Neisseria gonorrhoeae (Gonorrhea)
Infections with N. gonorrhoeae, a gram-negative intra-cellular diplococcus, are the second most common STD in the United States. It is estimated that 600,000 new cases of gonorrhea occur each year in the United States, and less than half of them are reported to the Centers for Disease Control. The emergence of antimicrobial-resistant strains, an increased frequency of asympto-matic infections, and changing patterns of sexual behavior have all contributed to a rise in its incidence. The highestrates of infection are seen in adolescents and young adults. N. gonorrhoeae infection can lead to PID with its concur-rent risks of infertility caused by adhesion formation, tubal damage, and hydrosalpinx formation. Studies also suggest that infection with N. gonorrhoeae may facilitate trans-mission of HIV. Infections with N. gonorrhoeae are easily acquired by women and can affect the genital tract, rec-tum, and pharynx. Gonorrhea is considered a reportable disease in all states, and sexual partners of infected indi-viduals must be tested and treated.
Signs and symptoms appear within 3 to 5 days of infection, but asymptomatic infections are common in both men and women. In men, infection is characterized by urethritis, a mucopurulent or purulent discharge from the urethra. In women, signs and symptoms are often mild enough to be over-looked, and can include purulent discharge from the urethra, Skene duct, cervix, vagina, or anus. Anal intercourse is notalways a prerequisite to anal infection. A greenish or yel-low discharge from the cervix indicative of cervicitis should alert the physician to the possibility of either N. gonorrhoeae or C. trachomatis infection. Infection of theBartholin glands is frequently encountered and can lead to secondary infections, abscesses, or cyst formation. When the gland becomes full and painful, incision and drainage are appropriate.
The laboratory diagnosis of N. gonorrhoeae infection in women is made by testing endocervical, vaginal, or urine specimens. Specimens can be tested by culture, nucleic hybridization, or NAAT. Culture is the most widely used testing modality for specimens obtained from the pharynx or rectum, as there are no nonculture tests that are FDA-approved for the testing of these specimens. Male urethral specimens may be tested by Gram-stain in symptomatic men, but are not recommended as definitive testing for women or asymptomatic men.
All patients who are tested for gonorrhea should also be tested for other STDS, including chlamydia, HIV, and syphilis.
Aggressive therapy for patients with either suspected or confirmed N. gonorrhoeae should be undertaken to prevent the serious sequelae of untreated disease. Because of the emergence of quinolone-resistant strains of N. gonorrhoeae, these antimicrobials are no longer used for the treatment of these infections. Antimicrobials currently used for therapy are ceftriaxone, cefixime, or ciprofloxacin. Due to the high likelihood of concurrent chlamydial infection, patients should be treated for chlamydia as well, if chlamydial infection is not ruled out by nucleic acid amplification test (NAAT).