The envelope phenotypes and coagglutination (CoA) W serogroups of 301 unselected clinical isolates of were studied. Of the 287 isolates from infections acquired in the Edinburgh area, 252 (88%) were of the wild-type phenotype, 17 (6%) were of Env phenotype with increased permeability of the cell envelope, and 18 (6%) were of Mtr phenotype with reduced permeability of the cell envelope. Mtr strains were isolated significantly more often from homosexual men than from heterosexual men and women (p>0.001). Of the isolates from homosexual men there were considerably fewer Mtr phenotypes among rectal isolates than among urethral and throat isolates. All isolates from homosexual men, 57% from heterosexual men and 52% from women were of CoA serogroup WII (including WII/WIII). Although the Mtr phenotype was strongly associated with serogroup-WII isolates from homosexual men, there was no such correlation between the Mtr phenotype and serogroup-WII isolates from heterosexual patients. It is suggested that hydrophobic compounds in the rectal environment are not the major factor in selecting serogroup-WII strains of Mtr phenotype associated with homosexually acquired infection. The hypothesis that the Mtr phenotype and serogroup WII are selected independently as a result of a more general selective pressure such as antibiotic usage, common to all infected sites, is discussed.


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