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

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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.

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