Gonorrhoea

Definition

• Gonorrhoea is a sexually transmitted infection with Neisseria gonorrhoeae, a Gram-negative diplococcus that primarily targets columnar and transitional epithelium.
• Common sites of infection are the cervix, urethra, rectum, pharynx and conjunctiva; the organism occurs only in humans and is almost always sexually transmitted.

Occurrence & epidemiology

Epidemiology

• The WHO estimated 82.4 million new infections among adults aged 15 to 49 worldwide in 2020.
• Prevalence is highest in key populations such as men who have sex with men, sex workers, transgender women, and adolescents and young people in high-burden countries.
• Coinfection with Chlamydia trachomatis is present in about 10–40 %, depending on the population.

Clinical features

• About 90 % of women with urogenital gonorrhoea are asymptomatic.
• Cervicitis presents with vaginal discharge, dysuria and intermenstrual or postcoital bleeding; speculum examination often shows mucopurulent or purulent cervical discharge, and the os bleeds easily on contact.
• In 10–20 % of infected women the infection ascends to cause pelvic inflammatory disease, with a risk of infertility and ectopic pregnancy.
• Disseminated gonococcal infection is uncommon and occurs predominantly in women; it presents with fever, pustular skin lesions, tenosynovitis and arthritis.
• Newborns may acquire conjunctivitis during passage through the birth canal.

Diagnosis

• Molecular tests (nucleic acid amplification testing, NAAT) are the gold standard; swabs are preferred in women and urine samples in men.
• Gram staining shows intracellular Gram-negative diplococci and is reliable in men with urethral discharge, but much less accurate for infections of the cervix, pharynx and rectum.
• Culture additionally allows susceptibility testing of the organism.

Keep learning in the app

Further reading (selection)

1. StatPearls: Gonorrhea (NCBI Bookshelf)
2. MSD Manual Professional: Gonorrhea
3. WHO fact sheet: Gonorrhoea (Neisseria gonorrhoeae infection)

Cross-references