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Postgonococcal urethritis. Relationship to penicillin sensitivity of the gonococcus
Abstract:
Postgonococcal urethritis (PGU) occurred in 69 (21.3%) of 344 men with urethral gonorrhoea. Each case of gonorrhoea was treated with intramuscular procaine penicillin 2.4 megaunits and the penicillin sensitivity was determined. All 69 of the isolates from patients with PGU were fully sensitive to penicillin (IC50 less than 0.08 iu penicillin per ml). Twenty-eight (10.2%) of 275 cases of gonorrhoea which were not followed by PGU were relatively resistant to penicillin. The persistence of gonococcal L-forms is therefore not likely to be a main cause of PGU. An incidental finding was that significantly more of the 69 men who developed PGU had a history of non-specific urethritis compared with the 224 men who fully recovered (P less than 0.01).
Insights
Postgonococcal urethritis (PGU) in men treated for gonorrhea was not linked to penicillin-resistant gonorrhea strains. A history of non-specific urethritis was significantly more common in men who developed PGU.
Area of Science:
- Urology
- Infectious Diseases
- Microbiology
Background:
- Postgonococcal urethritis (PGU) is a common complication following treatment for urethral gonorrhea.
- Understanding the etiological factors of PGU is crucial for effective treatment and prevention strategies.
- The role of penicillin resistance in Neisseria gonorrhoeae in the development of PGU requires further investigation.
Purpose of the Study:
- To investigate the relationship between penicillin sensitivity of gonococcal isolates and the development of postgonococcal urethritis (PGU).
- To explore potential risk factors associated with PGU, including a history of non-specific urethritis.
Main Methods:
- A cohort of 344 men diagnosed with urethral gonorrhea was studied.
- Patients were treated with intramuscular procaine penicillin.
- Penicillin sensitivity of gonococcal isolates was determined, and patients were monitored for PGU development.
- A history of non-specific urethritis was recorded and compared between patients with and without PGU.
Main Results:
- PGU occurred in 21.3% of men treated for gonorrhea.
- All gonococcal isolates from patients who developed PGU were fully sensitive to penicillin.
- Conversely, a higher proportion (10.2%) of cases not followed by PGU showed relative penicillin resistance.
- A history of non-specific urethritis was significantly more prevalent in men who developed PGU compared to those who recovered fully (P < 0.01).
Conclusions:
- The persistence of penicillin-sensitive gonococcal strains, not resistant strains or likely gonococcal L-forms, is associated with PGU.
- A history of non-specific urethritis appears to be a significant risk factor for developing PGU.
- These findings suggest that PGU may not be solely caused by treatment failure due to resistant gonorrhea.