Gonococcal peritonitis

Gonorrhea is any purulent infection caused by Neisseria gonorrhoeae, a classic common sexually transmitted disease. The primary infection site is mainly the male urethra or female endocervical lining, causing purulent inflammation of the urogenital tract. Infection can spread from the male urethra to the epididymis, testis and prostate, or from the female cervix to the fallopian tubes, ovaries, peritoneum, Bartholin glands, urethra and rectum; the pharynx, rectum and conjunctiva can also be primary sites. Hematogenous spread causes disseminated gonococcal infection (DGI). Penicillin is the first-line antibiotic; severe peritonitis may be treated with intraperitoneal 0.5% metronidazole. If non-surgical treatment fails or other surgical acute abdomen cannot be excluded, immediate surgical exploration is indicated.

Common symptoms

Abdominal tenderness; urinary frequency; peritoneal irritation signs; abdominal muscle tension; abdominal pain; purulent discharge; urinary urgency; dysuria; peritonitis

Causes

Gonococcal peritonitis is usually secondary to gonococcal infection elsewhere, such as acute pelvic peritonitis—most often secondary to acute gonococcal salpingitis, where tubal exudate flows through the fimbria into the peritoneal cavity causing localized pelvic inflammation. Acute primary gonococcal peritonitis is spread from vaginal gonorrhea; acute diffuse peritonitis results from rupture of gonococcal pyosalpinx, ovarian gonococcal abscess, or pelvic gonococcal abscess. The pathogen is Neisseria gonorrhoeae, a gram-negative diplococcus 0.6–0.8 µm in size, usually inside polymorphonuclear leukocytes; it requires 3–10% CO2 and chocolate blood agar or Thayer-Martin medium. Humans are the only natural host; the organism invades mucosa causing hyperemia, edema, serous exudation, then purulence and connective tissue proliferation. Major virulence factors include pili, PorB, Opa, Rmp, LOS, and IgA1 protease.

Treatment

Surgery, medication, supportive care

Prevention

Gonorrhea is primarily sexually transmitted; prevention must start with basics. (1) Promote healthy sexual habits and avoid non-marital contact. (2) Use condoms. (3) Keep personal items (towels, underwear, washbasins) separate. (4) Isolate and treat household acute gonorrhea cases, disinfect items, and trace/test/treat partners within one month.

Recommended Department

It is recommended to visit the general surgery department; before the visit you may first book an appointment and connect with experts through this platform.

Warm reminder: The above information is provided for health education reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek care at a regular hospital in time.