The incubation period is 10 to 20 days with most symptoms occurring between thefifteenth and twentieth days after being infected. A small number of people may beasymptomaticfor up to a lifetime. Between 30 and 60% of people with gonorrhea areasymptomaticor havesubclinicaldisease.
Women may complain of vaginal discharge,difficulty urinating (dysuria), projectile urination, off-cyclemenstrual bleeding, or bleeding after sexual intercourse. The cervix may appear anywhere from normal to theextreme of marked cervical inflammation with pus. Possibility of increased production of male hormones is common in many cases. Infection of the urethra (urethritis) causes littledysuria or pus. The combination of urethritis and cervicitis on examination stronglysupports a gonorrhea diagnosis, as both sites are infected in most gonorrhea patients.Gonorrhea is caused by the
bacteria. The infection is transmittedfrom one person to another through vaginal, oral, or anal sexual relations, thoughtransmission occurs rarely with "safe sex" practices of condom usage with lubrication.Men have a 20% chance of getting the infection by having sexual relations with a womaninfected with gonorrhea. Women have a 50% chance of getting the infection by havingsexual relations with a man infected with gonorrhea. An infected mother may transmitgonorrhea to her newborn during childbirth, a condition known asophthalmianeonatorum.
) is themost common presentation. Examination may show a reddened externalurethral meatus.Ascending infection may involve theepididymis,testiclesor prostate glandcausingsymptoms such as scrotal pain or swelling. Instances of blurred vision in one eye mayoccur in adults.
. This rare complication is associated withFitz-Hugh-Curtissyndrome. Additionally,septic arthritisin the fingers, wrists, toes, and ankles is alsocommon. This should be evaluated promptly with a culture of thesynovial fluid, blood,cervix, urethra, rectum, skin lesion fluid, or pharynx. The underlying gonorrhea should betreated; if this is done then usually a good prognosis will follow.
is now so high as to make itcompletely ineffective in most parts of the world.The fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) cannot be used in pregnancy. It is important to refer all sexual partners to be checked for gonorrhea to prevent spread of the disease and to prevent the patient from becoming re-infected withgonorrhea. Patients should also be offered screening for other sexually transmittedinfections. In areas where co-infection withchlamydiais common, doctors may prescribea combination of antibiotics, such as ceftriaxone withdoxycyclineor azithromycin, totreat both diseases.Penicillin is ineffective at treating rectal gonorrhea: this is because other bacteria withinthe rectum produce β-lactamases that destroy penicillin. All current treatments are lesseffective at treating gonorrhea of the throat, so the patient must be rechecked by throat