Gonococcemia
Other namesDisseminated gonococcal infection[1]
Neisseria gonorrhoeae
SpecialtyInfectious diseases Edit this on Wikidata
SymptomsFever, multijoint pain, hemorrhagic pustules
ComplicationsRarely leads to meningitis and endocarditis
CausesNeisseria gonorrhoeae infection
Risk factorsunprotected sex, female sex
Diagnostic methodNucleic Acid Amplification Techniques (NAAT)
TreatmentCephalosporins or Fluoroquinolones

Gonococcemia (also known as "Disseminated gonococcal infection"[1]) is a rare complication of mucosal Neisseria gonorrhoeae infection, or Gonorrhea, that occurs when the bacteria invade the bloodstream.[2] It is characterized by fever, tender hemorrhagic pustules on the extremities or the trunk, migratory polyarthritis, and tenosynovitis.[3] It also rarely leads to endocarditis and meningitis.[4] This condition occurs in 0.5-3% of individuals with gonorrhea, and it usually presents 2–3 weeks after acquiring the infection.[5] Risk factors include female sex, sexual promiscuity, and infection with resistant strains of Neisseria gonorrhoeae. This condition is treated with cephalosporin and fluoroquinolone antibiotics.[4]

Gonococcemia hemorrhagic pustule

Epidemiology

Neisseria gonorrhoeae is a gram negative diplococcus (also referred to as "Gonococcus") and a pathogenic bacteria.[2] In 2019, there were 616,392 reported cases of gonorrhea in the United States, with an overall increased rate 5.7% from 2018 to 2019.[6] Among those approximately 600,000 cases, it is estimated that 0.5-3% of gonorrheal infections result in gonococcemia. This condition is more common in women, affecting approximately 2.3-3% of women with gonorrhea and 0.4-0.7% of men.[4] This discrepancy is explained by increased incidence of silent gonorrheal infections in females and an increased rate of transmission to females that have sexual intercourse with infected males.[5] Gonococcemia also occurs more frequently in pregnant women, those with recent menstruation, and those with IUDs.[5]

Risk Factors

Symptoms

  • Fever
  • Migratory arthralgias
  • Hemorrhagic pustules
  • Tenosynovitis
  • Rarely headache, neck stiffness, and visual changes (associated with meningitis)

Treatment

Treatment typically consists of cephalosporin and fluoroquinolone antibiotics.[4] Gonococcemia is typically treated with intravenous or intramuscular cephalosporin antibiotics.[5] Approximately 10-30% of gonorrheal infections present with a co-infection of chlamydia, so it is common to add a one-time dose of oral azithromycin or doxycycline for coverage of Chlamydia trachomatis.[5] Bacterial resistance to antibiotics is increasingly common in Neisseria gonorrhoeae, so it is often advised to check susceptibility of the bacterial culture and then adjust the antibiotic therapy as needed.[4]

Pathogenesis

Neisseria gonorrhoeae is transmitted during sexual contact with an infected individual. The bacteria invade the non-ciliated columnar epithelium of the urogenital tract, oral mucosa, or anal mucosa following exposure.[2] Invasion of the host cells is made possible due to virulence factors such as Pili, LOS, Opa, and others.[2] Similarly, these virulence factors can be used for avoiding the host immune system, which may explain prolonged infection, bacterial resistance, and gonococcemia.[3]

Neisseria gonorrhoeae

See also

References

  1. 1 2 Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
  2. 1 2 3 4 Hill, Stuart A.; Masters, Thao L.; Wachter, Jenny (2016). "Gonorrhea - an evolving disease of the new millennium". Microbial Cell. 3 (9): 371–389. doi:10.15698/mic2016.09.524. ISSN 2311-2638. PMC 5354566. PMID 28357376.
  3. 1 2 3 4 5 6 7 8 Shirtliff, Mark E.; Mader, Jon T. (October 2002). "Acute Septic Arthritis". Clinical Microbiology Reviews. 15 (4): 527–544. doi:10.1128/CMR.15.4.527-544.2002. ISSN 0893-8512. PMC 126863. PMID 12364368.
  4. 1 2 3 4 5 Creighton, Sarah (2014-02-21). "Gonorrhoea". BMJ Clinical Evidence. 2014: 1604. ISSN 1752-8526. PMC 3931440. PMID 24559849.
  5. 1 2 3 4 5 Beatrous, Surget V.; Grisoli, Stratton B.; Riahi, Ryan R.; Matherne, Ryan J.; Matherne, Ryan J. (2017). "Cutaneous manifestations of disseminated gonococcemia". Dermatology Online Journal. 23 (1). doi:10.5070/D3231033674. PMID 28329470.
  6. ↑ "National Overview - Sexually Transmitted Disease Surveillance, 2019". www.cdc.gov. 2021-04-19. Retrieved 2021-11-03.
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