Last Updated: 2020-11-19
Gonorrhea, Neisser's disease.
A sexually transmitted infectious disease (STI or STD) caused by Neisseria gonorrhoeae that occurs worldwide. It is seen as an indicator for the prevention of HIV and other STDs, as it is often a co-infection (ulcers serve as entry portal).
- Worldwide approx. 300-600 million
- Incidence: 2-5/100000/year
- Saxony: 10,1 /100000/year
- Men: Women = 2:1
- Since the invention of penicillin in Europe, the incidence of the disease has been declining, and has been rising again since 2001.
- Occurring mainly in the 3rd and 4th decade of life
- With the exception of neonatal conjunctivitis, the transmission is only sexual.
- Risk factors
- High number of sexual partners
- Not using a condom
- Anal sex
- Oral sex
- Incubation period: 2-7 days
- Often indistinguishable from Chlamydia infection.
- Mostly a urethritis or a cervicitis appears. The distal rectal mucosa can also be affected. Hematogenic scattering is possible.
- Serous or purulent exclusion
- Burning during urination
- The urethra opening may be red.
- Balanitis, sometimes paraphimosis
- Pain in the perineum and lower abdomen
- 80% asymptomatic
- Serous or purulent discharge
- Burning and pain during urination
- Local redness and swelling, erosions and ulcerations
- Peritoneal pain (pelvic inflammatory disease)
- Bleeding disorder
- Swelling of the adnexa
- Pharyngitis (almost all cases of pharyngeal gonorrhoea are asymptomatic)
- Proctitis (often asymptomatic in both sexes)
- Deteriorated general condition, fever attacks
- Urethritis: All patients with urethritis should undergo the diagnostic steps listed in Table 1. If the complaint persists, the steps are described in Table 2.
Pharyngeal or anal complaints: For pharyngitis and anal complaints see Table 3.
|Table 1. diagnostic steps in all urethritis patients step||
For the detection of
Men: Swab from the urethra with the eSwab with thin swab (Figure 1):
Women: If culture is desired, take a smear of endocervix in gynaecology.
Gram-negative diplococci (Neisseria gonorrhoeae),
Men: first urine (at least 2 hours after last micturition)
Neisseria gonorrhoeae - PCR,
Chlamydia trachomatis - PCR
Blood sample collection
Lues serology,HIV Test
|Table 2: Diagnostic steps in case of persistent symptoms after therapy (after consultation with a management physician)||
Put the smear into the medium
Mycoplasma genitalium - PCR,Trichomonas vaginalis - PCR
Genito-anal, pharyngeal, less frequently other localizations.
- Urethritis gonorrhoica posterior
- Anal infestation
- Perihepatitis gonorrhoica
- Gonococcal sepsis
- Endometritis gonorrhoica
- Adnexitis gonorrhoica
- Peritonitis gonorrhoica
- Rectal gonorrhoea
- Vulvovaginitis gonorrhoica adultorum
- Gonococcal sepsis
- Perihepatitis gonorrhoica
Barrier measures (attention oral sex).
In general, the therapy recommendation is based on the pathogen detection.
The therapy during the first visit to the clinic depends on the results of the direct preparation (Table 1.)
Table 1. therapy recommendation according to the result of the direct preparation test result
|Interpretation||Procedure / Therapy|
|Direct preparation not conspicuous||Unclear urethritis||
Protected sex only,
Control in 1 week
In the direct preparation gram-negative diplococci (especially intracellular) and leukocytes (> 5/visual field)
Ceftriaxone i.m. 1.0g single dose
In the direct preparation leucocytes (> 5/visual field) and possibly bacteria
Doxycycline p.o. 100 mg 2x/d for 7 days
- Patients with documented urethritis should be tested for other STIs, including syphilis and HIV
- Clinical follow-up after 1 week (e.g. when discussing test results)
- Microbiological follow-ups are indicated for therapy with second-line therapy or persistent urethritis after pathogen-appropriate therapy
- Prohibition of unprotected sexual intercourse for 7 days after single-dose therapy or until completion of 7-day therapy
- Sexual partners of patients with gonorrhoea in the last 60 days should be tested for N. gonorrhoea by PCR and culture due to the high infection rate and treated on the same day, i.e. before the test result is available
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- Sherrard J, Barlow D. Gonorrhoea in men: clinical and diagnostic aspects. Sexually Transmitted Infections 1996;72:422-6.
- Yealy DM, Greene TJ, Hobbs GD. Underrecognition of CervicalNeisseria gonorrhoeaeandChlamydia trachomatisInfections in the Emergency Department. Academic Emergency Medicine 1997;4:962-7.
- Palladino S, Pearman JW, Kay ID, et al. Diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae genitourinary infections in males by the Amplicor PCR assay of urine. Diagnostic Microbiology and Infectious Disease 1999;33:141-6.
- Whiley DM, Garland SM, Harnett G, et al. Exploring 'best practice' for nucleic acid detection of Neisseria gonorrhoeae. Sexual Health 2008;5:17.
- Lebwohl, Mark. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. Elsevier, 2014. Print.
- British Association for Sexual Health and HIV national guideline for the management of infection with Neisseria gonorrhoeae (2019)
- Horner P. et al. 2016 European guideline on the management of non-gonococcal urethritis. International Journal of STD & AIDS 2016; 27: 928–937