Complications of Gonococcal Infection

Abstract

When the gonococci spread from the urethra and cervix they can cause serious medical problems. The introduction of sulphonamides and penicillin was accompanied by a marked reduction in the frequency of gonococcal complications. Since antibiotics the incidence of gonococcal arthritis has diminished to .1-.3% of cases. Gonorrheal arthritis formerly affected men more frequently but now it is more common in women. This change is attributed to the fact that males more often seek early treatment. Septicemic spread may cause generalized dermatitis arthritis endocarditis and meningitis. Although gonococci were thought to be restrained to local areas because they could survive only in tissues having columnar mucous epithelium recent immunologic mechanisms with serum bacteriological activity have been shown to be important also. Increased virulence of disseminated gonococci is another factor. Gonococci from systemic infectious behave differently from those of local infections and act more like meningococci. Menstruation and pregnancy appear to favor dissemination. Pelvic surgery also increases the risk. Septic gonococcal dermatitis occurs in 1-2% of patients with gonorrhea. The majority of cases are seen in female patients. Parenteral treatment with 4.5 million units of penicillin daily for 2 days followed by oral penicillin for 10 days has been successful. Some patients have a tendency to recover spontaneously . Gonococcal infection may extend from the cervix into the uterus and then into the fallopian tubes and finally into the peritoneal cavity. Abscess formation is the most frequent complication of acute pelvic inflammatory disease. Cul-de-sac aspirations usually reveal a mixed infection. Treatment therefore requires broad spectrum antibiotics. Tubal occlusion usually follows and causes infertility. Involvement of the heart is life-threatening. Arterial emboli can produce cerebral vas cular accidents or acute nephritis. Before the antibiotic era the gonoc occus was the etiology of 11-26% of cases of bacterial endocarditis. Since antibiotics in a report of a series of 95 cases of endocarditis no ne had gonococcal involvement and less that 5% of purulent pericarditis was of gonococcal origin. Reported incidence of abnormal electrocardiograms associated with disseminated gonorrhea has varied from 0 to 40%. Ophthalmic gonorrhea is a neonatal problem although adult cases do occur. Serious sequelae include corneal scarring perforation of the cornea panophthalmitis and phthisis bulbi. The antibiotic of choice is 50000 units/kg/day for children and 4.8 million units of procaine penicillin per day for adults. Local therapy is saline irrigation every 15 minutes followed by tetracline drops or chloramphenicol drops and decreasing in frequency as improvement occurs. Atropine drops are given concurrently. Treatment should be started early. The best prophylaxis is to treat the mothers in prenatal clinics and with 1% silver nitrate drops for the infant at birth. Gonococcal meningitis may occur in adults who have gential gonorrhea or in the newborn infant at birth.