Gonorrhoea

Gonorrhoea, gonococcal infection, Neisseria gonorrhoeae infection, "the clap".

Sexually transmitted infection caused by the gram-negative diplococcus Neisseria gonorrhoeae.

Approximately 1,000 new cases annually in Switzerland, with 600–800 occurring in men who have sex with men (MSM). Pharyngeal and rectal infections are often asymptomatic, acting as important reservoirs of transmission.

• Urogenital gonorrhoea
• Pharyngeal gonorrhoea
• Rectal gonorrhoea
• Disseminated gonorrhoea (e.g., arthritis-dermatitis syndrome, sepsis)

Transmission occurs via unprotected vaginal, oral, or anal sexual contact. Vertical transmission to neonates is possible during delivery. Risk factors include multiple sexual partners, MSM, and unprotected intercourse.

Incubation period: 1–7 days (typically 2–4).
♂: Urethritis with purulent discharge or asymptomatic (~10%).
♀: Often asymptomatic; occasionally cervicitis, dysuria, or lower abdominal pain.

Extragenital manifestations: Pharyngitis and proctitis are usually asymptomatic. Disseminated disease may present with arthritis, dermatitis, or endocarditis in rare cases

PCR (NAAT) from urethral, vaginal, pharyngeal, rectal swabs, or urine.
Culture is recommended if PCR is positive to enable antimicrobial susceptibility testing. Concurrent screening for Chlamydia, HIV, and syphilis is advised. Pharyngeal and rectal swabs are particularly important in MSM.

Primarily genitourinary tract, pharynx, rectum; in disseminated cases also joints, skin, heart, or central nervous system.

Unprotected sexual contact, frequent partner changes, history of MSM. Women are often asymptomatic despite infection.

Relevant only in disseminated gonorrhoea: cutaneous manifestations may include pustules or vasculitic lesions.

♂: Epididymitis, prostatitis, urethral stricture
♀: Salpingitis, pelvic inflammatory disease (PID), ectopic pregnancy, infertility
Both: Arthritis-dermatitis syndrome, septic arthritis, rare cases of endocarditis or meningitis

Timely treatment generally leads to full recovery in uncomplicated cases. Delayed diagnosis can result in severe complications. Multidrug-resistant strains are increasingly reported.

Safer sex practices (e.g. condoms, barrier methods), partner notification and treatment, routine screening in high-risk groups. Culture and resistance testing recommended. No licensed vaccine available in Switzerland.

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8. Barbee LA, Soge OO, et al. Time-to-clearance of N. gonorrhoeae RNA at the pharynx after treatment. J Clin Microbiol. 2022;60:e0039922 
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