Gonococcus

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

Updated: Feb 17, 2010

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Background
Pathophysiology
Epidemiology
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Background

Historically, gonorrhea is one of the first described infectious diseases. It is caused by the gram-negative diplococcus, Neisseria gonorrhoeae. Ocularly, it affects 2 populations, the sexually active adult population and the neonate. Ophthalmia neonatorum (neonatal conjunctivitis) is described in the article Conjunctivitis, Neonatal. This article discusses the adult disease.

Pathophysiology

Conjunctivitis can occur in adults, as well as children, following direct inoculation of organisms (usually as a result of hand-eye inoculation in adults) and can lead to blindness.

Frequency

United States

In the United States, gonorrhea is the second most commonly reported notifiable disease, with 339,593 cases documented in 2005.^[1]More cases may be unrecognized or unreported. Incidence, once believed to be on the decline because of public health initiatives, has been rising since 1984; however, rates in some demographic segments (eg, homosexuals) have decreased.

Incidence of antibiotic-resistant strains has been rising since the late 1940s. Of greatest concern is the rise in the percentage of cases due to penicillinase-producing N gonorrhoeae (PPNG).

International

Similar to the United States, in most countries, it is a ubiquitous infectious disease. Approximately 200 million new cases of gonorrhea occur worldwide each year.

Mortality/Morbidity

Gonorrhea is a major cause of morbidity throughout the world.

The most common long-term sequelae of gonorrhea are chronic pelvic pain in women after pelvic inflammatory disease (PID), septic abortion, chorioamnionitis in pregnancy, blindness after either neonatal conjunctivitis or adult conjunctivitis, and infertility of either sex.
Ectopic pregnancy is a life-threatening complication that may follow scarring of the female upper reproductive tract.
Disseminated infection may lead to meningitis or endocarditis.

Race

No racial predilection exists, but the disease is most common among urban poor and minority groups.

Sex

Gonococcal infections are 1.5 times more common in men than in women.

All sexually active populations are at risk, and the level of risk rises with the number of sex partners and the presence of other sexually transmitted diseases (STDs).
Serious sequelae are more common in women than in men. PID may lead to ectopic pregnancy or infertility, and disseminated gonorrheal infection (DGI) is more likely in women than in men.

Age

Gonococcal infection is more common in the sexually active age group (ie, 15-35 y).
Infection in children is a marker for child sexual abuse.

Proceed to Clinical Presentation

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

[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].
[Guideline] U.S. Preventive Services Task Force (USPSTF). Screening for gonorrhea: recommendation statement. National Guideline Clearinghouse. 2005.
[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].
[Guideline] American Academy of Ophthalmology Cornea/External Disease Panel. Conjunctivitis. National Guideline Clearinghouse. 2008.
Harkins T. Sexually transmitted diseases. Optom Clin. 1994;3(4):129-56. [Medline].
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Reed K, Jones MW. PPNG conjunctivitis. J Am Optom Assoc. Jun 1984;55(6):425-7. [Medline].
Schwab L, Tizazu T. Destructive epidemic Neisseria gonorrheae keratoconjunctivitis in African adults. Br J Ophthalmol. Jul 1985;69(7):525-8. [Medline].
Tight RR. Gonococcal conjunctivitis. JAMA. May 14 1982;247(18):2499. [Medline].
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].
Ullman S, Roussel TJ, Forster RK. Gonococcal keratoconjunctivitis. Surv Ophthalmol. Nov-Dec 1987;32(3):199-208. [Medline].
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].
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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