SUMMARY Three hundred and twenty nine strains of non-penicillinase-producing Neisseria gonorrhoeae (non-PPNG) isolated from men and women were tested for their susceptibility to a range of antibiotics, and were also auxotyped and serogrouped. Nearly 6% (18) of 312 strains tested were resistant to 1 mg/l or more penicillin (compared with 4.4% of PPNG strains isolated in 1981). Many (198, 64%) strains showed intermediate resistance to penicillin (0.12-0.5 mg/l). Nearly 5% (15) of 312 strains tested were resistant to 0.5 mg/l or more cefuroxime, and there was a high degree of cross resistance between these two antibiotics. High levels of resistance to erythromycin and tetracycline were also found, and there was also appreciable cross resistance between these antibiotics and the ,B lactam drugs. Resistance to spectinomycin was rare, and there was no cross resistance between spectinomycin and other agents tested. Levels of resistance between -strains isolated from different anatomical sites did not differ, except that resistance to erythromycin was greater in rectal isolates. Four main auxotypes were detected. Strains requiring arginine, hypoxanthine, and uracil (AHU -) were more prevalent from the cervix. We have shown that there is an association between auxotype, serogroup, and level of sensitivity to penicillin, cefuroxime, and tetracycline.The epidemiology and treatment of infections caused by penicillinase producing strains of Neisseria gonorrhoeae (PPNG) have been major concerns since the first description of these strains in 1976.1 2 The prevalence of infections with PPNG strains is highest in Africa and the Far East. In the United Kingdom the increase in the prevalence of PPNG strains was rapid between 1980 and 1983, but now appears to have slowed.3 Our own experience with PPNG strains isolated from patients attending the Praed Street Clinic mirrors that seen nationally, and we saw a decline in prevalence of PPNG strains in 1985.4 Though the problem of PPNG strains has been more spectacular, resistance to antibiotics in non-PPNG strains has continued to grow, particularly in the Far East. In Thailand more than half the non-PPNG strains are resistant to 1 mg/I or more benzylpenicillin, and 21% are resistant to 0.5 mg/l or more cefuroxime~;5 Resistance to penicillin in non-PPNG strains results from chromosomal mutations at multiple loci, each producing small increments in resistance. Some loci are specific for penicillin resistance (pen A), others mediate resistance to a

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SUMMARY Though the incidence of gonorrhoea caused by penicillinase producing Neisseria gonorrhoeae (PPNG) strains at St Mary's Hospital rose rapidly from 1980 to reach 6-2% in 1982, it declined in 1983 (8.6%) and in 1984 (6 5%), a trend that has continued in 1985. The use of penicillinase stable antibiotics or more effective contact tracing are unlikely to be responsible for this recent decline. We have always isolated very few PPNG strains from homosexual men, and the possible effects of the acquired immune deficiency syndrome (AIDS) on sexual behaviour in this group is therefore unlikely to be relevant.We have seen a steady increase in the proportion of PPNG strains carrying the 4-4 megadalton penicillinase plasmid(67% ofPPNG strains in 1984). Strains carrying both the 4.4 megadalton plasmid and the 24-5 megadalton conjugal plasmid were very common in 1982, but since then have declined in importance. PPNG strains carrying the 3-2 megadalton plasmid have become less common, and the presence of the 24-5 megadalton plasmid in these strains has not apparently led to their wider dissemination in the community. Whereas the basic pattern of PPNG auxotypes has changed little, since 1982 we have isolated an increasing number of mixed auxotypes with nutritional requirements other than just proline. PPNG strains carrying the 4-4 megadalton plasmid seem to be more resistant to erythromycin, tetracycline, and streptomycin than those carrying the 3-2 megadalton plasmid. Spectinomycin resistance has only occured in strains carrying the 4-4 megadalton plasmid.

SUMMARY A new direct immunofluorescence reagent (Syva and Genetic Systems Inc) was evaluated for its ability to detect Neisseria gonorrhoeae in specimens from populations with a high prevalence of the infection. Gonorrhoea was diagnosed by culture in 45 rhoea on the basis of history or examiantion were chosen for the initial evaluation of this reagent; thus men were included if they had a urethral discharge or a history suggestive of gonorrhoea and women were included if they had an abnormal vaginal discharge, were sexual contacts of patients with gonorrhoea, or were prostitutes. COLLECTION OF SPECIMENSSpecimens from the male urethra and the female urethra were collected with a single, small cotton swab and were used to prepare three slides (two for immunofluorescence and one for a Gram stain) and to inoculate selective and non-selective culture media. Cervical samples were taken using a 10 ,ul disposable loop (Gibco), which was recharged between investigations.As soon as the specimens needed for this study had been taken all patients were screened for gonorrhoea using the standard procedure adopted by the clinic. This differed from that above in that samples from men were taken with a 1 IlI loop and material was used to make the Gram smear before inoculation on to culture plates. IMMUNOFLUORESCENCE

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