Gonorrhea Causes, Diagnosis, Symptoms and Treatment

Tuesday, September 16th 2014. | Disease

Neisseria gonorrhoeae is a gram-negative diplococcus estimated to cause up to 600,000 infections per year in the United States.



  • Infected individuals may be symptomatic or asymptomatic, have complicated or uncomplicated infections, and have infections involving several anatomic sites.
  • Approximately 15% of women with gonorrhea develop pelvic inflammatory disease (PID). Left untreated, PID can be an indirect cause of infertility and ectopic pregnancies.
  • In 0.5% to 3.0% of patients with gonorrhea, the gonococci invade the bloodstream and produce disseminated disease.
  • The usual clinical manifestations of disseminated gonnococcal infection are tender necrotic skin lesions, tenosynovitis, and monoarticular arthritis.

DIAGNOSIS of Gonorrhoeae

  • Diagnosis of gonococcal infections can be made by gram-stained smears, culture (the most reliable method), or newer methods based on the detection of cellular components of the gonococcus (e.g., enzymes, antigens, DNA, or lipopolysaccharide) in clinical specimens.
  • Culture of exposed body areas is the most reliable means of diagnosing gonococcal infection.
  • Alternative methods of diagnosis include enzyme immunoassay (EIA), DNA probes, and nucleic acid amplification techniques employing polymerase chain reaction and ligase chain reaction.

TREATMENT of Gonorrhoeae

  • All currently recommended regimens are single-dose treatments with various oral or parenteral cephalosporins and fluoroquinolones .
  • Ceftriaxone (125 mg IM) is the only parenteral agent recommended by the CDC as a first-line agent for treatment of gonorrhea.
  • Coexisting chlamydial infection, which is documented in up to 50% of women and 20% of men with gonorrhea, constitutes the major cause of postgonococcal urethritis, cervicitis, and salpingitis in patients treated for gonorrhea. As a result, concomitant treatment with doxycycline or azithromycin is recommended in all patients treated for gonorrhea. A single dose of azithromycin (2g) is highly effective against chlamydia.
  • Pregnant women infected with Neisseria gonorrhoeae should be treated with either a cephalosporin or spectinomycin, because fluoroquinolones are contraindicated. Erythromycin or amoxicillin is the preferred treatment for presumed Chlamydia trachomatis infection.
  • Treatment of gonorrhea during pregnancy is essential to prevent ophthalmia neonatorum. The American Academy of Pediatrics recommends that either silver nitrate (1%), tetracycline (1%), or erythromycin (0.5%) be instilled in each conjunctival sac immediately postpartum to prevent ophthalmia neonatorum.
  • Infants born to infected mothers should also receive an intramuscular or intravenous injection of ceftriaxone, 50 mg/kg, for 7 days.


  • Combination gonorrhea/chlamydia therapy rarely results in treatment failures, and routine follow-up of patients treated with a regimen included in the CDC guidelines is not recommended.
  • Persistence of symptoms following any treatment requires culture of the site(s) of gonorrheal infection, as well as susceptibility testing if gonococci are isolated.

44-3. Presentation of Gonorrhea Infections




General Incubation period 1-14 days
Symptom onset in 2-8 days
Incubation period 1-14 days
Symptom onset in 10 days
Site of infection Most common—urethra
Others—rectum (usually due to rectal intercourse in MSM), oropharynx, eye
Most common—endocervical canal
Others—urethra, rectum (usually due to perineal contamination), oropharynx, eye
Symptoms May be asymptomatic or minimally symptomatic
Urethral infection—dysuria and urinary frequency
Anorectal infection—asymptomatic to severe rectal pain
Pharyngeal infection—asymptomatic to mild pharyngitis
May be asymptomatic or minimally symptomatic
Endocervical infection—usually asymptomatic or mildly symptomatic
Urethral infection—dysuria, urinary frequency
Anorectal and pharyngeal infection— symptoms same as for men
Signs Purulent urethral or rectal discharge can be scant to profuse
Anorectal—pruritus, mucopurulent discharge, bleeding
Abnormal vaginal discharge or uterine bleeding; purulent urethral or rectal discharge can be scant to profuse
Complications Rare (epididymitis, prostatitis, inguinal lymphadenopathy, urethral stricture) Disseminated gonorrhea Pelvic inflammatory disease and associated complications (i.e., ectopic pregnancy, infertility)
Disseminated gonorrhea (3 times more common than in men)


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