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Primary gonorrhea infection in Child
See also in: Anogenital
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Primary gonorrhea infection in Child

See also in: Anogenital
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Contributors: Saami Khalifian MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Gonorrhea is a common sexually transmitted infection caused by the gram-negative intracellular diplococcus Neisseria gonorrhoeae. It affects both males and females, most commonly individuals aged 15-24. It is highly contagious and primarily spread through sexual contact in sexually active adolescents. However, other routes of transmission are possible in children and adolescents, including via indirect contact through sharing of contaminated objects (especially in prepubescent girls), passage from an infected mother to her fetus during childbirth, or sexual abuse. Notably, all children with gonorrheal infection must be screened for sexual abuse, as this is the most frequent cause in infants and children.

The incubation period of N. gonorrhoeae is short. The average time from infection to symptom onset lasts approximately 2-7 days.

In prepubescent girls, the most common manifestation is vaginitis with discharge, itching, and pain. Unlike in older female patients, young girls are less likely to develop pelvic inflammatory disease (PID), since the ascending infection leading to PID is usually due in part to the menstrual cycle. In older pubescent girls, the endocervical canal is the most common site of infection, with manifestations similar to those seen in women, including dysuria, vaginal discharge, bleeding, and menstrual pain.

In boys, the manifestations are similar to those seen in adults, and the most common clinical manifestation is anterior urethritis, with purulent urethral discharge and dysuria. Complications include epididymitis, vesiculitis, and prostatitis, which occur via local extension. Epididymitis may manifest as unilateral testicular edema and pain together with the features of urethritis.

Notably, proctitis and pharyngitis occur in both sexes via direct mucosal infection, and are strongly associated with sexual assault in non-sexually active children; however, infections of the rectum and pharynx are often asymptomatic.

Neonates born to infected mothers commonly manifest a purulent conjunctivitis called ophthalmia neonatorum, which is a major cause of blindness in the developing world. In the United States, the rate of this infection is low due to routine screening of mothers and preventive application of antibiotic ointment immediately after birth. Neonatal infection can also lead to sepsis with invasive and disseminated gonococcal infections, including meningitis and arthritis.

In children and adolescents, disseminated and invasive gonococcal infections are uncommon.

Related topics: Gonococcal Conjunctivitis, Gonococcal Cervicitis, Disseminated Gonorrhea

Codes

ICD10CM:
A54.9 – Gonococcal infection, unspecified

SNOMEDCT:
15628003 – Gonorrhea

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

For girls – If there are concerns about sexual activity or assault, other sexually transmitted diseases (STDs) must be considered because presentation can range from asymptomatic to vaginal discharge to abdominal pain. The differential diagnosis includes:
For boys – If there are concerns about sexual activity or assault, other STDs are the main concern, including C. trachomatis infection, genital herpes infection, or other forms of urethritis (only if the direct examination and culture are negative). Presentation can range from asymptomatic to penile discharge to systemic symptoms.

In cases of arthritis, other causes of joint pain should be ruled out.

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Last Reviewed: 05/22/2017
Last Updated: 09/26/2019
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Primary gonorrhea infection in Child
See also in: Anogenital
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Primary gonorrhea infection (Female) : Urethral pus, Vaginal bleeding, Vaginal discharge, Dyspareunia, Dysuria, Sexually active
Clinical image of Primary gonorrhea infection
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