Symposium on Infectious Diseases

Conorrhea and Nongonococcal

Urethritis
Re(ent Advances

H. Hunter Handsfield, M.D., F.A.C.P.*

Gonorrhea and nongonococcal urethritis are currently the most

common sexually transmitted diseases in the United States and west-
ern Europe, and are among the most frequently encountered of all in-
fectious diseases. The past decade has seen several signal advances in
the understanding of the etiology, pathogenesis, epidemiology, clinical
manifestations, and management of these diseases. It is the purpose of
this paper to review these developments, with emphasis on a practical
clinical approach to patients.

GONORRHEA
ETIOLOGY

Neisseria gonorrhoeae is a strictly aerobic oxidase-positive gram-

negative diplococcus that metabolizes glucose but not maltose, su-
crose, or lactose. Growth is enhanced in the presence of atmospheric
carbon dioxide. The sensitivity of N. gonorrhoeae to drying is largely
responsible for the primary importance of sexual transmission. Recent
major advances in the elucidation of the biology and immunopathol-
ogy of N. gonorrhoeae include identification of some of the factors re-
sponsible for virulence (endotoxin,62 principal outer membrane pro-
tein/ 3 and pili12), mechanisms of antibiotic resistance,68 greater under-
standing of the nature of the immunologic responses of the host to
gonococcal infection,43, 60, 64 and the development of typing systems uti-
lizing serum bactericidal reactions,67 differential nutritional require-
ments (auxotyping14), antigenic differences in principal outer mem-
brane protein,42 and others.

*Assistant Clinical Professor of Medicine, University of California, San Diego

Medical Clinics of North America - Vo!. 62, No. 5, September 1978 925