Gonorrhea

Contact Precautions

Gonorrhea is a common sexually transmitted infection that usually starts as an infection of the genitourinary tract, especially the urethra and cervix. It can also cause infection in the eyes (conjunctivitis), pharynx, and anorectal area; pharyngeal and anorectal infections are not uncommon in females and homosexual males. Left untreated, gonorrhea spreads through the blood to the joints, tendons, meninges, and endocardium; in females, it also can lead to chronic pelvic inflammatory disease (PID) and sterility. Gonorrhea is especially prevalent among young people and those who have multiple sexual partners. With adequate treatment, the prognosis is excellent, although re-infection is common.

Causes

Gonorrhea is caused by the bacterial organism Neisseria gonorrhoeae (gonococcus), which is transmitted almost exclusively through sexual contact with an infected person. A child born to an infected mother can contract gonococcal ophthalmia neonatorum during passage through the birth canal. A patient with gonorrhea can contract gonococcal conjunctivitis by touching the eyes with a contaminated hand. Genitourinary gonorrhea in a child is considered an indicator of possible sexual abuse.

Complications

Gonorrhea can lead to PID, acute epididymitis, proctitis, salpingitis, septic arthritis, dermatitis, and perihepatitis. Severe gonococcal conjunctivitis can lead to corneal ulceration and, possibly, blindness. Rare complications include meningitis, osteomyelitis, pneumonia, and acute respiratory distress syndrome.

Assessment Findings

The patient may report unprotected sexual contact (vaginal, oral, or anal) with an infected person, an unknown partner, or multiple sex partners. He or she may also have a history of sexually transmitted infection.

After a 3- to 6-day incubation period, male patients may complain of dysuria, although patients of both genders can remain asymptomatic. Patients with rectal infection may be asymptomatic or may complain of anal pruritus, burning, and tenesmus and pain with defecation. Patients with pharyngeal infection may be asymptomatic or may complain of a sore throat. Some females may suffer uterine invasion, often around menstruation.

Assessment of a patient with gonorrhea reveals a low-grade fever. If the disease has become systemic, or if the patient has developed PID or acute epididymitis, the fever is higher. Other assessment findings vary with the infection site.

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