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| Clinical Background: |
N. gonorrhoeae is a gram-negative diplococcus that is the second most common sexually transmitted microbe in the United States today. Individuals at greatest risk are inner city residents less than 24 years of age who have unprotected sex with multiple sexual partners. The incidence of gonorrheae has recently decreased however it continues to be problematic, most likely as a result of transmission by women who are largely asymptomatic. Transmission requires direct, usually sexual contact. The bacterium is transmitted more effectively from men to women than from women to men. Neonates can acquire the organism at birth.
Gonorrhea – Rates by gender: U.S. 1981-1997 and the Healthy
People 2000 Objective (from Centers for Disease Control Sexually Transmitted Disease Surveillance 1997)
Diseases:
- Lower genital infection
- Symptomatic disease
Men: acute urethritis with scant clear to copious mucopurulent discharge,
dysuria, and increased urinary frequency within 7 days of infection
Women: acute endocervical infection with vaginal discharge, dysuria,
and an erythematous and friable cervical os
- Asymptomatic disease
Men: An estimated 10-50% of men are asymptomatically infected. If
left untreated, infections result in epididymitis, prostatitis, and urethral
strictures.
Women: Untreated asymptomatic infection can cause urethral abscesses,
salpingitis, tubo-ovarian abscesses, endometritis and Fitz-Hugh- Curtis syndrome
(perihepatitis). Long term sequelae include infertility and ectopic pregnancy
as a result of fallopian tube scarring and blockage.
- Anogenital/oropharyngeal infection: transmitted via receptive oral/anal intercourse in men and women or from contamination from cervical secretions in women.
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Anorectal disease: manifested by copious purulent rectal discharge, pain, tenesmus,
or bloody stools; may be asymptomatic
- Oropharyngeal disease: mild pharyngitis or asymptomatic infection
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Conjunctivitis "ophthalmia neonatorum"; tearing, edema, and purulent exudates;
corneal scarring and perforation can occur if left untreated; uncommon in developed
world due to administration of antibiotic eye drops at birth.
- Disseminated Infection:
1-3% of gonorrheae cases; most commonly seen in untreated asymptomatic patients;
patients with complement deficiencies (C7, C8, C9) are more prone to disseminated
disease; organism isolated from blood in <50% of cases
- Manifestations: dermatitis-arthritis syndrome
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