GONORRHEA

Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2005)

I. IDENTIFICATION

A. CLINICAL DESCRIPTION: A sexually transmitted bacterial disease (STD) caused by Neisseria gonorrhoeae. In males it is usually characterized by a purulent urethral discharge and dysuria. In females, initially, there is a urethritis or cervicitis often so mild it may pass unnoticed. Dependent upon sexual practices, pharyngal and anorectal infections can occur. In males, the urethral infection is usually self-limiting; however, it may progress to epididymitis, and in rare cases, it can disseminate into an arthritis-dermatitis syndrome, endocarditis, and meningitis. Twenty percent of women infected with gonorrhea may progress to uterine infection that may lead to endometritis or salpingitis (PID) and the subsequent risk of infertility.

B. REPORTING CRITERIA: Laboratory confirmation.

C. LABORATORY CRITERIA FOR CONFIRMATION:

• Isolation of typical Gram-negative, oxidase-positive diplococci (presumptive N. gonorrhoeae ) from clinical specimen, OR
• Demonstration of N. gonorrhoeae in a clinical specimen by detection of antigen or nucleic acid, OR
• Observation of Gram-negative intracellular diplococci in a urethral smear from a man.

D. WISCONSIN CASE DEFINITION: A laboratory confirmed infection.

II. ACTIONS REQUIRED / PREVENTION MEASURES

A. WISCONSIN DISEASE SURVEILLANCE CATEGORY II: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 72 hours of the identification of a case or suspected case.

B. EPIDEMIOLOGY REPORTS REQUESTED:

• Acute and Communicable Diseases Case Report (DPH 4151).
• Sexually Transmitted Diseases Morbidity and Epidemiologic Case Report (DPH 4243).

C. PUBLIC HEALTH INTERVENTIONS:

• Patients should be counseled on methods to reduce their risk for STDs, including HIV.
• Patients treated for gonorrhea should also be tested and treated for Chlamydia and have a syphilis serology done.
• Treated patients and sex partners should be advised to avoid sex at least three days following the completion of treatment and symptoms cease. Only patients whose symptoms persist after treatment need a test of cure.
• Recently there has been an increase in the number of strains of gonorrhea resistant to antibiotics, particularly penicillin and tetracyclines. These resistant strains are of special concern for the LHD and may require more extensive tests to identify, and are generally more expensive to treat than uncomplicated gonorrhea. Cases of resistant gonorrhea should be intensively followed and every attempt should be made to interview contacts and confirm their test results and treatment.
• Gonococcal infection may occur in newborns exposed to their mothers infected cervical exudate. The ophthalmia neonatorum caused by gonorrhea can lead to blindness and the infant may develop a disseminated infection. Instillation of prophylactic agent into the eyes of newborns is recommended to prevent gonococcal ophthalmia and is mandated by law. Gonococcal ophthalmia can lead to blindness and, untreated, can progress to disseminated gonococcal infection.
• Source investigation by LHD. Patients should to be interviewed for all sexual partners in the 30 days prior to the onset of symptoms or positive test.

 III. CONTACTS FOR CONSULTATION

A. BCDP / COMMUNICABLE DISEASE STD SECTION: (608) 266-7365.

B. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.

C. WSLH / BACTERIOLOGY: (608) 263-3421.

D. MILWAUKEE BUREAU OF LABORATORIES: (414) 286-3526.

IV. RELATED REFERENCES

1. Heymann DL, ed. GONOCCAL INFECTIONS. In: Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004:232-236

2. Sexually Transmitted Diseases Treatment Guidelines --- 2002. MMWR 2002;51(RR06):1-80

3. Sexually Transmitted Diseases Clinical Practice Guidelines, 1991, CDC.

4. Wisconsin Administrative Code, Chapter HSS 145, 1991, No. 430.

 

V . DISEASE TRENDS