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A commonly reported infectious disease in the United States, gonorrhea is sexually transmitted and principally affects adolescents and young adults. Infants can be infected by passage through an infected birth canal. Children can acquire the disease through sexual play, molestation, and sexual abuse. The principal manifestation of the uncomplicated infection is a urethral or vaginal discharge; however, localized infections of the fallopian tubes, joints, conjunctiva, and anus, as well as disseminated infection, can occur.


The gonococcus is a gram-negative kidney bean–shaped diplococcus, nonmotile and nonencapsulated, fastidious in its nutritional requirements. It grows best aerobically in CO2 with increased humidity on a medium of chocolate agar with antibiotics (Thayer-Martin medium) that suppress the growth of other microorganisms.1,2 Gonococci grow in small colonies that are easily identified; they elaborate indophenoloxidase—the basis for identification by an oxidase test. However, definitive identification (required in more complicated clinical settings and for medicolegal purposes) requires the use of specific fluorescein-conjugated antibody staining or sugar fermentation.


Neisseria gonorrhoeae infects nonciliated columnar and transitional epithelial cells.2 Attachment to the cells is mediated by pili and the outer-membrane opacity proteins. Within 24 to 48 hours after attachment, the organism synthesizes enzymes to facilitate penetration to submucosal tissues. The host produces a neutrophil response, which results in sloughing of the epithelium, submucosal abscesses, and a purulent exudate. N gonorrhoeae is capable of invading the bloodstream and disseminating to other sites, such as the joints and meninges. Bacteremic spread is also more likely to occur in conjunction with menstruation, which facilitates spread to the upper genital tract (salpingitis). Deficiency of one of the terminal components of the complement system (especially factors 5, 6, 7, or 8) places the patient at increased risk of disseminated, chronic, or recurrent gonococcal disease.3




Gonococcal infections are limited to humans, and transmission is almost always sexual (genital, anal, or oral). Over the past two decades, there was a steady decline in reported gonorrhea cases; however, in 2005 and 2006 rates of gonorrhea in the United States increased.4 Rates varied by age: In those younger than 1 year old, rates were 5/100,000, and in children 1 to 4 years of age rates were 0.82/100,000. In children 5 to 14 years of age, rates were 11/100,000. Rates were highest in adolescents and young adults ages 15 to 24 years at 490/100,000.4 Sexual transmission and risk factors for goncoccal infection are further discussed in Chapter 233. Overall, the highest rates were in the 20- to 24-year-old age group.5 For sex-specific rates, females ages 15 to 19 years and 20 to 24 years had the highest rates of gonorrhea (648/100,000 and 606/100,000, respectively), and for males the highest rates were in 20- to 24-year-old males at 454/100,000. In past years, gonorrhea rates in those 15 to 19 years old had decreased, but in 2006, the rate increased by 6.3%.5 Sexual transmission and ...

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