Clinical Presentation

Gonorrhea, caused by the bacterium Neisseria gonorrhoeae, is the second most common bacterial STD in the United States. The majority of gonococcal urethral infections in men produce symptoms. However, among women, more than 30% of infections are asymptomatic; untreated infection can result in complications such as pelvic inflammatory disease (PID), infertility, and ectopic pregnancy. Similar to chlamydia, there are little published data regarding prevalence rates of gonococcal infection in refugee populations arriving in the United States. The single publication on reporting rates of STDs in newly arriving refugees found that out of more than 2,500 refugees, only 0.2% were infected 3.

Signs and symptoms of gonorrhea may appear 1-14 days after a person is exposed to an infected person.

In men, signs and symptoms may include:

  • Pain or burning sensation when urinating
  • Penile discharge
  • Epididymitis
  • Rectal discharge, anal itching, soreness, bleeding, or painful bowel movements

In women, signs and symptoms may include:

  • Pain or burning sensation when urinating
  • Vaginal discharge
  • Intermenstrual bleeding
  • Rectal discharge, anal itching, soreness, bleeding, or painful bowel movements
  • Lower abdominal pain and dyspareunia

Other sites of infection include the eyes (gonococcal conjunctivitis) and pharynx. Disseminated gonococcal infection is associated with arthritis, tenosynovitis, skin lesions, fever or a combination of these findings. Skin changes range from maculopapular or pustular to hemorrhagic rashes and lesions. Arthritis and tenosynovitis most typically affect the wrists, knees, and ankles.

Gonococcal infection among infants usually results from exposure to infected cervical exudate at birth. Typically, an acute illness develops 2-5 days after birth, and may present as ophthalmia neonatorum, which may be complicated by a perforation of the globe of the eye and result in blindness. Other manifestations in infants are scalp abscesses, rhinitis, vaginitis, urethritis, arthritis, meningitis, and sepsis.

Diagnostic Testing

Specific diagnostic testing for gonorrhea may be performed on endocervical, vaginal, male urethral, or urine specimens. For screening purposes, urine samples tested by nucleic acid amplification tests are highly sensitive and specific. A Gram stain of discharge, or a urethral swab showing intracellular gram-negative diplococci, supports the diagnosis and may be sufficient to confirm gonorrhea in symptomatic men.

Because nonculture-based tests do not permit antimicrobial susceptibility testing, in cases of persistent gonococcal infection following treatment, both bacterial culture and antimicrobial susceptibility testing should be assessed. Refugees infected with N. gonorrhoeae are frequently co-infected with Chlamydia trachomatis.


  1. Stauffer WM, Painter J, Mamo B, et al. Sexually transmitted infections in newly arrived refugees: is routine screening for Neisseria gonorrheae and Chlamydia trachomatis infection indicated? Am J Trop Med Hyg 2012;86(2):292-5.