Description

Neisseria gonorrhoeae, an aerobic gram-negative diplococcus, is the etiologic agent of gonorrhea.

Epidemiology

• 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.

Risk Factors

• 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.

General Prevention

• 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.

Pathophysiology

• 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.