Gonococcal pharyngitis

Definition

Gonococcal pharyngitis is an infection of the throat involving the tonsils and the larynx (pharynx), caused by the bacterium Neisseria gonorrhoeae.

Alternative Names

Causes

Gonococcal pharyngitis is a sexually-transmitted disease. It is acquired through oral sex with an infected partner. The majority of throat infections caused by gonococci have no symptoms (asymptomatic).

When discomfort is present, it is generally mild. Symptoms involving the rest of the body are not normally present unless the person develops disseminated gonococcemia, a wide-spread infection of the bloodstream.

Untreated gonorrhea may spread to other parts of the body, causing inflammation of the testes or prostate in men, or pelvic inflammatory disease in women.

Gonococci in the throat is most common in men who have sex with men, where pharyngeal (throat) infection is present in 10 to 25% of cases of gonorrhea. Risk factors include recent exposure to gonorrhea, sexual activity with multiple partners, and performing oral sex.

Between 320,000-360,000 cases of gonorrhea

Symptoms

• Sore throat
• Difficulty swallowing
• Fever
• Tender, swollen lymph nodes in the neck

• Neck pain
• Nasal discharge
• Nasal congestion
• Muscle pain
• Joint stiffness
• Headache
• Abnormal taste

Note: There may be no symptoms.

Exams and Tests

A throat swab culture is positive for gonococcus. Note that standard strep throat testing will not pick up gonorrhea, and the clinician has to alert the lab that a gonococcal culture should be performed.. If you think you might have gonococcal pharyngitis, you should tell your health care provider.

Treatment

There are two parts to successfully treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first is to cure the affected person. The second is to locate, test, and treat all other sexual contacts to prevent further spread of the disease.

Mandatory reporting of gonococcal disease has been instituted and has, until recently, held the number of cases of gonorrhea at a low level. However, the incidence is once again rising, especially among men who have sex with men in large urban centers.

Beginning about the time of the Vietnam War, the United States saw the appearance of penicillin- and tetracycline-resistant strains of gonorrhea. In recent years, the incidence of fluroquinolone resistance in the gonococcus has also been rising.

Because of this, a new standardized treatment regimen has now been recommended by the CDC. Instead of the standard penicillin treatment, gonorrhea is now treated with newer antibiotics. As of 2006, the incidence of fluoroquinolone resistance in the U.S. has risen to the point that these agents are no longer considered first-line therapy.

This treatment regimen includes any one of the following antibiotics.

• INJECTIONS
  • Ceftriaxone IM (injected into a muscle)
• ORAL (by mouth) one-time dose
  • Cefixime
  • Cefpodoxime proxetil
  • Azithromycin 2g po x 1
• ORAL (by mouth) multiple dose
  • Erythromycin

In addition to treatment for gonorrhea, patients are usually treated at the same time for chlamydia. Chlamydia can be harder to diagnose, but may be found to cause infection at the same time.

A follow-up visit 7 days after treatment to recheck cultures and confirm the cure of infection is important.

Outlook (Prognosis)

Gonorrhea can be completely and quickly cured when diagnosed early and treated promptly before complications develop.

Possible Complications

BOTH SEXES

• Disseminated gonococcemia
• Gonococcal arthritis

• Urethral scarring and stricture
• Epididymitis
• Orchitis
• Prostatitis

• Pelvic inflammatory disease
• Salpingitis
• Perihepatitis
• Infertility
• Sterility
• Increased incidence of tubal pregnancy (ectopic pregnancy)

When to Contact a Medical Professional

Call your health care provider if you have had a known or suspected contact with an infected sexual partner.

Call your health care provider if you develop symptoms of gonococcal pharyngitis.

Prevention

Sexual abstinence is the only sure way to avoid gonorrhea, but this is often neither practical nor reasonable. Safer sex behaviors can reduce risk. The use of condoms, both male and female types, markedly decreases the likelihood of contracting a sexually transmitted disease -- but they must be used properly.

The condom should be in place from the beginning to end of sexual activity, and should be used EVERY time the person engages in sexual activity -- including oral sex -- with a non-monogamous partner or possibly infected partner.

Condoms are inexpensive, especially considering the potential consequences of contracting a sexually transmitted disease.

Treatment of all sexual partners is essential to prevent re-infection.