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Primary gonorrhea infection - Anogenital in
See also in: Overview
Other Resources UpToDate PubMed

Primary gonorrhea infection - Anogenital in

See also in: Overview
Contributors: Saami Khalifian MD, Susan Burgin MD, Paritosh Prasad MD
Other Resources UpToDate PubMed


Gonorrhea is a common sexually transmitted infection (STI) caused by the gram-negative intracellular diplococcus Neisseria gonorrhoeae. It is highly contagious and primarily spread through sexual contact, although it can also be passed to the fetus from a pregnant person during childbirth or via indirect contact through sharing of contaminated objects. There appears to be a higher rate of gonorrheal infection in women than men, although the overall incidence is likely underreported.

The incubation period of N gonorrhoeae is short. The average time from infection to symptom onset is approximately 2-7 days. Risk factors for acquiring N gonorrhoeae include having a new sex partner, more than one sex partner (or a sex partner with concurrent partners), and a history of STIs (or a sex partner with a history of STIs). Other risk factors include inconsistent condom use (if not in a mutually monogamous relationship), young age, and substance abuse. Some subgroups of men who have sex with men (MSM) are at higher risk as well.

In men, anterior urethritis is the most common presentation, with purulent urethral discharge and dysuria. Complications include epididymitis, vesiculitis, and prostatitis, which occur via local extension.

Proctitis and pharyngitis occurs in both sexes via direct mucosal infection, but the former is more prevalent in MSM. Notably, in men, clinical symptoms may disappear in approximately 6-8 months without treatment, which increases the risk for complications.

Systemic symptoms including fever, arthritis, tenosynovitis of large joints, and cutaneous pustules can occur from hematogenous dissemination. This occurs in less than 1% of patients. Risk factors for dissemination include complement deficiency.

Related topics: disseminated gonorrhea, gonococcal conjunctivitis


A54.9 – Gonococcal infection, unspecified

15628003 – Gonorrhea

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Differential Diagnosis & Pitfalls

  • Chlamydial infections
  • Other forms of Urethritis only if the direct examination and culture are negative.
  • Genital herpes simplex virus
  • Primary syphilis

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Last Reviewed:09/12/2021
Last Updated:09/19/2021
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Primary gonorrhea infection - Anogenital in
See also in: Overview
A medical illustration showing key findings of Primary gonorrhea infection (Male) : Testicular tenderness, Urethral pus, Dysuria, Sexually active
Clinical image of Primary gonorrhea infection - imageId=1869503. Click to open in gallery.  caption: 'A milky urethral discharge.'
A milky urethral discharge.
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