Gonorrhea

Toni Darville

doi:10.1542/pir.20-4-125

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Toni Darville, MD^*

^*Assistant Professor of Pediatrics, Department of Pediatric Infectious Diseases, Arkansas Children’s Hospital and the University of Arkansas for Medical Sciences, Little Rock, AR.

OBJECTIVES

After completing this article, readers should be able to:

Name the most common sexually transmitted diseases in sexually abused children.
Describe the clinical manifestations of gonorrhea in prepubertal compared with postpubertal females.
Describe the management of asymptomatic sexual partners of those who have gonorrhea.
List the syndrome that should be considered in any adolescent female who presents with right upper quadrant pain.
List the predominant manifestations of disseminated gonococcal infection.

Gonorrhea is a bacterial infection of the mucous membranes of the genitourinary tract that is caused by Neisseria gonorrhoeae, a Gram-negative diplococcus that is transmitted almost exclusively by sexual contact. The gonococcus causes urethritis, cervicitis, and salpingitis in females and urethritis and epididymitis in males. Anorectal infection also occurs, and orogenital exposure may lead to pharyngitis. An“ arthritis-dermatitis” syndrome may occur as a result of disseminated infection. Sexually abused female children may present with vulvovaginitis. Newborns may acquire the organism during delivery through an infected birth canal, leading to neonatal conjunctivitis.

Epidemiology

The incidence of gonorrhea in the United States has been declining since 1980. A peak incidence in modern times of 468 cases per 100,000 population occurred in 1975. In 1995, the overall rate was 150 cases per 100,000 population. Currently, some of the highest rates of gonorrhea are among adolescents. In 1991, the Centers for Disease Control and Prevention reported 1,044 cases per 100,000 females ages 15 to 19 years and 883 cases per 100,000 males ages 15 to 19 years. The increasing rates of gonorrhea among adolescents are consistent with reports of earlier initiation of sexual activity. The black:white incidence ratio has remained around 40:1 since the early 1990s. Gonorrhea is the most common sexually transmitted disease (STD) found in sexually abused children. Rarely, N gonorrhoeae may be spread by sexual play among children, but the index …