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Editor,—Hughes et al1 recently presented an investigation of the increased incidence of gonorrhoea diagnosed in GUM clinics in England, in 1994–6 within which they have included the data from our clinic.
We reviewed the incidence of gonococcal infection diagnosed in the department of genitourinary medicine, Coventry Healthcare NHS Trust in 1994 and 1996, using the same criteria which had been applied in their study (see table 1).
Similar to Hughes et al, we found that the incidence of gonorrhoea had increased remarkably in 1996 compared with 1994 (48 cases in 1994 and 94 in 1996) Of the total number of patients, 49 had other acute STIs at the time of presentation including 37 of them with chlamydial infection; 13 patients were homosexual and four had infection in the oropharyngeal, rectal, or both sites; 39 patients had attended the clinic previously and eight of them suffered from gonococcal infection.
We found a completely different picture with respect to the incidence of penicillin resistance in the gonococcal isolates; while six patients (13.5%) were found to be penicillin resistant in 1994 only three (3.03%) were found to be penicillin resistant in 1996; four homosexual patients were found to be penicillin resistant and two of them had contacts who lived outside Coventry. We have been using penicillin as the first line of treatment for gonorrhoea for the past 20 years or more and the incidence of treatment failure in our area is very low. Accordingly, we believe that the causes of increased incidence of gonococcal infection in the Coventry area are not related to penicillin resistance.
Although most of the patients infected were white, 117 cases (82%), the incidence of gonococcal infection was disproportionately high in black ethnic group, 19 cases (13%); this group however contributed 1.9% of the population in Coventry. Six patients were of Asian origin and interestingly they were second generation Asians and five of them were male, single, of 20–25 age group, and having three or more sexual partners.
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