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Section 3. Summaries of Infectious Diseases
Gonococcal Infections
Clinical ManifestationsEtiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
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CLINICAL MANIFESTATIONS
Gonococcal infections in children occur in 3 distinct age groups.
Infection in the newborn infant usually involves the eyes. Other types 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 transmitted sexually. Vaginitis is the most common manifestation. 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 vaginitis, urethritis, endocervicitis, and salpingitis. In males, infection often 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 in males and bartholinitis, pelvic inflammatory disease (PID), and perihepatitis (Fitz-Hugh-Curtis syndrome) in females. Even asymptomatic infection in females 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 of menstruation.
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ETIOLOGY
Neisseria gonorrhoeae is a gram-negative oxidase-positive
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