Gonorrhea differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Gonorrhea must be differentiated from nongonococcal urethritis, Trichomonas vaginalis infection, urethral stricture, acute prostatitis, and Reiter's syndrome.

Differentiating gonorrhea from other diseases

Conditions that must be considered in the differential diagnosis of gonorrhea:

• In women
  • Nongonorrheal urethritis
  • Bacterial vaginosis
  • Vaginitis
  • Cervicitis
  • Pregnancy
  • Endometriosis
• In men
  • Nongonorrheal urethritis
  • Prostatitis
  • Orchitis
  • Testicular torsion

• Urinary tract infections

vaginitis, ectopic pregnancy, pregnancy, tubo-ovarian abscess, endometriosis, and mucopurulent cervicitis. In men, consider epididymitis, orchitis, and testicular torsion

Disseminated gonococcal infection

Disseminated gonococcal infection must be differentiated from:

Disease	Findings
Herpes simplex virus (HSV)	Genital and extragenital lesions can mimic the skin lesions that occur in disseminated gonococcal infection Viral culture, polymerase chain reaction (PCR), and direct fluorescence antibody confirm the presence of the causative agent.
Syphilis	Presents with acute secondary syphilis usually presents with generalized, pustular lesions at the palms and soles with generalized lymphadenopathy Rapid plasma reagin (RPR), Venereal Disease Research Laboratory (VDRL) and Fluorescent treponemal antibody absorption (FTA-ABS) tests confirm the presence of the causative agent.
Hepatitis B virus (HBV) infection	Presents with fever, chills, polyarthritis, tenosynovitis, and urticarial rash Synovial fluid analysis usually shows noninflammatory fluid Elevated serum aminotransaminases and evidence of acute HBV infection on serologic testing confirm the presence of the HBV.
HIV infection	Present with generalized rash with mucus membrane involvement, fever, chills, and arthralgia. Joint effusions are uncommon
Acute rheumatic fever	Presents with polyarthritis and rash (rare presentation) in young adults. Microbiologic or serologic evidence of a recent streptococcal infection confirm the diagnosis. Poststreptococcal arthritis have a rapid response to salicylates or other antiinflammatory drugs.
Gout and other crystal-induced arthritis	Presents with acute monoarthritis with fever and chills Synovial fluid analysis confirm the diagnosis.
Reactive arthritis (Reiter syndrome)	Present with arthritis, tenosynovitis, dactylitis, and low back pain. Extraarticular manifestation include conjunctivitis, urethritis, and genital and oral lesions. There is no definitive diagnostic test. Reactive arthritis is a clinical diagnosis based upon the pattern of findings.
Lyme disease	Present with erythema chronicum migrans rash and monoarthritis as a later presentation. Clinical characteristics of the rash and and serologic testing confirm the diagnosis.