Case history #1
A 35-year-old white man presents with a history of unprotected insertive anal sex with 2 male partners and a 3-day history of urethral irritation, dysuria, and purulent discharge at the meatus.
Case history #2
A 24-year-old black woman presents with a history of unprotected vaginal sex with one male partner who told her that he had purulent urethral discharge that was treated as gonorrhea 1 week ago. The woman has had some increased vaginal discharge and pain with intercourse.
Gonorrhea can be symptomatic or asymptomatic at any site where unprotected sex has occurred. Pharyngeal gonorrhea is most often asymptomatic but can cause tonsillitis or pharyngitis. Rectal gonorrhea infection can also be asymptomatic or have symptoms of rectal pain and discharge. Although gonococcal urethritis is typically symptomatic, it can also be asymptomatic. Women with cervicitis may have no obvious symptoms or signs such as mucopurulent discharge at the cervical os. Similarly, upper genital tract infections (epididymitis, prostatitis, orchitis, and pelvic inflammatory disease) do not always have overt signs of urethritis or cervicitis. Exposure to infected genital secretions can lead to gonorrhea conjunctivitis that presents with thick white/yellow discharge.
A more severe and uncommon presentation of gonorrhea is disseminated gonococcal infection (DGI), which results from gonococcal bacteremia. DGI can present with petechial or pustular acral skin lesions, asymmetric arthralgia, tenosynovitis, or septic arthritis. It is occasionally complicated by perihepatitis, endocarditis, meningitis, or myocarditis. Patients with DGI may have no urogenital symptoms.
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