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Appendix L
PROSPECTS FOR IMMUNIZING AGAINST NEISSERIA GONORRHOEAE

Gonorrhea is the most commonly reported infectious disease in the United States. A typical case in males involves urethral discharge and dysuria, but in females the initial infection may be asymptomatic or produce nonspecific symptoms. Women with gonorrhea may develop pelvic inflammatory disease (including salpingitis). This infection of the pelvic organs may result in ectopic pregnancy or infertility. Epididymitis, bacterial endocarditis, disseminated gonococcal infection, septic arthritis, and ophthalmia neonatorum are rarer complications of the disease (Weisner and Thompson, 1982).

The increasing antibiotic resistance of N. gonorrhoeae is a source of growing concern and a consideration in the effort to develop an effective vaccine.

Pathogen Description

Capsule

In the 1970s, several researchers reported the discovery of a gonococcal polysaccharide capsule (Hendley et al., 1977; James and Swanson, 1977; Richardson and Sadoff, 1977). All of these reports were based primarily on morphological criteria, however, and a polysaccharide capsule has yet to be isolated. Most investigators now doubt the existence of a pneumococcal- or meningococcal-like capsule on the gonococcus. It is possible that the much greater severity of meningococcemia as compared to gonococcemia is due to the lack of a capsule on the gonococcus.

Recently, Noegel and Gotschlich (1983) carefully documented the presence of a polyphosphate surface layer on all Neisseria, including gonococci. The pathogenic Neisseria seems to have more abundant

The advice and assistance of W.Cates, E.Hook, W.McCormack, P.Russell, and F.Sparling in the preparation of this appendix are gratefully acknowledged. The committee assumes full responsibility for any judgments or assumptions.



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