Gonorrhea
A common sexually transmitted disease (STD), gonorrhea usually starts as an infection of the genitourinary (GU) tract, especially the urethra and cervix. It can also begin in the rectum, pharynx, or eyes. Left untreated, gonorrhea spreads through the blood to the joints, tendons, meninges, and endocardium; in females, it can also lead to chronic pelvic inflammatory disease (PID) and sterility.
Among sexually active individuals, incidence rates are highest in teenagers, nonwhites, the poor, poorly educated individuals, city dwellers, and unmarried people who live alone. It’s also prevalent in those with multiple partners. With adequate treatment, the prognosis is excellent, although reinfection is common.
Causes
Transmission of Neisseria gonorrhoeae, the organism that causes gonorrhea, occurs almost exclusively through sexual contact with an infected person.
Pediatric pointerA child born of an infected mother can contract gonococcal ophthalmia neonatorum during passage through the birth canal.
A patient with gonorrhea can contract gonococcal conjunctivitis by touching his eyes with a contaminated hand.
Complications
Gonorrhea can lead to PID, acute epididymitis, septic arthritis, dermatitis, and perihepatitis. Severe gonococcal conjunctivitis can lead to corneal ulceration and, possibly, blindness. Rare complications include meningitis, osteomyelitis, pneumonia, and acute respiratory distress syndrome.
Assessment
The patient may report unprotected sexual contact (vaginal, oral, or anal) with an infected person, an unknown partner, or multiple sex partners. He may also have a history of STDs.
After a 3- to 6-day incubation period, a male patient may complain of dysuria, although both sexes can remain asymptomatic.
A patient with a rectal infection may complain of anal pruritus, burning, and tenesmus, as well as pain with defecation. A patient with a pharyngeal infection may be asymptomatic or may complain of a sore throat.
A patient with a rectal infection may complain of anal pruritus, burning, and tenesmus, as well as pain with defecation. A patient with a pharyngeal infection may be asymptomatic or may complain of a sore throat.
Assessing for infection sites in gonorrhea
Inspection of a male patient’s urethral meatus reveals a purulent discharge. In a female patient, this discharge may be expressed from the urethra, and the meatus may appear red and edematous. Inspection of the cervix with a speculum discloses a greenish yellow discharge, the most common sign in females. Vaginal inspection reveals engorgement, redness, swelling, and a profuse, purulent discharge.
If the patient has a rectal infection, inspection may reveal a purulent discharge or rectal bleeding. In an ocular infection, inspection may reveal a purulent discharge from the conjunctiva; in a pharyngeal infection, redness and a purulent discharge.
If the infection has become systemic, papillary skin lesions—possibly pustular, hemorrhagic, or necrotic—may appear on the hands and feet.
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