Gonococcal Infections

Alternate Names
gonorrhea

Definition of Gonococcal Infections

Gonococcal infections are caused bybacteria. These infections are usually acquired through sexual contact. A gonococcal infection may also be passed from mother to baby during childbirth.

What is going on in the body?

Humans are the only host forIt is spread from person to person through sexual contact. It can spread through vaginal, anal, or oral sex. The bacteria can also be transmitted on contaminated fingers or sex toys. Gonococcal infections can be spread from an infected mother to her baby during childbirth.

The infection can affect any mucuous membrane. It is most common in the following locations:

• the eyes, especially in newborns
• the rectum
• the throat
• the urethra in men
• the vagina, cervix, and urethra in females

In women with gonorrhea, the bacteria can travel into the fallopian tubes and ovaries. The woman may develop pelvic inflammatory disease. Gonorrhea in males may spread to the testicles or the epididymis, which produces sperm.

Sometimes the bacteria can spread through the bloodstream to other areas of the body. The infection may then affect the abdomen, heart, joints, spinal cord, brain, and liver.

What are the signs and symptoms of the infection?

Most women with gonorrhea do not have any symptoms. Women who have symptoms may notice the following:

• abnormal menstrual bleeding
• abnormal vaginal discharge
• dyspareunia (pain with intercourse)
• eye pain and discharge
• frequent or painful urination
• rectal discomfort
• sore throat
• vaginal bleeding after sexual intercourse or exercise

About half of men with gonorrhea have no symptoms. Those with symptoms may notice the following:

• discharge of pus from the penis
• eye pain and discharge
• frequent or painful urination
• rectal discomfort
• sore throat

Gonorrhea that has spread to other parts of the body may cause a rash and fever. The person may have painful, swollen joints. Other symptoms are specific to the body part that is infected. An infection in the heart, for example, may cause heart valve problems.

Neonatal conjunctivitis is an eye infection in newborns that is usually caused by a gonococcal infection. Sometimes babies can develop abscesses in the scalp at the site where a fetal monitor electrode was attached. Babies can also have infections in other body organs.

What are the causes and risks of the disease?

Gonococcal infections are caused by Neisseria gonorrhoeae bacteria. It is spread through sexual contact or during childbirth.

Gonococcal infections are reported in approximately equal proportion among men and women. To some extent, this reflects a balance in likelihood of diagnosis: men are more often symptomatic and thus more likely to come in for care, whereas women are more likely to be screened and found to be infected in prenatal and family planning clinics.

Risk factors for gonococcal infection include the following:

• child abuse
• childbirth in an infected, untreated mother
• multiple sexual partners
• unprotected sexual contact
• use of an intrauterine device (IUD) for birth control

What can be done to prevent the disease?

Regular, consistent condom use may reduce, but does not eliminate, the risk of gonorrhea. Prompt treatment of an infected person and his or her sexual partners will prevent further spread.

Pregnant women should be tested and treated for gonorrhea as needed. All newborns should receive preventive antibiotic eyedrops, such as erythromycin or gentamicin.

How is the disease diagnosed?

Diagnosis of a gonococcal infection starts with a history and physical exam. The Neisseria gonorrhoeae bacteria can be cultured from infected body sites.

Testing for HIV, Chlamydia and syphilis should also be offered. These sexually transmitted infections (STIs) are more common in people with gonorrhea.

What are the long-term effects of the disease?

Gonococcal infections can cause serious long-term effects if they are not treated effectively. These effects, not commonly seen today, include the following:

• congestive heart failure, a condition in which a weakened heart cannot pump blood effectively
• death from overwhelming sepsis or bloodstream infection
• endocarditis, which is an infection involving the heart
• increased risk for tubal pregnancy
• infertility in females and males
• meningitis, or infection of the brain and spinal cord
• pelvic inflammatory disease, or widespread infection in the pelvis
• septic arthritis, with infection of one or more joints
• visual impairment, including blindness

What are the risks to others?

Gonococcal infections are very contagious. They are spread during sexual contact or childbirth.

What are the treatments for the disease?

Gonococcal infections are treated with antibiotics.

As a first choice, the Centers for Disease Control and Prevention (CDC) recommend either cefixime (i.e, Suprax), ceftriaxone (i.e., Rocephin), ciprofloxacin (i.e., Cipro, Proquin), levofloxacin (i.e., Levaquin), or ofloxacin (i.e., Floxin).

In pregnancy, ceftriaxone (i.e., Rocephin) is the treatment of choice with erythromycin as an alternate.

Doxycycline (i.e., Adoxa, Doryx, Oracea, Periostat, Vibramycin) or Azithromycin (i.e., Zithromax, Zmax) is added to the regimen to treat Chlamydia trachomatis, an infection which commonly occurs along with gonorrhea.

Penicillins are no longer used to treat gonorrhea because the bacteria have become resistant to them.

Pain medications can be used as needed.

Infected individuals should avoid sexual contact until the infection is completely gone. Infections that involve other body organs will also need treatment.

What are the side effects of the treatments?

Antibiotics may cause rash, stomach upset, and allergic reactions.

What happens after treatment for the disease?

Most people recover completely, if the gonococcal infection is treated effectively. Sexual partners should also be tested and treated for STIs.

How is the infection monitored?

Any new or worsening symptoms should be reported to the healthcare provider.