Nearly 20% of men with rectal colonization become symptomatic. Infection in untreated cases is complicated by involvement of testes and epididymis (Ison, 2011).
In females, nearly half of the uncomplicated N. gonorrhoeae infections are asymptomatic. Symptomatic females present with purulent or nonpurulent vaginal discharge due to cervicitis. Complicated infection is more common in women. Involvement of fallopian tubes and pelvic peritoneum occurs and patient presents with acute abdominal pain, nausea, vomiting, fever, malaise and ill health (Ison, 2011).
PID due to gonococcal infection is more common in the developing part of the world. It is acquired by sexual transmission. The infection spreads across the epithelium of fallopian tubes, ovaries and pelvic peritoneum causing inflammation of these structures and resultant adhesions and abscesses. Ovarian abscess and peritonitis are serious sequelae of the disease (Ison, 2011). Jane’s symptoms are suggestive of peritonitis.
Fallopian tube blockage and adhesions due to pelvic inflammatory disease and ovarian abscess can lead to infertility and ectopic pregnancy (Ison, 2011). Thus, Jane may develop infertility as a result of PID.
N. gonorrhoeae was earlier sensitive to antimicrobials but it has rapidly developed resistance. At present, 3rd generation extended cephalosporins are the drugs of choice. Penicillinase producing N. gonorrhoeae is drug resistant bacteria and this enzyme mediated resistance is acquired through plasmids. A low degree of resistance is also mediated as chromosomal resistance which is a result of additive effect of multiple mutations. They have become resistant to Tetracyclines but ceftriaxone nd azithromycin remain active (Ison, 2011).
Ison, C.A. (2011). Gonorrhoeae and the clinical picture of infection. In G. E. Gross & S. K. Tyring (Eds.), Sexually Transmitted Infections and Sexually Transmitted Diseases (pp. 79-80). New York: ...