Clinical features of gonorrhoea

Symptoms are present in the majority of affected men (90-95%) but only 50% of women (1).

Clinical features in men:

• genital tract infections
  • usually present within 2-5 days with urethritis characterised by urethral discharge (>80%) and/or dysuria (>50%)
  • may be asymptomatic in <10%
  • urethral discharge is usually described as mucopurulent or purulent
• rectal infection
  • is asymptomatic in majority but anal discharge (12%) or perianal/anal pain or discomfort (7%) may be seen in some patients (2)
• pharyngeal infection
  • is usually asymptomatic in more than 90% (2)
• rarely, epididymal tenderness/swelling or balanitis is seen on examination

Clinical features in women:

• genital tract infection
  • increased or altered vaginal discharge is seen in up to 50% of infected females.
  • mucopurulent endocervical discharge and easily induced endocervical bleeding (<50%)
  • lower abdominal pain - in up to 25%
  • pelvic/lower abdominal tenderness in <5%
  • intermenstrual bleeding or menorrhagia (1)
  • urethral infection may cause dysuria (12%) but not frequency
  • there may be bartholinitis
• rectal infections
  • frequently develops by transmucosal spread of infected genital secretions than from anal intercourse
  • usually asymptomatic
• pharyngeal infection
  • is usually asymptomatic in more than 90% (2)

Although uncommon patients may have features of complications of gonorrhoea:

• epididymo-orchitis or prostatitis in men and pelvic inflammatory disease (PID) in women.
• disseminated gonococcal infection causes arthralgia, arthritis, tenosynovitis(1), fever, malaise, myalgia and a diffuse pustular and erythematous rash.

Reference:

• (1) Health Protection Agency (HPA) 2010. Guidance for gonorrhoea testing in England and Wales.
• (2) Bignell C, Fitzgerald M; Guideline Development Group.UK national guideline for the management of gonorrhoea in adults, 2011. Int J STD AIDS. 2011;22(10):541-7.
• (3) Bignell C; IUSTI/WHO. 2009 European (IUSTI/WHO) guideline on the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS. 2009;20(7):453-7.