To the Editor.—
In his article "Gonococcal Proctitis in a Married Woman: Report of a Case" (238:2718, 1977), Nicholas J. Fiumara, MD, MPH, implies that he would not have obtained a rectal culture from his patient (in whom previous treatment for gonorrhea was suspected to have failed) had she not given a history of rectal intercourse. In fact, between 30% and 40% of women with endocervical gonococcal infection have positive rectal cultures,1 and the majority of such infections occur because of perineal contamination by cervicovaginal exudate, rather than through rectal intercourse.1,2The Center for Disease Control recommends that all women with gonorrhea be reexamined seven to 14 days after treatment, with both endocervical and rectal cultures,3 since 30% of women who fail treatment are detected only by the rectal culture.4 Had this been done, the patient's treatment failure might have been diagnosed two months earlier than
Handsfield HH. Gonococcal Proctitis. JAMA. 1978;240(12):1240–1241. doi:10.1001/jama.1978.03290120034017
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