Gonorrhea

Gonorrhea is a sexually-transmitted disease. It causes urethritis in males (asymptomatic in a minority). It causes urethritis, cervicitis, and pelvic inflammatory disease in females (often asymptomatic). Septicemia (disseminated gonococcal infection) occurs in 0.5% to 3% of untreated infections.

CASES/YEAR
1,640,000 (US); 106,100,000 (Global)
AGENT TYPE
Bacteria
OTHER NAMES
Gonococcal urethritis; Disseminated gonococcal infection (DGI);
ACUITY
Acute-Moderate
INCUBATION
2-14 days for male urethritis and usually >10 days for female cervicitis; [Merck Manual, p. 1704]
INITIAL SYMPTOMS
Urethritis in males (a minority are asymptomatic); Urethritis, cervicitis, and pelvic inflammatory disease in females (often asymptomatic); Septicemia (disseminated gonococcal infection) occurs in 0.5% to 3% of untreated infections; [CCDM]
PRECAUTIONS
Standard
COMMENTS
FINDINGS:
Other possible gonococcal infections are pharyngitis, proctitis, conjunctivitis, arthritis-dermatitis, and, rarely, endocarditis and meningitis. In females, infertility and ectopic pregnancy are complications of endometritis and salpingitis. [CCDM, p. 237]

DGI:
Disseminated gonococcal infection (DGI) is more common in women. Patients present with mild fever, migratory joint pains, and pustules on the extremities. The bacteria can be cultured from blood in less than 1/2 of DGI cases in the first week of illness. [Merck Manual, p. 1704-5] 1% to 3% of patients with untreated gonorrhea develop DGI. 50% to 70% of patients with DGI have skin lesions. The skin eruptions may recur with each episode of fever. The skin lesions begin as tiny papules or petechiae 1-5 mm in diameter. They may appear as vesicles, bullae, pustules, or hemorrhagic lesions. A common lesion is a gray necrotic center on a hemorrhagic base. Gram stain of exudates from lesions is usually negative, but immunofluorescence staining is usually positive. [PPID, 8th Ed, p. 740] The classic triad of DGI is polyarthritis, tenosynovitis, and skin lesions. There are typically 5-30 painless skin lesions (pustular or vesiculopustular) mainly on the extremities. Rare skin lesions are petechiae, papules, and nodules. A mild leukocytosis is common in DGI. Liver function tests may be elevated. The lack of conjunctivitis and sacroiliitis in DGI distinguishes it from Reiter's syndrome. In severe cases, patients have high fever and prostration. [Cecil, p. 1910]

OTHER COMPLICATIONS:
Endocarditis was a common complication in the past. Rare complications include osteomyelitis, septic shock, and ARDS. [PPID, p. 2621] Both males and females can be asymptomatic carriers of gonorrhea (10% of males and 20-40% of females). [5MCC-2020] Untreated gonococcal conjunctivitis rarely progresses to panophthalmitis and blindness. [Merck Manual, p. 942] Gonococcal or chlamydial perihepatitis (Fitz-Hugh-Curtis syndrome) are indistinguishable clinically. Findings of this complication of PID include right upper quadrant pain and low grade fever. [PPID, p. 1014] Men who have sex with men should be screened annually for rectal and pharyngeal gonorrhea. [Cecil, p. 1909-10] See "Pelvic inflammatory disease."
DIAGNOSTIC
Gram stain; Nucleic acid amplification test (NAAT) is preferred method for men/women & symptomatic/asymptomatic; Endocervical swab (women) & first catch urine (men); First catch urine from women might miss up to 10% of infections. [ABX Guide]
SCOPE
Global
SIGNS & SYMPTOMS
  • >arthralgia
  • >fatigue, weakness
  • >fever
  • >myalgia
  • E pharyngitis
  • G abdominal pain
  • G blood in stool
  • G constipation
  • G fecal leukocytes
  • G liver function test, abnormal
  • G nausea, vomiting
  • H leukocytosis
  • H lymphadenopathy
  • O conjunctivitis, acute
  • S papules or plaques
  • S petechiae and ecchymoses
  • S pustule
  • S rash on palms
  • S skin blister or vesicles
  • S skin or subcutaneous nodule
  • S ulcer of skin
  • U pyuria
  • *ARDS
  • *arthritis
  • *blindness
  • *endocarditis
  • *epididymo-orchitis
  • *erythema nodosum
  • *hepatitis
  • *meningitis
  • *myocarditis
  • *osteomyelitis
  • *pericarditis
  • *sepsis
  • *shock
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Sexual Contact
RESERVOIR
Human
RISK FACTORS
  • Work in a medical or research lab
REFERENCES FOR CASES/YEAR
1. (US) MMWR 2011: 321,849;; 820,000 cases/yr reported and estimated twice as many as the number reported; [ABX Guide] 2 X # reported = 1,640,000;
2. (Global) 1 million STIs /day; Each year 500 million cases of Chlamydia, Gonorrhea, Syphilis, and Trichomonas; [Fact sheets from WHO 2013] 106.1 million cases in 2008; [WHO: Baseline report on global sexually transmitted infection surveillance 2012]