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Gonococcal Infections

Gonococcal Infections is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

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

  • N. gonorrhoeae is a fastidious gram-negative intracellular diplococcus (1)[A].
  • Present as conjunctival, pharyngeal, urogenital, or anorectal infections. Urogenital infections are the most common (1)[A].
  • Hematogenous dissemination leads to fever, cutaneous lesions, arthralgias, purulent or sterile arthritis, tenosynovitis, endocarditis, or (rarely) meningitis (1)[A].
  • Asymptomatic carrier states occur in both sexes.
  • In newborns, gonococcal ophthalmia neonatorum, a purulent conjunctivitis, may occur after vaginal delivery by an infected mother, potentially leading to blindness if not treated promptly (1,2)[A].
  • System(s) affected: cardiovascular, musculoskeletal, nervous, reproductive, skin/exocrine
  • Synonym(s): gonococcal infection (GC); clap

Epidemiology

  • Predominant age: 15 to 24 years (1,2)[A]
  • Predominant sex: women 105/100,000; men 92/100,000 (2)[A]

Incidence
CDC 2016: 468,514 reported cases

Prevalence

Incidence and prevalence are roughly equal. The true prevalence is higher due to asymptomatic cases (2)[A]:

  • 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 relations.

Genetics
Deficiency of late components of complement cascade (C7–C9) makes individuals prone to develop dissemination of local gonococcal infections.

Risk Factors

  • History of previous gonorrhea infection or other STIs
  • Sexual exposure to an infected individual without use of barrier protection (condom)
  • New/multiple sexual partners
  • 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

Other STIs: Chlamydia, syphilis, HIV, hepatitis B, herpes (2,3)[A]

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Citation

Stephens, Mark B., et al., editors. "Gonococcal Infections." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116248/all/Gonococcal_Infections.
Gonococcal Infections. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116248/all/Gonococcal_Infections. Accessed April 26, 2019.
Gonococcal Infections. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116248/all/Gonococcal_Infections
Gonococcal Infections [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 26]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116248/all/Gonococcal_Infections.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Gonococcal Infections ID - 116248 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116248/all/Gonococcal_Infections PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -