Factors in the Resistance of Gonorrhea to Sulfonamides.

The problem of resistance to sulfonamide therapy1 in male gonorrhea is well known. Cox (1) states that, in varying degrees, clinical resistance is found in approximately 25 per cent of cases treated with sulfadiazine or sulfathiazole. More recently, the incidence of resistance has risen to approximately 50 per cent of cases admitted to the Boston Dispensary (2). This resistance is manifested either by persistence of symptoms or by persistence of positive cultures in asymptomatic carriers. Since gonorrhea is usually a self-limited disease, Cox emphasizes the importance of considering all cases as drug failures which do not clear up within 2 weeks after starting sulfonamide therapy. It is likewise important to recognize relapse after apparent cure as a manifestation of resistance, which is often missed in the clinic unless patients are followed every few days by smear, culture, and symptomatology for at least 4 weeks. Petro (3) summarizes the factors in sulfonamide resistance, emphasizing (1) factors interfering with the transport of drug to the site of infection in adequate dosage, (2) factors interfering with proper drainage of the products of inflammation, (3) factors within the invading organism, and (4) factors within the host and its bodily defenses. Determination of factors within the gonococcus responsible for this clinical resistance is a logical initial approach. To this end, correlation of the clinical course with laboratory observations on the growth characteristics of the organisms isolated from individual cases in the presence of sulfonamides has been reported by Cohn et al. (4),