see also:

• clinically important bacteria
• pelvic inflammatory disease (PID)
• sexually transmitted infections (STDs/STIs)
• epididymo-orchitis
• wikipedia

• the gonococcus (Neisseria gonorrhoeae) is an obligate aerobe, bean-shaped diplococcus, fastidious, oxidase +ve Gram -ve coccoid discovered in 1879
• it is transmitted by sexual contact and co-infections with other causes of sexually transmitted infections (STDs/STIs) is common
• in 2018, WHO estimates that 78 million people worldwide are infected with gonorrhea each year, with almost 1 million new cases in USA each year
• the European Centre for Disease Prevention and Control reported that in 2017, there were 75 cases of gonococcal disease per 100,000 people in the UK - 3x higher than the average rate in Europe (next highest rate is Ireland at 47 cases/100,000, then Iceland and Scandinavia and Malta), UK accounts for 55% of cases in Europe with 49,000 cases reported in Britons (10% are in France, 9% in Spain, 8% in Netherlands). Cases increased by 51% from 2013-2017 and is thought to be a signal of the prevalence sex without condoms, and almost half of cases were in gay men.
• sexual contact may result in either:
  • pelvic inflammatory disease (PID) with purulent cervical discharge (gonorrhoea) and 10% risk of infertility per episode
  • pharyngitis via oral sex or via tongue kissing (French kissing)
  • proctitis via anal sex
  • urethritis with purulent urethral discharge (gonorrhoea or “the clap”)
  • prostatitis
  • epididymo-orchitis
  • conjunctivitis
  • 10% of cases are thought to be asymptomatic
• neonates may develop conjunctivitis
• disseminated infections can occur, resulting in endocarditis, meningitis or gonococcal dermatitis-arthritis syndrome.
  • dermatitis-arthritis syndrome presents with arthralgia, tenosynovitis and painless non-pruritic (non-itchy) dermatitis.
• antibiotic resistance
  • 2018: 1st case of highly resistant strain to both ceftriaxone and azithromycin, requiring iv ertapenem - this case was acquired in South-East Asia