1) Kojima H: Culture of ejaculate for Neisseria gonorrhoeae, 1st Serually Transmitted Diseases World Congress, San Juan, 11. 19, 1981. 9) Kojima H, Mori C: Clinical studies on Conococcal and Chlamydial male urethritis using enzyme immunoassay (ETA). 81st Meeting of American Urological Association, NewYork. USA, J Urol, 135(4) Part 2: 336A, 5. 18-22, 1986. 10) Stephens R S, Tam, M R, Kuo C et al Monoclonal antibodies to Chlamydia trachomatis: Antibody specificities and antigen characterization. J Immunol, 128: 1083, 1982. 12) Kojima H, Mori, C, Ishida Y: Diagnosis of Chlamydia trachomatis urethritis by direct fluorescent antibody technique. 80th Annual Meeting of American Urological Association, Atlanta, USA, J Urol, 133 (4) Part 2: 208A, 5. 15, 1985. 13) Kojima H, Mori C, Tanaka Y: Clinical studies on

urethritis in Tokyo using enzyme immunoassay for Neisseria gonorrhoeae and fluorescent antibody technique for Chlamydia trachomatis, 32nd General Assembly of the International Union against Venereal Diseases and Treponematoses Montreal, Canada, 6. 20, 1984. 14) Kojima H, Mori C, Nakamura K: Absence of Chlamydia trachomatis (CT) particles in semen of patients with CT urethritis. 6th International Meeting of International Society for STD Research, Brighton, England, 7. 31, 1985.

Lack of symptoms, difficult diagnosis, resistance to chemotherapy and infectivity of gonococcal pharyngitis Hiroyuki Kojima Former Chief of Urology, Japanese Red Cross Medical Center The significant characteristics of STDs are (1) no spontaneous eradication without medical treatment; (2) asymptomatic infectious source; (3) lethal complications after a long asymptomatic period following infection. The more extragenital contact experienced during sex, the more the extragenital infection of. STDs. Neisseria gonorrhoeae and Chlamydia trachomatis both infect the pharynx, because a columnar epithelium of the same quality as the urethra and cervix also exist in the pharynx. Because Japanese are homogenously well educated, cautious people, the number of gonorrhea cases dropped to about one fifth in Japan after a big AIDS campaign by the mass media in 1985. However, the ratio of "male gonococcal urethritis infected by the female pharynx" in total male gonococcal urethritis has also been increased to about 50%. The defmition of a male gonococcal urethritis infected by the female pharynx not from the cervix can be clearly made only in Japan where fellatio without vaginal intercourse is commercialized. At present, about 30% of the cases of gonococcal male urethritis and female cervicitis also have gonococcal pharyngitis. Male gonococcal urethritis infected by the female pharynx has a longer latent period (mean 10.6 days) and less inflammatory symptoms (WBC count 7,900, CRP<0.5 11.1%) in comparison with gonococcal urethritis infected by the cervix (mean latent period 5.2 days, WBC count 9,500, CRP<0.5 28.9%) The significant characteristics of gonococcal pharyngitis are (1) lack of symptoms; (2) difficult detection of gonococcus; (3) difficult eradication of gonococcus. (1) Patients lack subjective symptoms, e.g., discharge and pain when swallowing. No redness or discharge can be observed by a clinician. (2) Because of numerous normal flora in the pharynx, a false negative by culture isolation and a false positive by PCR are frequent in pharyngeal specimens. (3) After the eradication of gonococcus from the urethra and cervix by chemotherapy, the same strain can be isolated from the pharynx of the same patient. Key words: extragenital STD infection, gonococcal pharyngitis, oral sex, neisseria gonorrhoeae, chlamydia trachomatis