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Epidemiology and pathogenesis of Neisseria gonorrhoeae infection

Gregory A Price, PhD
Margaret C Bash, MD, MPH
Section Editor
Noreen A Hynes, MD, MPH, DTM&H
Deputy Editor
Allyson Bloom, MD


Infection with Neisseria gonorrhoeae is a global problem. In the United States, it is the second most commonly reported communicable disease and the second most prevalent sexually transmitted infection (STI). Symptomatic gonorrhea results in urethritis in males and cervicitis in females. Untreated gonorrhea can lead to epididymitis in males and pelvic inflammatory disease (PID) in females, which can lead to serious sequelae such as infertility, ectopic pregnancy, and chronic pelvic pain [1]. Infrequently, gonococcal infections can become invasive, leading to disseminated gonococcal infections (DGI), which may result in gonococcal arthritis-dermatitis syndrome, suppurative arthritis, endocarditis, and meningitis.

The epidemiology and pathogenesis of gonorrhea will be discussed here. The clinical manifestations, diagnosis, and management of gonococcal infections are discussed in detail elsewhere. (See "Clinical manifestations and diagnosis of Neisseria gonorrhoeae infection in adults and adolescents" and "Cutaneous manifestations of gonorrhea" and "Treatment of uncomplicated gonococcal infections" and "Disseminated gonococcal infection".)


Global incidence — The precise global burden of N. gonorrhoeae is difficult to establish because of the lack of diagnostic capability and/or reporting systems in many parts of the world. The World Health Organization (WHO) has estimated the global incidence of several sexually transmitted infections (STIs) among individuals aged 15 to 49 years based on data from regions that have good case-based surveillance systems as well as data from population-based studies [2]. In 2008, the WHO estimated global incidence of N. gonorrhoeae was 106 million cases, which represented a 21 percent increase over the estimate for 2005. The highest incidence areas included Africa and the Western Pacific (including China and Australia) regions. In one review of infections during pregnancy in sub-Saharan Africa, the prevalence of sexually transmitted and reproductive tract infections was comparable with that of malaria [3]. The prevalence of N. gonorrhoeae during pregnancy ranged from 1.5 percent in West and Central Africa to 4.9 percent in East and Southern Africa.

There are several potential reasons for the increasing global rates of gonorrhea. As an example, in some areas, particularly sub-Saharan Africa, incidence rates of gonorrhea may be influenced by the increased prevalence of HIV infection (see 'Association with HIV' below). Improved diagnostics and increased reporting from certain countries also likely contribute.

United States

Incidence — Gonorrhea is the second most commonly reported communicable disease and the second most prevalent sexually transmitted infection (STI) in the United States. In 2013, there were 333,004 cases of gonorrhea reported in the US [1]. However, the actual number of cases is likely much higher due to under-reporting and asymptomatic infections [4,5].


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