Gonorrhea: a pediatric perspective.

Abstract

1. Lillian Sung, MD* 2. Noni E. MacDonald, MD, FRCP(C)† 1. 2. *Fellow, Pediatric Infectious Diseases. 3. 4. †Chief, Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada. 1. The most common presentation of gonorrhea in the neonatal period is purulent conjunctivitis. 2. Neisseria gonorrhoeae primarily causes infection of the endocervix in the postpubertal female in contrast to vaginitis in the prepubertal female. 3. The treatment of choice for gonococcal infections is a third-generation cephalosporin. The bacterium that causes gonorrhea is Neisseria gonorrhoeae , a nonmotile, Gram-negative diplococcus typically found intracellularly within the neutrophils in the purulent discharge of patients who have gonococcal urethritis or cervicitis. During the past 20 years, the number of cases of gonorrhea reported to the Centers for Disease Control and Prevention (CDC) has declined dramatically. The reported rate in 1975 was 468 cases per 100,000 persons, which declined to 168 cases in 1994 and 150 cases in 1995. Unfortunately, the rate of decline among adolescents has been less dramatic than among older adults, leaving adolescents and young adults between the ages of 15 and 24 years with the highest incidence of disease. Sexual transmission remains the most important means by which gonorrhea is spread. With the risk of transmission estimated to be 20% to 50% per contact, spread is more efficient if the source is an infected male rather than an infected female. Because sexual activity with more than one partner is an important factor in the persistence of gonorrhea in a population, coinfection with other sexually transmitted diseases (STDs) is common. Among individuals who have gonorrhea, coinfection with Chlamydia may be as high as 15% to 20%. Perinatal transmission may occur if an infected pregnant woman is not screened and treated prior to delivery. The primary site of infection with N gonorrhoeae is the columnar or cuboidal epithelium of the mucous membranes of the lower genital tract, rectum, pharynx, and conjunctivae. Adherence to the epithelium is aided by bacterial pili and other adherence factors. After …