Gonorrhea Complications: Untreated Risks in Women, Men & Both

Neisseria gonorrhoeae infection, if untreated, ascends from mucosal surfaces to cause serious reproductive and systemic sequelae. Antimicrobial resistance (especially to cephalosporins) heightens urgency.

In Women

• Pelvic Inflammatory Disease (PID): 10-20% of untreated cervical infections. Endometritis, salpingitis, oophoritis. → Tubal scarring → infertility (20%), ectopic pregnancy (9-10x risk), chronic pelvic pain (18%).
• Fitz-Hugh-Curtis Syndrome: Peri-hepatitis (RUQ pain, "violin string" adhesions).
• Pregnancy Complications: Miscarriage, preterm birth, low birth weight, chorioamnionitis, neonatal conjunctivitis (ophthalmia neonatorum → blindness if untreated), sepsis.
• Cervical Cancer Link: Gonorrhea ↑ HPV persistence/co-infection; not a direct carcinogen but synergistic.
• Disseminated Gonococcal Infection (DGI): 0.5-3% of untreated cases. Bacteremia → arthritis-dermatitis syndrome (tenosynovitis, pustular rash, migratory polyarthralgia).

In Men

• Urethritis: Purulent discharge, dysuria (symptomatic in >90%).
• Epididymitis: Unilateral testicular pain/swelling; can cause infertility via ductal obstruction.
• Prostatitis: Chronic pelvic pain syndrome.
• Stricture Formation: Urethral narrowing from recurrent inflammation.
• DGI: Same as women.

In All Genders

• DGI (Arthritis-Dermatitis Syndrome): Fever, tenosynovitis (wrists, fingers, ankles), hemorrhagic pustules on extremities, migratory polyarthralgia. Can progress to septic arthritis (monoarticular, often knee).
• Endocarditis: Rare; aortic valve predilection. High mortality.
• Meningitis: Very rare.
• HIV Synergy: Gonorrhea ↑ HIV acquisition/transmission 3-5x (mucosal disruption, immune cell recruitment).
• Reactive Arthritis (Reiter's): Post-infectious; triad: urethritis, conjunctivitis, arthritis. HLA-B27 associated.

Diagnosis & Treatment

• NAAT (urine/swab) – gold standard.
• Culture + Sensitivity: Essential for resistance tracking.
• CDC 2021 Regimen: Ceftriaxone 500mg IM (1g if ≥150kg) + Doxycycline 100mg BID ×7d (if chlamydia not excluded). Alternative: Gentamicin 240mg IM + Azithromycin 2g PO (if cephalosporin allergy).
• Test of Cure: NAAT at 7-14 days (pharyngeal); not routine for urogenital.
• Expedited Partner Therapy (EPT): Provide meds/prescription for partners without exam (legal in most states).

Prevention

• Condoms (consistent, correct use).
• Regular screening: Sexually active women <25 annually; MSM at least annually (more if high risk); pregnant women at first visit.
• Prompt treatment of partners.
• Antimicrobial stewardship to preserve cephalosporin efficacy.

Gonorrhea is not "just a discharge." Untreated, it silently damages fertility and seeds systemic infection. Early detection and complete treatment—with partner management—are essential.