Systemic Gonococcal Infection

Gonorrhea is a sexually transmitted infection (STI) caused by the bacteria Neisseria gonorrhoeae. It can infect both men and women and typically affects the urethra, rectum, or cervix.

Most new cases of the infection occur in women. Women who are infected with gonorrhea may also transmit the bacteria to their newborns during childbirth. According to the Mayo Clinic, gonorrhea infections in babies typically affect the eyes (Mayo Clinic, 2011).

According to the Centers for Disease Control and Prevention (CDC), there are 700,000 cases of gonococcal infections reported each year. The CDC also reports that gonorrhea is the second most common bacterial STI in the United States (CDC, 2011). Treatment for gonorrhea is effective and available. However, many cases go untreated.

Over time, the bacterium that causes gonorrhea can spread to the bloodstream and to other parts of the body. This can lead to a serious medical condition known as systemic gonococcal infection or disseminated gonococcal infection (DGI). Other names for the infection are:

• gonococcemia—disseminated
• gonococcal bacteremia
• gonococcal arthritis

Gonorrhea is a sexually transmitted infection that can be acquired through vaginal, anal, or oral intercourse. DGI can develop within two weeks of being infected with gonorrhea. Once in the bloodstream, gonorrhea can affect various tissues causing permanent damage.

Common complications associated with this infection include:

• gonococcal arthritis—rashes and inflammation of joints due to STI
• gonococcal endocarditis—damage to the inner lining of the heart muscle
• gonococcal meningitis—infection of the membranes covering the brain and spinal cord

Although gonorrhea is a common STI, certain groups have a higher risk for developing DGI. These include:

• people who have unprotected sex
• people with multiple sex partners
• men and women who are under the age of 25
• men and women who engage in sex work

When gonorrhea infections are not treated, the bacteria can spread, causing a number of different symptoms. Specific symptoms depend on the area of the body affected by the bacteria. However, some symptoms commonly occur with DGI, such as:

• fever or chills
• feeling ill or generally unwell (malaise)
• pain in the joints
• swelling in the joints
• pain in the tendons of the wrists or heels
• a skin rash with pink/red spots that become filled with pus

Your doctor will check to see if you have gonorrhea if you have symptoms of DGI. Tests for gonorrhea typically involve taking a sample (culture) from the infected area. The sample is sent to a laboratory where it is analyzed for the presence of bacteria. Results are often available within 24 hours.

Cultures for testing can be obtained from:

• the blood
• a skin lesion
• fluid from the joints
• the cervix
• the throat
• the anus
• the urethra

If you test positive for gonorrhea, your doctor may order additional tests to determine if you have other sexually transmitted infections. Gonorrhea is often diagnosed along with other STIs, such as chlamydia.

Treatment for DGI typically includes the use of antibiotics. Penicillin was once the primary treatment for gonorrhea. However, antibiotic-resistant strains of gonorrhea have made penicillin ineffective for treating this condition. Antibiotics called cephalosporins are often used to treat gonorrhea. Typically, these medications are administered through a vein in your arm (intravenously) rather than by mouth.

Treatment for DGI also involves identifying the source of the infection. If you have gonorrhea, your doctor will ask you about your sexual partners. These partners will need to be tested and treated if they have the infection. This must be done to prevent the spread of the disease.

If you develop DGI, your long-term outlook with treatment is quite good. Seeking medical attention when you develop symptoms will enable your doctor to diagnose and treat the infection. Symptoms are typically alleviated within one to two days after starting treatment.

Your long-term outlook may not be as good if you do not seek treatment for your symptoms or do not follow your doctor’s recommendations for treatment. Systemic gonococcal infections that affect different areas of the body can cause permanent damage.

Prevention of DGI requires prevention of gonorrhea. Not having sex (abstinence) is the only way to be completely sure that you will not develop this condition. If you do have sex, there are several steps that you can take to prevent gonorrhea. These include:

• having sex with one partner that you know does not have the infection
• using a condom every time you have sex
• making sure that sexual partners with gonorrhea are treated