Gonococcal Infections

Gonococcal Infections is a topic covered in the 5-Minute Pediatric Consult.

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Basics

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.

Incidence

  • 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.

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.

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