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 with Neisseria gonorrhea may be asymptomatic.
- 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.
- The exact incubation period of gonorrhea is unknown. The systemic resulting in cervicitis and urethritis which may present with dysuria, vaginal pruritus and vaginal mucopurulent discharge.
- If gonococcal infection left untreated, it can progress to fibrosis. The fibrosis 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 tube, 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. If left untreated, Ectopic pregnancies 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. However, 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 (endocervix, urethra, pharynx, or rectum) either symptomatic or asymptomatic.
This occurs in about 0.5 to 3% of patients who are infected with gonorrhea and is more common in women than men. [1]
- Development of disseminated gonococcal infection is the result of Neisserial organisms dissemination to the blood due to a variety of predisposing factors, such as:[2][3]
- Host factors
- Change In PH
- Pregnancy
- Menstruation
- Change In PH
- Virulence factors of the organism itself
- PorB.1A strains
- Result in serum resistance
- PorB.1A strains
- Failures of the host's immune defenses
- Complement deficiencies
- Host factors
- Disseminated gonococcal infection can lead to multiple distant sites of infection such as brain, heart and joints. Most common sign and symptoms include arthritis or arthralgias, tenosynovitis, and multiple skin lesions.
- When joints become involved, gonococcal arthritis can develop.
- 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.
- 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 other causes of ophthalmia neonatorum. If left untreated, it may cause corneal involvement such as corneal ulceration, diffuse opacification, and corneal perforation . This may lead to blindness, ultimately sepsis, or death. The onset of chlamydial conjunctivitis is usually later than gonococcal conjunctivitis.[5][6][7]
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)
Complications in men may include:
- Postinflammatory 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, 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
References
- ↑ O'Brien JP, Goldenberg DL, Rice PA (1983). "Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms". Medicine (Baltimore). 62 (6): 395–406. PMID 6415361.
- ↑ WATRING, WATSON G., and DANIEL L. VAUGHN. "Gonococcemia in pregnancy." Obstetrics & Gynecology 48.4 (1976): 428-430.
- ↑ Angulo, Juan M., and Luis R. Espinoza. "Gonococcal arthritis." Comprehensive therapy 25.3 (1999): 155-162.
- ↑ Bohnhoff M, Morello JA, Lerner SA (1986). "Auxotypes, penicillin susceptibility, and serogroups of Neisseria gonorrhoeae from disseminated and uncomplicated infections". J Infect Dis. 154 (2): 225–30. PMID 3088132.
- ↑ 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)