Condition

Gonococcal Cervicitis

Editors: Jared M. Baeten MD, PhD; Renee Ridzon MD; Esther Jolanda van Zuuren MD; Paritosh Prasad MD

Next Section >

Background Information

Description

  • Gonococcal cervicitis is a sexually transmitted bacterial infection caused by Neisseria gonorrhoeae.
    1
  • Infection is often asymptomatic. When present, symptoms may include:
    1
    ,
    3
    • Dysuria and lower abdominal or pelvic pain
    • Purulent or mucopurulent cervical discharge
    • Intermenstrual vaginal bleeding, particularly after sexual intercourse
  • Antibiotic resistance among N. gonorrhoeae isolates is a growing concern.
    1

Also Called

  • Gonorrhea

Epidemiology

Geographic Distribution

  • Neisseria gonorrhoeae is found worldwide.
    5

Incidence/Prevalence

Worldwide
  • STUDY SUMMARY
    estimated global incidence of Neisseria gonorrhoeae infection 20 per 1,000 women aged 15-49 years in 2016
    SYSTEMATIC REVIEW: Bull World Health Organ 2019 Aug 1;97(8):548

United States
  • Gonorrhea is the second most commonly reported sexually transmitted infection (STI) in the United States (most common is Chlamydia).
    1
  • STUDY SUMMARY
    overall incidence of gonorrhea 152.6 cases per 100,000 women in United States in 2019
    POPULATION-BASED SURVEILLANCE: CDC 2019 Sexually Transmitted Disease Surveillance

Europe
  • STUDY SUMMARY
    overall incidence of gonorrhea infection 13 cases per 100,000 women in Europe in 2018
    POPULATION-BASED SURVEILLANCE: ECDC Annual Epidemiological Report on Gonorrhea 2018 PDF

  • STUDY SUMMARY
    prevalence of Neisseria gonorrhoeae < 0.1% in Britain
    CROSS-SECTIONAL STUDY: Lancet 2013 Nov 30;382(9907):1795

Africa
  • STUDY SUMMARY
    estimated incidence of Neisseria gonorrhoeae infection 41 per 1,000 women aged 15-49 years in Africa in 2016
    SYSTEMATIC REVIEW: Bull World Health Organ 2019 Aug 1;97(8):548

  • The estimated prevalence of N. gonorrhoeae in pregnant persons attending antenatal care facilities in sub-Saharan Africa:
    • 3.7% in east and southern Africa
    • 2.7% in west and central Africa
    • Reference - JAMA 2012 May 16;307(19):2079

Risk Factors

  • Patient factors associated with a high risk for gonorrhea infection according to the United States Preventive Services Task Force (USPSTF):
    • History of or coexisting sexually transmitted infection
    • New sex partner
    • > 1 sex partner
    • Sex partner with concurrent partners
    • Sex partner with a sexually transmitted infection
    • Inconsistent condom use among persons not in a mutually monogamous relationship
    • History of exchanging sex for money or drugs
    • History of incarceration
    • Member of a population with increased prevalence of infection, including American Indian/Alaska Native, Black, Hispanic/Latino, and Native Hawaiian/ Pacific Islander persons
    • Residence in area of high community prevalence (consult local public health authorities for assistance in identifying locations and communities with increased prevalence of gonococcal infection)
    • Reference - USPSTF recommendation statement on screening for chlamydia and gonorrhea (JAMA 2021 Sep 14;326(10):949 or at USPSTF 2021 Sep 14)

Associated Conditions

  • Gonococcal infections at other sites, include:
    4
  • Coinfection with chlamydia
    1
    ,
    4
  • Other sexually transmitted infections, such as:
    1
    ,
    3
  • STUDY SUMMARY
    history of gonorrhea, syphilis, and chlamydia each associated with increased likelihood of subsequent HIV infection in women
    POPULATION-BASED SURVEILLANCE: Int J STD AIDS 2015 Feb;26(2):113

Etiology and Pathogenesis

Pathogen

  • Neisseria gonorrhoeae is a gram-negative diplococcus.
    • It is an obligate human pathogen that is highly evolved for colonization of mucosal surfaces.
    • Multiple serotypes have been identified.
    • PubMed28357376Microbial cell (Graz, Austria)Microb Cell2016090539371-389371Reference - Microb Cell 2016 Sep 5;3(9):371
  • N. gonorrhoeae is naturally competent for the uptake of extracellular DNA, enabling it to acquire antibiotic resistance determinants.
    • Mutations in penA, penB, and mtrR genes are responsible for penicillin resistance first seen in N. gonorrhoeae in the 1950s.
    • Multiple genetic mutations responsible for tetracycline resistance (rpsJ, penB, mtrR) developed shortly after.
    • Mutations in gyrA and parC genes confer fluoroquinolone resistance.
    • Mosaic penA genes are now thought to help mediate resistance to third-generation cephalosporins in some strains.
    • Additional mutations conferring resistance to cephalosporins and macrolides not seen in commensal oropharyngeal Neisseria species also exist.
    • Reference - Curr Opin Infect Dis 2014 Feb;27(1):62
  • N. gonorrhoeae virulence factors include:
    • Lipo-oligosaccharide, an endotoxin highly stimulatory to human immune system
    • Opacity-associated (Opa) proteins, which facilitate attachment and invasion of human cells including neutrophils
    • Type IV pili, which aid attachment to epithelial cells
    • Porins, associated with nutrient acquisition
    • IgA1 protease, which inactivates certain classes of secretory IgA in mucosal secretions
    • Reference - Nat Rev Microbiol 2012 Jan 31;10(3):178
  • PubMed28357376Microbial cell (Graz, Austria)Microb Cell2016090539371-389371Many virulence factors undergo phase and/or antigenic variations, including lipo-oligosaccharide, Opa proteins, and type IV pili, which hinders vaccine development (Microb Cell 2016 Sep 5;3(9):371).

Transmission

  • Sexual transmission:
    1
    ,
    2
    ,
    3
    ,
    4
    • Sexual transmission occurs via direct inoculation of infected secretion from one mucosal surface to another.
    • The route of inoculation and infection site may vary among patients.
      • Urogenital infection occurs via genital contact.
      • Cervical infection occurs via receptive vaginal sex.
      • Rectal infection occurs via receptive anal sex.
      • Oropharyngeal infection occurs via receptive oral sex.
    • Autoinoculation may spread infection from genital site to the conjunctiva or rectum.
  • Genital infection may be transmitted vertically to the conjunctiva of neonates (Curr Opin Infect Dis 2014 Feb;27(1):62).

Pathogenesis

  • Stages of pathogenesis in localized disease:
    • Interaction with nonciliated epithelial cells results in cellular invasion.
    • Cellular invasion leads to inflammation, neutrophil recruitment, and phagocytosis of bacterial cells.
    • Tumor necrosis factor from phagocytes and gonococcal products (including peptidoglycan and lipo-polysaccharide) damage ciliated epithelial cells of mucosal surfaces.
    • Damage to the mucosal epithelium allows bacteria to gain access to deeper tissues which may lead to complications such as pelvic inflammatory disease or epididymitis.
    • Reference - Nat Rev Microbiol 2009 Apr;7(4):274, Nat Rev Microbiol 2012 Jan 31;10(3):178
Next Section >

Published by EBSCO Information Services. Copyright © 2025, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.

DynaMed Levels of Evidence

Quickly find and determine the quality of the evidence.

DynaMed provides easy-to-interpret Level of Evidence labels so users can quickly find and determine the quality of the best available evidence. Evidence may be labeled in one of three levels:

1Level 1 (likely reliable) Evidence
Representing research results addressing clinical outcomes and meeting an extensive set of quality criteria which minimizes bias.
There are two types of conclusions which can earn a Level 1 label: levels of evidence for conclusions derived from individual studies and levels of evidence for conclusions regarding a body of evidence.
2Level 2 (mid-level) Evidence
Representing research results addressing clinical outcomes, and using some method of scientific investigation, but not meeting the quality criteria to achieve Level 1 evidence labeling.
3Level 3 (lacking direct) Evidence
Representing reports that are not based on scientific analysis of clinical outcomes. Examples include case series, case reports, expert opinion, and conclusions extrapolated indirectly from scientific studies.

Grades of Recommendation

Guideline producers are now frequently using classification approaches for their evidence and recommendations, and these classifications are recognized and requested by guideline users. When summarizing guideline recommendations for DynaMed users, the DynaMed Editors are using the guideline-specific classifications and providing guideline classification approach when this is done.

Download the full version of Levels of Evidence