Gonococcal Infections

Basics

Description

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

  • N. gonorrhoeae is a fastidious gram-negative intracellular diplococcus (1)[A].
  • Presents as conjunctival, pharyngeal, urogenital, or anorectal infection; 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 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) 2020: 677,769 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 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

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

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