Gonorrhea physical examination

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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.

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.

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	Mucopurulent urethral discharge Bull-headed clap (penile edema) Unilateral epididymal tenderness and edema (epididymitis)
Urogenital infection in women:	Mucopurulent urethral, cervical or vaginal discharge Positive cervical motion tenderness Friable cervical mucosa Abdominal pain with negative rebound tenderness Lower abdominal pain (consistent with PID) Right upper quadrant pain (Fitz-Hugh-Curtis syndrome) Labial edema and Bartholin’s gland enlargement and tenderness (Bartholinitis)
Proctitis	Anal mucopurulent discharge Anorectal tenderness Anorectal bleeding
Pharyngitis	Pharyngeal exudates Cervical lymphadenitis
Conjunctivitis	Adult conjunctivitis Conjunctival injection Purulent eye discharge Periorbital edema Corneal involvement Neonatal conjunctivitis Chemosis Severe lid edema Mucopurulent discharge Corneal involvement

Disseminated Gonococcal Infection

Dissemination gonococcal infection usually can result in two clinical syndromes:

• Septic arthritis (purulent arthritis)
• Arthritis-dermatitis syndromes (with a triad of tenosynovitis, dermatitis, and polyarthralgias)

Other, less common manifestations of disseminated gonococcal infection include:

• Endocarditis
• Meningitis

Physical examination of patients with disseminated gonococcal infection is usually remarkable for:

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	Painless skin lesions (on the torso, limbs, palms, and soles) which varis based on clinical stages Maculopapular, pustular, necrotic, or vesicular rash Hemorrhagic lesions Erythema nodosum Urticaria Erythema multiform
Eye	Conjunctivitis Conjunctival injection Purulent eye discharge Periorbital edema
Musculoskeletal	Arthritis Polyarthralgia with joint tenderness Decreased range of motion Erythema 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 Muscle abscess Localized tenderness Localaized edema Pain with motion
Central Nervous System	Meningitis Decreased mental status
Cardiac	Endocarditis New murmur Tachycardia

Images

The following are images associated with gonorrhea physical examination.

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  Gonococcal ophthalmia is due the pathogenic bacteria Neisseria gonorrhea

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  Gonococcal urethritis, which result in DGI and lead to gonococcal conjunctivitis

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  Purulent discharge emanating from the cervical os, and pooling in the vagina

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  Penile discharge in a patient with gonorrhea

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  Gonococcal pharyngitis

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  Ophthalmia neonatorum

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  Swollen testes consistent with epididymitis in a patient with gonorrhea

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  Gonococcal infection of the conjunctiva in a neonate

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  Cutaneous gonococcal lesion due to a disseminated Neisseria gonorrhea

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  The lesion on the left hand due to the systemic dissemination of the Neisseria gonorrhea.

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  Gonococcal arthritis, inflammation of the skin due to a disseminated gonococcal infection

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  Close-up of a gonococcal lesion on the skin of a patient’s arm

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  Lesions of skin and arthritic knee joints due to Neisseria gonorrhea

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  Gonococcal arthritis of the hand