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Section 3. Summaries of Infectious Diseases
Gonococcal Infections
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Gonococcal infections in children occur in 3 distinct age groups.
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Infection in the newborn infant usually involves the eyes. Other sites of infection include scalp abscess (which can be associated with fetal monitoring), vaginitis, and disseminated disease with bacteremia, arthritis, or meningitis.
In children beyond the newborn period, including prepubertal children, gonococcal infection may occur in the genital tract and almost always is sexually transmitted. Rarely, nonsexual transmission from household contact can occur. Vaginitis is the most common manifestation; pelvic inflammatory disease (PID) and perihepatitis can occur but are rare. Gonococcal urethritis in the prepubertal male is uncommon. Anorectal and tonsillopharyngeal infection also can occur in prepubertal children.
In sexually active adolescents, as in adults, gonococcal infection of the genital tract in females often is asymptomatic, and common clinical syndromes are urethritis, endocervicitis, and salpingitis. In males, infection usually is symptomatic, and the primary site is the urethra. Infection of the rectum and pharynx can occur alone or with genitourinary tract infection in either sex. Rectal and pharyngeal infections often are asymptomatic. Extension from primary genital mucosal sites can lead to epididymitis, bartholinitis, PID, and perihepatitis (Fitz-Hugh-Curtis syndrome). Even asymptomatic infection can progress to PID, with tubal scarring that can result in ectopic pregnancy or infertility. Infection involving other mucous membranes can produce conjunctivitis, pharyngitis, or proctitis. Hematogenous spread can involve skin and joints (arthritis-dermatitis syndrome) and occurs in up to 3% of untreated people with mucosal gonorrhea. Bacteremia causes a maculopapular rash with necrosis, tenosynovitis, and migratory arthritis. Arthritis may be reactive (sterile) or septic in nature. Meningitis and endocarditis occur rarely. Dissemination is more common in females infected within 1 week
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