Gonococcemia Workup

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 18, 2012
 

Laboratory Studies

The diagnosis of DGI should be based on clinical findings and confirmed with laboratory investigations if possible. Note the following:

CBC count

Patients with gonococcemia may have an elevated WBC count, in the range of 10,000-15,000/µL.

Erythrocyte sedimentation rate

The rates are usually mildly elevated, with values from 20-50 in most patients. Less than 50% of patients have erythrocyte sedimentation rates higher than 50.

Culture

The highest yield of N gonorrhoeae organisms is from mucosal sites, including the pharynx, the urethra, the cervix, or the rectum. Urethral and cervical cultures are typically the most revealing. Blood cultures yield positive culture results in 10-30% of patients and joint fluid in 20-30% of patients. Skin lesions yield organisms in only about 10% of patients. Immunofluorescence studies may improve the effectiveness in skin and joint fluid.

Polymerase and/or ligase chain reaction

These methods have a high sensitivity and a high specificity (78.6% and 96.4%, respectively). They are easily performed on urethral specimens and can even be performed on first-void urine specimens. These methods are noninvasive, rapid, sensitive, and specific, and they have facilitated the diagnosis of gonococcal infection.[17] However, these methods cannot report antibiotic sensitivities; therefore, they do not eliminate the need for culture in these patients. Also note the following:

  • Nucleic acid amplification tests, including the polymerase chain reaction, are sensitive and specific tests, as noted above. A pseudo-outbreak of pharyngeal gonorrhea in a group of prostitutes was determined to be the result of false-positive test results due to commensal oropharyngeal Neisseria species.[18]
  • Specific molecular tests may produce erroneous results. In certain circumstances, it may be advisable, in consultation with a medical microbiologist, to take a sample for culture or to perform a second molecular test aimed at a different part of the bacterial genome.
  • N gonorrhoeae was identified as the causative agent in a case of culture-negative dermatitis-arthritis syndrome using real-time polymerase chain reaction.[19] This technology can improve the speed and sensitivity of diagnosis and consequent management of patients with this syndrome.

Serologic tests

These tests include latex agglutination, enzyme-linked immunosorbent assay, immunoprecipitation, and complement fixation tests. Because of their lower sensitivity and specificity, especially in populations with a low prevalence of disease, these tests are not routinely used for diagnosis, but they can be used as adjuncts to the other laboratory tests and may help in making the diagnosis.

Other screenings

The US Preventive Services Task Force recommends that women at increased risk of gonorrhea also be screened for chlamydia, HIV, and syphilis.[20]

Pharyngeal gonococcal infections can occur in heterosexual men diagnosed with urethritis. Screening for pharyngeal colonization by N gonorrhoeae and Chlamydia trachomatis using validated nucleic acid amplification tests has been recommended for heterosexual men diagnosed with urethritis.[21]

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Other Tests

Because of the potential severity of pericarditis and endocarditis, a cardiologic examination, including echocardiography, is recommended, even though these conditions are rare.

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Histologic Findings

Histopathologic examination reveals a vasculitislike picture with a perivascular neutrophilic infiltrate and neutrophils containing pustules in the epidermis. Note the image below.

Cytologic smear of cutaneous acral pustule showingCytologic smear of cutaneous acral pustule showing gram-negative intracellular diplococci.
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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Rajendra Kapila, MD, MBBS  Associate Professor, Department of Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Rajendra Kapila, MD, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, and Infectious Diseases Society of New Jersey

Disclosure: Nothing to disclose.

Specialty Editor Board

Gregory J Raugi, MD, PhD  Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Dr. Neal Ammar, to the development and writing of this article.

References

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Disseminated gonococcemia, acral pustules.
Cytologic smear of cutaneous acral pustule showing gram-negative intracellular diplococci.
 
 
 
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