Clinical and laboratory studies of the epidemiology, etiology, and treatment of urethritis in the male

Abstract

Gonorrhea is one of the most common bacterial diseases of man. In 1966, an estimated 1,500,000 people in the United States acquired gonorrhea. During periods of military conflict, this disease becomes extraordinarily common in military personnel. For example, over 66,000 cases of gonococcal urethritis occurred among U. S. Forces in Viet Nam in 1966. In some areas, the annual incidence of gonorrhea approached 500 cases per 1,000 men. The second most common disease of military personnel is nongonococcal urethritis, a general classification of those urethritides which are not associated with demonstrable N. gonorrhea, but may not have a single etiology. Taken together, gonococcal and nongonococcal urethritis are several times as common as any other reportable infectious disease in military populations in the Far East. The series of studies from which this dissertation is drawn began early in 1965, and is still continuing. The studies were generated by the alarming increase in incidence of urethritis accompanying the Viet Nam build-up; by the unexpectedly high failure rate accompanying standard penicillin therapy of gonorrhea; by the lack of a consistent approach by military physicians to the diagnosis and treatment of nongonococcal urethritis; and by the immediate need for a practical solution to these problems. This research was approved and undertaken for the expressed purpose of finding an adequate treatment for urethritis; and of effecting preventive measures to reduce the incidence of urethritis in military personnel. However, the philosophy of the investigators was that these studies also afforded an opportunity to learn more about the epidemiology, etiology, and pathogenesis of the various urethritides. As the investigation progressed, a "story" became apparent which tied together gonorrhea, postgonococcal urethritis, and nongonococcal urethritis as sequential stages in the development of chronic urethritis in certain situations. It seemed appropriate, therefore, to describe this "story" in a series of manuscripts, dealing with certain aspects of the overall problem of urethritis, but presented in an order which corresponds to the natural sequence with which chronic urethritis often develops in the male. These manuscripts are included as chapters in this dissertation, in the same order in which they were prepared for publication. Chapter three is not yet finished. It is partly based upon recently completed work with gonorrhea infection in women, but is inserted into the dissertation since it pertains to the epidemiology of gonococcal infection in men.