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{{Gonorrhea}}
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==Overview==
In 50 to 70% of women, the Initial infection with ''[[Neisseria gonorrhea]]'' may be asymptomatic.
Initial infection is usually observed in the cervical region, but due to the presence of the surface pili, the infection may ascend through the [[uterus]] into the [[fallopian tubes]] and finally out into the [[peritoneal cavity]]. 
The exact [[incubation period]] of gonorrhea is unknown. It may result in [[cervicitis]] and [[urethritis]], which can present with [[dysuria]], vaginal [[pruritus]], and vaginal [[mucopurulent discharge]]. 
If gonococcal infection is left untreated, it can progress to [[fibrosis]], which can result in fallopian tube stricture, tubo-ovarian [[cyst]] or [[abscess]], [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]], [[Fitz-Hugh-Curtis syndrome|Perihepatitis (Fitz-Hugh-Curtis syndrome)]], and/or [[bartholinitis]]. The most common complication of untreated gonorrhea is [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]], which may lead to increased risks of [[ectopic pregnancy]]. If left untreated, [[ectopic pregnancy]] can be life-threatening for the mother.<ref name="pmid2512520">{{cite journal| author=McNeeley SG| title=Gonococcal infections in women. | journal=Obstet Gynecol Clin North Am | year= 1989 | volume= 16 | issue= 3 | pages= 467-78 | pmid=2512520 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2512520  }} </ref><ref name="pmid7427703">{{cite journal| author=Stansfield VA| title=Diagnosis and management of anorectal gonorrhoea in women. | journal=Br J Vener Dis | year= 1980 | volume= 56 | issue= 5 | pages= 319-21 | pmid=7427703 | doi= | pmc=1045815 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7427703  }} </ref>
In men, untreated gonorrhea may result in inflammation of the epididymis ([[epididymitis]]), prostate gland ([[prostatitis]]), and urethral structure (urethritis).
Disseminated gonococcal infection (DGI) occurs in about 0.5 to 3% of patients, commonly following asymptomatic mucosal infection in both sexes. Women are more likely to develop disseminated gonococcal infection than men.
Disseminated gonococcal infection can lead to the infection of multiple distant sites such as the [[brain]], the [[heart]], and [[joint]]s. The most common signs and symptoms include [[arthritis]] or [[arthralgias]], [[tenosynovitis]], and multiple [[skin lesions]].
 
Common [[complications]] of gonococcal infection in women may include [[salpingitis]], [[pelvic inflammatory disease]], [[infertility]], [[dyspareunia]], and [[ectopic pregnancy]].
Common [[complications]] of gonococcal infection in men may include post-inflammatory urethral strictures, [[abscess|urethral abscess]], [[lymphangitis|Penile lymphangitis]], penile edema, [[urinary tract infection]], and [[kidney failure]].
The prognosis of urogenital and disseminated gonococcal infection are generally good with adequate treatment.


==Natural history, complications, and prognosis==
==Natural history, complications, and prognosis==
===Natural History===
===Natural History===
'''Gonococcal infection in women'''
====Gonococcal infection in women====
*In in 70% of women, the Initial infection of ''[[Niesseria gonorrhea]]'' may be asymptomatic. However, the organism may cause a typical [[acute inflammatory reaction]] resulting frequently in a purulent exudate.   
*In 50 to 70% of women, the Initial infection with ''[[Neisseria gonorrhea]]'' may be asymptomatic.<ref name="pmid2512520">{{cite journal| author=McNeeley SG| title=Gonococcal infections in women. | journal=Obstet Gynecol Clin North Am | year= 1989 | volume= 16 | issue= 3 | pages= 467-78 | pmid=2512520 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2512520  }} </ref><ref name="pmid7427703">{{cite journal| author=Stansfield VA| title=Diagnosis and management of anorectal gonorrhoea in women. | journal=Br J Vener Dis | year= 1980 | volume= 56 | issue= 5 | pages= 319-21 | pmid=7427703 | doi= | pmc=1045815 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7427703 }} </ref>
*Initial infection is usually seen in the cervical region, but due to the presence of the surface pili, the infection may ascend through the uterus into the fallopian tubes and finally out into the [[peritoneal cavity]].  
*Initial infection is usually observed in the cervical region though, due to the presence of the surface pili, the infection may ascend through the [[uterus]] into the [[fallopian tubes]] and, finally, out into the [[peritoneal cavity]]. 
If gonococcal infection left untreated, it can result in [[cyst]] and [[abscess]] formation in one or more of the [[greater vestibular gland]]s ([[bartholinitis]]), [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]], and [[Fitz-Hugh-Curtis syndrome]].
*The exact [[incubation period]] of gonorrhea is unknown. It may result in [[cervicitis]] and [[urethritis]], which can cause [[dysuria]], vaginal [[pruritus]], and vaginal [[mucopurulent discharge]].
* The most common complication of untreated gonorrhea is [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]], a serious infection of the female reproductive tract.
*If gonococcal infection is left untreated, it can progress to [[fibrosis]], which can result in fallopian tube stricture, tubo-ovarian [[cyst]] or [[abscess]], [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]], [[Fitz-Hugh-Curtis syndrome|Perihepatitis (Fitz-Hugh-Curtis syndrome)]], and [[bartholinitis]].
* PID caused by gonorrhea can lead to scarring of the [[fallopian tubes]]. Scarring of the fallopian tube can lead to increased risks of [[ectopic pregnancy]] and as a result [[Fertilization|fertilized]] [[Ovum|egg]] may not be able to pass through the narrowed, scarred fallopian tube. Ectopic pregnancies are serious conditions which can be life-threatening to the mother.
*The most common complication of untreated gonorrhea is [[pelvic inflammatory disease|pelvic inflammatory disease (PID)]].
'''Gonococcal infection in men'''
*PID caused by gonorrhea can lead to scarring of the [[fallopian tubes]]. As a result of scarring and [[fibrosis]] of [[fallopian tubes]], the [[Fertilization|fertilized]] [[Ovum|egg]] may not be able to pass through the narrowed and scarred fallopian tube, which may lead to increased risks of [[ectopic pregnancy]] and [[infertility]]. If left untreated, [[ectopic pregnancy]] can be life-threatening for the mother.
* In men, untreated gonorrhea may result in inflammation of the epididymis ([[epididymitis]]), prostate gland ([[prostatitis]]) and urethral structure (urethritis).
===Disseminated gonococcal infection===
* In both sexes, disseminated gonococcal infection (DGI) can occur, leading to multiple distant sites of infection which can include the [[brain]], [[heart]] and [[joint]]s.
* When joints become involved, gonococcal arthritis can develop.  Gonococcal arthritis occurs after primary infection of the genitalia, anus, or throat.  This occurs in about 1% of patients who are infected with gonorrhea and is more common in women than men.
* Typical symptoms include a 5–7 day history of fever, shaking, chills, multiple skin lesions, fleeting migratory [[arthralgia|polyarthralgias]] and [[tenosynovitis]] in fingers, wrists, toes or ankles.  This should be evaluated promptly with a culture of the [[synovial fluid]], blood, cervix, urethra, rectum, skin lesion fluid, or pharynx.
allowing attachment to these surfaces. Adherence to the surface of [[spermatozoa]] allows transmission of the organism to the fallopian tube, the presumed mechanism of ascending infection. Initial infection may be asymptomatic, but the organism incites a typical acute inflammatory reaction resulting frequently in a purulent exudate. 
The clinical consequences of gonorrhea are due to classic pyogenic infection with resolution by fibrosis. Initial infection is usually seen in the cervical region, but due to the adherence to spermatozoa, the infection may ascend through the uterus into the fallopian tubes and finally out into the peritoneal cavity. A purulent vaginal discharge is often seen, but frequently the purulent material exudes from the fimbriated end of the fallopian tubes into the peritoneal cavity. Untreated infections may progress to fibrosis. The fibrotic reaction, depending on its location can lead to a variety of complications, such as urethral stricture, fallopian tube stricture, tubo-ovarian abscess, pelvic inflammatory disease (PID) and infertility. Peritonitis may present in PID and cause life threatening acute bowel obstruction.
It is important to treat the symptoms of gonorrhea as early as possible. When the infection is confined to the lower genital tract, it is much more responsive to antibiotic therapy. Once the infection ascends and becomes well established, it is difficult to deliver the needed concentrations of antibiotics and the infection is much more difficult to cure with drugs alone. This is due to the lack of blood flow in the walled off areas and is the reason that surgery often becomes necessary.
In pregnancy, gonococcus can be transmitted to the fetus at the time of delivery. This results in infection of the conjuctiva of the eye. This appears 1 to 4 days after birth as severe discharge with marked swelling and redness of the eyelids and conjunctiva. This can lead to corneal perforation and blindness. Diagnosis is made by gram stain of the exudate and culture
allowing attachment to these surfaces. Adherence to the surface of [[spermatozoa]] allows transmission of the organism to the fallopian tube, the presumed mechanism of ascending infection. Initial infection may be asymptomatic, but the organism incites a typical acute inflammatory reaction resulting frequently in a purulent exudate. 
The clinical consequences of gonorrhea are due to classic pyogenic infection with resolution by fibrosis. Initial infection is usually seen in the cervical region, but due to the adherence to spermatozoa, the infection may ascend through the uterus into the fallopian tubes and finally out into the peritoneal cavity. A purulent vaginal discharge is often seen, but frequently the purulent material exudes from the fimbriated end of the fallopian tubes into the peritoneal cavity. Untreated infections may progress to fibrosis. The fibrotic reaction, depending on its location can lead to a variety of complications, such as urethral stricture, fallopian tube stricture, tubo-ovarian abscess, pelvic inflammatory disease (PID) and infertility. Peritonitis may present in PID and cause life threatening acute bowel obstruction.
It is important to treat the symptoms of gonorrhea as early as possible. When the infection is confined to the lower genital tract, it is much more responsive to antibiotic therapy. Once the infection ascends and becomes well established, it is difficult to deliver the needed concentrations of antibiotics and the infection is much more difficult to cure with drugs alone. This is due to the lack of blood flow in the walled off areas and is the reason that surgery often becomes necessary.
In pregnancy, gonococcus can be transmitted to the fetus at the time of delivery. This results in infection of the conjuctiva of the eye. This appears 1 to 4 days after birth as severe discharge with marked swelling and redness of the eyelids and conjunctiva. This can lead to corneal perforation and blindness. Diagnosis is made by gram stain of the exudate and culture


allowing attachment to these surfaces. Adherence to the surface of [[spermatozoa]] allows transmission of the organism to the fallopian tube, the presumed mechanism of ascending infection. Initial infection may be asymptomatic, but the organism incites a typical acute inflammatory reaction resulting frequently in a purulent exudate.
====Gonococcal infection in men====
The clinical consequences of gonorrhea are due to classic pyogenic infection with resolution by fibrosis. Initial infection is usually seen in the cervical region, but due to the adherence to spermatozoa, the infection may ascend through the uterus into the fallopian tubes and finally out into the peritoneal cavity. A purulent vaginal discharge is often seen, but frequently the purulent material exudes from the fimbriated end of the fallopian tubes into the peritoneal cavity. Untreated infections may progress to fibrosis. The fibrotic reaction, depending on its location can lead to a variety of complications, such as urethral stricture, fallopian tube stricture, tubo-ovarian abscess, pelvic inflammatory disease (PID) and infertility. Peritonitis may present in PID and cause life threatening acute bowel obstruction.
*In men, untreated gonorrhea may result in inflammation of the epididymis ([[epididymitis]]), prostate gland ([[prostatitis]]), and urethral structure (urethritis).
It is important to treat the symptoms of gonorrhea as early as possible. When the infection is confined to the lower genital tract, it is much more responsive to antibiotic therapy. Once the infection ascends and becomes well established, it is difficult to deliver the needed concentrations of antibiotics and the infection is much more difficult to cure with drugs alone. This is due to the lack of blood flow in the walled off areas and is the reason that surgery often becomes necessary.
 
In pregnancy, gonococcus can be transmitted to the fetus at the time of delivery. This results in infection of the conjuctiva of the eye. This appears 1 to 4 days after birth as severe discharge with marked swelling and redness of the eyelids and conjunctiva. This can lead to corneal perforation and blindness. Diagnosis is made by gram stain of the exudate and culture
====Disseminated gonococcal infection====
*In both sexes, disseminated gonococcal infection (DGI) can occur. Women are more likely to developed disseminated gonococcal infection than men.  
*Disseminated gonococcal infection is a result of [[bacteremia|bacteremic]] spread of ''[[Neisseria gonorrhea]]'' from the primary site of infection ([[endocervix]], [[urethra]], [[pharynx]], or [[rectum]]).
*Disseminated gonococcal infection (DGI) occurs in about 0.5 to 3% of patients, commonly following asymptomatic mucosal infection.
*Disseminated gonococcal infection can lead to the infection of multiple distant sites such as the [[brain]], [[heart]], and [[joints]]. The most common signs and symptoms include [[arthritis]] or [[arthralgias]], [[tenosynovitis]], and multiple [[skin lesions]].
*When joints become involved, gonococcal [[arthritis]] can develop.  
*Disseminated gonococcal infection usually presents as an arthritis-dermatitis syndrome. Typical symptoms include a 5–7 day history of [[fever]], shaking, [[chills]], multiple [[skin lesions]], and fleeting migratory [[arthralgia|polyarthralgias]] and [[tenosynovitis]] in fingers, wrists, toes or ankles. This should be evaluated promptly with a culture of the [[synovial fluid]], blood, cervix, urethra, rectum, skin lesion fluid, or pharynx.
 
====Gonorrhea in pregnancy====
*In the absence of adequate [[prophylaxis]], 30% to 42% of infants born by vaginal delivery to infected mothers will develop [[gonococcal conjunctivitis]]. Gonococcal conjunctivitis tends to occur 2-7 days after birth, and tends to be more severe than [[ophthalmia neonatorum]] arising as the result of other causes. If left untreated, it may cause [[corneal]] involvement such as corneal [[ulceration]], diffuse opacification, and [[corneal perforation]]. This may lead to [[blindness]], [[sepsis]], or death. The onset of [[chlamydial]] conjunctivitis is usually later than [[gonococcal conjunctivitis]].<ref name="pmid25606121">{{cite journal| author=Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G| title=Neonatal conjunctivitis - a review. | journal=Malays Fam Physician | year= 2008 | volume= 3 | issue= 2 | pages= 77-81 | pmid=25606121 | doi= | pmc=4170304 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25606121  }} </ref><ref name="pmid24235191">{{cite journal| author=Matejcek A, Goldman RD| title=Treatment and prevention of ophthalmia neonatorum. | journal=Can Fam Physician | year= 2013 | volume= 59 | issue= 11 | pages= 1187-90 | pmid=24235191 | doi= | pmc=3828094 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24235191  }} </ref><ref name="pmid3084664">{{cite journal| author=Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC et al.| title=Ophthalmia neonatorum in Nairobi, Kenya: the roles of ''[[Neisseria gonorrhoeae]]'' and ''[[Chlamydia trachomatis]]''. | journal=J Infect Dis | year= 1986 | volume= 153 | issue= 5 | pages= 862-9 | pmid=3084664 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3084664  }} </ref>


===Possible complications===
===Possible complications===
[[Complications]] in women may include:
[[Complications]] in women may include:
*[[Salpingitis]] ([[scarring]] of the [[fallopian tubes]]), which can lead to problems getting [[pregnant]] or [[ectopic pregnancy]]
*[[Salpingitis]] ([[scarring]] of the [[fallopian tubes]]), which can lead to [[infertility]] or [[ectopic pregnancy]]
*[[Pelvic inflammatory disease]]
*[[Pelvic inflammatory disease]]
*[[Sterility]] (inability to become [[pregnant]])
*[[Infertility]]
*Painful [[intercourse]] ([[dyspareunia]])
*Painful [[intercourse]] ([[dyspareunia]])
*[[Pregnant]] women with severe [[gonorrhea]] may pass the [[disease]] to their baby while in the [[womb]] or during delivery


[[Complications]] in men may include:
[[Complications]] in men may include:
*[[Scarring]] or narrowing of the [[urethra]], the tube that carries [[urine]] out of the body
*Post-inflammatory urethral strictures
*[[Abscess]] (collection of [[pus]] around the [[urethra]])
*[[Abscess]] (collection of [[pus]] around the [[urethra]])
*[[Lymphangitis|Penile lymphangitis]]
*Penile edema
*[[Urination]] problems
*[[Urination]] problems
*[[Urinary tract infection]]
*[[Urinary tract infection]]
Line 47: Line 57:


[[Complications]] in both men and women may include:
[[Complications]] in both men and women may include:
*Disseminated [[infection]], which can be very serious
*Disseminated [[infection]]
*Long-term [[joint]] [[pain]], if the [[infection]] is left untreated
*Long-term [[joint]] [[pain]]
*[[Heart valve]] [[infection]]
*[[Endocarditis]]
*[[Meningitis]]
*[[Meningitis]]


===Prognosis===
===Prognosis===
* The underlying gonorrhea should be treated; if this is done, then usually a good prognosis will follow
The prognosis of gonococcal infection is generally good with adequate treatment.
* A gonorrhea infection that has not spread to the bloodstream or other areas almost always can be cured with antibiotics. Gonorrhea that has spread is a more serious infection but almost always gets better with treatment
*Disseminated gonococcal infection is a more serious infection, but is often associated with a favorable long-term prognosis with adequate treatment.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Sexually transmitted infections|Gonorrhea]]
 
[[Category:Infectious disease]]
[[Category:Gynecology]]
[[Category:Mature chapter]]
[[Category:FinalQCRequired]]
[[Category:Primary care]]
[[Category:Needs overview]]


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{{WS}}

Latest revision as of 17:50, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

In 50 to 70% of women, the Initial infection with Neisseria gonorrhea may be asymptomatic. Initial infection is usually observed in the cervical region, but due to the presence of the surface pili, the infection may ascend through the uterus into the fallopian tubes and finally out into the peritoneal cavity. The exact incubation period of gonorrhea is unknown. It may result in cervicitis and urethritis, which can present with dysuria, vaginal pruritus, and vaginal mucopurulent discharge. If gonococcal infection is left untreated, it can progress to fibrosis, which can result in fallopian tube stricture, tubo-ovarian cyst or abscess, pelvic inflammatory disease (PID), Perihepatitis (Fitz-Hugh-Curtis syndrome), and/or bartholinitis. The most common complication of untreated gonorrhea is pelvic inflammatory disease (PID), which may lead to increased risks of ectopic pregnancy. If left untreated, ectopic pregnancy can be life-threatening for the mother.[1][2] In men, untreated gonorrhea may result in inflammation of the epididymis (epididymitis), prostate gland (prostatitis), and urethral structure (urethritis). Disseminated gonococcal infection (DGI) occurs in about 0.5 to 3% of patients, commonly following asymptomatic mucosal infection in both sexes. Women are more likely to develop disseminated gonococcal infection than men. Disseminated gonococcal infection can lead to the infection of multiple distant sites such as the brain, the heart, and joints. The most common signs and symptoms include arthritis or arthralgias, tenosynovitis, and multiple skin lesions.

Common complications of gonococcal infection in women may include salpingitis, pelvic inflammatory disease, infertility, dyspareunia, and ectopic pregnancy. Common complications of gonococcal infection in men may include post-inflammatory urethral strictures, urethral abscess, Penile lymphangitis, penile edema, urinary tract infection, and kidney failure. The prognosis of urogenital and disseminated gonococcal infection are generally good with adequate treatment.

Natural history, complications, and prognosis

Natural History

Gonococcal infection in women

Gonococcal infection in men

  • In men, untreated gonorrhea may result in inflammation of the epididymis (epididymitis), prostate gland (prostatitis), and urethral structure (urethritis).

Disseminated gonococcal infection

  • In both sexes, disseminated gonococcal infection (DGI) can occur. Women are more likely to developed disseminated gonococcal infection than men.
  • Disseminated gonococcal infection is a result of bacteremic spread of Neisseria gonorrhea from the primary site of infection (endocervix, urethra, pharynx, or rectum).
  • Disseminated gonococcal infection (DGI) occurs in about 0.5 to 3% of patients, commonly following asymptomatic mucosal infection.
  • Disseminated gonococcal infection can lead to the infection of multiple distant sites such as the brain, heart, and joints. The most common signs and symptoms include arthritis or arthralgias, tenosynovitis, and multiple skin lesions.
  • When joints become involved, gonococcal arthritis can develop.
  • Disseminated gonococcal infection usually presents as an arthritis-dermatitis syndrome. Typical symptoms include a 5–7 day history of fever, shaking, chills, multiple skin lesions, and fleeting migratory polyarthralgias and tenosynovitis in fingers, wrists, toes or ankles. This should be evaluated promptly with a culture of the synovial fluid, blood, cervix, urethra, rectum, skin lesion fluid, or pharynx.

Gonorrhea in pregnancy

Possible complications

Complications in women may include:

Complications in men may include:

Complications in both men and women may include:

Prognosis

The prognosis of gonococcal infection is generally good with adequate treatment.

  • Disseminated gonococcal infection is a more serious infection, but is often associated with a favorable long-term prognosis with adequate treatment.

References

  1. ↑ 1.0 1.1 McNeeley SG (1989). "Gonococcal infections in women". Obstet Gynecol Clin North Am. 16 (3): 467–78. PMID 2512520.
  2. ↑ 2.0 2.1 Stansfield VA (1980). "Diagnosis and management of anorectal gonorrhoea in women". Br J Vener Dis. 56 (5): 319–21. PMC 1045815. PMID 7427703.
  3. ↑ Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G (2008). "Neonatal conjunctivitis - a review". Malays Fam Physician. 3 (2): 77–81. PMC 4170304. PMID 25606121.
  4. ↑ Matejcek A, Goldman RD (2013). "Treatment and prevention of ophthalmia neonatorum". Can Fam Physician. 59 (11): 1187–90. PMC 3828094. PMID 24235191.
  5. ↑ Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC; et al. (1986). "Ophthalmia neonatorum in Nairobi, Kenya: the roles of [[Neisseria gonorrhoeae]] and [[Chlamydia trachomatis]]". J Infect Dis. 153 (5): 862–9. PMID 3084664. URL–wikilink conflict (help)

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