Gonococcemia (disseminated)

Definition

Gonococcemia (disseminated) is a sexually-transmitted disease caused by the bacterium Neisseria gonorrhoeae, which spreads from the initial site of infection through the bloodstream to other parts of the body.

Causes, incidence, and risk factors

Gonorrhea is one of the most commonly reported sexually transmitted infectious diseases. It is transmitted through vaginal, oral, and anal intercourse. An infected woman may also transmit the infection to her newborn during childbirth. Gonorrhea in children older than newborns is almost always a sign of sexual abuse.

Gonorrhea is most prevalent in those 15-29 years old who live in high-density urban areas. Multiple unprotected sexual partners is a risk factor.

Disseminated gonococcemia generally follows the primary genital infection with gonorrhea by several days to 2 weeks. The infection spreads from the primary site through the bloodstream. Newborns are at increased risk for disseminated gonorrhea.

Symptoms

• Fever
• Chills, malaise
• Joint pain, either single or multiple joints (knee pain, wrist pain, ankle pain)
• Joint swelling (knees, wrists, ankles)
• Skin rash: begins as flat, pink-to-red spots that evolve into raised, pus-filled bumps
• Painful tendons of wrists or heels
• A combination of skin rash and aching, swollen tendons -- sometimes known as tenosynovitis-dermatitis syndrome

Signs and tests

• Blood culture
• Skin lesion culture
• Culture of synovial fluid from joints
• Urethral discharge culture
• Culture from endocervix
• Throat culture
• Anal culture

Treatment

There are two aspects of treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first aspect is to cure the affected person. The second is to locate and test all of the other sexual contacts and to treat them to prevent further spread of the disease.

That is why mandatory reporting has been instituted and has, until recently, held the number of cases of gonorrhea at a low level. However, the number of cases is once again rising.

Fluoroquinolone resistance in strains of gonorrhea has been increasing over the last 5 years, especially in Hawaii and areas on the West Coast. Because of this, a new standardized treatment regimen has been recommended by the Centers for Disease Control (CDC).

Instead of the old penicillin treatment, gonorrhea is now treated by a large number of new and very potent antibiotics, including ceftriaxone and other cephalosporins. For gonococcemia, treatment is usually begun with intravenous, rather than oral, antibiotics. Since chlamydia frequently occurs along with gonorrhea, treatment for chlamydia is often given at the same time.

A follow-up visit after treatment to recheck cultures and confirm the cure of infection is important.

Expectations (prognosis)

The outcome is expected to be good when compliance with therapy is maintained.

Complications

• Gonococcal endocarditis
• Gonococcal meningitis

Calling your health care provider

Call your health care provider if you have symptoms suggestive of disseminated gonococcemia.

Prevention

Abstinence is the only sure prevention. Other prevention consists of following safer sexual practices. Monogamous sexual relations with a known disease-free partner is one good means of prevention.

Latex condoms protect against gonorrhea and other sexually transmitted diseases when the status of a partner is unknown.

Treatment of all sexual partners of a known infected person is essential to prevent further spread or reinfection.

Illustrations

Circulatory system

Page Content:

Gonococcal bacteremia