Gonorrhea, after chlamydia infection, is the most common sexually transmitted disease (STD) worldwide, and various clinical presentations are described in the literature [1] [2] [3] [4]. One of them is gonococcal pharyngitis, developing after transmission of bacteria through receptive oral intercourse, more commonly during fellatio than cunnilingus [2] [3] [5]. It is seen in approximately 3-7% of heterosexual males and in 10-25% of heterosexual women and men who are having sex with men (MSM) who already suffer from gonorrhea, and the clinical course is asymptomatic in up to 90% of cases [1] [2] [3] [4]. Conversely, signs of acute pharyngitis or tonsillitis (fever, erythema of the throat and cervical lymphadenopathy) developing 3-4 days after acquisition of bacteria are encountered in symptomatic cases [1] [2]. Many patients simultaneously suffer from a genital gonorrhea infection, thus localized genital symptoms apart from pharyngeal complaints (if they appear) are often present [2] [4]. Although spontaneous resolution is seen in virtually all individuals, the diagnosis is not made in up to 26% of adolescent women, which is why many studies have advocated screening for gonococcal pharyngitis in patients who already exhibit some other type of infection [2] [4].

• Pain

  Pain relief for sore throat. [pareja-ideal.eu]

  The symptoms of this disease include fever, pelvic cramping, abdominal pain or pain during intercourse. [health24.com]

  Symptoms can include painful urination, unusual discharge from the genitals, pain in the pelvis or bowel, difficulty swallowing, and more. [wikihow.com]

  Women may have a discharge from the vagina, pain while urinating and a frequent urge to urinate, pain with sex, heavier periods and abdominal pain. What are gonorrhea care options? Gonorrhea can most often be treated and cured with antibiotics. [nicklauschildrens.org]

  bleeding, as well as painful bowel movements. [everydayhealth.com]

• Infectious Mononucleosis

  The white cell differential may assist in the presumptive diagnosis of infectious mononucleosis. [cdemcurriculum.com]

  MONONUCLEOSIS Infectious mononucleosis is most common in patients 15 to 30 years of age. 13 Patients typically present with fever, sore throat, and malaise. [aafp.org]

  Epstein-Barr virus (infectious mononucleosis) is the most common virus implicated with adenoviruses and the cold viruses-coronaviruses and rhinoviruses are also common. [outbreaknewstoday.com]

  mononucleosis) HIV (acute) Adenovirus -- To view the remaining sections of this topic, please sign in or purchase a subscription -- Last updated: October 2, 2017 Citation Auwaerter, Paul G, and John G Bartlett. [hopkinsguides.com]

  mononucleosis ( B27.- ) enteroviral vesicular pharyngitis ( B08.5 ) Use Additional code ( B95-B97 ) to identify infectious agent Gonococcus, gonococcal (disease) (infection) A54.9 - see also condition ICD-10-CM Diagnosis Code A54.9 Gonococcal infection [icd10data.com]

• Reiter Syndrome

  The arthritis of Reiter’s syndrome, however, may be chronic and recurrent and does not respond to antibiotic therapy. [dartmouth.edu]

  […] epididymitis without discharge also may be present. 1, 5 Chlamydia causes 15 to 40 percent of nongonococcal urethritis cases in men. 8 One to 2 percent of men who have nongonococcal urethritis develop sexually acquired reactive arthritis (formerly known as Reiter [aafp.org]

• Gangrene

  (infective) (malignant) (membranous) (phlegmonous) (pseudomembranous) (simple) (subacute) (suppurative) (ulcerative) (viral) J02.9 ICD-10-CM Diagnosis Code J02.9 Acute pharyngitis, unspecified 2016 2017 2018 2019 Billable/Specific Code Applicable To Gangrenous [icd10data.com]

• Pharyngitis

  Nevertheless, all patients in whom symptoms of pharyngitis develops shortly after receptive oral sex should undergo testing for gonococcal pharyngitis, primarily because it is an important source of further spread. [symptoma.com]

  […] suppurative) (ulcerative) (viral) J02.9 ICD-10-CM Diagnosis Code J02.9 Acute pharyngitis, unspecified 2016 2017 2018 2019 Billable/Specific Code Applicable To Gangrenous pharyngitis (acute) Infective pharyngitis (acute) NOS Pharyngitis (acute) NOS Sore [icd10data.com]

  pharyngitis, or strep throat. [healtharticles101.com]

  Gonococcal pharyngitis is an inflammatory disease that affects the throat. Causes of pharyngitis may be different, but in the case of gonococcal pharyngitis it pathogens are bacteria. This type of disease also called gonorrheal. [respiratory.vsebolezni.com]

  Viral pharyngitis Viruses are by far the most common cause of pharyngitis in both adults and children. [outbreaknewstoday.com]

• Sore Throat

  Pain relief for sore throat. [pareja-ideal.eu]

  If you have a sore throat, it is most likely a viral infection. According to CDC, 85 to 95 percent of sore throats among adults are due to a viral infection, which typically clears on its own in 5 to 7 days. [livestrong.com]

  However, this is one sore throat that you absolutely can avoid. [healtharticles101.com]

  […] of sore throat (pharyngitis). [aafp.org]

  This child isunlikely to be suffering from a serious or life-threatening cause of a sore throat. [cdemcurriculum.com]

• Pneumonia

  Explore these free sample topics: -- The first section of this topic is shown below -- PATHOGENS Bacteria: Streptococcus pyogenes (Group A Streptococcus, the predominant bacterial pathogen) Mycoplasma pneumoniae Arcanobacterium haemolyticum (can mimic [hopkinsguides.com]

  A54.49 Gonococcal infection of other musculoskeletal tissue A54.6 Gonococcal infection of anus and rectum A54.8 Other gonococcal infections A54.81 Gonococcal meningitis A54.82 Gonococcal brain abscess A54.83 Gonococcal heart infection A54.84 Gonococcal pneumonia [healthprovidersdata.com]

  […] other musculoskeletal tissue A54.5 Gonococcal pharyngitis A54.6 Gonococcal infection of anus and rectum A54.8 Other gonococcal infections A54.81 Gonococcal meningitis A54.82 Gonococcal brain abscess A54.83 Gonococcal heart infection A54.84 Gonococcal pneumonia [icd10data.com]

  References: [12] [1] Complications Hymenal and tubal synechiae, tubal motility disorders → infertility Gonococcal conjunctivitis (particularly in neonates, see neisserial conjunctivitis ) Of DGI : sepsis with endocarditis, meningitis, osteomyelitis, or pneumonia [amboss.com]

  Antibiotics probably inhibit progress of the infection into tonsillitis, peritonsillar and retropharyngeal abscesses, adenitis, and pneumonia. Group A streptococcal infection cannot be diagnosed reliably by clinical signs and symptoms. [ncemi.org]

• Arthritis

  Abstract The arthritis of rheumatic fever in adults may mimic acute gonococcal arthritis. [ncbi.nlm.nih.gov]

  DISSEMINATED GONOCOCCAL INFECTION (ARTHRITIS-DERMATITIS SYNDROME ) Disseminated gonococcal infection (DGI) develops in approximately 1% to 3% of patients with mucosal infections. It is the most common form of infectious arthritis. [dartmouth.edu]

  Rarely, disseminated disease may occur, which typically manifests with a triad of arthritis, pustular skin lesions, and tenosynovitis. [amboss.com]

  Joints commonly affected with tenosynovitis or septic arthritis include wrists, ankles, hands, and feet. [aafp.org]

  […] iridocyclitis A54.33 Gonococcal keratitis A54.39 Other gonococcal eye infection A54.4 Gonococcal infection of musculoskeletal system A54.40 Gonococcal infection of musculoskeletal system, unspecified A54.41 Gonococcal spondylopathy A54.42 Gonococcal arthritis [healthprovidersdata.com]

• Ulcer

  Whether or not the exposed individual has an ulcer, they should be treated if they were exposed to their partner's ulcer. [emedicinehealth.com]

  Gonococcal infection, unspecified 2016 2017 2018 2019 Billable/Specific Code pharynx A54.5 throat A54.5 Pharyngitis (acute) (catarrhal)(gangrenous) (infective) (malignant) (membranous) (phlegmonous) (pseudomembranous) (simple) (subacute) (suppurative) (ulcerative [icd10data.com]

  […] distinguishing factor visualization of intracytoplasmic inclusions (reticulate bodies) on histology Urinary tract infection distinguishing factor lack of growth on Thayer-Martin agar Genital herpes simplex distinguishing factor painful vesicles and ulcers [medbullets.com]

  Viral infections are typically accompanied by conjunctivitis, nasal congestion, hoarseness, cough, aphthous ulcers on the soft palate and myalgias. [ncemi.org]

  Acute pharyngitis in the absence of symptoms strongly suggestive of viral syndrome (cough, rhinorrhea, hoarseness, oral ulcers). Sore throat without rhinorrhea, cough, or hoarseness. [cdemcurriculum.com]

• Salpingitis

  In some women (usually during the first menses after exposure), the infection extends to the fallopian tubes, where it produces acute and chronic salpingitis and pelvic inflammatory disease. [histopathology-india.net]

  Gonococcal arthritis Complications in men may include: Epididymitis Orchitis Prostatitis Urethral scarring and stricture Complications in women may include: Increased chances of ectopic pregnancy Infertility Perihepatitis Pelvic inflammatory disease Salpingitis [lutheranhealthcare.org]

  Gonococci cause endocervicitis, vaginitis, and salpingitis. In men, gonococci attached to the mucous membrane of the urethra cause urethritis ... Pathogenesis of gonococcal infections. [5minuteconsult.com]

  […] concomitant chlamydial infection treat sexual partner to prevent reinfection Complications Fitz-Hugh-Curtis syndrome perihepatitis infection and inflammation of liver capsule adhesions of peritoneum to liver Pelvic inflammatory disease (PID) may include salpingitis [medbullets.com]

  Complications in women include pelvic inflammatory disease, bartholinitis (infection of the Bartholin glands, which are located in the vagina) and salpingitis (infection of the Fallopian tubes, the tubes that carry eggs from the ovaries to the womb). [health24.com]

• Meningism

  A54.41 Gonococcal spondylopathy A54.42 Gonococcal arthritis A54.43 Gonococcal osteomyelitis A54.49 Gonococcal infection of other musculoskeletal tissue A54.6 Gonococcal infection of anus and rectum A54.8 Other gonococcal infections A54.81 Gonococcal meningitis [healthprovidersdata.com]

  Examination for clinical evidence of endocarditis and meningitis should be performed. [cdc.gov]

  Rare complications of DGI include gonococcal meningitis, pericarditis, and endocarditis. Headache, neck pain and stiffness, fever, and decreased sensorium may indicate gonococcal meningitis. [emedicine.medscape.com]

  […] and endocarditis Ceftriaxone, 1 to 2 g IV every 12 hours for 10 to 14 days for meningitis and at least 4 weeks for endocarditis Pharyngeal gonococcal infection Ceftriaxone, 250 mg IM in a single dose plus Azithromycin, 1 g orally in a single dose, or [aafp.org]

  […] or endocarditis (rarely) Meningitis or endocarditis (rarely) Prostatitis (very rarely) See STI Atlas for images. [sti.guidelines.org.au]

The diagnosis of a gonococcal pharyngitis may be difficult to make, as signs and symptoms are frequently absent. For this reason, physicians must be meticulous when examining patients with a possible diagnosis of an STD. Firstly, a detailed history should be obtained, with an emphasis on sexual activity and "risky" exposure, but also if any other symptoms (for example, genital or systemic signs of infection) are present. The importance of a properly obtained patient history lies in the fact that findings from physical examination are almost always normal, or point to a non-specific pharyngitis comprised of cervical lymphadenopathy and erythema. Thus, if adequate clinical suspicion exists, microbiological investigations should be carried out. In the setting of gonococcal pharyngitis, gram staining of the pharyngeal swab is one of the most widely used methods to detect N. gonorrhea, and the test is advised in all human immunodeficiency virus (HIV) positive individuals, particularly men who are having sex with men (MSM) [3] [5] [6]. Also, cultivation of swab samples has been regarded as a potential diagnostic method [3] [5] [6]. However, the asymptomatic nature of gonocococal pharyngitis and frequent coinfection of other organs and tissues has disputed the role of routine testing in clinical practice [3]. Nevertheless, all patients in whom symptoms of pharyngitis develops shortly after receptive oral sex should undergo testing for gonococcal pharyngitis, primarily because it is an important source of further spread.

• Neisseria Gonorrhoeae

  KAPAVAC, GONOREJA Polish Zakażenie Neisseria gonorrhoeae, Rzeżączka Hungarian gonorrhoea k.m.n., gonorrhoea, Gonococcalis fertőzések, Gonorrhoea Norwegian Gonoré [fpnotebook.com]

  Neisseria gonorrhoeae may disseminate from mucosal surfaces via the bloodstream and produce arthriti... FIGURE 2-10. [5minuteconsult.com]

  Neisseria gonorrhoeae bateria Hamann, B. P. (2006). Disease, identification, prevention, and control. (3 ed.). New York, NY: McGraw-Hill Humanities/Social Sciences/Languages. [bms223project.weebly.com]

• Positive Throat Culture

  Gonococcal pharyngitis is diagnosed by a positive culture (Thayer-Martin medium) for Neisseria gonorrhoeae. [aafp.org]

In the absence of timely treatment the patient complications can occur. In addition to the primary treatment, the patient is required to comply with regulations regarding the supply. All food must undergo thorough heat treatment. [respiratory.vsebolezni.com]

Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. 2007;56:332-336. Handsfield HH, Sparling PF. Neisseria gonorrhoeae. [lutheranhealthcare.org]

[…] of treatment ( 1 ). [cdc.gov]

[…] or azithromycin treatment failures. [canada.ca]

Treatment advice Reduced susceptibility to the first line treatment of IMI Ceftriaxone and Azithromycin is emerging in urban Australia. [sti.guidelines.org.au]

Prognosis If gonorrhea infections are diagnosed and treated quickly and correctly, recovery usually is complete unless pelvic inflammatory disease (PID) develops. PID is more likely to develop if treatment is delayed. [womenshealthmag.com]

Hoarseness, in the setting of cough or coryza, suggests a viral etiology. [cdemcurriculum.com]

Her research has focused on the hormonal etiologies of reproductive cancers and the role of maternal, gestational, neonatal and early life factors in breast cancer risk, including endocrine disruptors such as diethylstilbestrol, a drug previously given [books.google.com]

The etiologic agent, NEISSERIA GONORRHOEAE, was isolated by Neisser in 1879. Definition (CSP) acute infectious disease characterized by primary invasion of the urogenital tract; the etiologic agent is Neisseria gonorrhoeae. [fpnotebook.com]

Etiology Pathogen Neisseria gonorrhoeae ( N. gonorrhoeae, gonococcus ) Gram-negative, intracellular, aerobic, diplococci Transmission Risk factors Multiple sexual partners Low socioeconomic status Lack of barrier protection (e.g., condomless sex ) Men [amboss.com]

GONOCOCCAL INFECTIONS Etiology Caused by Neisseria gonorrhoeae. Epidemiology Since 1997, there has been a gradual but steady increase in reported cases of gonococcal infection. [canada.ca]

Troisi is a cancer epidemiologist in the Division of Cancer Epidemiology and Genetics, at the National Institutes of Health’s Cancer Institute and an associate member of the Norris Cotton Cancer Center at Dartmouth College.. [books.google.com]

Epidemiology References: [1] [2] [3] [4] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Epidemiology Gonococcal infection is the second most common bacterial disease in the United States that is classified as a reportable and notifiable infection. [pedsinreview.aappublications.org]

Epidemiology Since 1997, there has been a gradual but steady increase in reported cases of gonococcal infection. Most affected are males 20–24 years of age and females 15–19 years of age. [canada.ca]

Introduction Classification Neisseria Gram-negative diplococci often intracellular within neutrophils Epidemiology incidence the second most common bacterial sexually-transmitted infection after Chlamydia location genital tract risk factors unprotected [medbullets.com]

Pathophysiology Gonococcal infections tend to be associated with the acute onset of symptoms and purulent mucosal drainage due to the organism's ability to recruit polymorphonuclear leukocytes (PMNs). [pedsinreview.aappublications.org]

Review Date: 5/19/2008 Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Maternal & Child Health Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Jatin M. [lutheranhealthcare.org]

/Avoidable - 0% Emergent - ED Care Needed - Not Preventable/Avoidable - 0% Primary diagnosis of injury 0% Primary diagnosis of mental health problems 0% Primary diagnosis of substance abuse 0% Primary diagnosis of Alcohol 0% Unclassified 100% Also called [medicbind.com]

She is also active in several large studies of women's health, including the Nurses' Health Study, the Kronos Early Estrogen Prevention Study, and the Women's Health Initiative. [books.google.com]

External resources CDC National Prevention Information Network (NPIN) National Center for HIV, STD and TB Prevention P.O. [drugs.com]

Treatment of all sexual partners is essential to prevent re-infection. Centers for Disease Control and Prevention (CDC). [lutheranhealthcare.org]

Additional Info CDC National Prevention Information Network (NPIN) National Center for HIV, STD and TB Prevention P.O. [womenshealthmag.com]

1. Shim BS. Current Concepts in Bacterial Sexually Transmitted Diseases. Korean Journal of Urology. 2011;52(9):589-597.
2. Mayor MT, Roett MA, Uduhiri KA. Diagnosis and management of gonococcal infections. Am Fam Physician. 2012;86(10):931-938.
3. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
4. Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e. New York, NY: McGraw-Hill; 2016.
5. Ng L-K, Martin IE. The laboratory diagnosis of Neisseria gonorrhoeae. Can J Infect Dis Med Microbiol. 2005;16(1):15-25.
6. Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. Seventh edition. Philadelphia: Elsevier/Saunders; 2013.