Gonorrhea is a gram negative intracellular diplococcus. Transmission can occur through vaginal , anal or oral intercourse as well as perinatally. Non specific or asymptomatic cases may lead to delayed diagnosis raising the risk for complications.
MSM (men who have sex with men) have a 42 fold higher rate than men who have sex with women only. Women are usually asymptomatic but when symptoms occur its normally within 10 days of exposure, may present like a urinary tract infection and commonly affect the endodermis and urethra.
Urethritis and copious mucopurulent discharge may progress to epididymitis and testicular or scrotal pain. Rectal infection may occur in both sexes, symptoms include rectal pain, painful bowel movements, discharge, soreness and bleeding.NAAT testing is preferred (Nucleic acid amplification testing) and concurrent testing for chlamydia is recommended. Consider syphilis and HIV testing in at risk persons. Ceftriaxone is first line therapy along with doxycycline when chlamydia infection is anticipated or has not been excluded.
