- • In men, findings include urethral discharge, urethral
burning with urination, and swelling of the glans penis.
- • In women, findings include lower abdominal pain;
cervicovaginal discharge, “spotting,” and bleeding;
and pain with intercourse.
- • Disseminated infection produces a rash consisting
of papules or pustules with an erythematous border; monoarticular
arthritis or tenosynovitis may also be present.
- • Definitive diagnosis can be made by Gram stain,
culture, molecular probe assay, or nucleic acid amplification testing.
Neisseria gonorrhoeae may cause
several adverse health outcomes, including local genitourinary infections,
upper reproductive tract disease, and disseminated gonococcal infections.
An important impact of N gonorrhoeae infection
is that it can facilitate acquisition of the human immunodeficiency
virus (HIV) and shedding of HIV in semen.
The global incidence of gonorrhea infections remains high, with
an estimated 62 million new cases each year. The highest rates occur
in sub-Saharan Africa, south and Southeast Asia, the Caribbean,
and Latin America. Although the overall prevalence of gonorrhea
has declined in the United States since 1975, it remains the second
most commonly reported communicable disease. Rates remain high in
certain groups, including African-Americans and Hispanics, men who
have sex with men (MSM), adolescents, and populations in the southeastern
United States. Race in itself is not a risk factor for gonorrhea
but may be a surrogate marker for socioeconomic and behavioral factors
that increase the risk for infection.
Screening is an important tool for identifying and treating asymptomatic
infection, the most common manifestation of gonorrhea, which serves
as a source of ongoing community transmission. In addition to screening
efforts directed at women to reduce the complications of untreated
disease in this population, routine screening in specific risk groups,
such as adolescents, MSM, or HIV-infected individuals is recommended.
Cohen MS, Hoffman IF, Royce RA, et al. Reduction
of concentration of HIV-1 in semen after treatment of urethritis:
Implications for prevention of sexual transmission of HIV-1. AIDSCAP Malawi
Research Group. Lancet
. (Classic article demonstrating the impact of
urethritis on seminal HIV viral load.)
The transmission of N gonorrhoeae following
a single episode of vaginal intercourse has been estimated to be
approximately 70–80% from male to female partners,
and 20–30% from female to male partners. Transmission through
either receptive or insertive rectal intercourse may be less efficient
than vaginal intercourse but data are limited. Penile-oral and oral-penile
transmission is probably the least efficient means of transmission
but does occur; again, data on the true frequency of transmission
Following introduction into a mucosal site, gonococci attach
to the surface of columnar epithelial cells and colonize mucosal
cells through parasite-directed endocytosis. The exuberant host immune
response to gonococcal infection, while leading to control of infection,
can account for many of the signs and symptoms of disease.
Edwards JL, Apicella MA. The molecular mechanisms
used by Neisseria gonorrhoeae to initiate infection differ between ...