THE PATHOGENESIS OF GONOCOCCAL URETHRITIS IN MEN - CONFOCAL AND IMMUNOELECTRON MICROSCOPIC ANALYSIS OF URETHRAL EXUDATES FROM MEN INFECTED WITH NEISSERIA-GONORRHOEAE

Confocal and immunoelectron microscopic analysis of urethral exudates from 12 men with gonococcal urethritis showed that Neisseria gonorrhoe ae can invade urethral epithelial cells, Studies with acridine orange stain demonstrated that the majority of organisms within urethral epit helial cells were viable at the time of fixation, Three-dimensional mo deling of an infected epithelial cell using image analysis of 21 digit ized confocal sections stained with YOYO-1 and DiIC(18)(3) revealed th at gonococcal invasion of these cells occurred in a polar fashion, mos t likely at the epithelial luminal surface, Serial immunoelectron micr ographs showed evidence of membrane fusion with pedestal formation bet ween the gonococcus and the epithelial cell, gonococci within vacuoles , and occasional gonococci free in the cytoplasm, Immunoelectron micro scopy studies showed ruptured vacuoles at the cell surface releasing o rganisms, These studies demonstrate that urethral epithelial cells are invaded by gonococci during the course of infection in males.