Potential Risks

In cases of untreated gonorrhea, the residual effects of chronic pelvic inflammatory disease, infertility, and ectopic pregnancy are well known. Other complications of untreated gonorrhea in both men and women include dermatitis (inflammation of the skin), carditis (inflammation of the heart), meningitis (inflammation of brain meninges), and arthritis (inflammation of the joints). The incidence of these complications is higher among women due to the prolonged period of infection without symptoms.

Newborn infants whose mothers have untreated gonorrhea may acquire gonococcal opthalmia neonatorum during the birth process. Infection to the infant is transmitted by direct contact between the baby’s eyes and the infected tissues of the mother. Opthalmia neonatorum is an acute conjunctivitis which can lead to corneal ulceration and subsequent blindness if not treated properly. The most effective means of prevention is the instillation of 1% silver nitrate solution into the eyes of infants at birth.

In females, extension of the gonococcal infection to the fallopian tubes is referred to as acute salpingitis (pelvic inflammatory disease or PID) and occurs in 10 to 15 percent of females with gonorrhea. Infection can escape from the fallopian tubes into the pelvis resulting in pelvic peritonitis. Patient’s history may reveal chills, fever, sever abdominal pain, nausea, and vomiting. Physical assessment may reveal swollen and tender inguinal lymph nodes and a purulent vaginal discharge. Patients may experience an exquisite pain when the cervix is manipulated during the pelvic examination. Abnormal laboratory values commonly include an elevated erythrocyte sedimentation rate and leukocytosis (increased number of white blood cells). Partial or complete closure of the fallopian tubes can occur due to scar formation which may predispose to tubal pregnancy or result in sterility. Approximately 15 percent of females with one episode of gonococcal salpingitis become sterile. Chronic pelvic inflammatory disease can lead to abnormal menstrual periods, pain with intercourse, low back pain, anemia, and periodic recurrence of the acute symptoms. Signs of pelvic inflammation (pain, purulent discharge) and communicability must be viewed as the most characteristic problems of patients with acute salpingitis of gonococcal origin. Interventions include drug therapy, follow-up and prevention of complications. Follow- up of patients with repeat pelvic examination and cultures for Neisseria gonorrhoeae is essential. Failure to examine and treat male sex partners is a major cause of recurrent gonococcal salpingitis.

Disseminated gonococcal infection results from the systemic spread of the organism via the bloodstream resulting in a variety of clinical manifestations including arthritis, tenosynovitis, skin eruptions, meningitis, endocarditis, pericarditis, toxic hepatitis, and, rarely, fulminant gonococcemia. A diagnosis of disseminated gonococcal infection is supported by the presence of Neisseria gonorrhoeae on culture or on specific immunoflourescent strain of blood, synovial fluid, cerebrospinal fluid, or skin lesions. Patients with disseminated gonococcal infection should preferably be hospitalized and treated with high doses of intravenous aqueous crystalline penicillin G until clinical improvement occurs.

Isolation of patients with gonorrhea is not necessary. Patients should be instructed not to engage in sexual activity for at least 24 hours after treatment. There is no evidence that an attack of gonorrhea produces immunity to subsequent infections. Patients should refrain from intercourse with untreated previous sexual partners to avoid reinfection.