JOURNAL OF CLINICAL MICROBIOLOGY, Dec. 1975, p. 498-503Copyright C 1975 American Society for Microbiology

Vol. 2, No. 6Printed in U.SA.

Improved Transport System for Neisseria gonorrhoeae inClinical SpecimensDOROTHY A. SYMINGTON

Ontario Ministry of Health, Provincial Public Health Laboratory, Toronto, Ontario, M5W 1R5 Canada

Received for publication 10 September 1975

Protective transport media have to be used to preserve Neisseria gonorrhoeaein clinical specimens during their transit to the laboratory. In this study, a C02-environment chamber, the Jembec chamber, was used for transport of clinicalspecimens requiring examination for gonococci. The survival ofN. gonorrhoeaepresent in clinical specimens when placed in Amies charcoal transport mediumwas compared to their survival when inoculated into Jembec chambers contain-ing either modified Thayer-Martin medium (MTM) or modified New York Citytransport medium (MNYC). For a period of up to 2 days in transit, the threesystems were not significantly different. However, after 3 days in transit,MNYC/Jembec chambers preserved significantly more gonococci than Amiescharcoal transport medium (P < 0.0001) or MTM/Jembec chambers (P = 0.006).MNYC/Jembec chambers withstood 241 miles (386 km) of postal transit duringwinter months; 80% of the gonococci present in clinical specimens remainedviable from 2 to 5 days under these conditions. The CO2 generated by the tabletin the Jembec chamber was sufficient to support the growth ofN. gonorrhoeae ifthe chambers were incubated at 36 C immediately after inoculation. However, ifdelayed in transit, the chambers had to be incubated in 5 to 10% CO2 to promotethe growth of N. gonorrhoeae. MNYC/Jembec chambers provide a selectiveenvironment that will protect and maintain the viability of N. gonorrhoeae forextended periods, allowing a reasonable time for postal transit of clinical speci-mens to the laboratory.

Gonorrhea is now recognized as one of themost prevalent communicable diseases inNorth America. The causative organism, Neis-seria gonorrhoeae, is a quite fastidious bacte-rium that autolyzes rapidly. In clinical speci-mens, the preservation and culturing ofN. gon-orrhoeae is further complicated by the presenceof numerous, faster-growing commensal orga-nisms. Ideally, clinical specimens should be di-rectly inoculated onto a suitable gonococcal cul-ture (GC) selective medium and immediatelyincubated at 36 C in 5 to 10% CO2. However,the necessary facilities are not available in phy-sicians' offices or in most venereal disease clin-ics.

Protective transport systems have to be usedto preserve N. gonorrhoeae in clinical speci-mens during transfer to the laboratory for cul-turing. For many years the type of transportsystem used was a nonnutrient, semisolid,buffered-agar medium, initially described byStuart (16) and subsequently modified by otherauthors (1, 15). More recently, the Transgrowsystem used was a non-nutrient, semisolid,a combined transport and culture medium forN. gonorrhoeae and N. meningitidis, has been

used in some areas of North America. AlthoughTransgrow medium has proved to have somevalue in the bacteriological diagnosis of gonor-rhea, it does have several important shortcom-ings. Commercial preparations of Transgrowhave been found to contain variable C02 concen-trations (3), and different batches of the me-dium vary in their ability to support growth ofN. gonorrhoeae. Condensation frequently accu-mulates inside the bottles, blocking visibility ofgrowth on the slope. This moisture also contrib-utes to the spreading ofcontaminants and inter-feres with the formation of isolated colonies.Inoculation and subculturing of coloniesthrough the narrow bottle neck is awkward.

Recently Martin et al. (9) described a newsystem called "Gono-Pak" for cultivation of N.gonorrhoeae. This system consists of a petriplate containing modified Thayer-Martin me-dium (MTM), which is inoculated, then sealed,in a plastic bag along with a C02-generatingtablet. Holston et al. (8) evaluated this systemin a clinical trial and found it to be as efficientas the CO2 atmosphere in a candle jar for sup-porting growth of N. gonorrhoeae. In a pre-vious study (17) we found that the Gono-Pak

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TRANSPORT SYSTEM FOR N. GONORRHOEAE 499

system with a petri plate containing modifiedNew York City transport medium (MNYC) (7)was suitable for both transportation and incuba-tion ofN. gonorrhoeae.A rectangular plastic plate with a small well

to accommodate a C02-generating tablet is nowmarketed as a Jembec plate (Ames Co., Divi-sion of Miles Laboratories, Elkart, Ind.). Thisplate and a C02-generating tablet, sealed in a

plastic "zip-lock" pouch, provides a CO2 environ-ment chamber that will be referred to as a

Jembec chamber (Fig. 1). Jembec plates con-taining prepoured MTM medium are marketedas Neigon plates by Flow Laboratories Inc.,Rockville, Md. In this study, we compared theefficiency of three different transport media forpreserving gonococci in clinical specimens, as

follows: (i) Amies charcoal transport medium;(ii) Jembec chambers containing Neigon platesof modified Thayer-Martin medium (MTM/Jembec), and (iii) Jembec chambers containingplates of modified New York City transportmedium (MNYC/Jembec).

MATERIALS AND METHODSMedia. Amies charcoal transport medium was

prepared according to the method ofAmies (1). Modi-fied Thayer-Martin medium was purchased as Nei-gon plates from Flow Laboratories Inc., Rockville,Md. The manufacturer states that this medium hasthe formula listed in Table 1.MNYC was prepared according to the formula

shown in Table 1, modified from the procedure ofFaur et al. (5, 6, 7). The main modification was the

replacement of 3 ug of vancomycin per ml by 4 tg oflincomycin per ml. This change was made becauserecent reports have shown that 3 to 10% of strains ofN. gonorrhoeae are sensitive to vancomycin (2, 4, 13,14). Additional minor changes made were in theother manufactured ingredients and the agar con-

centration. MNYC selective medium was preparedaccording to the same formula as the transport me-

dium, except the agar concentration was 1% and theyeast concentration was 2.5%.

Quality control. Each batch of MNYC and MTMmedium was tested by the quality control methodrecommended by the Center for Disease Control,Atlanta, Ga. (11).

Collection of specimens. Clinical specimens (twourethral swabs from each male and two endocervicalswabs from each female patient) were received fromSt. Michael's Hospital, Toronto, Special TreatmentClinic. Specimens from this clinic were delivered bycourier and reached the laboratory within 24 h. The

FIG. 1. The Jembec chamber.

TABLE 1. Formulae ofMTM and MNYC transport media

MTM medium MNYC transport medium"

Ingredient Amount (per liter) Ingredient Amount (per liter)

Agar 12.5 g Oxoid agar no. 4 12 gPeptone 15 g Proteose peptone no. 3 15 gKH2PO4 1 g (Difco)K2HPO4 4 g KH2PO4 1 gSodium chloride 5 g K2HPO4 4 gCorn starch 1 g Sodium chloride 5 gDistilled water 1,000 ml Corn starch 1 gL-Cysteine hydrochloride 260 mg Distilled water 615 mlL-Glutamine 100 mg Fresh yeast dialysateL-Cystine 10 mg (Fleishmann 2040) 50 mlCoenzyme 1 2.5 mg 3% Lysed horse erythro-Hemoglobin 10 g cytes 200 mlCocarboxylase 1 g Horse serum 120 mlDextrose 5.55 g 50 g% Dextrose 10 mlTrimethoprim lactate 5 mg Trimethoprim lactate 5 mgColistin 7.5 mg Colistin 7.5 mgVancomycin 3.5 mg Lincomycin 4 mgNystatin 50,000 U Amphotericin B 1 mg

a After addition of distilled water, autoclave at 15 lb/in2 for 15 min, cool to 50 C, and add the remainingingredients.

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500 SYMINGTON

subsequent storage of these specimens was varied.Specimens were also received by mail from SudburyRegional Health Unit, Special Treatment Clinic,located 241 miles (386 km) north of Toronto. Thislatter study was undertaken to test the ability of thedifferent transport systems to withstand the rigorsof Northern Ontario winter temperatures, postalhandling, and prolonged periods in transit.

At St. Michael's Hospital, the first swab was inoc-ulated onto an MTM/- or MNYC/Jembec plate andthen placed in Amies charcoal transport medium.The second swab was used to make a smear forGram staining. The plates were sealed in the bagwith the TABCO2 tablet in the well and transferredalong with Amies medium to the laboratory. On re-ceipt, the swabs in Amies medium were cultured byour routine GC laboratory on a petri plate contain-ing MNYC selective medium. The MTM/- or MNYC/Jembec chambers were stored at room temperaturefor the various periods, and then the plates were

incubated at 36 C in 5% C02. Two hundred fifty-eight specimens were received in MTM/Jembecchambers and 377 in MNYC/Jembec chambers.

In Sudbury, the first swab was processed as de-scribed above; the second swab was used to make asmear and then placed in a second Amies charcoaltransport medium. One of the swabs from Amiesmedium was cultured immediately or within 24 h bySudbury Regional Public Health Laboratory (locatedin the same building as the clinic) on a petri platecontaining MNYC selective medium and incubatedin a candle jar at 36 C. The other swab in Amiesmedium and the inoculated Jembec chamber weremailed to Toronto. The swabs taken first or secondwere alternated for culturing in Sudbury or mailingto Toronto. On receipt in Toronto, the Jembec plateswere incubated at 37 C in a 5% C02 incubator. Theswab received in Amies medium was plated on apetri plate containing MNYC selective medium andincubated under the same conditions. Both plateswere read after 24 and 48 h of incubation. Sixty-seven specimens were received as MTM/Jembecchambers and 173 as MNYC/Jembec chambers.The transit time of specimens from Sudbury toToronto was 1 to 5 days, with an average of 3 days.

N. gonorrhoeae was identified on the basis of colo-nial morphology, oxidase reaction, Gram stain, andfluorescent antibody technique.

Statistical analysis. The results obtained wereanalyzed by a standard Z test for population propor-tions (12).

RESULTS

Quality control and shelf life of media.Four separate batches of MTM/Jembec plateswere checked. The first batch of plates was

satisfactory for the quality control standards.Candida sp. grew on the other three batches.The size of the Candida colonies was smaller,but the number was comparable to the controlplate without antibiotics. No shelf-life controlwas carried out on the Neigon plates since theirexact preparation date was not known.

MNYC transport medium prepared in ourmedia laboratory consistently inhibited thegrowth of a standard inoculum of 50 to 100organisms of Escherichia coli, Staphylococcusaureus, Proteus sp., and Candida sp. N. gonor-rhoeae always grew on freshly prepared media,and the number of colonies was comparable tothe growth on the same medium without anti-biotics. Occasionally the size of the colony wassmaller on one batch of medium, and this phe-nomenon was traced to the quality of horseserum used. MNYC/Jembec plates, stored atroom temperature, had a shelf life of 1 month or2 months when stored at 4 C. Amphotericin Bwas the most unstable ingredient in this me-dium; inhibition of growth of Candida was thefirst quality control criterion to fail.

Conditions of incubation ofJembec plates.We found that in Jembec chambers containingeither MTM or MNYC medium, the CO2 gener-ated by the tablet was adequate to support thegrowth ofN. gonorrhoeae in clinical specimens,provided the chambers were incubated at 36 Cimmediately after inoculation. However, wethought it necessary to determine whether suffi-cient CO2 for support of gonococcal growth wasstill present in the chambers after some storagetime. Our previous study (17) showed that aGono-Pak system was comparable to Amies me-dium for recovery ofgonococci from clinical spec-imens up to 24 h, but neither reliably preservedN. gonorrhoeae for 72 h. However, for dura-tions between 24 and 48 h, the Gono-Pak sys-tem was superior to Amies medium. We there-fore chose to store specimens in MTM/- orMNYC/Jembec chambers for 48 h at room tem-perature and then either incubate them at 36 Cin their bags in a regular incubator or removethe plates from the bags and incubate them at36 C in a 5% C02 incubator. The correspondingswabs from the same patients, which were re-ceived in Amies charcoal transport medium,were processed by our routine GC departmentimmediately after they were received in thelaboratory, which was within 24 h of sampling.The number ofN. gonorrhoeae isolated by thisprocedure was considered as the total numberof positive specimens. On MTM/Jembec plates,65% of the gonococci were recovered when theplates were incubated in their bags in a regularincubator, but 83% were recovered from theplates that were incubated in a 5% C02 incuba-tor (P = 0.2). On MNYC/Jembec plates, 38% ofthe gonococci were recovered from the platesincubated in a 5% C02 incubator (P < 0.0001)(Table 2). Since these results showed that thepresence of 5% fresh C02 during incubationimproved the recovery of gonococci from bothMTM/- and MNYC/Jembec chambers, in all

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further studies these plates were incubated at36 C in a 5% CO2 incubator.Comparison of Amies charcoal transport

medium to MTM/- and MNYC/Jembec cham-bers. The recovery of gonococci from clinicalspecimens inoculated into these three transportsystems was recorded after 48 or 72 h in transitand compared to the results obtained by our

routine GC laboratory with swabs received inAmies medium (Table 3). These swabs were

cultured within 24 h of sampling. The survivalrates after 48 and 72 h in transit were 70 and34%, respectively, from Amies; 84 and 33% forMTMIJembec chambers; and 85 and 87% forMNYC/Jembec chambers. After transit timesof 48 h or less, there was no significant differ-

ence in survival of gonococci in any of thesethree transport systems. At 72 h or longer,MNYC/Jembec chambers gave a significantlybetter recovery rate than Amies medium (P <0.0001) or MTM/Jembec chambers (P = 0.006).MTMIJembec chambers grew more contami-nants (31%) than did MNYC/Jembec chambers(19%).

Field trial in Sudbury. The results of thistrial are presented in Table 4. Sixty-seven speci-

mens were mailed in MTM/Jembec chambers;23 of these specimens contained N. gonor-

rhoeae, but only 9 (39%) grew on MTM/Jembecplates after mailing and incubation in Toronto,and only 5 (33%) grew from the correspondingAmies medium. There was no significant differ-

TABLE 2. Influence of incubation conditions on growth of Neisseria gonorrhoeae after 48 h of storage inMTMI- or MNYC/Jembec chambers

Positive from Jembec chambers

No. of speci- No. positive by MTM medium (Neigon) MNYC transport mediummens exam- routine examina-

ined tion C02 Without C02 C02 Without C02

No. % No. % No. 9c No. %

114 18 15 83119 17 11 6596 18 15 83

110 21 8 38

TABLE 3. Recovery ofNeisseria gonorrhoeae from clinical specimens transported in Amies charcoal transportmedium, MTMI-, or MNYCIJembec chambers

Positive after storage time of

48h 72hNo. of speci- No. positive bymens exam- routine examina- Amies char- MTM/Jem MNYC/Jem Amies char- MTM/Jem- MNYC/Jem-

ined tion coal trans- coal trans-. bec chamber bec chamber - bec chamber bec chamberport medium port medium

No. % No. % No. % No. 9i No. % No. %

195 41 29 70114 18 15 83155 43 37 86173 40 15 3733 15 5 33

122 24 21 87

TABLE 4. Recovery ofNeisseria gonorrhoeae from clinical specimens after transport from Sudbury to Toronto

Positive after transport to Toronto in

No. of specimens No. positive when cul- Amies charcoal trans- MTM/Jembec cham- MNYC/Jembec cham-examined tured immediately in port medium bers bers

No. % No. % No. %

67 23 5 22 9 39173 57 23 39 46 80

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502 SYMINGTON

ence between these two transport systems (P =0.18). One hundred seventy-three specimenswere mailed to Toronto in MNYC/Jembec cham-bers; 57 of these specimens contained gonococci.Of the MNYC/Jembec plates 46 (80.3%) werepositive after incubation in Toronto, but thecorresponding swabs mailed in Amies mediumyielded only 23 (39%) positives. The MNYC/Jembec chambers gave a significantly higherrecovery rate than Amies medium (P < 0.0001)or MTM/Jembec chambers (P < 0.0003). Sixty-eight percent of the positives on MNYC/Jembecplates could be identified after 24 h of incuba-tion, but only 42.8% of those from Amies me-dium grew in that time. Contaminants grew on20 (11%) of the MNYC/Jembec plates, but 54(31%) of the swabs plated from Amies mediumyielded bacterial or yeast contamination.

DISCUSSIONThe results of this study demonstrated that

the MNYC/Jembec chamber was the most effi-cient of the three transport systems evaluatedfor preservation of gonococci present in clinicalspecimens. The MTM/Jembec chambers gaveno significant improvement in recovery of N.gonorrhoeae as compared to Amies charcoaltransport medium in a field trial (P = 0.26).On the other hand, the number of gonococci

recovered from MNYC/Jembec chambers wassignificantly greater than from Amies charcoaltransport medium (P < 0.0001) or fromMTM/Jembec chambers (P < 0.0003) in thistrial. Furthermore, the N. gonorrhoeae sur-vival time was longer in the MNYC/Jembecchambers than in the other two systems.Fewer bacterial or yeast contaminants grew

on the MNYC/Jembec plates than onMTM/Jembec plates, which confirmed our ob-servation from quality control studies thatMNYC transport medium was more selectivethan MTM medium. In particular, amphoteri-cin B was a more effective fungicide than nysta-tin. MNYC/Jembec plates also grew fewer con-taminants from the same specimens when cul-tured after transport in Amies charcoal trans-port medium. About 30% of the MTM/Jembecplates that were sent to Sudbury could not beinoculated because the medium had dislodgedor broken. Initially, we had a similar problemwith MNYC/Jembec plates, but we were able toeliminate this by increasing the agar concentra-tion in the medium.The results presented in this article have

shown that the Jembec chamber containingMNYC transport medium was a good transportand growth system for recovery of N. gonor-rhoeae from clinical specimens. In these clinical

trials, over 80% of the N. gonorrhoeae presentsurvived for 72 h in transit in MNYC/Jembecchambers. With a petri plate of MNYC in aGono-Pak system, we previously obtained relia-ble survival of gonococci for up to 48 h (17). Theincrease in survival time in the Jembec cham-ber could possibly be attributed to the fact thatthe Jembec plate has a better seal, and thus anadequate CO2 concentration is maintained forlonger periods. In addition, there was little de-hydration of medium in the Jembec plates.However, although CO2 generated by theTABCO, tablet was initially sufficient to sup-port the growth ofN. gonorrhoeae, this concen-tration did not remain constant during trans-port. The organisms were viable after 48 h intransit, but the Jembec plates had to be incu-bated in a CO2 incubator or candle jar to facili-tate growth.From our experience, we believe that the

Jembec chamber is a major improvement overthe Transgrow system for the recovery of N.gonorrhoeae from clinical specimens that aredelayed in transit. In our hands, MNYC trans-port medium was more selective and more pro-tective for gonococci than MTM medium. TheJembec plates were much easier to handlethan Transgrow bottles both for inoculationand subculturing. These plates should be storedat 4 C and brought to room temperature beforeuse. At 4 C they had a shelf life of 2 months.The Jembec chamber could be used in two

ways. For physicians who see only a few pa-tients, the Jembec chambers should be sent tothe laboratory immediately after inoculationand then incubated at 35 C in 5% CO2 for 48 h.At clinics, where many patients are seen in theevening, it would be advantageous to have a36 C incubator and place the Jembec chambersinside immediately after inoculation and thenleave them overnight before transfer to the lab-oratory. On receipt at the laboratory theplates would need only to be incubated for 24 hat 36 C in 5% CO2. This overnight incubation atthe clinic would enable results to be available24 h earlier than if Amies charcoal transportmedium were used. Small, inexpensive, porta-ble incubators are marketed now by Flow Labo-ratories, Inc., Rockville, Md., and are ideal forthis purpose.

The Jembec chamber is by no means thecomplete solution to the quest for a foolproofmethod for the bacteriological diagnosis of gon-orrhea. Because N. gonorrhoeae is a fastidiousbacterial species present among many contami-nants in clinical specimens, several other fac-tors are critical. Of paramount importance isthe type of specimen collected in order to in-crease the chance of recovering gonococci if the

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TRANSPORT SYSTEM FOR N. GONORRHOEAE 503

organisms are present. A major improvementin the rates of gonococcal recovery could beachieved by administrative measures to ensureimmediate transfer of specimens to the labora-tory for inoculation onto GC selective medium.However, although delays in transit continueto exist, a transport outfit containing anMNYC/Jembec chamber, a slide, sterile swabs,and a data sheet is robust enough to withstandwinter temperatures and postal handling. Suchan outfit provides a selective environment thatwill protect and maintain the viability of 80%N. gonorrhoeae for up to 72 h. This allows areasonable time for postal transfer of specimensto the laboratory.

ACKNOWLEDGMENTSI wish to thank W.T.R. Linton and staff at St. Michael's

Hospital, Special Treatment Clinic; J.B. Cook and staff atSudbury Regional Health Unit for their cooperation; thestaffs of Sudbury Regional Public Health Laboratory andthe GC and media laboratories in Toronto for their assis-tance; and S. Toma for constructive criticism of themanuscript.

LITERATURE CITED1. Amies, C. R. 1967. A modified formula for the prepara-

tion of Stuart's transport medium. Can. J. PublicHealth 58:296-300.

2. Brorson, J. E., J. Holmberg, B. Nygeren, and S. See-berg. 1973. Vancomycin-sensitive strains ofN. gonor-rhoeae. A problem for the diagnostic laboratory. Br.J. Vener. Dis. 49:452-453.

3. Chapel, T., M. Smeltzen, D. Printz, R. Dassel, and J.Lewis. 1973. An evaluation of commercially suppliedTransgrow and Amies media for the detection ofNeis-seria gonorrhoeae. Health Lab. Sci. 11:28-33.

4. Cross, R. C., M. B. Hoger, R. Theibaur, B. Pasternack,and F. J. Brady. 1971. VCN-inhibited strains of N.gonorrhoeae. HSMHA Health Rep. 86:990-992.

5. Faur, Y. C., M. H. Weisburd, M. E. Wilson, and P. S.

May. 1973. A new medium for the isolation of patho-genic Neisseria (NYC medium) I. Formulation andcomparisons with standard media. Health Lab. Sci.10:44-54.

6. Faur, Y. C., M. H. Weisburd, and M. E. Wilson. 1973. Anew medium for the isolation of pathogenic Neisseriza(NYC Medium) II. Effect of amphotericin B and Tri-methoprim lactate on selectivity. Health Lab. Sci.10:55-60.

7. Faur, Y. C., M. H. Weisburd, and M. E. Wilson. 1973. Anew medium for the isolation of pathogenic Neisseria(NYC Medium). III. Performance as a culture andtransport medium without the addition of ambientcarbon dioxide. Health Lab. Sci. 10:61-74.

8. Holston, J. L., T. S. Hosty, and J. E. Martin, Jr. 1974.Evaluation of the Bag-CO2-generating tablet methodfor isolation of N. gonorrhoeae. Am. J. Clin. Pathol.62:558-562.

9. Martin, J. E., Jr., J. H. Armstrong, and P. B. Smith.1974. A new system for cultivation ofN. gonorrhoeae.Appl. Microbiol. 27:802-805.

10. Martin, J. E., Jr., and A. Lester. 1971. Transgrow. Amedium for transport and growth of N. gonorrhoeaeand N. meningitidis. HSMHA Health Rep. 86:30-33.

11. Protocol for testing of Transgrow. 1971. Center forDisease Control, Atlanta, Georgia.

12. Remington, R. D., and M. A. Schork. 1970. Statisticswith applications to biological and health sciences.Prentice-Hall, Inc., Englewood Cliffs, N.J.

13. Reyn, A. 1969. Recent developments in the laboratorydiagnosis of gonococcal infections. Bull. W.H.O.40:245-253.

14. Reyn, A., and M. W. Bentzo. 1972. Comparison of aselective and non-selective medium in the diagnosisof gonorrhea to ascertain the sensitivity of N. gonor-rhoeae to Vancomycin. Br. J. Vener. Dis. 48:363-368.

15. Ringertz, 0. 1960. A modified Stuart medium for thetransport of gonococcal specimens. Acta Pathol. Mi-crobiol. Scand. 48:105-112.

16. Stuart, R. D. 1946. The diagnosis and control of gonor-rhea by bacteriological cultures, with a preliminaryreport on a new method for transporting clinical mate-rial. Glasgow Med. J. 27:131-142.

17. Symington, D. A. 1975. An evaluation ofNew York Citytransport medium for detection of N. gonorrhoeae inclinical specimens. Health Lab. Sci. 12:69-75.

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ERRATAPolypectate Digestion by Yersinia

V. LYLE VON RIESENDepartment of Medical Microbiology, University ofNebraska Medical Center, Omaha, Nebraska 68105

Volume 2, no. 6, p. 552, column 1, lines 8 and 9: Change "(4; see reference 2 or 3)" to read "(3; seereference 2 or 4)."

Convenient, Simplified Preparation of LessCommonly Used Media

V. LYLE VON RIESENDepartment of Medical Microbiology, University ofNebraska Medical Center, Omaha, Nebraska 68105

Volume 2, no. 6, p. 555, column 2, line 9: Change "(water-soluble. . .)" to "(water-insoluble...)."

Improved Transport System for Neisseria gonorrhoeae inClinical SpecimensDOROTHY A. SYMINGTON

Ontario Ministry of Health, Provincial Public Health Laboratory, Toronto, Ontario M5W IR5, Canada

Volume 2, no. 6, p. 498, column 1, paragraph 2, line 9: Change sentence beginning "More re-cently, the Transgrow system used .. ." to read "More recently, the Transgrow system, developedby Martin and Lester (10) as a combined transport and culture medium for N. gonorrhoeae andN. meningitidis, has been used in some areas of North America."Volume 2, no. 6, p. 500, column 2, sentence beginning 7 lines from bottom should read as follows:

"On MNYC/Jembec plates, 38% of the gonococci was recovered from the plates incubated in theirbags in a regular incubator, but 83% was recovered from the plates incubated in a 5% CO2 in-cubator (P < 0.0001) (Table 2)."

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