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For further information, see CMDT Part 33-26: Gonococcal Infections

Key Features

Essentials of Diagnosis

  • Purulent, profuse urethral discharge with dysuria, especially in men; yields positive gram-stained smear

  • In men

    • Urethritis

    • Epididymitis

    • Prostatitis

    • Proctitis

    • Pharyngitis

  • In women

    • Asymptomatic or cervicitis with purulent discharge

    • Vaginitis, salpingitis, proctitis also occur

  • Disseminated disease

    • Two clinical syndromes, though there can be overlap

      • Purulent arthritis or

      • Triad of rash, tenosynovitis and arthralgias

  • Nucleic acid amplification is preferred diagnostic test

General Considerations

  • Gonorrhea is caused by Neisseria gonorrhoeae, a gram-negative diplococcus


  • Gonorrhea is transmitted as a result of sexual activity and has its greatest incidence in the 15- to 29-year-old age group

Clinical Findings

Symptoms and Signs

  • Asymptomatic infection is common and occurs in both sexes

  • Other sites of primary infection (eg, the pharynx) must always be considered


  • In men

    • Initially, burning on urination and a serous or milky discharge

    • One to 3 days later, urethral pain is more pronounced, and the discharge becomes yellow, creamy, and profuse, sometimes blood-tinged

    • May regress and become chronic or progress to involve the prostate, epididymis, and periurethral glands with acute, painful inflammation

    • Chronic infection leads to prostatitis and urethral strictures

    • Rectal infection is common in homosexual men

  • In women

    • Dysuria

    • Urinary frequency and urgency, with a purulent urethral discharge


  • Infection may be asymptomatic, with only slightly increased vaginal discharge and moderate cervicitis on examination

  • Vaginitis and cervicitis with inflammation of Bartholin glands are common

  • Infection may remain as a chronic cervicitis

  • It may progress to involve the uterus and fallopian tubes with acute and chronic salpingitis and ultimate scarring of tubes and sterility

  • In pelvic inflammatory disease, anaerobes and chlamydiae often accompany gonococci

  • Rectal infection may result from spread of organism from the genital tract or from anal coitus

    Disseminated disease

  • Skin lesions

    • Maculopapular, pustular or hemorrhagic

    • Tend to be few in number and peripherally located

  • Tenosynovitis: often in hands, wrists, feet and ankles

  • Arthritis: can occur in one or more joints and may be migratory

  • Rare: gonococcal endocarditis or meningitis


  • Direct inoculation of gonococci into the conjunctival sac occurs by autoinoculation from a genital infection

  • Purulent conjunctivitis may rapidly progress to panophthalmitis and loss of the eye unless treated promptly

Differential Diagnosis

  • Nongonococcal urethritis

  • Cervicitis or vaginitis due to

    • Chlamydia trachomatis

    • Gardnerella vaginalis

    • Trichomonas

    • Candida

    • Other pathogens associated with sexually transmitted infections

  • Pelvic inflammatory disease

  • Proctitis

  • Reactive arthritis


Laboratory Tests

  • Nucleic acid amplification tests

    • The preferred testing method for diagnosing gonococcal infection at ...

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