N. gonorrhoeae; fastidious gram-negative diplococcus; infecting mucous membranes. Incubation period: 2 - 7 days.
Epidemiology. Gonorrhea is the second most frequently occurring STD and its incidence, although not comparable with that of chlamydiae, is also higher in adolescents than in other age groups. But remarkable here again is the strikingly high number of socially disadvantaged young people. Often, a coexisting infection with chlamydiae is observed.
In contrast to the impression within the public health community, a significantly greater increase in gonorrhea has been observed in all parts of the world where such diseases are registered systematically. Thus, according to the Neisseria Reference Laboratory in Australia, an increase of more than 3-fold of gonorrhea has occurred. This recent increase in gonorrhea is presumed to be the result of poor sexual health among young people, a relapse to unsafe sexual behavior and increasing antibiotic resistance associated with treatment failure.
Symptoms, Diseases and Sequelae. Infections of gonorrhea are asymptomatic in more than 40% of all female cases. The clinical spectrum of gonorrhea includes all the symptoms, diseases and sequelae that are caused by chlamydial infections, including disseminated infections. In gonorrhea, however, the discharge is characterized as purulent, and in cases of PID the girls suffer from heavier pain frequently combined with fever.
Diagnosis. As described for chlamydial infections, in gonorrhea infections the new urine-specimen-based DNA amplification techniques PCR and LCR show the highest sensitivities and acceptance. Therefore, these methods should be used if possible.
Based on smears obtained from the cervix, the urethra and, if need be, the anus, the gold standard method uses cultures of N. gonorrhoeae, which shows sensitivities of 90%. This method, used in tandem with tests for antibiotic resistance, is still the most approved for identifying N. gonorrhoeae. The considerable sensitivity of N. gonorrhoeae against exsiccation or decline in temperature, however, may result in false-negative findings.
Microscopic examination of colored smears used as a screening method only is not suitable to unambiguously classify N. gonorrhoeae. Antibody tests as ELISA are less sensitive and are not recommended.
The reported worldwide increase in the local resistance of N. gonorrhoeae to antibiotics but is developing differentially. Hence, thorough testing is indicated to characterize this worrisome situation.
Treatment. Uncomplicated gonorrhea should be treated on an outpatient basis, preferably by a single dose because of the noncompliance of many adolescents. Girls suffering from complicated and disseminated gonorrhea have to be treated in the hospital (
table 10). A simultaneous infection with Chlamydia should be considered in all cases of gonorrhea.
Revision date: June 21, 2011
Last revised: by Jorge P. Ribeiro, MD