Epidemiology

Etiology

Pathogen
- Neisseria gonorrhoeae (N. gonorrhoeae, gonococcus)
- Gram-negative, intracellular, aerobic, diplococci

Gonococcal conjunctivitis
- Affects newborns (vertical transmission) and sexually active individuals
- Manifests as hyperacute conjunctivitis
Gonococcal pharyngitis
- Sore throat
- Pharyngeal exudate
- Cervical lymphadenitis

Gram stain
- Findings: polymorphonuclear leukocytes and intracellular gram-negative diplococci

Hematogenous spread of N. gonorrhoeae from an untreated mucosal gonococcal infection

DGI typically manifests as gonococcal arthritis without symptoms of a localized mucosal infection.

Arthritis-dermatitis syndrome
- Polyarthralgias: migratory, asymmetric arthritis that can become purulent
- Tenosynovitis: simultaneous inflammation of several tendons (e.g., in the fingers, toes, wrists, ankles)
- Dermatitis
  - Vesicular, pustular, or maculopapular lesions, possibly with a necrotic or hemorrhagic center
  - Distribution: acral (i.e., the extensor surfaces of the hands and feet, sometimes involving the palms and soles), the trunk
Purulent gonococcal arthritis
- Abrupt monoarticular or oligoarticular inflammation
- Commonly affects knees, ankles, elbows, and wrists
- Skin manifestations and tenosynovitis are typically absent.