Introduction
Gonorrhea is a common sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It most often affects the genital tract but can also infect the throat, rectum and eyes. Both men and women can carry and spread the infection, sometimes without any symptoms.
Pathophysiology
Gonococci attach to mucous membrane cells using pili and outer membrane proteins. They produce an IgA protease that helps them survive on mucosal surfaces. The bacteria cause local inflammation by invading superficial mucosa and triggering an acute immune response with neutrophil infiltration. If untreated, infection can ascend (in women) from cervix to fallopian tubes causing salpingitis, pelvic inflammatory disease (PID) and scarring. In men, spread to epididymis and prostate can occur. Rarely, bacteria enter the bloodstream causing disseminated gonococcal infection (arthritis, dermatitis, tenosynovitis).
Incubation Period
Usually 2–7 days after exposure, but may be longer. Some infected persons remain asymptomatic and still transmit the disease.
Clinical Features
In Men
- Purulent urethral discharge (white, yellow or green)
- Painful or burning micturition
- Swollen, tender epididymis or testes (if complicated)
In Women
- Often mild or no symptoms
- Abnormal vaginal discharge
- Pelvic pain, pain on intercourse
- May progress to PID with fever, lower abdominal pain and infertility risk
Other Sites
- Pharyngeal gonorrhea: sore throat (often asymptomatic)
- Rectal infection: discharge, pain, tenesmus (often asymptomatic)
- Neonatal conjunctivitis: eye infection in newborns passing through infected birth canal
Complications
- Pelvic inflammatory disease → infertility, ectopic pregnancy
- Prostatitis, epididymo-orchitis in men → possible infertility
- Disseminated infection → septic arthritis, tenosynovitis, skin lesions
- Neonatal conjunctivitis → blindness if untreated
Diagnosis
- Microscopy and Gram stain of urethral/cervical discharge (gram-negative diplococci in neutrophils)
- Culture on selective media (Thayer-Martin) — useful for antibiotic sensitivity
- Nucleic acid amplification tests (NAAT/PCR) — highly sensitive and recommended for urine, vaginal, pharyngeal and rectal samples
- Test for other STIs (chlamydia, syphilis, HIV) should be done concurrently
Treatment
Treatment must follow current local or WHO/CDC guidelines and consider local resistance patterns. Single-dose injectable therapy is preferred for uncomplicated infection:
- Preferred: Ceftriaxone 500 mg–1 g IM single dose (dose depends on guidelines and patient weight).
- If chlamydia coinfection not excluded: add doxycycline 100 mg orally twice daily for 7 days.
- In case of severe allergy or resistance, follow local expert advice.
- Treat sexual partners and advise abstinence until treatment completed and test-of-cure if indicated.
- Neonatal conjunctivitis: topical/systemic antibiotics and urgent ophthalmology care.
Prevention
- Consistent condom use during vaginal, anal and oral sex
- Screening of high-risk individuals and pregnant women
- Prompt treatment of cases and notification/treatment of sexual partners
- Avoid sex until both partners complete therapy and symptoms resolve
- Education on safer sex practices and regular STI check-ups
Public Health Notes
Antibiotic resistance in N. gonorrhoeae is increasing globally — surveillance and guideline-updated therapy are essential. Use NAAT for screening and reserve culture when resistance testing is required.
Detailed Notes:
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