Gonorrhea natural history, complications, and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Gonorrhea (gonorrhoea in British English) is amongst the most common sexually transmitted diseases in the world and is caused by Gram-negative bacterium Neisseria gonorrheae. The term comes from Ancient Greek γονόρροια (gonórrhoia), literally "flow of seed"; in ancient times it was incorrectly believed that the pus discharge associated with the disease contained semen.[1]
Natural history, comlications, and prognosis
In men, inflammation of the epididymis (epididymitis), prostate gland (prostatitis) and urethral structure (urethritis) can result from untreated gonorrhea.
In women, untreated gonorrhea can result in cyst and abscess formation in one or more of the greater vestibular glands (bartholinitis), causing trouble walking; PID; and Fitz-Hugh-Curtis syndrome.
The most common result of untreated gonorrhea is pelvic inflammatory disease, a serious infection of the female reproductive tract. PID causes scarring of the fallopian tubes which leads to increased risks of causing an ectopic pregnancy as a fertilized egg may not be able to pass through the narrowed, scarred fallopian tube. Ectopic pregnancies are serious conditions which are potentially life-threatening to the mother.
In both sexes, disseminated gonococcal infection (DGI) can occur, leading to multiple distant sites of infection which can include the brain, heart and joints.
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 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. The underlying gonorrhea should be treated; if this is done then usually a good prognosis will follow.
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.
Possible complications
Complications in women may include:
- Salpingitis (scarring of the fallopian tubes), which can lead to problems getting pregnant or ectopic pregnancy
- Pelvic inflammatory disease
- Sterility (inability to become pregnant)
- 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:
- Scarring or narrowing of the urethra, the tube that carries urine out of the body
- Abscess (collection of pus around the urethra)
- Urination problems
- Urinary tract infection
- Kidney failure
Complications in both men and women may include:
- Disseminated infection, which can be very serious
- Long-term joint pain, if the infection is left untreated
- Heart valve infection
- Meningitis