Gonococci cause both localized infections, usually in the genital tract, and disseminated infections with seeding of various organs. Gonococci reach these organs via the bloodstream (gonococcal bacteremia).
Gonorrhea in men is characterized primarily by urethritis accompanied by dysuria and a purulent discharge. Epididymitis can occur.
In women, infection is located primarily in the endocervix, causing a purulent vaginal discharge and intermenstrual bleeding (cervicitis). The most frequent complication in women is an ascending infection of the uterine tubes (salpingitis, PID), which can result in sterility or ectopic pregnancy as a result of scarring of the tubes. Women with PID may also have a rare perihepatitis characterized by right upper quadrant pain. This is called Fitz-Hugh-Curtis syndrome and is characterized by “violin-string” adhesions. This syndrome is also caused by Chlamydia trachomatis.
Disseminated gonococcal infections (DGIs) commonly manifest as arthritis, tenosynovitis, or pustules in the skin. Disseminated infection is the most common cause of septic arthritis in sexually active adults. The clinical diagnosis of DGI is often difficult to confirm using laboratory tests because the organism is not cultured in more than 50% of cases.
Other infected sites include the anorectal area, throat, and eyes. Anorectal infections occur chiefly in women and homo sexual men. They are frequently asymptomatic, but a bloody or purulent discharge (proctitis) can occur. In the throat, pharyngitis occurs, but many patients are asymptomatic.
In newborn infants, purulent conjunctivitis (ophthalmia neonatorum) is the result of gonococcal infection acquired from the mother during passage through the birth canal. The incidence of gonococcal ophthalmia has declined greatly in recent years because of the widespread use of pro phylactic erythromycin eye ointment (or silver nitrate) applied shortly after birth. Gonococcal conjunctivitis also occurs in adults as a result of the transfer of organisms from the genitals to the eye.
Other sexually transmitted infections (e.g., syphilis and non gonococcal urethritis caused by C. trachomatis) can coexist with gonorrhea; therefore, appropriate diagnostic and therapeutic measures must be taken.
