Gonococcal pharyngitis is a mild and localized type of infection caused by Neisseria gonorrhoeae, a gram-negative bacterial pathogen. Many patients are asymptomatic, and receptive oral sex is the predominant route of bacterial acquisition. The diagnosis can rarely be made based on clinical criteria, which is why a thorough patient history and appropriate microbiological studies are necessary.
Presentation
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].
Entire Body System
- Inflammation
Pharyngitis ( inflammation of the throat) that may cause mild to severe difficulty in swallowing may also occur in men and women with gonorrhoea. [dermnetnz.org]
If untreated, these gonorrhea infections can spread to higher portions of the reproductive tract, causing prostatitis (prostate inflammation) and epididymitis (inflammation of the epididymis) in men, and pelvic inflammatory disease (PID) in women. [womenshealthmag.com]
[…] occurs in patients < 40 years old More common in women (4:1) Two possible clinical presentations Clinical triad ( arthritis-dermatitis syndrome ) Polyarthralgias : migratory, asymmetric arthritis that may become purulent Tenosynovitis : simultaneous inflammation [amboss.com]
In men, symptoms of gonorrhoea can include epididymitis (an inflammation of the scrotal tubes) and prostatitis (infection of the prostrate gland). However, the main symptom in men is a urethral discharge, and often pain on passing urine. [health24.com]
- Infertility
Infertility occurs when inflammatory adhesions close the tubes at both ends, blocking the ascent of sperm and the descent of ova. Infected fallopian tubes ('pus tubes') have the shape of a retort flask. [histopathology-india.net]
Her research program includes several large randomized clinical trials evaluating optimal infertility treatment for younger and older women seeking to conceive and a prospective cohort study investigating the role of preconception nutrition and oxidative [books.google.com]
In the long run it can cause lesions in the fallopian tubes leading to infertility. [diseasespictures.com]
If an infected woman is untreated, gonorrhea can spread to the fallopian tubes, where it can cause scarring and infertility. [womenshealthmag.com]
Without treatment, prolonged infection may lead to complications, such as a hymenal and tubal synechiae that lead to infertility in women. Epidemiology References: [1] [2] [3] [4] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
- Falling
GAS pharyngitis occurs year round, but its highest incidence is in the late fall to early spring. [cdemcurriculum.com]
Respiratoric
- Aspiration
The diagnosis of septic arthritis is supported by finding an elevated leukocyte count, poor mucin clot, and elevated protein in the aspirated joint fluid. Fewer than 50% of joint culture results are positive for N. gonorrhoeae. [dartmouth.edu]
Cultures from skin lesions in disseminated gonococcal infections are usually negative, but joint aspirate may have greater yield. [aafp.org]
Positive Gram-stained smears of exudate, CSF, or joint aspirate provide a presumptive basis for initiating treatment for N. gonorrhoeae. [cdc.gov]
- Dyspnea
Patients with endocarditis may develop atypical chest pain, cough, and dyspnea and may also develop the arthralgias and rash typical of DGI. Gonococcal endocarditis can cause severe valvular damage and death if not recognized and treated rapidly. [emedicine.medscape.com]
Gastrointestinal
- Lower Abdominal Pain
Major symptoms include vaginal discharge, dysuria, intermenstrual bleeding, dyspareunia (painful intercourse), and mild lower abdominal pain. [emedicine.medscape.com]
Symptoms in women may include: Strong-smelling vaginal discharge Pain and burning while peeing Peeing more often than usual Pain during vaginal sex Sore throat Fever and severe lower abdominal pain, if the infection has spread to the fallopian tubes and [everydayhealth.com]
[…] stage Creamy or green, pus-like or bloody vaginal discharge Itchy or irritable vulva Painful urination (burning sensation) Lower abdominal pain may indicate pelvic inflammatory disease or peritonitis Discharge in men can be mild to severe and does recede [dermnetnz.org]
Lower abdominal pain accompanied by a new or different vaginal discharge and fever (38 °C or higher) Painful or frequent urination, or inability to urinate Signs of any possible complications such as chest pain Men Men need immediate medical attention [health24.com]
It is the body’s way of expelling the foreign agent. [7] Any unusual vaginal discharge should be examined by a doctor. 3 Check for pelvic and lower abdominal pain. [wikihow.com]
- Dysphagia
It is helpful to differentiate pain on swallowing (odynophagia) from difficulty swallowing (dysphagia), the latter being more likely caused by obstruction or abnormal muscular movement. [ncemi.org]
- Odynophagia
It is helpful to differentiate pain on swallowing (odynophagia) from difficulty swallowing (dysphagia), the latter being more likely caused by obstruction or abnormal muscular movement. [ncemi.org]
Cardiovascular
- Hypotension
Hypotension or other signs of poor perfusion (weak pulses, delayed capillary refill, mottling of skin) are not expected and suggest the emergent need for resuscitation and the search for serious or life threatening etiology. [cdemcurriculum.com]
Jaw & Teeth
- Mouth Breathing
Breathing Breathing is normal in most cases of acute pharyngitis. [cdemcurriculum.com]
[…] viruses are more prevalent during certain seasons. 4 Coryza, conjunctivitis, malaise or fatigue, hoarseness, and low-grade fever suggest the presence of viral pharyngitis. 12 Children with viral pharyngitis also can present with atypical symptoms, such as mouth-breathing [aafp.org]
Musculoskeletal
- Arthralgia
Neisseria gonorrhoeae may disseminate from mucosal surfaces via the bloodstream and produce arthritis/arthralgia and a rash. The most characteristic lesion is the hemorrhagic vesicopustule seen in the web space of the teenage girl's hand. [5minuteconsult.com]
Patients with endocarditis may develop atypical chest pain, cough, and dyspnea and may also develop the arthralgias and rash typical of DGI. Gonococcal endocarditis can cause severe valvular damage and death if not recognized and treated rapidly. [emedicine.medscape.com]
Clinical manifestations of disseminated gonococcal infection include skin lesions ( Figure 15 ), arthralgia, tenosynovitis, arthritis ( Figure 16 ), hepatitis, myocarditis, endocarditis, and meningitis. [std.uw.edu]
Dis seminated Gonococcal Infection (DGI) Disseminated gonococcal infection (DGI) results from gonococcal bacteremia, often resulting in petechial or pustular, acral skin lesions, asymmetrical arthralgias, tenosynovitis or septic arthritis, and is rarely [antimicrobe.org]
Skin
- Blister
These outbreaks usually are characterized by mildly to moderately painful clusters of blisters over the infected area. The recurrences usually resolve spontaneously, with the blisters disappearing in about 5 days. [emedicinehealth.com]
Adults Adolescents Women Men Babies 7: A _______ is a painless lesion that is symptomatic of the primary stage of syphilis; it appears at the site of contact. boil blister chancre spirochete sore 8: The stages of syphilis are ______, ______, and _____ [sexuality.jbpub.com]
[…] cold beneath you and you lay your ear to it staring out at the carnage Relief for a stuffy nose cough and sore throat Colds are very common: Adults come down with a cold two to four times a year and children Its characteristic symptoms are fluid-filled blisters [pareja-ideal.eu]
Neurologic
- Burning Sensation
Males Inflammation of the urethra Creamy or green pus-like discharge from the penis; blood can also be present Painful urination (burning sensation) Painful testicles Females Often there are no symptoms until the infection has progressed to a more advanced [dermnetnz.org]
Symptoms in males include burning sensation during urination, discharge from the penis, and painful swelling of the testes. Symptoms in females include painful urination, vaginal discharge, and vaginal bleeding between periods. [fpnotebook.com]
Urethritis (inflammation of the urethra) in men begins with a burning sensation during urination and a thick or watery discharge that drips from the opening at the end of the penis. Infection without any symptoms is common. [emedicinehealth.com]
Workup
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.
Microbiology
- Positive Throat Culture
Gonococcal pharyngitis is diagnosed by a positive culture (Thayer-Martin medium) for Neisseria gonorrhoeae. [aafp.org]
Treatment
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
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]
Etiology
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]
Epidemiology
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
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]
Prevention
/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]
References
- Shim BS. Current Concepts in Bacterial Sexually Transmitted Diseases. Korean Journal of Urology. 2011;52(9):589-597.
- Mayor MT, Roett MA, Uduhiri KA. Diagnosis and management of gonococcal infections. Am Fam Physician. 2012;86(10):931-938.
- Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
- 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.
- Ng L-K, Martin IE. The laboratory diagnosis of Neisseria gonorrhoeae. Can J Infect Dis Med Microbiol. 2005;16(1):15-25.
- Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. Seventh edition. Philadelphia: Elsevier/Saunders; 2013.