Gonococcemia

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Gonococcemia
Other namesDisseminated gonococcal infection [1]
NeisseriaGonorrhoeae.jpg
Neisseria gonorrhoeae
Specialty Infectious diseases   OOjs UI icon edit-ltr-progressive.svg
Symptoms Fever, multijoint pain, hemorrhagic pustules
Complications Rarely leads to meningitis and endocarditis
CausesNeisseria gonorrhoeae infection
Risk factors unprotected sex, female sex
Diagnostic method Nucleic Acid Amplification Techniques (NAAT)
TreatmentCephalosporins or Fluoroquinolones

Gonococcemia (also known as "Disseminated gonococcal infection" [1] ) is a rare complication of mucosal Neisseria gonorrhoeae infection, or Gonorrhea, that occurs when the bacteria invade the bloodstream. [2] It is characterized by fever, tender hemorrhagic pustules on the extremities or the trunk, migratory polyarthritis, and tenosynovitis. [3] Patients also commonly experience joint pain (e.g. knee) due to the purulent arthritis. [4] It also rarely leads to endocarditis and meningitis. [5] This condition occurs in 0.5-3% of individuals with gonorrhea, and it usually presents 2–3 weeks after acquiring the infection. [6] Risk factors include female sex, sexual promiscuity, and infection with resistant strains of Neisseria gonorrhoeae. This condition is treated with cephalosporin and fluoroquinolone antibiotics. [5]

Contents

Gonococcemia hemorrhagic pustule Gonococcal lesion on the skin PHIL 2038 lores.jpg
Gonococcemia hemorrhagic pustule

Epidemiology

Neisseria gonorrhoeae is a gram negative diplococcus (also referred to as "Gonococcus") and a pathogenic bacteria. [2] In 2019, there were 616,392 reported cases of gonorrhea in the United States, with an overall increased rate 5.7% from 2018 to 2019. [7] Among those approximately 600,000 cases, it is estimated that 0.5-3% of gonorrheal infections result in gonococcemia. This condition is more common in women, affecting approximately 2.3-3% of women with gonorrhea and 0.4-0.7% of men. [5] This discrepancy is explained by increased incidence of silent gonorrheal infections in females and an increased rate of transmission to females that have sexual intercourse with infected males. [6] Gonococcemia also occurs more frequently in pregnant women, those with recent menstruation, and those with IUDs. [6]

Risk Factors

Symptoms

Treatment

Treatment typically consists of cephalosporin and fluoroquinolone antibiotics. [5] Gonococcemia is typically treated with intravenous or intramuscular cephalosporin antibiotics. [6] Approximately 10-30% of gonorrheal infections present with a co-infection of chlamydia, so it is common to add a one-time dose of oral azithromycin or doxycycline for coverage of Chlamydia trachomatis . [6] Bacterial resistance to antibiotics is increasingly common in Neisseria gonorrhoeae, so it is often advised to check susceptibility of the bacterial culture and then adjust the antibiotic therapy as needed. [5]

Pathogenesis

Neisseria gonorrhoeae is transmitted during sexual contact with an infected individual. The bacteria invade the non-ciliated columnar epithelium of the urogenital tract, oral mucosa, or anal mucosa following exposure. [2] Invasion of the host cells is made possible due to virulence factors such as Pili, LOS, Opa, and others. [2] Similarly, these virulence factors can be used for avoiding the host immune system, which may explain prolonged infection, bacterial resistance, and gonococcemia. [3]

Neisseria gonorrhoeae Wild type Neisseria gonorrhoeae (29347475808).jpg
Neisseria gonorrhoeae

See also

Related Research Articles

<span class="mw-page-title-main">Gram-negative bacteria</span> Group of bacteria that do not retain the Gram stain used in bacterial differentiation

Gram-negative bacteria are bacteria that, unlike gram-positive bacteria, do not retain the crystal violet stain used in the Gram staining method of bacterial differentiation. Their defining characteristic is that their cell envelope consists of a thin peptidoglycan cell wall sandwiched between an inner (cytoplasmic) membrane and an outer membrane. These bacteria are found in all environments that support life on Earth.

<span class="mw-page-title-main">Pelvic inflammatory disease</span> Infection of uterus, fallopian tubes, ovaries or the inner surface of pelvis

Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, mainly the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no symptoms. Signs and symptoms, when present, may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, bleeding after sex, or irregular menstruation. Untreated PID can result in long-term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.

Urethritis is the inflammation of the urethra. The most common symptoms include painful or difficult urination and urethral discharge. It is a commonly treatable condition usually caused by infection with bacteria. This bacterial infection is often sexually transmitted, but not in every instance; it can be idiopathic, for example. Some incidence of urethritis can appear asymptomatic as well.

<span class="mw-page-title-main">Conjunctivitis</span> Inflammation of the eye

Conjunctivitis, also known as pink eye or Madras eye, is inflammation of the conjunctiva and the inner surface of the eyelid. It makes the eye appear pink or reddish. Pain, burning, scratchiness, or itchiness may occur. The affected eye may have increased tears or be "stuck shut" in the morning. Swelling of the sclera may also occur. Itching is more common in cases due to allergies. Conjunctivitis can affect one or both eyes.

<i>Neisseria gonorrhoeae</i> Species of bacterium

Neisseria gonorrhoeae, also known as gonococcus (singular) or gonococci (plural), is a species of Gram-negative diplococci bacteria first isolated by Albert Neisser in 1879. An obligate human pathogen, it primarily colonizes the mucosal lining of the urogenital tract; however, it is also capable of adhering to the mucosa of the nose, pharynx, rectum, and conjunctiva. It causes the sexually transmitted genitourinary infection gonorrhea as well as other forms of gonococcal disease including disseminated gonococcemia, septic arthritis, and gonococcal ophthalmia neonatorum.

<i>Neisseria</i> Genus of bacteria

Neisseria is a large genus of bacteria that colonize the mucosal surfaces of many animals. Of the 11 species that colonize humans, only two are pathogens, N. meningitidis and N. gonorrhoeae.

<span class="mw-page-title-main">Tenosynovitis</span> Inflammation of the fluid sheath (synovium) around a tendon

Tenosynovitis is the inflammation of the fluid-filled sheath that surrounds a tendon, typically leading to joint pain, swelling, and stiffness. Tenosynovitis can be either infectious or noninfectious. Common clinical manifestations of noninfectious tenosynovitis include de Quervain tendinopathy and stenosing tenosynovitis.

Nongonococcal urethritis (NGU) is inflammation of the urethra that is not caused by gonorrheal infection.

<span class="mw-page-title-main">Epididymitis</span> Inflammation of the epididymis, part of the testicle

Epididymitis is a medical condition characterized by inflammation of the epididymis, a curved structure at the back of the testicle. Onset of pain is typically over a day or two. The pain may improve with raising the testicle. Other symptoms may include swelling of the testicle, burning with urination, or frequent urination. Inflammation of the testicle is commonly also present.

<span class="mw-page-title-main">Septic arthritis</span> Inflammation of a joint due to infection

Acute septic arthritis, infectious arthritis, suppurative arthritis, pyogenic arthritis, osteomyelitis, or joint infection is the invasion of a joint by an infectious agent resulting in joint inflammation. Generally speaking, symptoms typically include redness, heat and pain in a single joint associated with a decreased ability to move the joint. Onset is usually rapid. Other symptoms may include fever, weakness and headache. Occasionally, more than one joint may be involved, especially in neonates, younger children and immunocompromised individuals. In neonates, infants during the first year of life, and toddlers, the signs and symptoms of septic arthritis can be deceptive and mimic other infectious and non-infectious disorders.

<span class="mw-page-title-main">Ofloxacin</span> Antibiotic to treat bacterial infections

Ofloxacin is a quinolone antibiotic useful for the treatment of a number of bacterial infections. When taken by mouth or injection into a vein, these include pneumonia, cellulitis, urinary tract infections, prostatitis, plague, and certain types of infectious diarrhea. Other uses, along with other medications, include treating multidrug resistant tuberculosis. An eye drop may be used for a superficial bacterial infection of the eye and an ear drop may be used for otitis media when a hole in the ear drum is present.

<i>Neisseria meningitidis</i> Species of bacterium that can cause meningitis

Neisseria meningitidis, often referred to as the meningococcus, is a Gram-negative bacterium that can cause meningitis and other forms of meningococcal disease such as meningococcemia, a life-threatening sepsis. The bacterium is referred to as a coccus because it is round, and more specifically a diplococcus because of its tendency to form pairs.

<span class="mw-page-title-main">Cefotaxime</span> Chemical compound

Cefotaxime is an antibiotic used to treat several bacterial infections in humans, other animals, and plant tissue culture. Specifically in humans it is used to treat joint infections, pelvic inflammatory disease, meningitis, pneumonia, urinary tract infections, sepsis, gonorrhea, and cellulitis. It is given either by injection into a vein or muscle.

<span class="mw-page-title-main">Neonatal conjunctivitis</span> Medical condition

Neonatal conjunctivitis is a form of conjunctivitis which affects newborn babies following birth. It is typically due to neonatal bacterial infection, although it can also be non-infectious. Infectious neonatal conjunctivitis is typically contracted during vaginal delivery from exposure to bacteria from the birth canal, most commonly Neisseria gonorrhoeae or Chlamydia trachomatis.

<span class="mw-page-title-main">Cefodizime</span> Chemical compound

Cefodizime is a 3rd generation cephalosporin antibiotic with broad spectrum activity against aerobic gram positive and gram negative bacteria. Clinically, it has been shown to be effective against upper and lower respiratory tract infections, urinary tract infections, and gonorrhea. Cefodizime is a bactericidal antibiotic that targets penicillin-binding proteins (PBPs) 1A/B, 2, and 3 resulting in the eventual death of the bacterial cell. In vivo experimental models of infection showed that bacterial clearance by this drug is at least as effective compared with other 3rd generation cephalosporins. It has similar adverse effect profile to other 3rd generation cephalosporins as well, mainly being limited to gastrointestinal or dermatological side effects.

<span class="mw-page-title-main">Gonorrhea</span> Sexually transmitted infection

Gonorrhoea or gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. Infection may involve the genitals, mouth, or rectum.

Pneumococcal infection is an infection caused by the bacterium Streptococcus pneumoniae.

<span class="mw-page-title-main">Antibiotic resistance in gonorrhea</span>

Neisseria gonorrhoeae, the bacterium that causes the sexually transmitted infection gonorrhea, has developed antibiotic resistance to many antibiotics. The bacteria was first identified in 1879.

Neisseria cinerea is a commensal species grouped with the Gram-negative, oxidase-positive, and catalase-positive diplococci. It was first classified as Micrococcus cinereus by Alexander von Lingelsheim in 1906. Using DNA hybridization, N. cinerea exhibits 50% similarity to Neisseria gonorrhoeae.

<span class="mw-page-title-main">Zoliflodacin</span> Chemical compound

Zoliflodacin is an experimental antibiotic that is being studied for the treatment of infection with Neisseria gonorrhoeae (gonorrhea). It has a novel mechanism of action which involves inhibition of bacterial type II topoisomerases. Zoliflodacin is being developed as part of a public-private partnership between Innoviva Specialty Therapeutics and the Global Antibiotic Research & Development Partnership (GARDP), and the drug has demonstrated clinical efficacy equivalent to ceftriaxone in Phase III clinical trials.

References

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  2. 1 2 3 4 Hill, Stuart A.; Masters, Thao L.; Wachter, Jenny (2016). "Gonorrhea - an evolving disease of the new millennium". Microbial Cell. 3 (9): 371–389. doi:10.15698/mic2016.09.524. ISSN   2311-2638. PMC   5354566 . PMID   28357376.
  3. 1 2 3 4 5 6 7 8 Shirtliff, Mark E.; Mader, Jon T. (October 2002). "Acute Septic Arthritis". Clinical Microbiology Reviews. 15 (4): 527–544. doi:10.1128/CMR.15.4.527-544.2002. ISSN   0893-8512. PMC   126863 . PMID   12364368.
  4. Li, Raymund; Hatcher, Jason D. (2025), "Gonococcal Arthritis", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   29261865 , retrieved 2025-01-19
  5. 1 2 3 4 5 Creighton, Sarah (2014-02-21). "Gonorrhoea". BMJ Clinical Evidence. 2014: 1604. ISSN   1752-8526. PMC   3931440 . PMID   24559849.
  6. 1 2 3 4 5 Beatrous, Surget V.; Grisoli, Stratton B.; Riahi, Ryan R.; Matherne, Ryan J.; Matherne, Ryan J. (2017). "Cutaneous manifestations of disseminated gonococcemia". Dermatology Online Journal. 23 (1). doi: 10.5070/D3231033674 . PMID   28329470.
  7. "National Overview - Sexually Transmitted Disease Surveillance, 2019". www.cdc.gov. 2021-04-19. Retrieved 2021-11-03.