Gonococcal Infections

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Description

  • Neisseria gonorrhoeae, a gram-negative intracellular diplococcus, causes a sexually and vertically transmitted bacterial infection. It typically presents in the urogenital tract, pharynx, rectum, or conjunctiva. Urogenital infection is most common. Disseminated infections can lead to arthritis, tenosynovitis, rash, endocarditis, or meningitis. Asymptomatic carriers are common, especially among women.
  • In neonates, N. gonorrhoeae causes ophthalmia neonatorum after vaginal delivery, which can lead to blindness if untreated.

Epidemiology

  • Age: 15 to 49 years; highest in 20 to 24 years age group
  • Sex: global incident rate of 19 (11 to 29) per 1,000 women and 23 (10 to 43) per 1,000 men (1)
  • Concern: Extended-spectrum cephalosporin (ESC) resistance is growing worldwide.

Incidence

  • Annual incidence noted in 2020 was 82.4 million new cases per year (1).
  • In the United States, the rate of gonorrhea increased by 60.6% among men and 43.6% among women, with the highest rates observed in adolescents, young adults, and certain racial and ethnic minorities (2).

Prevalence

  • Incidence and prevalence are roughly equal. The true prevalence is higher due to asymptomatic cases
  • The incidence in men is higher than in women.

Etiology and Pathophysiology

  • Only N. gonorrhoeae and Neisseria meningitidis are pathogenic.
  • Infection progresses through:
    • Neisseria strains produce pili, which are critical for host cell attachment, genetic transfer, and motility.
    • The outer membrane contains three proteins—PorB, Opa, and Rmp—that assist in acquiring nutrients, facilitate attachment, and prevent bacterial destruction.
    • Colonization and invasion of epithelial cells.
    • Transcellular transcytosis occurs, leading to the release of the bacteria into the subepithelial layer and intracellular proliferation.
    • The host response features leukocyte infiltration, epithelial sloughing, formation of microabscesses in the submucosa, and the production of purulent pus.

Genetics

Deficiency of late components of complement cascade (C7–C9) predisposes to disseminated disease.

Risk Factors

  • Age ≤25 years
  • Prior or current STI or partner with STI
  • Inconsistent condom use
  • Multiple/new sexual partners
  • Men who have sex with men (MSM)
  • Commercial sex work or substance use
  • Infants born to infected mothers
  • Children: Suspect sexual abuse.
  • Autoinoculation (e.g., conjunctivitis)

General Prevention

  • Consistent condom use during all forms of sexual activities
  • Partner treatment; consider expedited partner therapy (EPT)
  • Routine STI screening in high-risk populations
  • All newborns should receive ocular erythromycin 0.5% ointment to prevent gonococcal ophthalmia neonatorum.

Commonly Associated Conditions

Other STIs:

  • Chlamydia trachomatis
  • Syphilis
  • HIV
  • Hepatitis B and C
  • Herpes

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