Unique Gonococcal Phenotype Associated with Asymptomatic Infection in Men and with Erroneous Diagnosis of Nongonococcal Urethritis

Abstract

The percentage of gonococcal isolates in King County, Washington, requiring citrulline and uracil (CU auxotype) increased from 1.6% in 1986 to 16.5% in 1997. Among men, urethral infection with the CU auxotype (n=93), in comparison with infection by other auxotypes (n=1211), was associated with coexisting chlamydial infection, younger age, heterosexual contact, and fewer new recent partners (P<. 05). Among heterosexual men, urethral infection with the CU auxotype, compared with infection with other auxotypes, less often produced symptoms of urethral discharge (75% vs. 92%) or dysuria (47% vs. 74%) or signs of moderate or profuse urethral discharge (57% vs. 89%, P<.05 for each comparison), produced symptoms of longer duration (7. 0 vs. 4.5 days, P<.01), less often resulted in urethral smears showing gram-negative intracellular diplococci (67% vs. 95%, P<.01), and thus more often was erroneously diagnosed as nongonococcal urethritis. Several mechanisms could explain reduced inflammatory response to the CU auxotype and its recent spread.

Untreated Gonococcal and Chlamydial Infection in a Probability Sample of Adults

“…Longstanding infections may represent low organism burden, partial immunological clearance, 26 or infection with organism strains that cause less symptomatic disease. 27 In some cases, these persistent asymptomatic infections may be associated with significant sequelae, such as infertility. In other cases, the clinical importance and transmissibility of these infections is less clear.…”

The impact of the phase of an epidemic of sexually transmitted infection on the evolution of the organism

“…More recently (1996 to 1997), the CU auxotype, which is also associated with asymptomatic infection, has increased in prevalence in this region, despite an overall decline in gonorrhoea rates of 80%. 36 The exact reasons for the changes in subtype distribution of gonorrhoea are not well understood. This CU auxotype is more likely than other auxotypes to be misdiagnosed as non-gonococcal urethritis, which may account for part of the increase.…”

Watering can perineum – a forgotten complication of gonorrhoea

“…Urethral strictures are the result of a chronic inflammatory process. Chronic, oligosymptomatic or asymptomatic gonococcal urethritis is mainly caused by Neisseria gonorrhoea strains with specific serological auxotype characteristics: gonococcal serotype IA‐1: type AHU − are mainly responsible for chronic infections 4 . Rupture of periurethral abscesses and extravasation of urine into the cavernous tissue of the bulb may in addition be responsible fibrosis.…”

“…Chronic, oligosymptomatic or asymptomatic gono-coccal urethritis is mainly caused by Neisseria gonorrhoea strains with specific serological auxotype characteristics: gonococcal serotype IA-1: type AHUare mainly responsible for chronic infections. 4 Rupture of periurethral abscesses and extravasation of urine into the cavernous tissue of the bulb may in addition be responsible fibrosis. Other causes of stricture include trauma, balanitis xerotica obliterans, congenital and infections with agents, such as chlamydia, schistosoma haematobium and tuberculosis.…”