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Gonococcemia - disseminated

Definition

Disseminated gonococcemia is a sexually-transmitted disease caused by the bacteria Neisseria gonorrhoeae.

Alternative Names

Gonococcal bacteremia

Causes, incidence, and risk factors

Gonorrhea is one of the most common infectious diseases. Anyone who has any type of sex can catch gonorrhea. The infection can be spread through the mouth, vagina, penis, or anus.

Disseminated gonococcemia can be very serious. It generally develops about several days to 2 weeks after the primary gonorrhea infection. The infection spreads through the bloodstream to other parts of the body. An infected woman may spread the infection to her newborn during childbirth.

Every state in the United States requires that health care providers tell their State Board of Health about any diagnosed cases of gonorrhea. This is done to make sure the patient gets proper follow up care and that anyone who had sexual contact with the patient is found and tested.

More than 700,000 persons in the United States get gonorrhea every year, according to the Centers for Disease Control and Prevention (CDC). In general, gonorrhea is most common in people 20 to 24 years old.

The disease is more common in large cities, inner-city areas, populations with lower overall levels of education, and people with lower socioeconomic status.

Risk factors include having multiple sexual partners, having a partner with a past history of any sexually transmitted disease, and having sex without using a condom.

Symptoms

• Chills
• Fever
• General ill feeling (malaise)
• Joint pain
• Joint swelling
• Painful tendons of wrists or heels
• Skin rash -- flat, pink-to-red spots turn into raised, pus-filled bumps

The combination of skin rash and aching, swollen tendons is sometimes known as tenosynovitis-dermatitis syndrome.

Signs and tests

Gonorrhea is often associated with the presence of other sexually transmitted diseases. About half of women with gonorrhea are also infected with chlamydia, another very common STD that can result in sterility. If you have gonorrhea, you should request testing for other sexually transmitted diseases, including AIDS.

Cultures (cells that grow in a lab dish) provide absolute proof of a gonorrhea infection. Generally, samples for a culture are taken from the cervix, vagina, urethra, anus, or throat. Cultures can provide a preliminary diagnosis often within 24 hours and a confirmed diagnosis within 72 hours.

See:

• Blood culture
• Culture from endocervix
• Urethral discharge culture

Treatment

There are two goals in treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first is to cure the infection in the patient. The second is to locate and test all of the other people the person had sexual contact with and treat them to prevent further spread of the disease.

Penicillin used to be given to patients with gonorrhea. But it is not often used anymore because some types of the gonorrhea bacteria no longer respond to the drug. This is called antibiotic resistance. Antibiotic resistance is major public health threat in which bacteria cannot be killed with the usual antibiotic medicines.

The bacteria responsible for gonorrhea is growing increasingly resistant to another class of antibiotics called fluoroquinolones, which includes ciprofloxacin, ofloxacin, or levofloxacin. The U.S. Centers for Disease Control and Prevention now recommendeds against using these medicines to treat gonorrhea.

Gonorrhea is now treated with potent antibiotics called cephalosporins, including ceftriaxone (Rocephin). For gonococcemia, treatment is usually first given through an IV rather than by mouth. Since chlamydia frequently occurs along with gonorrhea, treatment for chlamydia is often given at the same time.

A follow-up visit after treatment is important to recheck lab tests and make sure the infection is cured.

Expectations (prognosis)

With proper treatment, the outcome is expected to be good. When treatment is delayed there is a greater chance of complications.

Complications

• Gonococcal endocarditis
• Gonococcal meningitis

Calling your health care provider

Call your health care provider if you have symptoms of disseminated gonococcemia.

Prevention

Abstinence is the only sure prevention. Other prevention consists of following safer sexual practices. Monogamous sexual relations with a known disease-free partner is one good means of prevention.

Latex condoms protect against gonorrhea and other sexually transmitted diseases when the status of a partner is unknown.

Treatment of all sexual partners of a known infected person is essential to prevent further spread or reinfection.

References

Centers for Disease Control and Prevention (CDC). Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2006: Fluoroquinolones No Longer Recommended for Treatment of Gonococcal Infections. MMWR. 2007; 56(14);332-336.

U.S. Preventive Services Task Force. Screening for Gonorrhea: Recommendation Statement. Am Fam Physician. Nov. 1, 2005; 72(9); 1783-1786.

Cohen J, Powderly WG. Infectious Diseases. 2nd ed. New York, NY: Elsevier; 2004:2173-2186.

Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2004. Atlanta, GA: U.S. Department of Health and Human Service, September 2005.

Weinstock H, Berman S, Cates W. Sexually transmitted disease among American youth: Incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004; 36: 6-10.

Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines 2002. MMWR. 2002;51(no. RR-6).

Review Date:6/22/2007
Reviewed By:Cyrus Badshah, M.D., Ph.D., Assistant Professor of Clinical Medicine, College of Physicians and Surgeons, Columbia University; Assistant Attending Physician, Department of Medicine, Division of Infectious Diseases & Medical Director, Chest (TB)Clinic and Directly Observed Therapy Program, Harlem Hospital Center. Review provided by VeriMed Healthcare Network.

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