Gonorrhea history and symptoms

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

Overview

Half of women with gonorrhea are asymptomatic while others have vaginal discharge, lower abdominal pain or pain with intercourse. Most men who are infected have symptoms such as urethritis associated with burning with urination and discharge from the penis. Either sex may also acquire gonorrhea of the throat from performing oral sex on an infected partner, usually a male partner. Such infection is asymptomatic in 90% of cases, and produces a sore throat in the remaining 10%. The incubation period is 2 to 14 days with most of these symptoms occurring between 4–6 days after being infected. Rarely, gonorrhea may cause skin legions and joint infection (pain and swelling in the joints) after traveling through the blood stream. Very rarely it may settle in the heart causing endocarditis or in the spinal column causing meningitis (both are more likely among individuals with suppressed immune systems.

History and Symptoms

History

In patients with suspected sexually transmitted diseases the following history should be sought:

• Past history of similar symptoms or STDs in patient, current or past partners

• Type of contraception used

• History of sexual assault.

• Menstrual history (date of the last menstrual period, duration. intermittent bleeding, pain)

• Reproductive history (details of parity, including any history of ectopic pregnancies)

Symptoms

• The incubation time varies from 2 to 14 days with most symptoms occurring between days 2 and 5 after being infected from an infected partner.
• A small number of people may be asymptomatic for up to a year. They may be completely unaware that they have caught the disease, and therefore do not seek treatment. This increases the risk of complications and the chances of passing the infection on to another person.
• Between 30–60% of women with gonorrhea are asymptomatic or have subclinical disease.

Type of Gonococcal Infection	Symptoms
Male Genitourinary	Thick, copious, white, yellow, or green colored discharge from penis Burning and pain while urinating Increased urinary frequency or urgency Painful or swollen testicles scrotal pain or swelling. Decreased or abnormal urine stream may suggest stricture
Female Genitourinary	Vaginal discharge (thin, purulent, and mildly odorous) Dyspareunia Spotting Bleeding after sexual intercourse Urinary frequency and urgency Dysuria Severe lower abdomen pain (if the infection spreads to the fallopian tubes, ovaries, endometrium)
Gonococcal proctitis (Rectal)	Often asymptomatic Anal discharge Pain on defecating Rectal bleeding Pruritus Tenesmus Bloody diarrhea
Gonococcal pharyngitis	Usually asymptomatic Sore throat
Ophthalmia neonatorum	Occurs within 2-5 days after birth Severe white bilateral discharge Tearing Eyelids swellings

Type of Disseminated gonorrheal infection	Symptoms
Arthritis Dermatitis Syndrome	Thick, copious, white, yellow, or green colored discharge from penis Burning and pain while urinating Increased urinary frequency or urgency Painful or swollen testicles scrotal pain or swelling. Decreased or abnormal urine stream may suggest stricture
Gonorrhea Meningitis	Settle in the spinal column (both are more likely among individuals with immunosuppression Headache, neck pain and stiffness, fever, and decreased sensorium may indicate gonococcal meningitis
Gonorrhea Endocarditis	Very rarely it may settle in the heart causing endocarditis. Endocarditis may present as fever, chills,malaise, atypical chest pain as well as typical features of disseminated infections More common in men compared to women Severe damage to valve may occur

Female

• If the infection spreads to the bloodstream, fever, vomiting, rash, and arthritis-like symptoms may occur.
• Pain on right upper side of abdomen (right upper quadrant) may occur due to inflammation of liver (perihepatitis)

Gonococcal proctitis (Rectal)

• It is usually contracted from having rough anal sex. It can be avoided by using toys instead. It may affect both men and women
• Often asymptomatic
• Anal discharge
• Pain on defecating
• Rectal bleeding.
• Pruritus
• Tenesmus
• Bloody diarrhea

Gonococcal pharyngitis

• Caused by oral sex with a partner infected with gonorrhea.
• Usually asymptomatic
• Sore throat

Disseminated gonorrheal infection

• It is a rare complication of gonorrheal infection.
• It is difficult to diagnosis because by the time the systemic manifestations appear the local lesions may have resolved.
• Features may include:
  • Joint or tendon pain (commonest presentation). The pain can involve single or multiple joints (mono or polyarthralgia) and is often migratory in nature
  • It may also present as pain, swelling and decreased mobility suggestive of purulent arthritis. Knee is the commonest involved site.
  • Rash commonly found below neck, palm and sole.
  • Fever

• 
  Skin lesion on foot in a patient with Gonorrhea
• 
  Gonococcal infection of the conjunctiva in a neonate
• 
  Penile discharge in a patient with Gonorrhea
• 
  Swollen testes consistent with epididymitis in a patient with Gonorrhea

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References