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
• 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 ages 20 to 24 years
• Predominant sex: Men 213/100,000; Women 146/100,000

Incidence
Centers for Disease Control and Prevention (CDC) 2018: 583,405 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 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
• 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]