Gonorrhea is caused by Neisseria gonorrhoeae. About 800,000 people in the United States per year are infected with gonorrhea, or 1 in 339 people. The majority of patients with rectal gonorrhea are asymptomatic, with 50% of male patients and up to 95% of female patients with rectal gonorrhea. A significant percentage of women diagnosed with gynecologic gonorrhea will also have gonorrhea in the anorectum, believed to be contiguous spread from the genital infection. Only 4% of women with gonorrhea will have the anorectum as the only site of involvement, whereas 40-50% of men who practice anoreceptive intercourse will have the anorectum as the exclusive site of infection.
The incubation period for gonorrhea ranges from 3 days to 2 weeks. Symptomatic anorectal gonococcal infection results in itching or a sense of urgency, accompanied by a thick, yellow, mucoid and sometimes bloody rectal discharge. If left untreated, a more advanced systemic infection can occur, resulting in such conditions as endocarditis, pericarditis, and migratory arthritis of large joints. Abscesses, fistulae and ulcers are not typical sequelae of rectal gonorrhea.
Diagnosis is confirmed by culture. Gram stains of the rectal discharge are unreliable. Because of the unreliability of Gram staining, a high index of suspicion warrants empiric treatment with antibiotics. Because of the high rate of concomitant infection with Chlamydia, appropriate treatment for Chlamydia should be given as well. Sexual partners from the past 60 days should also be treated.