Q&A: Complications of Gonorrhea

Gonorrhea, or infection with the gram-negative coccus Neisseria gonorrhoeae, is a major cause of morbidity among sexually-active individuals worldwide. In the United States, it is the second most commonly reported communicable disease, with more than 500,000 cases reported annually, with probably an equal number of cases that remain unreported. In the UK, the prevalence of gonorrhoea has increased gradually over a period of ten years, principally in men with a disproportionate increase in men who have sex with men (MSM).

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This is a Question & Answer revision article designed for medical students and professionals preparing for the PLAB, MRCP or USMLE examinations. They are based on actual questions from these examinations. You may find the Sexually Transmitted Infections article more useful, or one of our many articles on Diseases & Conditions, Medical Syndromes, Health & Wellness or Home Remedies.

In this article:
Complications of Gonorrhoea
MCQ exam: clinical scenario
MCQ exam: answer
MCQ exam: explanation

Complications of Gonorrhoea

Gonorrhea is a major cause of urethritis in men and cervicitis in women; the latter can result in pelvic inflammatory disease (PID), infertility, ectopic pregnancy, and chronic pelvic pain. Extragenital infections of the pharynx and rectum are prevalent in certain groups, such as men who have sex with men (MSM). Invasive infections with N. gonorrhoeae, including disseminated gonococcal infection, endocarditis, and meningitis, are uncommon but can result in serious morbidity. Gonococcal resistance to several classes of antimicrobial agents is widespread. The growing threat of antimicrobial resistance in N. gonorrhoeae highlights the importance of ensuring the availability of appropriate diagnostic modalities for surveillance.

MCQ exam: clinical scenario

Gonorrhoea typically causes:

a) Varicocele
b) Orchitis
c) Hydrocele
d) Epididymitis
e) Seminoma

MCQ exam: answer

The correct answer is D.

MCQ exam: explanation

Gonorrhea and tuberculosis almost always infect the epididymis before testis.

Acute unilateral epididymitis can be a complication of gonococcal infection, although it is more commonly due to C. trachomatis infection, especially in patients less than 35 years of age. Combined gonococcal and chlamydial infections of the epididymis are more frequent than epididymal infections caused by N. gonorrhoeae alone. Unilateral testicular pain and swelling may be the sole presenting complaints of men with epididymitis.

Reference(s)
1). UpToDate: Clinical manifestations and diagnosis of Neisseria gonorrhoeae infection in adults and adolescents. Available online: https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-neisseria-gonorrhoeae-infection-in-adults-and-adolescents