-absorption tests (FTA-ABS) were negative, and treponemes were not identified on dark-field microscopy, a Jarisch-Herxheimer reaction on this patient raised the possibility that she also had incubating syphilis.