Epidemiology

Etiology

• Pathogen
  • Neisseria gonorrhoeae (N. gonorrhoeae, gonococcus)
  • Gram-negative, intracellular, aerobic, diplococci

Pathophysiology

Clinical features

Extragenital gonococcal infections

• Gonococcal conjunctivitis
  • Affects newborns (vertical transmission) and sexually active individuals
  • Manifests as hyperacute conjunctivitis
• Gonococcal pharyngitis
  • Sore throat
  • Pharyngeal exudate
  • Cervical lymphadenitis

Diagnostics

• Gram stain
  • Findings: polymorphonuclear leukocytes and intracellular gram-negative diplococci

Treatment

Disseminated gonococcal infection (DGI)

Etiology

Hematogenous spread of N. gonorrhoeae from an untreated mucosal gonococcal infection

Clinical features

DGI typically manifests as gonococcal arthritis without symptoms of a localized mucosal infection.

• Arthritis-dermatitis syndrome
  • Polyarthralgias: migratory, asymmetric arthritis that can become purulent
  • Tenosynovitis: simultaneous inflammation of several tendons (e.g., in the fingers, toes, wrists, ankles)
  • Dermatitis
    • Vesicular, pustular, or maculopapular lesions, possibly with a necrotic or hemorrhagic center
    • Distribution: acral (i.e., the extensor surfaces of the hands and feet, sometimes involving the palms and soles), the trunk
• Purulent gonococcal arthritis
  • Abrupt monoarticular or oligoarticular inflammation
  • Commonly affects knees, ankles, elbows, and wrists
  • Skin manifestations and tenosynovitis are typically absent.