Gonorrhea with Intracellular Inclusions

Abstract

Certain viruses and similar organisms (including possibly the virus of the disease of Nicholas and Favre and very probably the asteromyces peripneumoniae, and perhaps also the chlamydozoon oculogenitalis) can cause a urethritis which varies in its clinical features but which may be included in the types of urethritis described by Waelsch and by Reiter.In the present state of our knowledge we cannot establish a connection between any group of the clinical signs and any specific filtrable infecting organism. The organisms are often present in association with the gonococcus and attention has been drawn to them particularly since the discovery of penicillin which rapidly controls the effects of the gonococcus but may leave a prolonged chronic urethritis, known as post-penicillin urethritis. In these cases the viruses play an imp x t a n t part.The detection of inclusion bodies is a delicate procedure, requiring examination of scrapings from the urethral canal, staining with Giemsa, and examination by a worker who is familiar with this type of research.Local treatment effectively relieves the symptoms, but aureomycin gives the best results, especially if the infecting agent is chlamydozoon. When the gonococcal infection has been thoroughly controlled, the frequency of occurrence of virus urethritis justifies the use of aureomycin, even if inclusion bodies have not been found, in prolonged chronic urethritis or in Reiter's syndrome. In cases of resistance t o aureomycin the other antibiotics should be tried, in association with local treatment.A search for inclusion bodies has been carried out in 14 of the author's cases: in four cases, results were definitely positive (3 of asteromyces and 1 of chlamydozoon). Aureomycin gave excellent results in the three positive cases, and gave good results in six of the Len cases where inclusion bodies were not found. In addition, aureomycin was given to 51 cases of amicrobial urethritis in which the presence of filtrable organisms could be suspected: in 30 of these the discharge stopped from the beginning of treatment, 11 were improved, and in ten there was either no effect or a relapse occurred.