Incidence of Disseminated Gonococcal Infection Correlated with the Presence of AHU Auxotype of Neisseria gonorrhoeae in a Community

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Abstract
Strains of Neisseria gonorrhoeae requiring arginine, hypoxanthine, and uracil (AHU) may cause disseminated gonococcal infection (DGI). A significant epidemiologic association was noted between the incidence of disseminated gonococcal infection and the presence of gonococci of the AHU auxotype in the community over a nine-year period. Thirty-nine patients with DGI were identified from hospital records of January 1974-December 1982. During this interval, gonococcal isolates from patients in the community were collected at a venereal disease clinic and a hospital emergency room. The incidence of patients hospitalized for DGI dropped significantly after 1978. The year of highest incidence of DGI was 1977, when there were 429 cases of DGI per 100,000 cases of uncomplicated gonorrhea; the incidence of gonococcal isolates of the AHU auxotype in that year was 26.3%. In contrast, this auxotype accounted for only 4.6% of gonococcal isolates in 1980, when the incidence of DGI had decreased to 58 cases per 100,000 cases of uncomplicated gonorrhea. When DGI and gonococci of the AHU auxotype from the community were ranked for incidence by year, a significant correlation between the two was found (P < .001). Thus the incidence of patients with DGI in the hospital reflected the presence of gonococci of the AHU auxotype in the community.