Gonorrhea natural history, complications, and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
In 50 to 70% of women, the Initial infection with Neisseria gonorrhea may be asymptomatic. Initial infection is usually observed in the cervical region, but due to the presence of the surface pili, the infection may ascend through the uterus into the fallopian tubes and finally out into the peritoneal cavity. The exact incubation period of gonorrhea is unknown. It may result in cervicitis and urethritis, which can present with dysuria, vaginal pruritus, and vaginal mucopurulent discharge. If gonococcal infection is left untreated, it can progress to fibrosis, which can result in fallopian tube stricture, tubo-ovarian cyst or abscess, pelvic inflammatory disease (PID), Perihepatitis (Fitz-Hugh-Curtis syndrome), and/or bartholinitis. The most common complication of untreated gonorrhea is pelvic inflammatory disease (PID), which may lead to increased risks of ectopic pregnancy. If left untreated, ectopic pregnancy can be life-threatening for the mother.[1][2] In men, untreated gonorrhea may result in inflammation of the epididymis (epididymitis), prostate gland (prostatitis), and urethral structure (urethritis). Disseminated gonococcal infection (DGI) occurs in about 0.5 to 3% of patients, commonly following asymptomatic mucosal infection in both sexes. Women are more likely to develop disseminated gonococcal infection than men. Disseminated gonococcal infection can lead to the infection of multiple distant sites such as the brain, the heart, and joints. The most common signs and symptoms include arthritis or arthralgias, tenosynovitis, and multiple skin lesions.
Common complications of gonococcal infection in women may include salpingitis, pelvic inflammatory disease, infertility, dyspareunia, and ectopic pregnancy. Common complications of gonococcal infection in men may include post-inflammatory urethral strictures, urethral abscess, Penile lymphangitis, penile edema, urinary tract infection, and kidney failure. The prognosis of urogenital and disseminated gonococcal infection are generally good with adequate treatment.
Natural history, complications, and prognosis
Natural History
Gonococcal infection in women
- In 50 to 70% of women, the Initial infection with Neisseria gonorrhea may be asymptomatic.[1][2]
- Initial infection is usually observed in the cervical region though, due to the presence of the surface pili, the infection may ascend through the uterus into the fallopian tubes and, finally, out into the peritoneal cavity.
- The exact incubation period of gonorrhea is unknown. It may result in cervicitis and urethritis, which can cause dysuria, vaginal pruritus, and vaginal mucopurulent discharge.
- If gonococcal infection is left untreated, it can progress to fibrosis, which can result in fallopian tube stricture, tubo-ovarian cyst or abscess, pelvic inflammatory disease (PID), Perihepatitis (Fitz-Hugh-Curtis syndrome), and bartholinitis.
- The most common complication of untreated gonorrhea is pelvic inflammatory disease (PID).
- PID caused by gonorrhea can lead to scarring of the fallopian tubes. As a result of scarring and fibrosis of fallopian tubes, the fertilized egg may not be able to pass through the narrowed and scarred fallopian tube, which may lead to increased risks of ectopic pregnancy and infertility. If left untreated, ectopic pregnancy can be life-threatening for the mother.
Gonococcal infection in men
- In men, untreated gonorrhea may result in inflammation of the epididymis (epididymitis), prostate gland (prostatitis), and urethral structure (urethritis).
Disseminated gonococcal infection
- In both sexes, disseminated gonococcal infection (DGI) can occur. Women are more likely to developed disseminated gonococcal infection than men.
- Disseminated gonococcal infection is a result of bacteremic spread of Neisseria gonorrhea from the primary site of infection (endocervix, urethra, pharynx, or rectum).
- Disseminated gonococcal infection (DGI) occurs in about 0.5 to 3% of patients, commonly following asymptomatic mucosal infection.
- Disseminated gonococcal infection can lead to the infection of multiple distant sites such as the brain, heart, and joints. The most common signs and symptoms include arthritis or arthralgias, tenosynovitis, and multiple skin lesions.
- When joints become involved, gonococcal arthritis can develop.
- Disseminated gonococcal infection usually presents as an arthritis-dermatitis syndrome. Typical symptoms include a 5–7 day history of fever, shaking, chills, multiple skin lesions, and fleeting migratory polyarthralgias and tenosynovitis in fingers, wrists, toes or ankles. This should be evaluated promptly with a culture of the synovial fluid, blood, cervix, urethra, rectum, skin lesion fluid, or pharynx.
Gonorrhea in pregnancy
- In the absence of adequate prophylaxis, 30% to 42% of infants born by vaginal delivery to infected mothers will develop gonococcal conjunctivitis. Gonococcal conjunctivitis tends to occur 2-7 days after birth, and tends to be more severe than ophthalmia neonatorum arising as the result of other causes. If left untreated, it may cause corneal involvement such as corneal ulceration, diffuse opacification, and corneal perforation. This may lead to blindness, sepsis, or death. The onset of chlamydial conjunctivitis is usually later than gonococcal conjunctivitis.[3][4][5]
Possible complications
Complications in women may include:
- Salpingitis (scarring of the fallopian tubes), which can lead to infertility or ectopic pregnancy
- Pelvic inflammatory disease
- Infertility
- Painful intercourse (dyspareunia)
Complications in men may include:
- Post-inflammatory urethral strictures
- Abscess (collection of pus around the urethra)
- Penile lymphangitis
- Penile edema
- Urination problems
- Urinary tract infection
- Kidney failure
Complications in both men and women may include:
- Disseminated infection
- Long-term joint pain
- Endocarditis
- Meningitis
Prognosis
The prognosis of gonococcal infection is generally good with adequate treatment.
- Disseminated gonococcal infection is a more serious infection, but is often associated with a favorable long-term prognosis with adequate treatment.
References
- ↑ 1.0 1.1 McNeeley SG (1989). "Gonococcal infections in women". Obstet Gynecol Clin North Am. 16 (3): 467–78. PMID 2512520.
- ↑ 2.0 2.1 Stansfield VA (1980). "Diagnosis and management of anorectal gonorrhoea in women". Br J Vener Dis. 56 (5): 319–21. PMC 1045815. PMID 7427703.
- ↑ Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G (2008). "Neonatal conjunctivitis - a review". Malays Fam Physician. 3 (2): 77–81. PMC 4170304. PMID 25606121.
- ↑ Matejcek A, Goldman RD (2013). "Treatment and prevention of ophthalmia neonatorum". Can Fam Physician. 59 (11): 1187–90. PMC 3828094. PMID 24235191.
- ↑ Fransen L, Nsanze H, Klauss V, Van der Stuyft P, D'Costa L, Brunham RC; et al. (1986). "Ophthalmia neonatorum in Nairobi, Kenya: the roles of [[Neisseria gonorrhoeae]] and [[Chlamydia trachomatis]]". J Infect Dis. 153 (5): 862–9. PMID 3084664. URL–wikilink conflict (help)