Gonococcal Peritonitis

Gonorrhea is purulent infection by N. gonorrhoeae, a classic STD. Primary sites: male urethra or female endocervix. It spreads to epididymis/testis/prostate in men, or fallopian tubes/ovaries/peritoneum/Bartholin glands/urethra/rectum in women; pharynx/rectum/conjunctiva may be primary sites. Disseminated gonococcal infection (DGI) can occur. Penicillin is first-line; severe peritonitis may need 0.5% metronidazole IP; surgery if non-surgical fails.

Common Symptoms

Abdominal tenderness; urinary frequency; peritoneal signs; abdominal guarding; abdominal pain; purulent discharge; urgency; dysuria; peritonitis

Causes and Pathogenesis

Gonococcal peritonitis usually follows other gonococcal foci: acute pelvic peritonitis mostly follows gonococcal salpingitis (tubal exudate spilling from fimbriae). Acute primary gonococcal peritonitis spreads from vaginal gonorrhea; acute diffuse peritonitis follows rupture of tubo-ovarian/pelvic gonococcal abscess. N. gonorrhoeae (Neisser, 1879) is a kidney/Gram-negative diplococcus 0.6-0.8 µm, usually within PMNs; grows on chocolate agar or Thayer-Martin in 3-10% CO2. Humans are the only host; it invades columnar epithelium causing hyperemia/edema/serous exudate/pus/fibrosis. Steps: adhesion, invasion, intracellular survival, host response; internalization via actin microfilaments; transcytosis across basement membrane. Virulence factors: (1) pili (phase/antigenic variation); (2) PorB porin (invasion, serum resistance); (3) Opa opacity proteins; (4) Rmp (immunogenic antibodies block serum killing—important in DGI); (5) LOS (inflammation); (6) IgA1 protease.

Treatment

Surgery, drug therapy, supportive therapy

Preventive Measures

1. Healthy sexual habits; avoid non-marital sex. 2. Use condoms. 3. Personal towels/underwear/basins. 4. Isolate acute gonorrhea households; trace/treat sex partners within 1 month.

Department to Visit

It is recommended to visit the General Surgery department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.