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Neisseria gonorrhoeae, an aerobic gram-negative diplococcus, is the etiologic agent of gonorrhea.
- Gonorrhea is the second most common sexually transmitted infection (STI) in the United States.
- Coinfection with Chlamydia trachomatis commonly occurs in sexually active patients.
- Less than half of all infections are estimated to be detected or reported.
- In the United States, there are >800,000 new cases of gonorrhea each year. Rates of infection are highest among adolescents and young adults.
- Racial and sexual behavior disparities are present, with a disproportionately high incidence in ethnic minorities and males who have sex with males.
- Vaginal delivery to an infected mother is a risk factor for neonatal disease.
- Sexual abuse should be considered in all prepubertal children presenting with gonorrhea.
- Risk factors for sexually active adolescents include
- Multiple sexual partners
- Inconsistent or lack of condom use
- Inconsistent screening by health care providers
- Transmission risk
- The risk of male-to-female transmission is 50% per episode of vaginal intercourse.
- The risk of female-to-male transmission is ~20% per episode.
- Rectal intercourse is also a mode of transmission.
- Ophthalmia neonatorum:
- Prophylactic ophthalmic ointment is mandatory in the United States regardless of method of delivery.
- Instillation of 0.5% erythromycin ophthalmic ointment in both eyes occurs immediately after birth.
- Maternal infection:
- Routine screening cervical cultures should be performed at the first prenatal visit.
- Repeat in the third trimester if high risk.
- Incubation period is 2 to 7 days.
- Transmission results from contact with infected mucosa and secretions, usually through vaginal delivery, sexual activity, and (rarely) household contact in prepubertal children.
- In prepubertal children, genital infection is mild; ascending or disseminated infection rarely occurs. In adolescents, estrogenization protects the vagina from infection and instead serves as a conduit for cervical exudate.
- Immunity is not induced by infection.
Commonly Associated Conditions
Pediatric gonococcal infections can be categorized by age group: neonates, prepubertal children, and sexually active adolescents.
- Neonatal gonococcal diseases include ophthalmia neonatorum, scalp abscess (complication of fetal scalp monitoring), and, rarely, disseminated disease.
- Prepubertal gonococcal disease usually occurs in the genital tract. Vaginitis is the most common manifestation. Pelvic inflammatory disease (PID), perihepatitis (Fitz-Hugh–Curtis syndrome), urethritis, proctitis, and pharyngitis rarely occur. Consider sexual abuse.
- Gonococcal diseases in sexually active adolescents resemble those found in adults and may be asymptomatic.
- Both sexes: pharyngitis, anorectal infection, tenosynovitis-dermatitis syndrome, or arthritis
- Females: Genital tract infection may cause urethritis, vaginitis, and endocervicitis. Ascending genital tract infection may lead to PID and perihepatitis.
- Males: Acute urethritis is the predominant manifestation. Epididymitis also occurs.