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The relationship between pharyngeal carriage of Neisseria meningitidis and anogenital infection with Neisseria gonorrhoeae was investigated at two separate clinics for sexually transmitted diseases in New York City. Of the entire study group of 738 patients, 310 (42%) had pharyngeal N. meningitidis. Gonorrhea appeared in 130 (17.9%) of the 738 patients. Of the 130 patients with anogenital gonorrhea, 73 (56.3%) had N. meningitidis-positive pharyngeal cultures. Neisseria meningitidis was found in the pharyngeal cultures of 39% of the gonorrhea-free patients; 23.2% of patients with N. meningitidis-positive pharyngeal cultures had concomitant anogenital gonorrhea. Of the patients free of pharyngeal N. meningitidis, 13.1% had anogenital gonorrhea. In both facilities, the pharyngeal carriers of N. meningitidis had a 1.9 times greater risk of genital gonorrhea as compared with N. meningitidis-negative patients. Patients with anogenital gonorrhea at both study sites were 1.4-1.7 times more likely to be pharyngeal carriers of N. meningitidis as compared with gonorrhea-free patients.

The prevalence of most sexually transmitted diseases is disproportionately increased in gay men and paradoxically decreased in lesbian women. The spectrum of diseases seen in gay men include a variety of enteric infections including hepatitis A, shigellosis, salmonellosis, Campylobacter enteritis, amebiasis, giardiasis, and enterobiasis as well as the more common sexually transmitted diseases. Hepatitis B is endemic in gay male populations. The patterns of sexual behavior are the major factors contributing to this unique epidemiology and pathology. Increased sexual activity explained by the unrestrained cultural expectation of maleness, the functional overlap during sex between the genital-urinary and gastrointestinal systems, and anonymous sexual activity are all significant epidemiologic components.

Stool specimens from 89 high-risk, sexually active homosexual men were screened for enteric protozoal cysts. Patients whose specimens contained nonpathogenic cysts were investigated further by examination of fresh purged specimens. A total of 27 of the initial specimens (30%) contained protozoal cysts. Twenty-three patients (26%) harbored pathogens. There were 18 cases (20%) of amebiasis and 11 cases (12%) of giardiasis. Six men (7%) had concurrent amebiasis and giardiasis. The presence of infections correlated with a history of anilingus but not with place of birth, travel, or history of symptoms. The exceptionally high rate of prevalence of intestinal protozoal infection in this population suggests that enteric protozoal infections are important among sexually transmitted diseases.

The efficacy of 3 g of amoxicillin plus 1 g of probenecid was compared with the efficacy of 3.5 g of ampicillin plus 1 g of probenecid for the treatment of uncomplicated gonorrhea. In a clinical trial no therapeutic failure was seen among 60 patients who were treated with the former regimen. The combination of ampicillin plus probenecid resulted in two therapeutic failures (3.6%) among the 55 patients given it. It was concluded that amoxicillin plus probenecid is as effective as ampicillin plus probenecid for the treatment of uncomplicated gonorrhea.

Thirty-nine homosexual men seeking treatment for symptomatic proctitis were examined for anorectal gonorrhea by study of gram-stained smears obtained via an anoscope and by a blindly obtained anorectal swab specimen. Anorectal specimens for culture were obtained from all men. The sensitivity of the anoscopically obtained smears was 79% as compared with 53% for the blindly obtained smears. It was concluded that gram-stained smears obtained through an anoscope can provide rapid diagnosis of most cases of symptomatic anorectal gonorrhea. All patients with symptomatic proctitis should have routine anoscopy and examination of gram-stained smears obtained via anoscopy as part of their diagnostic evaluation.

The authors conducted a retrospective study of 125 male patients treated for anal gonorrhea with 4 g of spectinomycin in a social hygiene clinic. Of those treated, nine (7.2%) still had cultures positive for Neisseria gonorrhoeae when tested again five to 14 days after treatment.