Correlation of A uxo type and Penicillin Susceptibility of Neisseria gonorrhoeae with Sexual Preference and Clinical Manifestations of Gonorrhea

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Abstract
Strains of N. gonorrhoeae requiring arginine, hypoxanthine and uracil (Arg-Hyx-Ura-) are highly susceptible to penicillin G and were associated with asymptomatic urethral infection and disseminated gonococcal infection (DGI). Arg-Hyx-Ura- strains were recovered from 48% of 282 heterosexual men and women vs. only 9% of 69 homosexual or bisexual men (P < 0.0001). In a separate population of consecutive men with urethral gonococcal infections, urethral discharge was absent in 0 of 96 homosexual men vs. 18 of 261 heterosexual men (P < 0.025). Homosexual men accounted for none of 41 cases of DGI in men in 1970-1973, compared with 35% of men with uncomplicated gonorrhea in 1978. Asymptomatic urethral gonococcal infection and DGI may be uncommon in homosexual men, perhaps because infection with Arg-Hyx-Ura- strains is relatively uncommon. Screening cultures of urethral specimens for N. gonorrhoeae had a low yield among homosexual men in the population studied. Strains of N. gonorrhoeae recovered from homosexual men were significantly more resistant to penicillin than were isolates from heterosexual subjects; this was true even for non-Arg-Hyx-Ura- strains. This difference may help to explain the lesser efficacy of ampicillin in treatment of rectal gonococcal infection in homosexual men.