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Gonococcal and Nongonococcal Urethritis in Men: Clinical and Laboratory Differentiation

NORMAN F. JACOBS Jr., M.D.; and STEPHEN J. KRAUS, M.D.
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Presented in part at the annual meeting of the American Federation for Clinical Research, Atlantic City, New Jersey, on 4 May 1974.

Use of trade names is for identification only and does not constitute endorsement by the Public Health Service or by the U.S. Department of Health, Education, and Welfare.

▸Requests for reprints should be addressed to Norman F. Jacobs, Jr., M.D., Venereal Disease Research Branch, Bacteriology Division, Center for Disease Control, Atlanta, GA 30333.


Atlanta, Georgia


Ann Intern Med. 1975;82(1):7-12. doi:10.7326/0003-4819-82-1-7
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The clinical and laboratory features of urethritis were studied in 400 symptomatic men at a venereal disease clinic. Most patients (54%) had nongonococcal urethritis; only 46% had gonococcal urethritis. In 85% of the cases, the Gram stain was read as unequivocally positive or negative; its accuracy in these cases was 98%. In 15% of the Gram stains, rare typical extracellular Gram-negative diplococci were intermingled with many atypical pleomorphic Gram-negative diplococci; in these cases cultures were essential for diagnosis. Patients with gonococcal urethritis usually had symptoms of both dysuria and discharge of short duration; patients with nongonococcal urethritis had variable symptoms of longer duration (P < 0.0005). Spontaneous purulent discharge was found only in patients with gonococcal urethritis. Most patients with nongonococcal urethritis had no discharge or mucoid discharge obtained only after penile stripping. These findings provide a basis for the rapid differential diagnosis of urethritis, which will permit immediate, definitive treatment for most men with urethritis.

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