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Gonorrhea

Last updated: April 6, 2021

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Gonorrhea is a sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae that leads to genitourinary tract infections such as urethritis, cervicitis, pelvic inflammatory disease (PID) and epididymitis. The disease primarily affects individuals between 15–24 years of age and has an incubation period of 2–7 days. Gonorrhea is commonly asymptomatic, especially in women, which increases the chance of further spreading and complications. In symptomatic cases, typical clinical symptoms include purulent vaginal or urethral discharge, dysuria, and signs of epdidymitis (e.g., scrotal pain) or PID (e.g., pelvic pain, dyspareunia). Gonorrhea may also cause extragenitourinary manifestations, such as proctitis and pharyngitis. Rarely, disseminated disease may occur, which typically manifests with a triad of arthritis, pustular skin lesions, and tenosynovitis. Diagnostic tests include nucleic acid amplification testing, gram stains, and bacterial cultures from urine or swabs of the genitourinary tract as well as blood and synovial fluid in disseminated infection. Treatment consists of antibiotics, mainly ceftriaxone and azithromycin, but may require different approaches in more severe cases. Without treatment, prolonged infection may lead to complications, such as a hymenal and tubal synechiae that lead to infertility in women.

  • Incidence [1][2]
    • Second most commonly reported infectious disease in the US after chlamydia
    • ∼ 820,000 cases per year in the US
  • Age: primarily individuals between 15–24 years of age

Epidemiological data refers to the US, unless otherwise specified.

Overview

  • An asymptomatic course is common, particularly in women, and increases the risk of further spread and complications.
  • Incubation time: 2–7 days

Urogenital manifestations

Extragenital manifestations

Disseminated gonococcal infection (DGI)

  • Epidemiology
    • ∼ 2% of cases
    • Most common in individuals < 40 years old and female individuals (4:1)
  • Clinical features: Two distinct clinical presentations are possible.
    • Arthritis-dermatitis syndrome
      • Polyarthralgias: migratory, asymmetric arthritis that may become purulent
      • Tenosynovitis: simultaneous inflammation of several tendons (e.g., fingers, toes, wrist, ankle)
      • Dermatitis: vesicular, pustular, or maculopapular lesions, possibly with a necrotic or hemorrhagic center
        • Most commonly distributed on the trunk, extremities (sometimes involving the palms and soles)
        • Typically < 10 lesions with a transient course (subside in 3–4 days)
      • Additional manifestations: fever and chills (especially in the acute phase)
    • Purulent gonococcal arthritis
    • Genitourinary manifestations in only 25% of affected individuals
    • Not to be confused with reactive arthritis

Sexual partners must be treated simultaneously to avoid reinfections.

We list the most important complications. The selection is not exhaustive.

  1. Sancta St. Cyr, Lindley Barbee, Kimberly A. Workowski, Laura H. Bachmann, Cau Pham, Karen Schlanger, Elizabeth Torrone, Hillard Weinstock, Ellen N. Kersh, Phoebe Thorpe. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69 (50): p.1911-1916. doi: 10.15585/mmwr.mm6950a6 . | Open in Read by QxMD
  2. Guidance on the Use of Expedited Partner Therapy in the Treatment of Gonorrhea. https://www.cdc.gov/std/ept/gc-guidance.htm. Updated: March 1, 2021. Accessed: March 9, 2021.
  3. Chlamydia and Gonorrhea — Two Most Commonly Reported Infectious Diseases in the United States. https://www.cdc.gov/features/dsstddata/. Updated: April 22, 2011. Accessed: April 10, 2017.
  4. Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States, 2008.