Four cases of gonococcal pharyngotonsillitis have been presented, along with a review of the world literature. This entity is most commonly seen in those individuals practicing fellatio, i.e., females and homosexual males. The infection may be passed to the newborn by the infected genitals of the mother during birth, to the infant from adult molestation, or among sexually promiscuous children. Most gonococcal pharyngeal infections result in a carrier state, and as such, are possible reservoirs of propagated infections. When symptomatic, the most frequent complaint is a sore throat. Physical finding among symptomatic patients reveal a wide spectrum ranging from mild hyperemia of the pharynx or tonsils, to exudative tonsillitis with tender cervical lymph nodes and moderate elevation of temperature. Most authorities agree that the preferred treatment is 4.8 million units of procaine penicillin G I.M., with one gm of probenecid by mouth thirty minutes before the injection. If allergic to penicillin, tetracycline should be given, 1.5 gm by mouth stat, then 0.5 gm four times a day for a total of 9 gm. A routine blood agar culture of the throat will not reveal the presence of the gonococcus. Thayer-Martin (or Transgrow) media must be used. Failure to detect pathogenic bacteria in a routine culture may lead to either no treatment or improper treatment of a gonococcal pharyngotonsillar infection. This may result in a carrier state, or even worse, to a disseminated gonococcal infection.
