Among female patients, acute infections acquired by vaginal intercourse may be asymptomatic or may be associated with dysuria, lower pelvic pain, and vaginal discharge. Untreated cases may be complicated by ascending infection, leading to acute inflammation of the fallopian tubes (salpingitis) and ovaries. Scarring of the fallopian tubes may occur, with resultant infertility and an increased risk for ectopic pregnancy. Gonococcal infection of the upper genital tract may spread to the peritoneal cavity, where the exudate may extend up the right paracolic gutter to the dome of the liver, resulting in gonococcal perihepatitis. Depending on sexual practices, other sites of primary infection in both males and females include the oropharynx and the anorectal area, with resultant acute pharyngitis and proctitis, respectively.
Disseminated infection is much less common than local infection, occurring in 0.5% to 3% of cases of gonorrhea. It is more frequent in females than in males. Manifestations include, most commonly, tenosynovitis, arthritis, and pustular or hemorrhagic skin lesions. Endocarditis and meningitisarerarepresentations.Strainsthatcausedisseminated infection usually are resistant to the lytic action of complement, but rare patients with inherited complement deficiencies are susceptible to systemic spread regardless of the infecting strain.
Gonococcal infection may be transmitted to infants during passage through the birth canal. The affected neonate may develop purulent infection of the eyes (ophthalmia neonatorum), an important cause of blindness in the past. The routine application of antibiotic ointment to the eyes of newborns has markedly reduced this disorder.
Both culture and a variety of tests that detect organism-specific nucleic acids can be used to diagnose gonococcal infections. The advantage of culture is that it permits determination of antibiotic sensitivity. Nucleic acid–based tests are more rapid and somewhat more sensitive than culture, and are being used increasingly.
GonorrheaisacommonSTDaffectingthegenitourinarytract.Controlofdisseminationrequiresaneffectivecomplement-mediatedimmuneresponse.
Gonorrheapresentswithdysuriaandamilky,purulenturethraldischarge,althoughahighfrequencyofcasesareasymptomatic.
About30%ofmenwithgonococcalurethritisalsoareinfectedwithC. trachomatis.
Pregnantwomencantransmitgonorrheatonewbornsduringpassagethroughthebirthcanal.
Diagnosiscanbemadebycultureoftheexudatesaswellasbynucleicacidamplificationtechniques.
Nongonococcal urethritis (NGU) and cervicitis are the most common forms of STD. A variety of organisms are implicated in the pathogenesis of NGU and cervicitis, including C. trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, and Ureaplasma urealyticum. In the United States, most cases are apparently caused by C. trachomatis, and this organism is believed to be the most common bacterial cause of STD in the United States. Mycoplasma genitalium is a close second as a cause of NGU. The frequency of causative agents varies geographically and in certain patient populations such a men having sex with men. In almost 50% of the cases world wide no pathogen can be identified. As discussed earlier, gonorrhea infection frequently is accompanied by chlamydial infection.