Overview
Definition
A sexually transmitted infection that primarily affects the mucous membranes of the reproductive tract.
Epidemiology
The second most commonly reported communicable disease in the US (after Chlamydia).
Etiology & Risk Factors
- Neisseria gonorrhoeae (a Gram-negative intracellular diplococcus).
Clinical Symptoms
- Men: Purulent urethral discharge (thick white/yellow), severe dysuria
- Women: Often asymptomatic, but can cause cervicitis (vaginal discharge, post-coital bleeding), dysuria, and lower abdominal pain
- Both: Can cause pharyngitis or proctitis depending on sexual practices
Clinical Approach
Diagnosis
- Nucleic Acid Amplification Test (NAAT): Gold Standard. Done on a urine sample or swab of the affected site.
- Gram stain of urethral discharge (in men) showing Gram-negative diplococci within neutrophils is highly specific.
Management
- First-line: Single dose of IM Ceftriaxone (500mg)
- If Chlamydia has NOT been excluded by NAAT, must co-treat for Chlamydia with Doxycycline (100mg PO BID for 7 days)
- Must treat all sexual partners from the last 60 days
Complications
- Women: Pelvic Inflammatory Disease (PID), which can lead to infertility, ectopic pregnancy, and Fitz-Hugh-Curtis syndrome (perihepatitis)
- Men: Epididymitis
- Disseminated Gonococcal Infection (DGI): Purulent arthritis, tenosynovitis, and a pustular rash