Gonorrhea natural history, complications, and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Gonorrhea (gonorrhoea in British English) is amongst the most common sexually transmitted diseases in the world and is caused by Gram-negative bacterium Neisseria gonorrheae. The term comes from Ancient Greek γονόρροια (gonórrhoia), literally "flow of seed"; in ancient times it was incorrectly believed that the pus discharge associated with the disease contained semen.[1]
Natural history, complications, and prognosis
- In men, inflammation of the epididymis (epididymitis), prostate gland (prostatitis) and urethral structure (urethritis) can result from untreated gonorrhea.
- In women, untreated gonorrhea can result in cyst and abscess formation in one or more of the greater vestibular glands (bartholinitis), causing trouble walking; PID; and Fitz-Hugh-Curtis syndrome.
- The most common result of untreated gonorrhea is pelvic inflammatory disease, a serious infection of the female reproductive tract.
- PID causes scarring of the fallopian tubes which leads to increased risks of causing an ectopic pregnancy as a fertilized egg may not be able to pass through the narrowed, scarred fallopian tube. Ectopic pregnancies are serious conditions which are potentially life-threatening to the mother.
- 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.
- 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.
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