Gonococcal bacteremia

Alternative names
Gonococcemia (disseminated)

Definition
Gonococcemia (disseminated) is a sexually-transmitted disease caused by the bacterium Neisseria gonorrhoeae, which spreads from the initial site of infection through the bloodstream to other parts of the body.

Causes, incidence, and risk factors
Gonorrhea is one of the most commonly reported sexually transmitted infectious diseases. It is transmitted through vaginal, oral, and anal intercourse. An infected woman may also transmit the infection to her newborn during childbirth. Gonorrhea in children older than newborns is a sign of sexual abuse.

Gonorrhea is most prevalent in those 15 to 29 years old who live in high-density urban areas. Multiple unprotected sexual partners is a risk factor.

Disseminated gonococcemia generally follows the primary genital infection with gonorrhea by several days to 2 weeks. The infection spreads from the primary site through the bloodstream. Newborns are at increased risk for disseminated gonorrhea.

Symptoms

     
  • Fever  
  • Chills, malaise  
  • Joint pain, either single or multiple joints (knee pain, wrist pain, ankle pain)  
  • Joint swelling (knees, wrists, ankles)  
  • Skin rash: begins as flat, pink-to-red spots that evolve into raised, pus-filled bumps  
  • Painful tendons of wrists or heels  
  • A combination of skin rash and aching, swollen tendons - sometimes known as tenosynovitis-dermatitis syndrome

Signs and tests

     
  • Blood culture  
  • Skin lesion culture  
  • Culture of synovial fluid from joints  
  • Urethral discharge culture  
  • Culture from endocervix  
  • Throat culture  
  • Anal culture

Treatment

There are two aspects of treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first aspect is to cure the affected person. The second is to locate and test all of the other sexual contacts and to treat them to prevent further spread of the disease.

That is why mandatory reporting has been instituted and has, until recently, held the number of cases of gonorrhea at a low level. However, the incidence is once again rising.

Beginning about the time of the Vietnam War, the United States saw the appearance of penicillin- and tetracycline-resistant strains of gonorrhea. These resistant strains have been increasing over the last few years. Because of this, a new standardized treatment regimen has now been recommended by the Centers for Disease Control (CDC).

Instead of the standard penicillin treatment, gonorrhea is now treated by a large number of new and very potent antibiotics, including ceftriaxone and levofloxacin. For gonococcemia, treatment is usually begun with intravenous antibiotics.

A follow-up visit after treatment to recheck cultures and confirm the cure of infection is important.

Expectations (prognosis)
The outcome is expected to be good when compliance with therapy is maintained.

Complications

     
  • Gonococcal endocarditis  
  • Gonococcal meningitis

Calling your health care provider
Call your health care provider if you have symptoms suggestive of disseminated gonococcemia.

Prevention
Abstinence is the only sure prevention. Other prevention consists of following safer sexual practices. Monogamous sexual relations with a known disease-free partner is a good means of prevention. Latex condoms help protect against gonorrhea and other sexually transmitted diseases when the status of a partner is unknown or unsafe sexual practices are indulged in.

Treatment of all sexual partners of a known infected person is essential to prevent further spread or reinfection.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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