Cutaneous manifestations of gonorrhea
- Abdul-Ghani Kibbi, MD, FACP, FAAD
Abdul-Ghani Kibbi, MD, FACP, FAAD
- Professor and Chair, Department of Dermatology
- American University of Beirut Medical Center
- Ossama Abbas, MD
Ossama Abbas, MD
- Assistant Professor, Department of Dermatology
- American University of Beirut Medical Center
Gonorrhea is a common bacterial sexually transmitted disease caused by infection with Neisseria gonorrhoeae, a Gram-negative aerobic diplococcus. Although gonorrhea primarily affects the mucosa, cutaneous manifestations also may occur, particularly in patients with disseminated gonococcal infection (DGI).
Early diagnosis and treatment of gonorrhea is desirable, as untreated infection may result in pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy, or infertility, and may facilitate human immunodeficiency virus (HIV) transmission [1-3]. The recognition of gonorrhea-related skin manifestations may assist with early diagnosis, thereby decreasing transmission of the disease and reducing the risk for complications.
The clinical manifestations of primary cutaneous gonorrhea, secondary cutaneous gonorrhea, and disseminated gonococcemia will be reviewed here. The epidemiology, pathogenesis, extracutaneous manifestations, diagnosis, and management of gonococcal infection are discussed separately. (See "Epidemiology and pathogenesis of Neisseria gonorrhoeae infection" and "Clinical manifestations and diagnosis of Neisseria gonorrhoeae infection in adults and adolescents" and "Treatment of uncomplicated gonococcal infections" and "Disseminated gonococcal infection" and "Gonococcal infection in the newborn".)
Neisseria gonorrhoeae is a Gram-negative, intracellular aerobic diplococcus that exclusively infects humans. The bacterium is capable of colonizing various mucosal surfaces including genitourinary, rectal, and pharyngeal sites. The outer membrane proteins and pili structures of Neisseria gonorrhoeae facilitate its attachment to host mucosal epithelial cells and allow for the penetration of the organism into the subepithelium [1,4,5]. (See "Epidemiology and pathogenesis of Neisseria gonorrhoeae infection", section on 'Pathogenesis'.)
The presence of Neisseria gonorrhoeae in host tissue usually elicits an acute inflammatory response that can manifest clinically as purulent discharge, epithelial sloughing, or abscess formation. Infrequently, hematologic dissemination occurs. (See "Disseminated gonococcal infection".)
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- CUTANEOUS MANIFESTATIONS
- Primary cutaneous gonorrhea
- - Extragenital
- - Genital
- Secondary cutaneous gonorrhea
- - Genital
- - Anal
- - Oral
- Disseminated gonococcal infection
- - Tenosynovitis, dermatitis, polyarthralgia syndrome
- - Purulent arthritis syndrome without skin lesions
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS