Gonococcemia (also known as "Disseminated gonococcal infection"
) is a rare complication of mucosal ''
Neisseria gonorrhoeae
''Neisseria gonorrhoeae'', also known as ''gonococcus'' (singular) or ''gonococci'' (plural), is a species of Gram-negative diplococci bacteria first isolated by Albert Ludwig Sigesmund Neisser, Albert Neisser in 1879. An obligate human pathog ...
'' infection, or
Gonorrhea
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.
Gonorrhea is spread through sexual c ...
, that occurs when the bacteria invade the bloodstream.
It is characterized by fever, tender hemorrhagic pustules on the extremities or the trunk, migratory polyarthritis, and
tenosynovitis
Tenosynovitis is the inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon, typically leading to joint pain, swelling, and stiffness. Tenosynovitis can be either infectious or noninfectious. Common clinical mani ...
.
Patients also commonly experience joint pain (e.g. knee) due to the purulent arthritis. It also rarely leads to
endocarditis
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves. Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, o ...
and
meningitis
Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, intense headache, vomiting and neck stiffness and occasion ...
.
This condition occurs in 0.5-3% of individuals with gonorrhea, and it usually presents 2–3 weeks after acquiring the infection.
Risk factors include female sex, sexual promiscuity, and infection with resistant strains of ''Neisseria gonorrhoeae''. This condition is treated with cephalosporin and fluoroquinolone antibiotics.
Epidemiology
''
Neisseria gonorrhoeae
''Neisseria gonorrhoeae'', also known as ''gonococcus'' (singular) or ''gonococci'' (plural), is a species of Gram-negative diplococci bacteria first isolated by Albert Ludwig Sigesmund Neisser, Albert Neisser in 1879. An obligate human pathog ...
'' is a
gram negative
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 ...
diplococcus (also referred to as "Gonococcus") and a
pathogen
In biology, a pathogen (, "suffering", "passion" and , "producer of"), in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a Germ theory of d ...
ic bacteria.
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.
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.
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.
Gonococcemia also occurs more frequently in pregnant women, those with recent menstruation, and those with IUDs.
Risk Factors
* Infection with certain strains of ''Neisseria gonorrhoeae''
* Prolonged infection
* Female sex (due to asymptomatic infection, and therefore prolonged infection)
* Sexual promiscuity
*
Immune system deficiencies
* Infection during
menstruation
Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and Mucous membrane, mucosal tissue from the endometrium, inner lining of the uterus through the vagina. The menstrual cycle is characterized ...
,
pregnancy
Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins.
Conception (biology), Conception usually occurs ...
, or in the
puerperium
The postpartum (or postnatal) period begins after childbirth and is typically considered to last for six to eight weeks. There are three distinct phases of the postnatal period; the acute phase, lasting for six to twelve hours after birth; the ...
period
Symptoms
* Fever
* Migratory
arthralgia
Arthralgia () literally means ' joint pain'. Specifically, arthralgia is a symptom of injury, infection, illness (in particular arthritis), or an allergic reaction to medication
Medication (also called medicament, medicine, pharmaceuti ...
s
* Hemorrhagic pustules
*
Tenosynovitis
Tenosynovitis is the inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon, typically leading to joint pain, swelling, and stiffness. Tenosynovitis can be either infectious or noninfectious. Common clinical mani ...
* Rarely headache, neck stiffness, and visual changes (associated with meningitis)
Treatment
Treatment typically consists of
cephalosporin
The cephalosporins (sg. ) are a class of β-lactam antibiotics originally derived from the fungus '' Acremonium'', which was previously known as ''Cephalosporium''.
Together with cephamycins, they constitute a subgroup of β-lactam antibio ...
and
fluoroquinolone
Quinolone antibiotics constitute a large group of broad-spectrum bacteriocidals that share a bicyclic core structure related to the substance 4-quinolone. They are used in human and veterinary medicine to treat bacterial infections, as well ...
antibiotics.
Gonococcemia is typically treated with intravenous or intramuscular cephalosporin antibiotics.
Approximately 10-30% of gonorrheal infections present with a co-infection of
chlamydia
Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium ''Chlamydia trachomatis''. Most people who are infected have no symptoms. When symptoms do appear, they may occur only several w ...
, so it is common to add a one-time dose of oral
azithromycin
Azithromycin, sold under the brand names Zithromax (in oral form) and Azasite (as an eye drop), is an antibiotic medication used for the treatment of several bacterial infections. This includes otitis media, middle ear infections, strep throa ...
or
doxycycline
Doxycycline is a Broad-spectrum antibiotic, broad-spectrum antibiotic of the Tetracycline antibiotics, tetracycline class used in the treatment of infections caused by bacteria and certain parasites. It is used to treat pneumonia, bacterial p ...
for coverage of ''
Chlamydia trachomatis
''Chlamydia trachomatis'' () is a Gram-negative, Anaerobic organism, anaerobic bacterium responsible for Chlamydia infection, chlamydia and trachoma. ''C. trachomatis'' exists in two forms, an extracellular infectious elementary body (EB) and an ...
''.
Bacterial resistance
Antimicrobial resistance (AMR or AR) occurs when microbes evolve mechanisms that protect them from antimicrobials, which are drugs used to treat infections. This resistance affects all classes of microbes, including bacteria (antibiotic resista ...
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.
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.
Invasion of the host cells is made possible due to
virulence factor
Virulence factors (preferably known as pathogenicity factors or effectors in botany) are cellular structures, molecules and regulatory systems that enable microbial pathogens (bacteria, viruses, fungi, and protozoa) to achieve the following:
* c ...
s such as Pili, LOS, Opa, and others.
Similarly, these virulence factors can be used for avoiding the host immune system, which may explain prolonged infection, bacterial resistance, and gonococcemia.
See also
*
Primary gonococcal dermatitis
*
List of cutaneous conditions
Many skin conditions affect the human integumentary system—the organ system covering the entire surface of the Human body, body and composed of Human skin, skin, hair, Nail (anatomy), nails, and related muscle and glands. The major function o ...
References
{{Bacterial cutaneous infections
Bacterium-related cutaneous conditions
Medical triads