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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

Synopsis

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

Codes

ICD10CM:
A54.9 – Gonococcal infection, unspecified

SNOMEDCT:
15628003 – Gonorrhea

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

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:
  • Trichomoniasis
  • Vulvovaginal candidiasis (yeast infection)
  • Chlamydial infections
  • Urinary tract infection
  • Bacterial vaginosis
  • Genital herpes simplex virus
  • Primary syphilis
  • Human papillomavirus infection (Genital wart)
  • Pelvic inflammatory disease
  • Tubo-ovarian abscess
  • Acute appendicitis
  • Mesenteric adenitis
  • Ectopic pregnancy
  • Ovarian torsion
  • Endometriosis
  • Pyelonephritis
  • Cystitis
For boys – If there are concerns about sexual activity or assault, other STIs are the main concern, including Chlamydial infections, Genital herpes simplex virus, 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.
  • Chlamydial infections
  • Other forms of Urethritis only if the direct examination and culture are negative.
  • Genital herpes simplex virus
  • Primary syphilis
In cases of arthritis, other causes of joint pain should be ruled out.

Best Tests

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Therapy

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References

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Last Reviewed:09/12/2021
Last Updated:09/19/2021
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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 © 2024 VisualDx®. All rights reserved.