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Gonorrhea

Last updated: October 5, 2020

Summary

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.

Epidemiology

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

References:[1][2][3][4]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[1][5]

Clinical features

Gonorrhea can present with a wide variety of symptoms and courses. An asymptomatic course is common, particularly in women, and increases the risk of further spreading and complications!

References:[1][5][6][7][8][9]

Diagnostics

References:[1][6][8][10][11]

Treatment

Sexual partners must be treated simultaneously to avoid reinfections!

References:[1][12]

Complications

References:[8][9]

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

References

  1. Wong B. Gonorrhea. In: Haran Chandrasekar P, Gonorrhea. New York, NY: WebMD. http://emedicine.medscape.com/article/218059. Updated: October 7, 2016. Accessed: March 26, 2017.
  2. Gonorrhea - CDC Fact Sheet (Detailed Version). https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea-detailed.htm. Updated: October 25, 2016. Accessed: April 10, 2017.
  3. Ghanem KG. Clinical manifestations and diagnosis of Neisseria gonorrhoeae infection in adults and adolescents . In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-neisseria-gonorrhoeae-infection-in-adults-and-adolescents#H790870951.Last updated: May 27, 2016. Accessed: April 10, 2017.
  4. Miller KE. Diagnosis and treatment of Neisseria gonorrhoeae infections. Am Fam Physician. 2006; 73 (10): p.1779-1784.
  5. Robbins R. Gonococcal Arthritis. Gonococcal Arthritis. New York, NY: WebMD. http://emedicine.medscape.com/article/333612-overview. Updated: August 12, 2016. Accessed: April 10, 2017.
  6. Goldenberg DL, Sexton DJ. Disseminated gonococcal infection. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/disseminated-gonococcal-infection.Last updated: September 12, 2016. Accessed: April 10, 2017.
  7. Summary. https://www.cdc.gov/std/laboratory/2014labrec/default.htm. Updated: March 14, 2014. Accessed: April 10, 2017.
  8. Mayor MT, Roett MA, Uduhiri KA. Diagnosis and Management of Gonococcal Infections. Am Fam Physician. 2012; 86 (10): p.931-938.
  9. 2015 Sexually Transmitted Diseases Treatment Guidelines: Gonococcal Infections. https://www.cdc.gov/std/tg2015/gonorrhea.htm. Updated: July 27, 2016. Accessed: March 25, 2017.
  10. 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.
  11. Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States, 2008.
  12. Current Epidemiology of Selected STDs.