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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
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.
- 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)