References:

Global Infectious Diseases and Epidemiology Online Network: Infectious Diseases of the Philippines, 2013 eBook Edition, ISBN 978-1-61755-582-4, by Stephen Berger. Accessed here.


Agent	BACTERIUM. Neisseria gonorrheae. An aerobic gram-negative coccus.
Reservoir	Human
Vector	None
Vehicle	Sexual contact Childbirth Exudates
Incubation Period	2 to 7 days
Diagnostic Tests	Smear (male), culture. Consult laboratory for proper acquisition & transport Nucleic acid amplification
Typical Adult Therapy	Ceftriaxone 250 mg IM X 1. PLUS Azithromycin 1 g PO as single dose.
Typical Pediatric Therapy	Weight ⇐45 kg: Ceftriaxone 125 mg IM X 1 Weight >45 kg: as for adult. PLUS Azithromycin
Clinical Hints	Copious urethral discharge (male) or cervicitis beginning 2 to 7 days after sexual exposure; PID; fever, painful pustules and suppurative arthritis (primarily encountered in postmenstrual females).
Synonyms	Blennorragie, Blenorragia, Gonococcemia, Gonore, Gonorre, Gonorrea, Gonorrhea, Gonorrhee, Gonorrho, Gonorrhoe, Infeccion gonococica, Infeccoes gonococicas, Neisseria gonorrhoeae.

Gonorrhea

Gonorrhea in males typically presents as urethral discomfort, dysuria, and discharge.

The degree of discomfort and discharge are variable.
Asymptomatic infection is common among females, but may also occur in males.
Gonococcal epididymitis presents with unilateral pain and swelling localized posteriorly within the scrotum.
Gonorrhea in the female are usually manifest as vaginal discharge and endocervicitis.
The discharge is thin, purulent and mildly odorous.
Dysuria or a scant urethral discharge may be present.
Non-gonococcal urethritis, including infection by Chlamydia trachomatis and other Neisseria species may mimic gonococcal infection.
Infection can be passed to the male urethra from the pharynx through fellatio.
Levels of serum Prostate-specific Antigen (PSA) may be elevated in patients with gonorrhea.

Gonococcal Pelvic Inflammatory Disease

Pelvic or lower abdominal pain suggests infection of the endometrium, fallopian tubes, ovaries or peritoneum.

Pain may be midline, unilateral, or bilateral.
Fever and vomiting may be present.
Right upper quadrant pain from perihepatitis (Fitz-Hugh-Curtis syndrome) may occur following the spread of organisms upward along peritoneal planes to the hepatic capsule (The syndrome is also reported as a complication of gonorrhea in males)

Gonococcal proctitis is often asymptomatic, but rectal pain, pruritus, tenesmus, bloody diarrhea and rectal discharge may be present.
Gonococcal pharyngitis may be asymptomatic, or associated with severe inflammation. Neisseria gonorrhoeae is often present in throat specimens from patients with urethritis.
Gonococcal conjunctivitis is usually unilateral in adults; however, neonatal infection (ophthalmia neonatorum) involves both eyes.
- Symptoms include pain, redness, and a purulent discharge and may result in blindness.
- Rare instances of corneal perforation are reported.
Disseminated gonococcal infection is characterized by joint or tendon pain, of single or multiple joints.
- Severe pain, swelling, and decreased mobility in a single joint (usually the knee) suggest purulent arthritis.
- Tenosynovitis is common, usually affecting the small joints of the hands.
- A rash is present in 25% of patients with gonococcemia.
- Additional complications include meningitis, endocarditis, septic shock with ARDS, subcutaneous abscess, Fournier’s gangrene, pyomyositis and other localized infections.