Gonococcal Infections

Description

A sexually or vertically transmitted bacterial infection caused by Neisseria gonorrhoeae:

• N. gonorrhoeae is a fastidious gram-negative intracellular diplococcus (1).
• Presents as conjunctival, pharyngeal, urogenital, or anorectal infection; urogenital infections are the most common.
• Hematogenous dissemination leads to fever, cutaneous lesions, arthralgias, purulent or sterile arthritis, tenosynovitis, endocarditis, or (rarely) meningitis (1).
• Asymptomatic carrier states occur in men and women (more often in women) (1).
• In newborns of infected mothers, gonococcal ophthalmia neonatorum, a purulent conjunctivitis, may occur after vaginal delivery; can lead to potential blindness if not treated promptly (1),(2)[A]
• System(s) affected: cardiovascular, musculoskeletal, nervous, reproductive, skin/exocrine
• Synonym(s): gonococcal infection; clap

Epidemiology

• Predominant age: 15- to 44-year-olds account for 92% of cases; highest rate among those aged 20 to 24 years
• Predominant sex: men 213/100,000; women 146/100,000

Incidence
Centers for Disease Control and Prevention (CDC) 2021: 710,151 reported cases

Prevalence

• Rates peaked in mid-1970s and fell 74% over the next 20 years with national control program. Rates have been slowly increasing since 2012 (2)[A].
• Rates in men now higher than women (2)[A]

Etiology and Pathophysiology

Infection requires four steps: (i) mucosal attachment—bacterial proteins bind to receptors on host cells, (ii) local penetration/invasion, (iii) local proliferation, (iv) inflammatory response or dissemination. N. gonorrhoeae spreads most commonly through sexual contact.

Genetics
Deficiency of late components of complement cascade (C7–C9) predisposes to disseminated disease.

Risk Factors

• History of previous gonorrhea infection or other STIs
• Age ≤25 years
• Sexual exposure to an infected individual without appropriate use of barrier protection (condom)
• New/multiple sexual partners
• Men who have sex with men (MSM)
• Inconsistent condom use
• Commercial sex work or drug use
• Infants: infected mother
• Children: sexual abuse by infected individual
• Autoinoculation (finger to eye)

General Prevention

• Condoms offer partial protection and must be used appropriately during oral, anal, and vaginal sex.
• Treat sexual contacts; consider expedited partner therapy (EPT) (2)[A].

Commonly Associated Conditions