Neisseria gonorrhoeae causes urogenital, anorectal, conjunctival, and pharyngeal
infections. Urogenital tract
infections are most common. Men with
gonorrhea may present with penile discharge and
dysuria, whereas women may present with mucopurulent discharge or
pelvic pain; however, women often are asymptomatic. Neonatal
infections include
conjunctivitis and scalp
abscesses. If left untreated,
gonorrhea may cause
pelvic inflammatory disease in women, or it may disseminate, causing synovial and
skin manifestations. Urogenital N. gonorrhoeae
infection can be diagnosed using culture or
nucleic acid amplification testing. Urine
nucleic acid amplification tests have a sensitivity and specificity comparable to those of cervical and urethral samples.
Fluoroquinolones are no longer recommended for the treatment of
gonorrhea because of antimicrobial resistance. A single
intramuscular injection of
ceftriaxone, 250 mg, is first-line treatment for uncomplicated urogenital, anorectal, or pharyngeal gonococcal
infections. This dosage is more effective for common pharyngeal
infections than the previously recommended dose of 125 mg.
Ceftriaxone should routinely be accompanied by
azithromycin or
doxycycline to address the likelihood of
coinfection with Chlamydia trachomatis.
Azithromycin may be used as an alternative treatment option for patients with previous
allergic reactions to
penicillin, but because of the likelihood of antimicrobial resistance, its use should be limited. Gonococcal
infection should prompt physicians to test for other
sexually transmitted infections, including human immunodeficiency virus. Because of high
reinfection rates, patients should be retested in three to six months. The U.S. Preventive Services Task Force recommends screening for
gonorrhea in all sexually active women at increased risk of
infection. It also recommends intensive behavioral counseling for persons with or at increased risk of contracting
sexually transmitted infections.
Condom use is an effective strategy to reduce the risk of
infection.