Paradox of the Immune Response to Uncomplicated Gonococcal Urethritis

The antigonococcal immune response of 35 men with uncomplicated gonorrhea was studied with use of methods to detect immune lymphocytes, serum and secretion antibodies. As compared to 24 normal controls, lymphocyte blastogenesis induced by gonococcal antigens was marginally greater for 11 men with a first infection and significantly greater (p≤0.001) for 24 men with multiple infections. Antigonococcal antibodies were found in the serum of one of 24, six of 11, and 16 of 24 men with no, one and more than one infection respectively. Antigonococcal IgA antibodies were found in the urethral secretions of nine of 11 men with a first and in 20 of 24 men with multiple gonococcal infections. Among subjects with multiple infections the majority, 13 of 24, had antigonococcal activity detected by all three test systems. These data suggest that a variety of potential effectors — lymphocytes, serum antibodies and secretion IgA antibodies — with antigonococcal activity is insufficient for protection from recurrent disease. (N Engl J Med 289:1170–1174, 1973)