Gonorrhea natural history, complications, and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Natural history, complications, and prognosis
Natural History
Gonococcal infection in women
- In in 70% of women, the Initial infection of Niesseria gonorrhea may be asymptomatic. However, the organism may cause a typical acute inflammatory reaction resulting frequently in a purulent exudate.
- Initial infection is usually seen 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.
If gonococcal infection left untreated, it can result in cyst and abscess formation in one or more of the greater vestibular glands (bartholinitis), pelvic inflammatory disease (PID), and Fitz-Hugh-Curtis syndrome.
- The most common complication of untreated gonorrhea is pelvic inflammatory disease (PID), a serious infection of the female reproductive tract.
- PID caused by gonorrhea can lead to scarring of the fallopian tubes. Scarring of the fallopian tube can lead to increased risks of ectopic pregnancy and as a result fertilized egg may not be able to pass through the narrowed, scarred fallopian tube. Ectopic pregnancies are serious conditions which can be life-threatening to 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, leading to multiple distant sites of infection which can include the brain, heart and joints.
- When joints become involved, gonococcal arthritis can develop. Gonococcal arthritis occurs after primary infection of the genitalia, anus, or throat. This occurs in about 1% of patients who are infected with gonorrhea and is more common in women than men.
- Typical symptoms include a 5–7 day history of fever, shaking, chills, multiple skin lesions, 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.
allowing attachment to these surfaces. Adherence to the surface of spermatozoa allows transmission of the organism to the fallopian tube, the presumed mechanism of ascending infection. Initial infection may be asymptomatic, but the organism incites a typical acute inflammatory reaction resulting frequently in a purulent exudate. The clinical consequences of gonorrhea are due to classic pyogenic infection with resolution by fibrosis. Initial infection is usually seen in the cervical region, but due to the adherence to spermatozoa, the infection may ascend through the uterus into the fallopian tubes and finally out into the peritoneal cavity. A purulent vaginal discharge is often seen, but frequently the purulent material exudes from the fimbriated end of the fallopian tubes into the peritoneal cavity. Untreated infections may progress to fibrosis. The fibrotic reaction, depending on its location can lead to a variety of complications, such as urethral stricture, fallopian tube stricture, tubo-ovarian abscess, pelvic inflammatory disease (PID) and infertility. Peritonitis may present in PID and cause life threatening acute bowel obstruction. It is important to treat the symptoms of gonorrhea as early as possible. When the infection is confined to the lower genital tract, it is much more responsive to antibiotic therapy. Once the infection ascends and becomes well established, it is difficult to deliver the needed concentrations of antibiotics and the infection is much more difficult to cure with drugs alone. This is due to the lack of blood flow in the walled off areas and is the reason that surgery often becomes necessary. In pregnancy, gonococcus can be transmitted to the fetus at the time of delivery. This results in infection of the conjuctiva of the eye. This appears 1 to 4 days after birth as severe discharge with marked swelling and redness of the eyelids and conjunctiva. This can lead to corneal perforation and blindness. Diagnosis is made by gram stain of the exudate and culture allowing attachment to these surfaces. Adherence to the surface of spermatozoa allows transmission of the organism to the fallopian tube, the presumed mechanism of ascending infection. Initial infection may be asymptomatic, but the organism incites a typical acute inflammatory reaction resulting frequently in a purulent exudate. The clinical consequences of gonorrhea are due to classic pyogenic infection with resolution by fibrosis. Initial infection is usually seen in the cervical region, but due to the adherence to spermatozoa, the infection may ascend through the uterus into the fallopian tubes and finally out into the peritoneal cavity. A purulent vaginal discharge is often seen, but frequently the purulent material exudes from the fimbriated end of the fallopian tubes into the peritoneal cavity. Untreated infections may progress to fibrosis. The fibrotic reaction, depending on its location can lead to a variety of complications, such as urethral stricture, fallopian tube stricture, tubo-ovarian abscess, pelvic inflammatory disease (PID) and infertility. Peritonitis may present in PID and cause life threatening acute bowel obstruction. It is important to treat the symptoms of gonorrhea as early as possible. When the infection is confined to the lower genital tract, it is much more responsive to antibiotic therapy. Once the infection ascends and becomes well established, it is difficult to deliver the needed concentrations of antibiotics and the infection is much more difficult to cure with drugs alone. This is due to the lack of blood flow in the walled off areas and is the reason that surgery often becomes necessary. In pregnancy, gonococcus can be transmitted to the fetus at the time of delivery. This results in infection of the conjuctiva of the eye. This appears 1 to 4 days after birth as severe discharge with marked swelling and redness of the eyelids and conjunctiva. This can lead to corneal perforation and blindness. Diagnosis is made by gram stain of the exudate and culture
allowing attachment to these surfaces. Adherence to the surface of spermatozoa allows transmission of the organism to the fallopian tube, the presumed mechanism of ascending infection. Initial infection may be asymptomatic, but the organism incites a typical acute inflammatory reaction resulting frequently in a purulent exudate. The clinical consequences of gonorrhea are due to classic pyogenic infection with resolution by fibrosis. Initial infection is usually seen in the cervical region, but due to the adherence to spermatozoa, the infection may ascend through the uterus into the fallopian tubes and finally out into the peritoneal cavity. A purulent vaginal discharge is often seen, but frequently the purulent material exudes from the fimbriated end of the fallopian tubes into the peritoneal cavity. Untreated infections may progress to fibrosis. The fibrotic reaction, depending on its location can lead to a variety of complications, such as urethral stricture, fallopian tube stricture, tubo-ovarian abscess, pelvic inflammatory disease (PID) and infertility. Peritonitis may present in PID and cause life threatening acute bowel obstruction. It is important to treat the symptoms of gonorrhea as early as possible. When the infection is confined to the lower genital tract, it is much more responsive to antibiotic therapy. Once the infection ascends and becomes well established, it is difficult to deliver the needed concentrations of antibiotics and the infection is much more difficult to cure with drugs alone. This is due to the lack of blood flow in the walled off areas and is the reason that surgery often becomes necessary. In pregnancy, gonococcus can be transmitted to the fetus at the time of delivery. This results in infection of the conjuctiva of the eye. This appears 1 to 4 days after birth as severe discharge with marked swelling and redness of the eyelids and conjunctiva. This can lead to corneal perforation and blindness. Diagnosis is made by gram stain of the exudate and culture
Possible complications
Complications in women may include:
- Salpingitis (scarring of the fallopian tubes), which can lead to problems getting pregnant or ectopic pregnancy
- Pelvic inflammatory disease
- Sterility (inability to become pregnant)
- Painful intercourse (dyspareunia)
- Pregnant women with severe gonorrhea may pass the disease to their baby while in the womb or during delivery
Complications in men may include:
- Scarring or narrowing of the urethra, the tube that carries urine out of the body
- Abscess (collection of pus around the urethra)
- Urination problems
- Urinary tract infection
- Kidney failure
Complications in both men and women may include:
- Disseminated infection, which can be very serious
- Long-term joint pain, if the infection is left untreated
- Heart valve infection
- Meningitis
Prognosis
- The underlying gonorrhea should be treated; if this is done, then usually a good prognosis will follow
- A gonorrhea infection that has not spread to the bloodstream or other areas almost always can be cured with antibiotics. Gonorrhea that has spread is a more serious infection but almost always gets better with treatment