Gonococcal pharyngitis

Alternative names
Pharyngitis - gonococcal

Definition
Gonococcal pharyngitis is an infection of the throat involving the tonsils and the larynx (pharynx), caused by the bacterium Neisseria gonorrhoeae.

Causes, incidence, and risk factors

Gonococcal pharyngitis is a sexually-transmitted disease. It is acquired through oral sex with an infected partner. The majority of throat infections caused by gonococci have no symptoms (asymptomatic).

When discomfort is present, it is generally mild. Symptoms involving the rest of the body are not normally present unless the person develops disseminated gonococcemia, a wide-spread infection of the bloodstream.

Untreated gonorrhea may spread to other parts of the body, causing inflammation of the testes or prostate in men or pelvic inflammatory disease in women.

Gonococci in the throat are present in 10 to 20% of women who have gonorrhea. In homosexual men with gonorrhea, pharyngeal (throat) infection is present in 10 to 25%. Risk factors include recent exposure to gonorrhea, sexual activity with multiple partners and performing oral sex.

Almost 360,000 cases of gonorrhea were reported to the Centers for Disease Control and Prevention in 2000. The incidence has remained steady for several years at 1 case per 1000 people.

Symptoms

     
  • Sore throat  
  • Difficulty swallowing  
  • Fever  
  • Tender, swollen lymph nodes in the neck

Additional symptoms that may be associated with this disease:

     
  • Neck pain  
  • Nasal discharge  
  • Nasal congestion  
  • Muscle pain  
  • Joint stiffness  
  • Headache  
  • Abnormal taste

Note: There may be no symptoms.

Signs and tests
A throat swab culture is positive for gonococcus. Note that standard strep throat testing will not pick up gonorrhea. If you think you might have gonococcal pharyngitis, you should tell your health care provider.

Treatment

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

Mandatory reporting of gonococcal disease 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. Resistant strains have been increasing over the last few years.

Because of this, a new standardized treatment regimen has now been recommended by the CDC. Instead of the standard penicillin treatment, gonorrhea is now treated with newer antibiotics.

This treatment regimen includes any one of the following antibiotics.

     
  • INJECTIONS       o Ceftriaxone IM (injected into a muscle)       o Spectinomycin IM (injected into a muscle)  
  • ORAL (by mouth) one-time dose       o Cefixime       o Ciprofloxacin       o Ofloxacin       o Cefuroxime Axetil       o Cefpodoxime proxetil       o Enoxacin  
  • ORAL (by mouth) multiple dose       o Erythromycin

In addition to treatment for gonorrhea, patients are usually treated at the same time for chlamydia. Chlamydia can be harder to diagnose, but may be found to cause infection at the same time.

A follow-up visit 7 days after treatment to recheck cultures and confirm the cure of infection is important.

Expectations (prognosis)
Gonorrhea can be completely and quickly cured when diagnosed early and treated promptly before complications develop.

Complications
BOTH SEXES

     
  • Disseminated gonococcemia  
  • Gonococcal arthritis

MALE

     
  • Urethral scarring and stricture  
  • Epididymitis  
  • Orchitis  
  • Prostatitis

FEMALE

     
  • Pelvic inflammatory disease  
  • Salpingitis  
  • Perihepatitis  
  • Infertility  
  • Sterility  
  • Increased incidence of tubal pregnancy (ectopic pregnancy)

Calling your health care provider

Call your health care provider if you have had a known or suspected contact with an infected sexual partner.

Call your health care provider if you develop symptoms of gonococcal pharyngitis.

Prevention

Sexual abstinence is the only sure way to avoid gonorrhea, but this is often neither practical nor reasonable. Safer sex behaviors can reduce risk. The use of condoms, both male and female types, markedly decreases the likelihood of contracting a sexually transmitted disease - but they must be used properly.

The condom should be in place from the beginning to end of sexual activity, and should be used EVERY time the person engages in sexual activity - including oral sex - with a non-monogamous partner or possibly infected partner.

Condoms are inexpensive, especially considering the potential consequences of contracting a sexually transmitted disease.

Treatment of all sexual partners is essential to prevent re-infection.

Johns Hopkins patient information

Last revised: December 8, 2012
by Armen E. Martirosyan, M.D.

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