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I. DEFINITION

Gonorrhea is a sexually transmitted disease caused by a bacterial infection with Neisseria gonorrhoeae (a gram-negative oxidase-positive diplococcus) with possible serious consequences if spread to the newborn.

II. INCIDENCE

In 2017, the Centers for Disease Control and Prevention reported the rate of gonorrhea in the United States at approximately 171.9 gonorrhea cases per 100,000 population. The incidence is highest in females 15 to 24 years of age. If routine ophthalmic prophylaxis was not used, it is estimated that 30% to 40% of newborn infants born to infected mothers would become infected.

III. PATHOPHYSIOLOGY

N gonorrhoeae primarily affects the endocervical canal of the mother. The infant may become infected during passage through an infected cervical canal or by contact with contaminated amniotic fluid if rupture of membranes has occurred. Co-infection with Chlamydia trachomatis is frequent, and human immunodeficiency virus (HIV) transmission is enhanced in the presence of gonorrhea. Untreated maternal gonococcal disease is associated with increased risk of preterm delivery and small for gestational age infants.

IV. CLINICAL PRESENTATIONS

  1. Ophthalmia neonatorum (neonatal conjunctivitis). The most common clinical manifestation of neonatal disease (∼80% of the cases). This occurs in 1% to 2% of infants born to mothers with gonococcal infection despite appropriate eye prophylaxis. For a description of this disease, see Chapter 58.

  2. Gonococcal arthritis. The onset of gonococcal arthritis can occur at any time from 2 to 21 days after delivery. It is secondary to gonococcemia. The source of bacteremia has been attributed to infection of the mouth, nares, and umbilicus. Multiple joints usually are affected, with the most common sites being the knees and ankles. The infant may present with mild or moderate symptoms.

  3. Sepsis and meningitis. See Chapters 146 and 140, respectively.

  4. Scalp abscess. Usually secondary to intrauterine fetal monitoring.

  5. Other localized infections. Gonococcal infections involving mucous membranes such as the pharynx, vagina, urethra, and anus have been described.

V. DIAGNOSIS

  1. Gram stain and culture. Gram stain of any exudate should be performed. Material may be obtained by swabbing the eye, pharynx, or anorectal areas. Blood should be obtained for culture. Fluid should be aspirated from an affected joint and Gram stain and culture obtained (in case of arthritis). Gonococcal cultures from nonsterile sites (eg, the pharynx, rectum, and vagina) should be done using selective media.

  2. Lumbar puncture with spinal fluid studies. Cell count, protein, glucose, culture, and Gram stain should be ordered to rule out bacterial meningitis.

VI. MANAGEMENT

Isolation precautions for all infectious diseases, including maternal and neonatal precautions, breast feeding, and visiting issues, can be found in Appendix F.

  1. Hospitalization. Infants with clinical evidence of ophthalmia neonatorum, scalp abscess, or disseminated infection should be hospitalized. Complete sepsis evaluation including lumbar puncture should be performed. Tests for ...

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