Risk Factors
Infection with certain strains of Neisseria gonorrhoeae
Prolonged infection
Female sex (due to asymptomatic infection, and therefore prolonged infection)
Sexual promiscuity
Immune system deficiencies
Infection during menstruation, pregnancy, or in the puerperium period

Symptoms
Fever
Migratory arthralgias
Hemorrhagic pustules
Tenosynovitis
Rarely headache, neck stiffness, and visual changes (associated with meningitis)

Treatment
Treatment typically consists of cephalosporin and fluoroquinolone antibiotics. Gonococcemia is typically treated with intravenous or intramuscular cephalosporin antibiotics. Approximately 10-30% of gonorrheal infections present with a co-infection of chlamydia, so it is common to add a one-time dose of oral azithromycin or doxycycline for coverage of Chlamydia trachomatis. Bacterial resistance to antibiotics is increasingly common in Neisseria gonorrhoeae, so it is often advised to check susceptibility of the bacterial culture and then adjust the antibiotic therapy as needed. Pathogenesis
Neisseria gonorrhoeae is transmitted during sexual contact with an infected individual. The bacteria invade the non-ciliated columnar epithelium of the urogenital tract, oral mucosa, or anal mucosa following exposure. Invasion of the host cells is made possible due to virulence factors such as Pili, LOS, Opa, and others. Similarly, these virulence factors can be used for avoiding the host immune system, which may explain prolonged infection, bacterial resistance, and gonococcemia. See also
Primary gonococcal dermatitis
List of cutaneous conditions


== References ==
Spotting is more common in longer cycles. A womans vulva may swell just prior to ovulation, especially the side on which ovulation will occur. One of the groin lymph nodes (on the side on which ovulation will occur) will swell to about the size of a pea, and may become tender. Causes
Mittelschmerz is believed to have a variety of causes:

Follicular swelling: The swelling of follicles in the ovaries prior to ovulation. While only one or two eggs mature to the point of being released, a number of follicles grow during the follicular phase of the menstrual cycle (non-dominant follicles atrophy prior to ovulation). Because follicles develop on both sides, this theory explains mittelschmerz that occurs simultaneously on both sides of the abdomen.Ovarian wall rupture: The ovaries have no openings; at ovulation the egg breaks through the ovarys wall. This may make ovulation itself painful for some women. Fallopian tube contraction: After ovulation, the fallopian tubes contract (similar to peristalsis of the esophagus), which may cause pain in some women. Smooth muscle cell contraction: At ovulation, this pain may be related to smooth muscle cell contraction in the ovary as well as in its ligaments. These contractions occur in response to an increased level of prostaglandin F2-alpha, itself mediated by the surge of luteinizing hormone (LH).Irritation: At the time of ovulation, blood or other fluid is released from the ruptured egg follicle. This fluid may cause irritation of the abdominal lining.