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Primary gonorrhea infection - Suspected Child Abuse
See also in: Overview,Anogenital
Other Resources UpToDate PubMed

Primary gonorrhea infection - Suspected Child Abuse

See also in: Overview,Anogenital
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 affects both males and females, most commonly individuals aged 15-24. It is highly contagious and primarily spread through sexual contact in sexually active adolescents. However, other routes of transmission are possible in children and adolescents, including via indirect contact through sharing of contaminated objects (especially in prepubescent girls), passage from an infected mother to her fetus during childbirth, or sexual abuse. Notably, all children with gonorrheal infection must be screened for sexual abuse, as this is the most frequent cause in infants and children.

The incubation period of N gonorrhoeae is short. The average time from infection to symptom onset lasts approximately 2-7 days.

In prepubescent girls, the most common manifestation is vaginitis with discharge, itching, and pain. Unlike in older female patients, young girls are less likely to develop pelvic inflammatory disease (PID), since the ascending infection leading to PID is usually due in part to the menstrual cycle. In older pubescent girls, the endocervical canal is the most common site of infection, with manifestations similar to those seen in women, including dysuria, vaginal discharge, bleeding, and menstrual pain.

In boys, the manifestations are similar to those seen in adults, and the most common clinical manifestation is anterior urethritis, with purulent urethral discharge and dysuria. Complications include epididymitis, vesiculitis, and prostatitis, which occur via local extension. Epididymitis may manifest as unilateral testicular edema and pain together with the features of urethritis.

Notably, proctitis and pharyngitis occur in both sexes via direct mucosal infection, and are strongly associated with sexual assault in non-sexually active children; however, infections of the rectum and pharynx are often asymptomatic.

Neonates born to infected mothers commonly manifest a purulent conjunctivitis called ophthalmia neonatorum, which is a major cause of blindness in the developing world. In the United States, the rate of this infection is low due to routine screening of mothers and preventive application of antibiotic ointment immediately after birth. Neonatal infection can also lead to sepsis with invasive and disseminated gonococcal infections, including meningitis and arthritis.

In children and adolescents, disseminated and invasive gonococcal infections are uncommon.

Related topics: disseminated gonorrhea, gonococcal cervicitis, gonococcal conjunctivitis


A54.9 – Gonococcal infection, unspecified

15628003 – Gonorrhea

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For girls – If there are concerns about sexual activity or assault, other STIs must be considered because presentation can range from asymptomatic to vaginal discharge to abdominal pain. The differential diagnosis includes:
For boys – If there are concerns about sexual activity or assault, other STIs are the main concern, including C trachomatis infection, genital herpes infection, or other forms of urethritis (only if the direct examination and culture are negative). Presentation can range from asymptomatic to penile discharge to systemic symptoms.
In cases of arthritis, other causes of joint pain should be ruled out.

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Last Reviewed:09/12/2021
Last Updated:09/19/2021
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Patient Information for Primary gonorrhea infection - Suspected Child Abuse
Contributors: Medical staff writer


Infection with the bacterium Neisseria gonorrhea is commonly called gonorrhea or "the clap." Gonorrhea is a contagious sexually transmitted infection spread by unprotected oral, vaginal, and anal sex. The bacterium can live in the mouth, semen, or vaginal fluids of infected persons. It is possible to be infected without symptoms and continue to spread the disease.

As with some other sexually transmitted infections, women are more likely to have symptoms than men; in women, the symptoms include pelvic pain, vaginal discharge, and painful intercourse. Although men rarely have symptoms, it is possible for either a man or a woman to be infected without symptoms. If the infection is not treated, it can spread to other parts of the body, including the throat, joints, and eyes (potentially leading to blindness). In women in particular, an untreated infection can cause pelvic inflammatory disease (PID) and impair fertility. In men, inflammation of the testes (epididymitis) can lead to infertility. It can also be spread to babies during birth by an infected mother.

Because of the risk of spread and the harmful effects of leaving an infection untreated, it is important to discuss your concerns with your doctor and to seek out testing and treatment.

Who’s At Risk

Anyone who is sexually active can get gonorrhea. Remember that many people lack symptoms (are asymptomatic) and do not know they are infected, so it is very important to always practice safe, protected sex. Teens and young adults are at the highest risk for contracting gonorrhea.

Signs & Symptoms

Gonorrhea may display no symptoms, particularly in women.

Infection often starts with only mild symptoms of discomfort with urination. Later there may be frequent and painful urination or defecation; a thick, cloudy, or bloody discharge from the penis, vagina, or rectum; or pain with sexual intercourse. Gonorrhea infection in the throat may present a sore throat only.

Occasionally, gonorrhea infection can spread throughout the body and presents with symptoms of fever, chills, swollen or painful joints, and small bumps on the hands or feet that may be red or purple. This is referred to as the arthritis-dermatitis syndrome.

Self-Care Guidelines

Gonorrhea is highly contagious and can have many serious side effects if left untreated. If you are sexually active and suspect you have been exposed to gonorrhea, you should seek medical care immediately. You should avoid any further sexual activity and notify any previous sexual partners.

Gonorrhea can be prevented by abstaining from casual sexual activity and using condoms correctly during any sexual contact. If you are in a long-term relationship, make sure that you know your partner's sexual history or ask your partner to be tested before engaging in sexual activity.

When to Seek Medical Care

  • There is a discharge from the vagina, penis, or rectum.
  • There is burning or pain during urination or defecation.
  • You are concerned or know that a sexual partner has similar symptoms or has been diagnosed with gonorrhea.


A sample of body fluid will be taken for cultures in a lab. Tests may also be done for other sexually transmitted infections that commonly occur at the same time as gonorrhea.

Antibiotics are prescribed for treatment of gonorrhea. Because drug-resistant strains of bacteria are becoming common, it is extremely important that you finish all of the antibiotics and see the doctor again if you still have symptoms after treatment.


Bolognia, Jean L., ed. Dermatology, pp.1282-1287. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1105, 2205-2206, 2208-2209. New York: McGraw-Hill, 2003.
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Primary gonorrhea infection - Suspected Child Abuse
See also in: Overview,Anogenital
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.
Copyright © 2023 VisualDx®. All rights reserved.