Evolution of Gonococcal infection and complication

Gonorrhea is a sexually transmitted disease that exists only in humans. It can also be transmitted to the newborn during delivery if it is not detected; as a result, Nesseria gonorrhoeae infection develops differently in adults and children. If the disease is not treated in time, the complications will appear.

Adult

  1. Local genital infections

In the usual forms: the infection evolves favorably in a few days under adapted antibiotic treatment. Complications may occur in case of poorly treated infection or asymptomatic forms in women

  • In men: gonorrhea is acute anterior urethritis with discharge of pus sometimes abundant and dysuria (hot-piss). It occurs after an incubation of 1 to 15 days (3 to 5 in general). It heals without treatment in 15 days to 6 months. This urethritis can be subacute (5 to 15%) and sometimes asymptomatic. Complications are possible: ascending infections (orchitis, epididymitis, and prostatitis). Repeated infections can cause narrowing of the urethra.
  • In women: it is most often cervicitis, usually clinically silent (80% of cases) with sometimes purulent losses or urethritis. Possible complications are ascending infection with pyosaipynx resulting in tubal obstruction in the absence of treatment. Infections in women can persist 6 months. They are the main source of gonococcal spread. The infection can spread to the upper genital tract in the form of endometriosis (infection of the uterine lining), salpingitis (infection of the Fallopian tubes and risk of infertility and pregnancy extra- uterine) or pelvis-peritonitis (infection of the envelopes surrounding the abdominal organs). These complications make the full gravity of the gonococcal infection in women

. Local extra-genital infections related to sexual habits

A pharyngeal infection is usually asymptomatic, erythema or tonsillitis can accompany it. Anal infections affect about 4% of consultants (women or homosexual men). In general, they are asymptomatic with sometimes tenesmus, proctitis with mucopurulent secretions in which the gonococcus can be highlighted. Ocular infections are rarer.

  • Disseminated infections

They represent 1 to 3% of gonorrhea. They originate from one of the previous locations. Septicemia can lead to arthritis (polyarthralgia, purulent arthritis), skin lesions (maculopapules sometimes necrotic of the extremities), endocarditis (rare but serious), meningitis (exceptional)

In the child

In the newborn: purulent ophthalmia that can lead to blindness. The contamination occurs at the time of delivery, during passage through the genital tract. Prophylaxis: the Crede method (instillation of eye drops with silver nitrate or a non-sensitizing antibiotic) is mandatory at birth in France. Gonococcal infections of children always pose medico-legal problems (incest, rape …)