Sexually Transmitted Infections: Gonorrhea

Introduction

• Description: Infection with Neisseria gonorrhoeae, a gram-negative intracellular diplococcus, remains common.

• Prevalence: In 2019 a total of 616,392 cases of gonorrhea were reported in the United States, and the national gonorrhea rate increased to 152.6 cases per 100,000 women. Before COVID-19, it was the second most commonly reported communicable disease.

• Predominant Age: 15–30 years (85%); highest prevalence at ages 15–19 years.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Infection by the gram-negative intracellular diplococcus, N. gonorrhoeae.

• Risk Factors: It is estimated that the rate of infection with one act of intercourse with an infected partner is 20% for men but 60%–80% for women. For this reason, any patient exposed to gonorrhea within the preceding month should be tested and treated presumptively. This rate increases to 60%–80% for both sexes with four or more exposures. The groups with the highest risk are adolescents, drug users, and sex workers.

Signs and Symptoms

• Asymptomatic (50%)

• Malodorous, purulent discharge from the urethra, Skene duct, cervix, vagina, or anus (even without rectal intercourse) 3–5 days after exposure (40%–60%)

• Simultaneous urethral infection (70%–90%)

• Infection of the pharynx (10%–20%)

• Gonococcal conjunctivitis (can rapidly lead to blindness)

• Polyarthritis

• Septic abortion or postabortal sepsis

Diagnostic Approach