Gonococcal infection of the penis.

The occurrence of skin lesions in gonococcal bacteraemia is well recognized and well documented (Keil, 1938; Abu-Nassar, Hill, Fred, and Yow, 1963; Kvorning, 1963; O'Sullivan, 1964; Ackerman, Miller, and Shapiro, 1965; Fred, Eiband, Martincheck, and Yow, 1965; Bj6rnberg and Gisslen, 1966). Less well documented is the occurrence of lesions due to direct implantation of gonococci on the skin, either by accidental inoculation (Sears, 1947) or by sexual intercourse. The latter has been known to cause primary gonococcal skin lesions both extragenitally, for example on the sternum or in the axilla (Pugh, 1930), and genitally. Here, we are concerned with primary gonococcal skin lesions of the male genitalia and we restrict ourselves to those involving the penis. Such lesions are infrequently reported and are undoubtedly rare. It is possible that the gonococcus is not always looked for in such lesions because it is not expected; and this is perhaps because stratified squamous epithelium has for long enjoyed a formidable reputation as a most inhospitable host to this organism. Hunter's ill-fated and misleading self-inoculations of 1767 notwithstanding (Hunter, 1786), early unsuccessful experiments between 1789 and 1880 in inoculating the glans, prepuce, or shaft of the penis, listed by Hill (1943) in her comprehensive review, created the impression that primary gonococcal infection of the skin was extremely improbable if not impossible. This belief was epitomized by Bumm in what Belgodere (1930) described as the loi de Bumm, which contestait dogmatiquement au gonocoque tout pouvoir agressif vis-a'-vis des epithdliums pavimentaux. Belgodere quoted this argument in 1930 in order skilfully to demolish it. But 15 years later Harkness declared 'I do not consider it to be possible for the gonococcus to penetrate a healthy epidermis, and in my opinion it is always necessary for the superficial layers to be destroyed before the organisms are able