Gonococcal pharyngeal infections. Report of 110 cases.

Routine examination for gonorrhoea has hitherto been aimed at the demonstration of Neisseria gonorrhoeae in secretions from the urethra, cervix, and rectum. Bacteriological investigation has been limited to the genital organs directly implicated in sexual intercourse, to adjacent sites often involved in gonococcal infection, and the rectum in homosexual men. It has been almost completely disregarded that other sexual activities are often practised concurrently with genital coitus, and also that the techniques used by homosexuals are by no means confined to peno-rectal contact. In this connection, special attention should be paid to cunnilingus and fellatio, as gonococci may be transferred thereby from the genitalia to the mouth. That oro-genital practices are in common use is clear from the reports of Kinsey and others (1948, 1953), who stated that nearly 60 per cent. of all American men had had such contact, while women seemed somewhat less interested. However, little attention has hitherto been paid to gonococcal oro-pharyngeal infections. Until recent years only a few communications on this subject have been presented, in which the diagnosis of Neisseria gonorrhoeae has been unequivocally established. Thus single cases of pharyngitis (Fiumara, Wise and Many, 1967; Metzger, 1970), ulceration of the tongue (Cowan, 1969), and asymptomatic pharyngeal infection (Thatcher, McCraney, Kellogg, and Whaley, 1969) have been reported. Gonococci were demonstrated in specimens from the tonsils of two out of fifty patients admitting oro-genital contact during their latest intercourse (Hellgren, 1971). The starting point for our investigation was a male patient who attended in April, 1970, a few days after having practised cunnilingus, but not