Gonorrhea infects mucosal membranes outside the genital tract. Serious gonococcal infections and complications can occur.

Most cases of gonorrhea are uncomplicated lower genital tract infections: cervicitis and urethritis. However, N. gonorrhoeae infects mucosal membranes outside the genital tract as well: conjunctiva, throat (oropharynx) and rectum. In addition more serious infections and complications can occur.

Left untreated, N. gonorrhoeae may spread to the epididymis (epididymitis), prostate (prostatitis), and urethral stricture. In women, complications may include abscess formation in the urethra, infection of the fallopian tubes (salpingitis) and pelvic inflammatory disease (PID).

Oropharyngeal gonorrhea

Mode(s) of transmission: oral sex

Symptoms: sore

Anorectal gonorrhea

Mode(s) of transmission:

• anal intercourse ,
• autoinoculation (spread of infection by exposure of rectal mucosa to cervical secretions discharged from the vagina).

Symptoms:

• large amounts of purulent discharge,
• burning or stinging pain,
• spasms of the anal spincter,
• urgency,
• blood in stools,
• anal itching,
• painful bowel movements.

Anorectal gonorrhea may also be asymptomatic

Gonococcal conjunctivitis

Gonococcal conjunctivitis most frequently occurs in newborns of mothers with gonorrhea.

Gonococcal conjunctivitis may lead to scarring or perforation of the cornea, resulting in blindness if not treated promptly.

Mode(s) of transmission

During Birth: exposure to secretions during passage through birth canal (ophthalmia neonatorum).

Routine application of silver nitrate drops or erythromycin to the eyes of newborns has largely eliminated infant cases of gonococcal conjunctivitis.

Adolescent/Adult: autoinoculation (transfer of infected fresh secretions on contaminated hands or objects into the conjunctiva of the eye).

Symptoms:

• tearing,
• edema,
• purulent discharge.

Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) is the term applied to gonococcal infections that ascend from the lower genital tract through the cervical opening to the upper genital tract.

Mode of transmission: ascension of pathogens (Neisseria gonorrhoeae, Chlamydia trachomatis, etc.) from the lower genital tract to the upper genital tract.

Symptoms:

• may not be present,
• lower abdominal pain,
• tenderness of the uterus, fallopian tubes and/or ovaries,
• fever.

Pelvic inflammatory disease includes any or all of the following:

• uterus (endometritis),
• fallopian tubes (salpingitis),
• abdominal cavity (pelvic peritonitis),
• abscesses of the fallopian tubes and/or ovaries (tubo-ovarian abscesses),
• and/or Fitz-Hugh Curtis syndrome (perihepatitis).

Gonococcal abscesses may be difficult to cure, because the enclosed pockets filled with pus prevent penetration of antibiotics.

Approximately 8-10% of women with gonococcal cervicitis will develop pelvic inflammatory disease (1,000,000 women each year in the U.S.).

Pelvic inflammatory disease may result in permanent damage to the reproductive organs, infertility and ectopic pregnancy (pregnancy in the pelvic cavity outside the uterus). The inflammatory response to PID results in scarring and blockage of fallopian tubes (spermatic tubes and ducts in men) leading to infertility and ectopic pregnancy

Disseminated gonococcal infection

Approximately 1-3% of persons with uncomplicated gonorrhea will develop disseminated gonococcal infection (DGI).

Disseminated gonococcal infection most often results from untreated asymptomatic infection or immune deficiencies that predispose to more serious infection

Mode of transmission: invasion of the bloodstream, tissues, joints and/or spinal fluid

Symptoms:

• fever,
• chills,
• skin lesions (hands and feet),
• joint pain in hands, feet, ankles and elbows.

Complications:

• septic arthritis,
• endocarditis,
• meningitis,
• HIV infection (people infected with gonorrhea are more susceptible to HIV infection).

Gonococci are often not isolated from clinical specimens: diagnosis may be based on isolation of gonococci from mucosal site(s) of patient or sexual partner(s).

Read more on sexually transmitted infections:

Uncomplicated gonorrhea

Cervicitis

Sexually transmitted infection

PID: Risk factors and prevention

STI and STD

Pelvic inflammatory disease

Trichomonas vaginalis

Bacterial vaginosis

Human papillomavirus

Sources:

Neisseria and Branhamella in Manual of Clinical Microbiology, 6th edition. ASM Press 1995.

Gonorrhea. Centers for Disease Control and Prevention (CDC)