Gonococcal resistance to penicillin in the light of recent literature.

Recent years have witnessed a slight decrease in the sensitivity of certain gonococcal strains to penicillin. A survey of the pertinent literature, however, indicates that most reports of gonococcal infections which are unresponsive to "adequate" doses of penicillin are not sufficiently substantiated by valid clinical and laboratory studies to demonstrate beyond doubt the existence of truly penicillin-resistant strains. Nevertheless, the possibility of such resistance is real and important. Investigations to determine with certainty whether the gonococcus is acquiring a significant degree of resistance should include measurement of penicillin blood levels, prevention of re-exposure, confirmation of diagnosis by cultures, elimination of possible host factors when apparently recalcitrant cases are encountered, and careful laboratory confirmation of the in vitro penicillin-resistance of the strains involved.