Gonorrhea physical examination: Difference between revisions

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==Overview==
==Overview==
Gonococcal infections are typically asymptomatic in women until complications such as [[Pelvic inflammatory disease|PID]] develop. Women with gonococcal infection may present with [[Mucopurulent discharge|mucopurulent]] [[urethral]], [[cervical]] or [[vaginal]] discharge; friable appearance of the cervix; and cervical motion tenderness. Common physical examination findings of gonococcal infection among men include [[Mucopurulent discharge|mucopurulent]] urethral discharge. Less commonly penile edema, and epididymal tenderness and edema ([[epididymitis]]) may also be seen as a part of complicated gonococcal infection.
Women with gonococcal infection usually appear to be well until complications such as [[Pelvic inflammatory disease|PID]] develop. Physical examination of women with gonococcal infection is usually remarkable for [[mucopurulent discharge|mucopurulent]] [[urethral]], [[cervical]], or [[vaginal]] discharge; friable appearance of the [[cervix]]; and cervical motion tenderness. One common physical examination finding of gonococcal infection in men is [[Mucopurulent discharge|mucopurulent]] urethral discharge. Less commonly, penile edema and epididymal tenderness and edema ([[epididymitis]]) may also be observed as part of complicated gonococcal infection.<ref name="pmid26042815">{{cite journal| author=Workowski KA, Bolan GA, Centers for Disease Control and Prevention| title=Sexually transmitted diseases treatment guidelines, 2015. | journal=MMWR Recomm Rep | year= 2015 | volume= 64 | issue= RR-03 | pages= 1-137 | pmid=26042815 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26042815  }} </ref><ref name="pmid9038638">{{cite journal| author=Sherrard J, Barlow D| title=Gonorrhoea in men: clinical and diagnostic aspects. | journal=Genitourin Med | year= 1996 | volume= 72 | issue= 6 | pages= 422-6 | pmid=9038638 | doi= | pmc=1195730 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9038638  }} </ref><ref name="pmid76760">{{cite journal| author=Barlow D, Phillips I| title=Gonorrhoea in women. Diagnostic, clinical, and laboratory aspects. | journal=Lancet | year= 1978 | volume= 1 | issue= 8067 | pages= 761-4 | pmid=76760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=76760  }} </ref>


Physical examination of patients with pharyngeal gonococcal infection is usually remarkable for mild pharyngeal exudates and rectal gonococcal infection is usually remarkable for [[Mucopurulent discharge|mucopurulent]] anal discharge
Physical examination of patients with pharyngeal gonococcal infection is usually remarkable for mild pharyngeal exudates and rectal gonococcal infection is usually remarkable for [[Mucopurulent discharge|mucopurulent]] anal discharge.
Physical examination of patients with disseminated gonococcal infection (DGI) is usually remarkable for fever, pustular or vesicular rash, and musculoskeletal findings.
Physical examination of patients with disseminated gonococcal infection (DGI) is usually remarkable for [[fever]], pustular or vesicular rash, and musculoskeletal findings.<ref name="pmid26042815">{{cite journal| author=Workowski KA, Bolan GA, Centers for Disease Control and Prevention| title=Sexually transmitted diseases treatment guidelines, 2015. | journal=MMWR Recomm Rep | year= 2015 | volume= 64 | issue= RR-03 | pages= 1-137 | pmid=26042815 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26042815  }} </ref><ref name="pmid16297736">{{cite journal| author=Rice PA| title=Gonococcal arthritis (disseminated gonococcal infection). | journal=Infect Dis Clin North Am | year= 2005 | volume= 19 | issue= 4 | pages= 853-61 | pmid=16297736 | doi=10.1016/j.idc.2005.07.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16297736  }} </ref>


==Physical examination==
==Physical examination==
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* Bull-headed clap (penile edema)
* Bull-headed clap (penile edema)
* Unilateral epididymal tenderness and edema ([[epididymitis]])
* Unilateral epididymal tenderness and edema ([[epididymitis]])
* Sign of urethral stricture
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Urogenital infection in women''':<ref name="pmid26042815">{{cite journal| author=Workowski KA, Bolan GA, Centers for Disease Control and Prevention| title=Sexually transmitted diseases treatment guidelines, 2015. | journal=MMWR Recomm Rep | year= 2015 | volume= 64 | issue= RR-03 | pages= 1-137 | pmid=26042815 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26042815  }} </ref><ref name="pmid76760">{{cite journal| author=Barlow D, Phillips I| title=Gonorrhoea in women. Diagnostic, clinical, and laboratory aspects. | journal=Lancet | year= 1978 | volume= 1 | issue= 8067 | pages= 761-4 | pmid=76760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=76760  }} </ref><ref name="pmid17448399">{{cite journal| author=Huppert JS, Biro F, Lan D, Mortensen JE, Reed J, Slap GB| title=Urinary symptoms in adolescent females: STI or UTI? | journal=J Adolesc Health | year= 2007 | volume= 40 | issue= 5 | pages= 418-24 | pmid=17448399 | doi=10.1016/j.jadohealth.2006.12.010 | pmc=1976261 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17448399  }} </ref><ref name="pmid806017">{{cite journal| author=Eschenbach DA, Buchanan TM, Pollock HM, Forsyth PS, Alexander ER, Lin JS et al.| title=Polymicrobial etiology of acute pelvic inflammatory disease. | journal=N Engl J Med | year= 1975 | volume= 293 | issue= 4 | pages= 166-71 | pmid=806017 | doi=10.1056/NEJM197507242930403 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=806017  }} </ref><ref name="pmid17561186">{{cite journal| author=Risser WL, Risser JM, Benjamins LJ, Feldmann JM| title=Incidence of Fitz-Hugh-Curtis syndrome in adolescents who have pelvic inflammatory disease. | journal=J Pediatr Adolesc Gynecol | year= 2007 | volume= 20 | issue= 3 | pages= 179-80 | pmid=17561186 | doi=10.1016/j.jpag.2006.08.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17561186  }} </ref><ref name="pmid4963696">{{cite journal| author=Rees E| title=Gonococcal bartholinitis. | journal=Br J Vener Dis | year= 1967 | volume= 43 | issue= 3 | pages= 150-6 | pmid=4963696 | doi= | pmc=1047872 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4963696  }} </ref>
| style="padding: 5px 5px; background: #DCDCDC;" | '''Urogenital infection in women''':<ref name="pmid26042815">{{cite journal| author=Workowski KA, Bolan GA, Centers for Disease Control and Prevention| title=Sexually transmitted diseases treatment guidelines, 2015. | journal=MMWR Recomm Rep | year= 2015 | volume= 64 | issue= RR-03 | pages= 1-137 | pmid=26042815 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26042815  }} </ref><ref name="pmid76760">{{cite journal| author=Barlow D, Phillips I| title=Gonorrhoea in women. Diagnostic, clinical, and laboratory aspects. | journal=Lancet | year= 1978 | volume= 1 | issue= 8067 | pages= 761-4 | pmid=76760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=76760  }} </ref><ref name="pmid17448399">{{cite journal| author=Huppert JS, Biro F, Lan D, Mortensen JE, Reed J, Slap GB| title=Urinary symptoms in adolescent females: STI or UTI? | journal=J Adolesc Health | year= 2007 | volume= 40 | issue= 5 | pages= 418-24 | pmid=17448399 | doi=10.1016/j.jadohealth.2006.12.010 | pmc=1976261 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17448399  }} </ref><ref name="pmid806017">{{cite journal| author=Eschenbach DA, Buchanan TM, Pollock HM, Forsyth PS, Alexander ER, Lin JS et al.| title=Polymicrobial etiology of acute pelvic inflammatory disease. | journal=N Engl J Med | year= 1975 | volume= 293 | issue= 4 | pages= 166-71 | pmid=806017 | doi=10.1056/NEJM197507242930403 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=806017  }} </ref><ref name="pmid17561186">{{cite journal| author=Risser WL, Risser JM, Benjamins LJ, Feldmann JM| title=Incidence of Fitz-Hugh-Curtis syndrome in adolescents who have pelvic inflammatory disease. | journal=J Pediatr Adolesc Gynecol | year= 2007 | volume= 20 | issue= 3 | pages= 179-80 | pmid=17561186 | doi=10.1016/j.jpag.2006.08.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17561186  }} </ref><ref name="pmid4963696">{{cite journal| author=Rees E| title=Gonococcal bartholinitis. | journal=Br J Vener Dis | year= 1967 | volume= 43 | issue= 3 | pages= 150-6 | pmid=4963696 | doi= | pmc=1047872 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4963696  }} </ref>
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**Periorbital edema
**Periorbital edema
**Corneal involvement
**Corneal involvement
*Neonatal Conjunctivitis
*[[Neonatal conjunctivitis]]
**[[Chemosis]]
**[[Chemosis]]
**Severe lid edema
**Severe lid edema
Line 62: Line 61:


===Disseminated Gonococcal Infection===
===Disseminated Gonococcal Infection===
Dissemination gonococcal infection usually can result two clinical syndromes:  
Dissemination gonococcal infection usually can result in two clinical syndromes:<ref name="pmid16297736">{{cite journal| author=Rice PA| title=Gonococcal arthritis (disseminated gonococcal infection). | journal=Infect Dis Clin North Am | year= 2005 | volume= 19 | issue= 4 | pages= 853-61 | pmid=16297736 | doi=10.1016/j.idc.2005.07.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16297736  }} </ref><ref name="pmid22353959">{{cite journal| author=Bleich AT, Sheffield JS, Wendel GD, Sigman A, Cunningham FG| title=Disseminated gonococcal infection in women. | journal=Obstet Gynecol | year= 2012 | volume= 119 | issue= 3 | pages= 597-602 | pmid=22353959 | doi=10.1097/AOG.0b013e318244eda9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22353959  }} </ref><ref name="pmid6415361">{{cite journal| author=O'Brien JP, Goldenberg DL, Rice PA| title=Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms. | journal=Medicine (Baltimore) | year= 1983 | volume= 62 | issue= 6 | pages= 395-406 | pmid=6415361 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6415361  }} </ref>
*[[Septic arthritis]] (purulent arthritis)
*[[Septic arthritis]] (purulent arthritis)
*Arthritis-dermatitis syndromes (with a triad of [[tenosynovitis]], [[dermatitis]], and [[polyarthralgias]])
*Arthritis-dermatitis syndromes (with a triad of [[tenosynovitis]], [[dermatitis]], and [[polyarthralgias]])
Other less common manifestations of disseminated gonococcal infection include:
Other, less common manifestations of disseminated gonococcal infection include:
*[[Endocarditis]]
*[[Endocarditis]]
*[[Meningitis]]
*[[Meningitis]]
*[[Osteomyelitis]]
Physical examination of patients with disseminated gonococcal infection is usually remarkable for:<ref name="pmid26042815">{{cite journal| author=Workowski KA, Bolan GA, Centers for Disease Control and Prevention| title=Sexually transmitted diseases treatment guidelines, 2015. | journal=MMWR Recomm Rep | year= 2015 | volume= 64 | issue= RR-03 | pages= 1-137 | pmid=26042815 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26042815  }} </ref><ref name="pmid16297736">{{cite journal| author=Rice PA| title=Gonococcal arthritis (disseminated gonococcal infection). | journal=Infect Dis Clin North Am | year= 2005 | volume= 19 | issue= 4 | pages= 853-61 | pmid=16297736 | doi=10.1016/j.idc.2005.07.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16297736  }} </ref>
Physical examination of patients with disseminated gonococcal infection is usually remarkable for:


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
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<div align="center">
<div align="center">
<gallery heights="175" widths="175">
<gallery heights="175" widths="175">
Image: Gonorrhea15.jpeg|Gonococcal ophthalmia is due the pathogenic bacteria [[Neisseria gonorrhea]]
Image: Gonorrhea07.jpeg|Purulent discharge emanating from the cervical os, and pooling in the vagina - Source: https://www.cdc.gov/
Image: Gonorrhea11.jpeg|Gonococcal urethritis, which result in DGI and lead to gonococcal [[conjunctivitis]]
Image:Gonorrhea penile discharge.jpg|Penile discharge in a patient with gonorrhea - Source: https://www.std.gov/
Image: Gonorrhea07.jpeg|Purulent discharge emanating from the cervical os, and pooling in the vagina
Image:Gonorrhea20.jpg|Gonococcal pharyngitis - Source: https://www.cdc.gov/
Image:Gonorrhea penile discharge.jpg|Penile discharge in a patient with gonorrhea
Image:220px-Gonococcal_ophthalmia_neonatorum.jpg|[[Ophthalmia neonatorum]] - Source: https://www.cdc.gov/
Image:Gonorrhea20.jpg|Gonococcal pharyngitis
Image:Gonorrhea36.jpg|Close-up of a gonococcal lesion on the skin of a patient’s arm - Source: https://www.cdc.gov/
Image:220px-Gonococcal_ophthalmia_neonatorum.jpg|[[Ophthalmia neonatorum]]
Image:Gonorrhea35.jpg|Lesions of skin and arthritic knee joints due to Neisseria gonorrhea - Source: https://www.cdc.gov/
Image:Gonorrhea-epididymitis.jpg||Swollen testes consistent with [[epididymitis]] in a patient with gonorrhea
Image:Gonorrhea3.jpg|Gonococcal arthritis of the hand - Source: https://www.cdc.gov/
Image:Ophthalmia neonatorum (gonococcal conjunctivitis).jpg|Gonococcal infection of the conjunctiva in a neonate
Image:Gonorrhea24.jpg|Cutaneous gonococcal lesion due to a disseminated Neisseria gonorrhea
Image:Gonorrhea28.jpg[[Colposcopic]] view of this patient’s [[cervix]] reveled an eroded ostium due to Neisseria gonorrhea infection
Image:Gonorrhea29.jpg|The lesion on the left hand due to the systemic dissemination of the Neisseria gonorrhea.
Image:Gonorrhea34.jpg|Gonococcal arthritis, inflammation of the skin  due to a disseminated gonococcal infection
Image:Gonorrhea36.jpg|Close-up of a gonococcal lesion on the skin of a patient’s arm
Image:Gonorrhea35.jpg|Lesions of skin and arthritic knee joints due to Neisseria gonorrhea
Image:Gonorrhea3.jpg|Gonococcal arthritis of the hand
</gallery>
</gallery>
</div>
</div>
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{{Reflist|2}}
{{Reflist|2}}


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


{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Gynecology]]
[[Category:FinalQCRequired]]
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Rheumatology]]
[[Category:Dermatology]]
[[Category:Neurology]]
[[Category:Cardiology]]
[[Category:Urology]]
[[Category:Gastroenterology]]

Latest revision as of 21:55, 29 July 2020

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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

Women with gonococcal infection usually appear to be well until complications such as PID develop. Physical examination of women with gonococcal infection is usually remarkable for mucopurulent urethral, cervical, or vaginal discharge; friable appearance of the cervix; and cervical motion tenderness. One common physical examination finding of gonococcal infection in men is mucopurulent urethral discharge. Less commonly, penile edema and epididymal tenderness and edema (epididymitis) may also be observed as part of complicated gonococcal infection.[1][2][3]

Physical examination of patients with pharyngeal gonococcal infection is usually remarkable for mild pharyngeal exudates and rectal gonococcal infection is usually remarkable for mucopurulent anal discharge. Physical examination of patients with disseminated gonococcal infection (DGI) is usually remarkable for fever, pustular or vesicular rash, and musculoskeletal findings.[1][4]

Physical examination

Common urogenital and extragenital Infection

The most common site of gonococcal infection is the urethra, endocervix, rectum, and pharynx. Physical examination of patients with gonococcal infection is usually remarkable for:

Type of Gonococcal Infection Physical Examination
Urogenital infection in men[2]
  • Mucopurulent urethral discharge
  • Bull-headed clap (penile edema)
  • Unilateral epididymal tenderness and edema (epididymitis)
Urogenital infection in women:[1][3][5][6][7][8]
Proctitis[9]
Pharyngitis[10][11]
Conjunctivitis

Disseminated Gonococcal Infection

Dissemination gonococcal infection usually can result in two clinical syndromes:[4][12][13]

Other, less common manifestations of disseminated gonococcal infection include:

Physical examination of patients with disseminated gonococcal infection is usually remarkable for:[1][4]

Disseminated Gonococcal Infection Organ systems
General Appearance
  • Fever (usually less than 39°C)
  • Chills
  • Generalized malaise

Note: Occurs in the acute phase of infection

Skin
Eye
  • Conjunctivitis
    • Conjunctival injection
    • Purulent eye discharge
    • Periorbital edema
Musculoskeletal

Note: purulent arthritis may be abrupt onset of monoarthritis or oligoarthritis without skin lesions and fever

  • Tenosynovitis
    • Erythema along a tendon sheath
    • Local tenderness along a tendon sheath
    • Painful active or passive range of motion

Note: most commonly occurs in hands and less commonly lower extremities

Central Nervous System
Cardiac

Images

The following are images associated with gonorrhea physical examination.[14][15]

References

  1. ↑ 1.0 1.1 1.2 1.3 Workowski KA, Bolan GA, Centers for Disease Control and Prevention (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR Recomm Rep. 64 (RR-03): 1–137. PMID 26042815.
  2. ↑ 2.0 2.1 Sherrard J, Barlow D (1996). "Gonorrhoea in men: clinical and diagnostic aspects". Genitourin Med. 72 (6): 422–6. PMC 1195730. PMID 9038638.
  3. ↑ 3.0 3.1 Barlow D, Phillips I (1978). "Gonorrhoea in women. Diagnostic, clinical, and laboratory aspects". Lancet. 1 (8067): 761–4. PMID 76760.
  4. ↑ 4.0 4.1 4.2 Rice PA (2005). "Gonococcal arthritis (disseminated gonococcal infection)". Infect Dis Clin North Am. 19 (4): 853–61. doi:10.1016/j.idc.2005.07.003. PMID 16297736.
  5. ↑ Huppert JS, Biro F, Lan D, Mortensen JE, Reed J, Slap GB (2007). "Urinary symptoms in adolescent females: STI or UTI?". J Adolesc Health. 40 (5): 418–24. doi:10.1016/j.jadohealth.2006.12.010. PMC 1976261. PMID 17448399.
  6. ↑ Eschenbach DA, Buchanan TM, Pollock HM, Forsyth PS, Alexander ER, Lin JS; et al. (1975). "Polymicrobial etiology of acute pelvic inflammatory disease". N Engl J Med. 293 (4): 166–71. doi:10.1056/NEJM197507242930403. PMID 806017.
  7. ↑ Risser WL, Risser JM, Benjamins LJ, Feldmann JM (2007). "Incidence of Fitz-Hugh-Curtis syndrome in adolescents who have pelvic inflammatory disease". J Pediatr Adolesc Gynecol. 20 (3): 179–80. doi:10.1016/j.jpag.2006.08.004. PMID 17561186.
  8. ↑ Rees E (1967). "Gonococcal bartholinitis". Br J Vener Dis. 43 (3): 150–6. PMC 1047872. PMID 4963696.
  9. ↑ Stansfield VA (1980). "Diagnosis and management of anorectal gonorrhoea in women". Br J Vener Dis. 56 (5): 319–21. PMC 1045815. PMID 7427703.
  10. ↑ Kraus SJ (1Link title979). "Incidence and therapy of gonococcal pharyngitis". Sex Transm Dis. 6 (2 Suppl): 143–7. PMID 386537. Check date values in: |year= (help)
  11. ↑ Osborne NG, Grubin L (1979). "Colonization of the pharynx with Neisseria gonorrhoeae: experience in a clinic for sexually transmitted diseases". Sex Transm Dis. 6 (4): 253–6. PMID 119330.
  12. ↑ Bleich AT, Sheffield JS, Wendel GD, Sigman A, Cunningham FG (2012). "Disseminated gonococcal infection in women". Obstet Gynecol. 119 (3): 597–602. doi:10.1097/AOG.0b013e318244eda9. PMID 22353959.
  13. ↑ O'Brien JP, Goldenberg DL, Rice PA (1983). "Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms". Medicine (Baltimore). 62 (6): 395–406. PMID 6415361.
  14. ↑ STD Gonorrhea Infection Gallery http://www.std-gov.org/std_picture/gonorrhea_w.htm Accessed on September 22, 2016
  15. ↑ Centers for Disease Control and Prevention. Public Health Image Library (PHIL) http://phil.cdc.gov/phil/home.asp Accessed on September 22, 2016


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