Gonococcus Clinical Presentation

  • Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 17, 2010
 

History

In all patients presenting with possible STDs, history should include past history of STDs (including HIV), known symptoms of STDs in current or past partners, type of contraception, and any history of sexual assault.

In women, history also should include the date of the last menstrual period and the details of parity, including any history of ectopic pregnancies.

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Physical

  • Ocular or periocular manifestations
    • Anterior chamber - Cellular reaction, hypopyon, endophthalmitis
    • Conjunctiva - Chemosis, acute purulent exudate, hemorrhages
    • Cornea - Punctate epithelial keratitis; marginal, sterile stromal infiltrates; epithelial defects; infectious stromal infiltrates; stromal ulcerations; descemetocele; perforation; opacification
    • Lids - Erythema, edema
  • Genitourinary tract, male
    • Mucopurulent or purulent urethral discharge
    • Unilateral epididymal tenderness and edema
  • Lower genitourinary tract, female
    • Mucopurulent or purulent cervical discharge
    • Vaginal discharge or bleeding; vulvovaginitis in children
  • Upper genitourinary tract, female
    • PID
    • Lower abdominal tenderness with or without rebound tenderness
    • Cervical motion tenderness
    • Adnexal tenderness
    • Fever
    • Upper right abdominal tenderness (with perihepatitis)
  • Rectal - Mucopurulent or purulent discharge
  • DGI may present with any of the following findings:
    • Fever - Usually below 39°C
    • Skin changes - Maculopapular, pustular, necrotic, or vesicular rash typically occurs on the torso, limbs, palms, and soles. The rash usually spares the face, scalp, and mouth. Hemorrhagic lesions, erythema nodosum, urticaria, and erythema multiforme occur less frequently. Skin lesions are usually in different stages of development at the time of clinical presentation.
    • Joints - Most patients may have polyarthralgia with pain, tenderness, decreased range of motion, and erythema. Less often, purulent arthritis may affect a single joint with severe pain, tenderness, edema, erythema, and decreased range of motion. Tenosynovitis presents as erythema and local tenderness along a tendon sheath, with pain on active or passive range of motion. Tenosynovitis most often occurs in the hands, but it may be found in the tendons of the lower extremities.
    • Central nervous system - Patients with gonococcal meningitis may present with meningismus or decreased mental status.
    • Cardiac - Patients with gonococcal endocarditis may have a new murmur, tachycardia, and fever. Embolic lesions may be present.
    • Muscle - DGI can cause abscess formation within the soft tissues, presenting as localized tenderness, edema, and pain with motion.
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Causes

Gonococcal infection usually follows mucosal inoculation during vaginal, anal, or oral sexual contact. It also may be caused by inoculation of mucosa by contaminated fingers or other objects.

Neonatal infection may follow conjunctival inoculation during birth or direct infection through the scalp at the sites of fetal monitoring electrodes.

  • Risk factors
    • Sexual exposure to an infected individual without barrier protection
    • Multiple sexual partners
    • Infants - Passage through the infected birth canal of the mother
    • Children - Sexual abuse by an infected individual
    • For PID, use of an intrauterine device (IUD)
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Contributor Information and Disclosures
Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS  Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Fernando H Murillo-Lopez, MD  Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. [Guideline] Centers for Disease Control and Prevention (CDC). Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. Apr 13 2007;56(14):332-6. [Medline].

  2. [Guideline] U.S. Preventive Services Task Force (USPSTF). Screening for gonorrhea: recommendation statement. National Guideline Clearinghouse. 2005.

  3. [Guideline] Centers for Disease Control and Prevention (CDC). Updated recommended treatment regimens for gonococcal infections and associated conditions - United States, April 2007. Accessed July 17, 2007. [Full Text].

  4. [Guideline] American Academy of Ophthalmology Cornea/External Disease Panel. Conjunctivitis. National Guideline Clearinghouse. 2008.

  5. Harkins T. Sexually transmitted diseases. Optom Clin. 1994;3(4):129-56. [Medline].

  6. Isenberg SJ, Apt L, Campeas D. Ocular applications of povidone-iodine. Dermatology. 2002;204 Suppl 1:92-5. [Medline].

  7. Kestelyn P, Bogaerts J, Meheus A. Gonorrheal keratoconjunctivitis in African adults. Sex Transm Dis. Oct-Dec 1987;14(4):191-4. [Medline].

  8. Lee JS, Choi HY, Lee JE, Lee SH, Oum BS. Gonococcal keratoconjunctivitis in adults. Eye. Sep 2002;16(5):646-9. [Medline].

  9. Reed K, Jones MW. PPNG conjunctivitis. J Am Optom Assoc. Jun 1984;55(6):425-7. [Medline].

  10. Schwab L, Tizazu T. Destructive epidemic Neisseria gonorrheae keratoconjunctivitis in African adults. Br J Ophthalmol. Jul 1985;69(7):525-8. [Medline].

  11. Tight RR. Gonococcal conjunctivitis. JAMA. May 14 1982;247(18):2499. [Medline].

  12. Ullman S, Roussel TJ, Culbertson WW, Forster RK, Alfonso E, Mendelsohn AD, et al. Neisseria gonorrhoeae keratoconjunctivitis. Ophthalmology. May 1987;94(5):525-31. [Medline].

  13. Ullman S, Roussel TJ, Forster RK. Gonococcal keratoconjunctivitis. Surv Ophthalmol. Nov-Dec 1987;32(3):199-208. [Medline].

  14. Wan WL, Farkas GC, May WN, Robin JB. The clinical characteristics and course of adult gonococcal conjunctivitis. Am J Ophthalmol. Nov 15 1986;102(5):575-83. [Medline].

  15. Zajdowicz TR, Kerbs SB, Berg SW, Harrison WO. Laboratory-acquired gonococcal conjunctivitis: successful treatment with single-dose ceftriaxone. Sex Transm Dis. Jan-Mar 1984;11(1):28-9. [Medline].

 
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