Gonococcal Infections

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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; clap


  • Predominant age: 15- to 44-year-olds account for 92% of cases; highest rate among those ages 20 to 24 years
  • Predominant sex: women 203/100,000; men 142/100,000

Centers for Disease Control and Prevention (CDC) 2017: 555,608 reported cases


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.

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 appropriate 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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