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Gonorrhea in Adolescents and Young Adults

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Sexually Transmitted Infections in Adolescence and Young Adulthood

Abstract

Gonorrhea is the second most common notifiable disease in the USA. Since 2009, rates of gonorrhea have steadily risen, which is largely attributable to increases among men. If untreated, this infection can cause significant morbidity including hematogenous dissemination, pelvic inflammatory disease, and female infertility, which is often irreversible. Neisseria gonorrhoeae has developed resistance to multiple antibiotics, which has significantly limited treatment options. In this chapter, we will review the epidemiology and pathophysiology of gonorrhea, and we will describe the microbiologic characteristics of N. gonorrhoeae. We will also provide an overview of its main clinical presentations and the latest advances in diagnosis and treatment.

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References

  1. CDC. 2015 Sexually transmitted diseases surveillance. 2015; https://www.cdc.gov/std/stats15/gonorrhea.htm. Accessed 01/11/17. 2017.

  2. CDC. Sexually transmitted infections among young Americans. 2013.

    Google Scholar 

  3. CDC. Sexually transmitted disease surveillance 2014. Atlanta: US Department of Health and Human Services; 2015.

    Google Scholar 

  4. Greydanus DE, Dodich C. Pelvic inflammatory disease in the adolescent: a poignant, perplexing, potentially preventable problem for patients and physicians. Curr Opin Pediatr. 2015;27(1):92–9.

    PubMed  Google Scholar 

  5. Scott HM, Irvin R, Wilton L, et al. Sexual behavior and network characteristics and their association with bacterial sexually transmitted infections among black men who have sex with men in the United States. PLoS One. 2015;10(12):e0146025.

    PubMed  PubMed Central  Google Scholar 

  6. Lewis FM, Dittus P, Salmon ME, Nsuami MJ. School-based sexually transmitted disease screening: review and programmatic guidance. Sex Transm Dis. 2016;43(2 Suppl 1):S18–27.

    PubMed  PubMed Central  Google Scholar 

  7. Marrazzo JM, Apicella MA. 214 – Neisseria gonorrhoeae (Gonorrhea) A2 – Bennett, John E. In: Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases (Eighth Edition). Philadelphia: Content Repository Only!; 2015:2446–2462.e2443.

    Google Scholar 

  8. Brooks GF, Carroll KC, Butel JS, Morse SA, Mietzner TA The Neisseriae. In: Brooks GF, Carroll KC, Butel JS, Morse SA, Mietzner TA, ed. Jawetz, Melnick, & Adelberg’s medical microbiology. 26th ed. New York: McGraw-Hill; 2013.

    Google Scholar 

  9. Edwards JL, Apicella MA. The molecular mechanisms used by Neisseria gonorrhoeae to initiate infection differ between men and women. Clin Microbiol Rev. 2004;17(4):965–81. table of contents

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Detels R, Green AM, Klausner JD, et al. The incidence and correlates of symptomatic and asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in selected populations in five countries. Sex Transm Dis. 2011;38(6):503–9.

    PubMed  PubMed Central  Google Scholar 

  11. Delpech V, Martin IM, Hughes G, Nichols T, James L, Ison CA. Epidemiology and clinical presentation of gonorrhoea in England and Wales: findings from the Gonococcal Resistance to Antimicrobials Surveillance Programme 2001-2006. Sex Transm Infect. 2009;85(5):317–21.

    CAS  PubMed  Google Scholar 

  12. Bozicevic I, Fenton KA, Martin IM, et al. Epidemiological correlates of asymptomatic gonorrhea. Sex Transm Dis. 2006;33(5):289–95.

    PubMed  Google Scholar 

  13. Ramsey KH, Schneider H, Cross AS, et al. Inflammatory cytokines produced in response to experimental human gonorrhea. J Infect Dis. 1995;172(1):186–91.

    CAS  PubMed  Google Scholar 

  14. Griffiss JM, Lammel CJ, Wang J, Dekker NP, Brooks GF. Neisseria gonorrhoeae coordinately uses Pili and Opa to activate HEC-1-B cell microvilli, which causes engulfment of the gonococci. Infect Immun. 1999;67(7):3469–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Makino S, van Putten JP, Meyer TF. Phase variation of the opacity outer membrane protein controls invasion by Neisseria gonorrhoeae into human epithelial cells. EMBO J. 1991;10(6):1307–15.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Parsons NJ, Curry A, Fox AJ, Jones DM, Cole JA, Smith H. The serum resistance of gonococci in the majority of urethral exudates is due to sialylated lipopolysaccharide seen as a surface coat. FEMS Microbiol Lett. 1992;69(3):295–9.

    CAS  PubMed  Google Scholar 

  17. Timmerman MM, Shao JQ, Apicella MA. Ultrastructural analysis of the pathogenesis of Neisseria gonorrhoeae endometrial infection. Cell Microbiol. 2005;7(5):627–36.

    CAS  PubMed  Google Scholar 

  18. Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med. 2015;372(21):2039–48.

    PubMed  Google Scholar 

  19. Workowski K. In the clinic. Chlamydia and gonorrhea. Ann Intern Med. 2013;158(3):Itc2–1.

    PubMed  Google Scholar 

  20. McCutchan JA. Epidemiology of venereal urethritis: comparison of gonorrhea and nongonococcal urethritis. Rev Infect Dis. 1984;6(5):669–88.

    CAS  PubMed  Google Scholar 

  21. Sherrard J, Barlow D. Gonorrhoea in men: clinical and diagnostic aspects. Genitourin Med. 1996;72(6):422–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Bignell C. 2009 European (IUSTI/WHO) guideline on the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS. 2009;20(7):453–7.

    CAS  PubMed  Google Scholar 

  23. Taylor SN. Epididymitis. Clin Infect Dis. 2015;61(Suppl 8):S770–3.

    PubMed  Google Scholar 

  24. Marrazzo JM, Martin DH. Management of women with cervicitis. Clin Infect Dis. 2007;44(Suppl 3):S102–10.

    PubMed  Google Scholar 

  25. Curran JW. Management of gonococcal pelvic inflammatory disease. Sex Transm Dis. 1979;6(2 Suppl):174–80.

    CAS  PubMed  Google Scholar 

  26. Sweet RL, Blankfort-Doyle M, Robbie MO, Schacter J. The occurrence of chlamydial and gonococcal salpingitis during the menstrual cycle. JAMA. 1986;255(15):2062–4.

    CAS  PubMed  Google Scholar 

  27. McCormack WM. Pelvic inflammatory disease. N Engl J Med. 1994;330(2):115–9.

    CAS  PubMed  Google Scholar 

  28. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recommend Rep. 2015;64(Rr-03):1–137.

    Google Scholar 

  29. Wiesenfeld HC, Hillier SL, Krohn MA, et al. Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease. Obstet Gynecol. 2002;100(3):456–63.

    PubMed  Google Scholar 

  30. Westrom L, Joesoef R, Reynolds G, Hagdu A, Thompson SE. Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis. 1992;19(4):185–92.

    CAS  PubMed  Google Scholar 

  31. Haggerty CL, Schulz R, Ness RB. Lower quality of life among women with chronic pelvic pain after pelvic inflammatory disease. Obstet Gynecol. 2003;102(5. Pt 1):934–9.

    PubMed  Google Scholar 

  32. Peterman TA, O’Connor K, Bradley HM, Torrone EA, Bernstein KT. Gonorrhea control, United States, 1972-2015, a narrative review. Sex Transm Dis. 2016;43(12):725–30.

    PubMed  PubMed Central  Google Scholar 

  33. Moore MS, Golden MR, Scholes D, Kerani RP. Assessing trends in chlamydia positivity and gonorrhea incidence and their associations with the incidence of pelvic inflammatory disease and ectopic pregnancy in Washington state, 1988-2010. Sex Transm Dis. 2016;43(1):2–8.

    PubMed  Google Scholar 

  34. Danby CS, Cosentino LA, Rabe LK, et al. Patterns of extragenital chlamydia and gonorrhea in women and men who have sex with men reporting a history of receptive anal intercourse. Sex Transm Dis. 2016;43(2):105–9.

    PubMed  PubMed Central  Google Scholar 

  35. Osborne NG, Grubin L. Colonization of the pharynx with Neisseria gonorrhoeae: experience in a clinic for sexually transmitted diseases. Sex Transm Dis. 1979;6(4):253–6.

    CAS  PubMed  Google Scholar 

  36. Ocular prophylaxis for gonococcal ophthalmia neonatorum: reaffirmation recommendation statement. Am Fam Physician. 2012;85(2):195–6; quiz 197–8.

    Google Scholar 

  37. Pellerano RA, Bishop V, Silber TJ. Gonococcal conjunctivitis in adolescents. Recognition and management. Clin Pediatr. 1994;33(2):114–6.

    CAS  Google Scholar 

  38. Wan WL, Farkas GC, May WN, Robin JB. The clinical characteristics and course of adult gonococcal conjunctivitis. Am J Ophthalmol. 1986;102(5):575–83.

    CAS  PubMed  Google Scholar 

  39. McAnena L, Knowles SJ, Curry A, Cassidy L. Prevalence of gonococcal conjunctivitis in adults and neonates. Eye (Lond). 2015;29(7):875–80.

    CAS  Google Scholar 

  40. Del Rio C, Stephens DS, Knapp JS, Rice RJ, Schalla WO. Comparison of isolates of Neisseria gonorrhoeae causing meningitis and report of gonococcal meningitis in a patient with C8 deficiency. J Clin Microbiol. 1989;27(5):1045–9.

    PubMed  PubMed Central  Google Scholar 

  41. O'Brien JP, Goldenberg DL, Rice PA. Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms. Medicine. 1983;62(6):395–406.

    CAS  PubMed  Google Scholar 

  42. Bleich AT, Sheffield JS, Wendel GD Jr, Sigman A, Cunningham FG. Disseminated gonococcal infection in women. Obstet Gynecol. 2012;119(3):597–602.

    PubMed  Google Scholar 

  43. Bardin T. Gonococcal arthritis. Best Pract Res Clin Rheumatol. 2003;17(2):201–8.

    PubMed  Google Scholar 

  44. Shetty A, Ribeiro D, Evans A, Linnane S. Gonococcal endocarditis: a rare complication of a common disease. J Clin Pathol. 2004;57(7):780–1.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Cachay E, Mathews WC, Reed SL, Swancutt MA, Fierer J. Gonococcal meningitis diagnosed by DNA amplification: case report and review of the literature. AIDS Patient Care STDS. 2007;21(1):4–8.

    PubMed  Google Scholar 

  46. Landis SJ, Stewart IO, Chernesky MA, et al. Value of the gram-stained urethral smear in the management of men with urethritis. Sex Transm Dis. 1988;15(2):78–84.

    CAS  PubMed  Google Scholar 

  47. Lossick JG, Smeltzer MP, Curran JW. The value of the cervical gram stain in the diagnosis and treatment of gonorrhea in women in a venereal disease clinic. Sex Transm Dis. 1982;9(3):124–7.

    CAS  PubMed  Google Scholar 

  48. Ison CA. Laboratory methods in genitourinary medicine. Methods of diagnosing gonorrhoea. Genitourin Med. 1990;66(6):453–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Thayer JD, Martin JE Jr. A selective medium for the cultivation of N. gonorrhoeae AND N. Meningitidis. Public Health Rep. 1964;79:49–57.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Van Dyck E, Ieven M, Pattyn S, Van Damme L, Laga M. Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by enzyme immunoassay, culture, and three nucleic acid amplification tests. J Clin Microbiol. 2001;39(5):1751–6.

    PubMed  PubMed Central  Google Scholar 

  51. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae – 2014. Morb Mortal Wkly Rep Recomm Rep 2014;63(Rr-02):1–19.

    Google Scholar 

  52. Harryman L, Scofield S, Macleod J, et al. Comparative performance of culture using swabs transported in Amies medium and the Aptima Combo 2 nucleic acid amplification test in detection of Neisseria gonorrhoeae from genital and extra-genital sites: a retrospective study. Sex Transm Infect. 2012;88(1):27–31.

    PubMed  Google Scholar 

  53. Stewart CM, Schoeman SA, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of self-taken swabs versus clinician taken swab cultures for diagnosing gonorrhoea in women: single centre, diagnostic accuracy study. BMJ. 2012;345:e8107.

    PubMed  PubMed Central  Google Scholar 

  54. Van Der Pol B, Ferrero DV, Buck-Barrington L, et al. Multicenter evaluation of the BDProbeTec ET System for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens, female endocervical swabs, and male urethral swabs. J Clin Microbiol. 2001;39(3):1008–16.

    Google Scholar 

  55. Kent CK, Chaw JK, Wong W, et al. Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003. Clin Infect Dis. 2005;41(1):67–74.

    PubMed  Google Scholar 

  56. Schachter J, Moncada J, Liska S, Shayevich C, Klausner JD. Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men. Sex Transm Dis. 2008;35(7):637–42.

    CAS  PubMed  Google Scholar 

  57. Kirkcaldy RD, Harvey A, Papp JR, et al. Neisseria gonorrhoeae antimicrobial susceptibility surveillance – the gonococcal isolate surveillance project, 27 sites, United States, 2014. MMWR Surveill Summ. 2016;65(7):1–19.

    PubMed  Google Scholar 

  58. LeFevre ML. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161(12):902–10.

    PubMed  Google Scholar 

  59. Newacheck PW, Hung YY, Park MJ, Brindis CD, Irwin CE Jr. Disparities in adolescent health and health care: does socioeconomic status matter? Health Serv Res. 2003;38(5):1235–52.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA

    Valeria D. Cantos & Carlos del Rio

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  1. Valeria D. Cantos
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  2. Carlos del Rio
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Correspondence to Valeria D. Cantos .

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Editors and Affiliations

  1. Hubert Department of Global Health, Rollins School of Public Health Emory University, Atlanta, GA, USA

    Sophia A. Hussen

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Cantos, V.D., del Rio, C. (2020). Gonorrhea in Adolescents and Young Adults. In: Hussen, S. (eds) Sexually Transmitted Infections in Adolescence and Young Adulthood. Springer, Cham. https://doi.org/10.1007/978-3-030-20491-4_12

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  • DOI: https://doi.org/10.1007/978-3-030-20491-4_12

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