Gonorrhea: Symptoms, Complications, and Importance of Prompt Treatment

Gonorrhea is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It infects mucosal surfaces of the genitals, rectum, pharynx, and eyes. Many infections are asymptomatic, especially in women.

Symptoms (When Present)

• Men: Urethral discharge (yellow-green), dysuria, testicular pain/swelling (epididymitis).
• Women: Increased vaginal discharge, dysuria, intermenstrual bleeding, pelvic pain (PID).
• Rectal: Discharge, pruritus, bleeding, tenesmus.
• Pharyngeal: Usually asymptomatic; sore throat possible.
• Ocular: Purulent conjunctivitis (neonatal or autoinoculation).

Short-Term Effects

• Urethritis, cervicitis, proctitis, pharyngitis, conjunctivitis
• Disseminated gonococcal infection (DGI): fever, dermatitis, tenosynovitis, migratory polyarthralgia, septic arthritis

Long-Term Complications (Untreated)

• Women: Pelvic inflammatory disease (PID) → tubal scarring → infertility, ectopic pregnancy, chronic pelvic pain.
• Men: Epididymitis → infertility (rare).
• Both: DGI (arthritis, endocarditis, meningitis), Fitz-Hugh–Curtis syndrome (perihepatitis).
• Neonates: Ophthalmia neonatorum → corneal perforation, blindness.
• HIV risk: Gonorrhea increases HIV acquisition/transmission 3–5 fold.

Diagnosis and Treatment

• NAAT (nucleic acid amplification test) on urine or swabs—gold standard.
• Culture for antimicrobial susceptibility (rising resistance).
• Current CDC regimen (2021): Ceftriaxone 500 mg IM single dose (1 g if ≥150 kg) PLUS doxycycline 100 mg PO BID × 7 days if chlamydia not ruled out.
• Test-of-cure for pharyngeal infection; routine not needed for genital/rectal.
• Partner notification and treatment essential (expedited partner therapy where legal).

Key message: Gonorrhea is curable but increasingly resistant. Early testing and guideline-based treatment prevent sequelae and transmission.