What are the signs and symptoms of gonorrhea infection in females?

Updated: Jun 15, 2021
  • Author: Shahab Qureshi, MD, FACP; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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The most common site of gonococcal infection in women is the endocervix (80%-90%), followed by the urethra (80%), rectum (40%), and pharynx (10%-20%). If symptoms develop, they often manifest within 10 days of infection.

Major symptoms include vaginal discharge, dysuria, intermenstrual bleeding, dyspareunia (painful intercourse), and mild lower abdominal pain.

When gonococcal cervicitis is either asymptomatic or unrecognized, the patient may progress to PID, often in proximity to a menstrual period. PID may be asymptomatic or silent and occurs in 10-20% of infected women. Symptoms of PID include the following:

  • Lower abdominal pain (most consistent symptom of PID)
  • Increased vaginal discharge or mucopurulent urethral discharge
  • Dysuria (usually without urgency or frequency)
  • Cervical motion tenderness
  • Adnexal tenderness (usually bilateral) or adnexal mass
  • Intermenstrual bleeding
  • Fever, chills, nausea, and vomiting (less common)

Acute perihepatitis (Fitz-Hugh-Curtis syndrome) occurs primarily through direct extension of N gonorrhoeae or Chlamydia trachomatis from the fallopian tube to the liver capsule and overlying peritoneum. Acute perihepatitis is more commonly associated with C trachomatis. Patients with this syndrome may report right upper quadrant pain, nausea, vomiting, and fever, and friction rub may be heard along the right anterior costal margin. Cases tend to occur in individuals with PID and therefore should be among the differential diagnoses of right upper quadrant pain in young sexually active women.

Vaginal discharge from endocervicitis is the most common presenting symptom of gonorrhea and is usually described as thin, purulent, and mildly odorous. Many patients have minimal or no symptoms from gonococcal cervicitis. Dysuria or a scant urethral discharge may be due to urethritis accompanying cervicitis.

Gonorrheal infection of the Bartholin glands (glands near the labia) is asymptomatic in one third of cases but may manifest as perilabial pain, edema, tenderness, and discharge.

Pelvic or lower abdominal pain suggests ascending infection of the endometrium, fallopian tubes, ovaries, and peritoneum. Pain may be midline, unilateral, or bilateral. Fever, nausea, and vomiting may be present. Pelvic examination usually demonstrates bilateral adnexal tenderness, possible tenderness over the uterine fundus, and possible cervical motion tenderness. Abdominal examination elicits lower quadrant tenderness. PID related to gonococcal infection may follow the onset of menses by a few days. The possibility of ectopic pregnancy should always be considered in patients with pelvic or lower abdominal pain.

Rectal infection is often asymptomatic, but rectal pain, pruritus, tenesmus, and rectal discharge may be present if the rectal mucosa is infected. Bloody diarrhea may also occur. Rectal infection may occur from anal intercourse or, in women, by local spread of the organism.

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