What are the extragenital manifestations of gonorrhea?

Updated: Jun 15, 2021
  • Author: Shahab Qureshi, MD, FACP; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Men and women may exhibit gonococcal infection of the pharynx, rectum, and eye.

Gonococcal pharyngitis is most commonly acquired during orogenital contact, with fellatio predisposing to infection more so than cunnilingus. Pharyngitis is often asymptomatic; however, it may present as exudative pharyngitis with cervical lymphadenopathy. Most cases of pharyngeal infection resolve spontaneously and are believed to be less transmissible than rectal or genital gonorrhea.

Although rectal cultures are positive for gonorrhea in up to 40% of women with cervical gonorrhea (a similar percentage noted in infected homosexual men), symptoms of proctitis are unusual. When symptoms do occur, males are more likely to exhibit symptoms, since trauma during anal intercourse or inoculum size may play a role.

Eye involvement in adults occurs by autoinoculation of gonococci into the conjunctival sac from a primary site of infection, such as the genitals, and is usually unilateral. The most common form of presentation is a purulent conjunctivitis, which may rapidly progress to panophthalmitis and loss of the eye unless promptly treated. Gonococcal conjunctivitis is often reported to be painful and may exhibit photophobia and purulent drainage.

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