Primary gonorrhea infection - Suspected Child Abuse
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
Differential Diagnosis & Pitfalls
, , or other forms of (only if the direct examination and culture are negative). Presentation can range from asymptomatic to penile discharge to systemic symptoms.