Except in disseminated disease, the sites of infection typically reflect areas involved in sexual contact.

• Urethritis and cervicitis have an incubation period of 2-7 days and ~10 days, respectively. See above for details.
• Anorectal gonorrhea can cause acute proctitis in women (due to the spread of cervical exudate to the rectum) and MSM.
• Pharyngeal gonorrhea is usually mild or asymptomatic and results from oral-genital sexual exposure (typically fellatio). Pharyngeal infection almost always coexists with genital infection, resolves spontaneously, and is rarely transmitted to sexual contacts.
• Ocular gonorrhea is typically caused by autoinoculation and presents as a markedly swollen eyelid, hyperemia, chemosis, and profuse purulent discharge.
• Gonorrhea in pregnancy can have serious consequences for both the mother and the infant.
  • - Salpingitis and PID are associated with fetal loss.
  • - Third-trimester disease can cause prolonged rupture of membranes, premature delivery, chorioamnionitis, funisitis, and neonatal sepsis.
  • - Ophthalmia neonatorum, the most common form of gonorrhea among neonates, is preventable by prophylactic ophthalmic ointments (e.g., containing erythromycin or tetracycline), but treatment requires systemic antibiotics.
• Gonococcal arthritis results from dissemination of organisms due to gonococcal bacteremia. Pts present during a bacteremic phase (relatively uncommon) or with suppurative arthritis involving one or two joints (most commonly the knees, wrists, ankles, and elbows), with tenosynovitis and skin lesions. Menstruation and complement deficiencies of the membrane attack complex (C5-C9) are risk factors for disseminated disease.