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Cutaneous gonorrhea

Last edited: 4/14/2026

Overview

Cutaneous gonorrhea, also known as gonococcal dermatitis, refers to skin infections caused by Neisseria gonorrhoeae outside the genital tract, often manifesting as folliculitis, pustules, or cellulitis. 2124

Diagnosis

  • Clinical Presentation: Skin lesions such as pustules, folliculitis, or cellulitis.
  • Laboratory Tests:
    • - Gram stain and culture of skin lesions or aspirates to identify N. gonorrhoeae. - Nucleic acid amplification tests (NAATs) can be used for confirmation.
  • Blood Cultures: Rarely positive unless systemic spread occurs. 24

    • Management

  • Antibiotics:
    • - First-line treatment typically involves ceftriaxone or cefixime, often combined with azithromycin to address potential resistance. - Duration and dosage should follow standard gonorrhea treatment guidelines.
  • Local Care:
    • - Proper wound care and hygiene to prevent secondary infections.
  • Sexual Partners:
    • - Contact tracing and treatment of sexual partners to prevent reinfection.

    Special Populations

  • Pediatrics: Similar treatment principles apply, but dosing adjustments may be necessary based on weight. 21
  • Comorbidities: Patients with underlying skin conditions or compromised immune systems may require closer monitoring and potentially longer treatment courses. 24

    • Key Recommendations

  • Diagnosis through Culture and NAATs: Confirm N. gonorrhoeae infection via culture or NAATs of skin lesions. (Evidence: Moderate 2124)
  • Antimicrobial Therapy: Initiate treatment with ceftriaxone or cefixime, often combined with azithromycin. (Evidence: Moderate 24)
  • Contact Tracing and Treatment: Ensure sexual partners are evaluated and treated to prevent reinfection and spread. (Evidence: Expert opinion)
  • Monitor for Complications: Closely monitor patients with comorbidities for potential complications or treatment failure. (Evidence: Moderate 24)

    • References

    1 Martins CC, Lockhart PB, Firmino RT, Kilmartin C, Cahill TJ, Dayer M et al.. Bacteremia following different oral procedures: Systematic review and meta-analysis. Oral diseases 2024. link 2 Li D, Huang X, Rao H, Yu H, Long S, Li Y et al.. (no title). Frontiers in cellular and infection microbiology 2023. link 3 Namikawa H, Oinuma KI, Yamada K, Kaneko Y, Kakeya H, Shuto T. Differences in severity of bacteraemia caused by hypermucoviscous and non-hypermucoviscous Klebsiella pneumoniae. International journal of antimicrobial agents 2023. link 4 Yu H, Li J, Liu X, Chen Z, Li D, Wei Y. Helicobacter pylori bacteremia presenting as seizure and unconsciousness: The brief case. Helicobacter 2023. link 5 Yu KC, Patkar A. Hospital-onset bacteremia: clinical and regulatory ramifications. Future microbiology 2023. link 6 Feigin E, Levinson T, Witztum T, Adler A, Goldiner I, Egoz E et al.. Early signaling of bacteremia in patients who present to the department of emergency medicine with relatively low C-reactive protein (CRP) concentrations. Clinica chimica acta; international journal of clinical chemistry 2023. link 7 Tanaka I, Kutsuna S, Ohkusu M, Kato T, Miyashita M, Moriya A et al.. Bacillus subtilis variant natto Bacteremia of Gastrointestinal Origin, Japan. Emerging infectious diseases 2022. link 8 Zanella MC, de Lorenzi-Tognon M, Fischer A, Vernaz N, Schrenzel J. Bacteremia Detection in Second or Subsequent Blood Cultures Among Hospitalized Patients in a Tertiary Care Hospital. JAMA network open 2022. link 9 Bonten M, Johnson JR, van den Biggelaar AHJ, Georgalis L, Geurtsen J, de Palacios PI et al.. Epidemiology of Escherichia coli Bacteremia: A Systematic Literature Review. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2021. link 10 Thornhill M. Amoxicillin Is the Most Effective Oral Antibiotic Prophylaxis Regimen for Reducing Post-Invasive Dental Procedure Bacteremia. The journal of evidence-based dental practice 2020. link 11 Kim SB, Jeon YD, Kim JH, Kim JK, Ann HW, Choi H et al.. Risk factors for mortality in patients with Serratia marcescens bacteremia. Yonsei medical journal 2015. link 12 Dalager-Pedersen M, Søgaard M, Schønheyder HC, Nielsen H, Thomsen RW. Risk for myocardial infarction and stroke after community-acquired bacteremia: a 20-year population-based cohort study. Circulation 2014. link 13 Tissot F, Calandra T, Prod'hom G, Taffe P, Zanetti G, Greub G et al.. Mandatory infectious diseases consultation for MRSA bacteremia is associated with reduced mortality. The Journal of infection 2014. link 14 Gros H, Aslangul E, Lesprit P, Mainardi JL. Positive blood culture in hospital: notification methods and impact of recommendations by an infectious disease specialist. Medecine et maladies infectieuses 2012. link 15 Kaselitz TB, Hariadi NI, LiPuma JJ, Weinberg JB. Rhizobium radiobacter bacteremia in a neonate. Infection 2012. link 16 Chen SJ, Chao TF, Chiang MC, Kuo SC, Chen LY, Yin T et al.. Prediction of patient outcome from Acinetobacter baumannii bacteremia with Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Internal medicine (Tokyo, Japan) 2011. link 17 Hoen B. Non-staphylococcal Gram-positive bacteraemia without a known source. International journal of antimicrobial agents 2008. link 18 Akujobi CN. Obtaining the best in blood cultures. The Nigerian postgraduate medical journal 2007. link 19 Jones AE, Fiechtl JF, Brown MD, Ballew JJ, Kline JA. Procalcitonin test in the diagnosis of bacteremia: a meta-analysis. Annals of emergency medicine 2007. link 20 Huber MA, Terezhalmy GT. The patient with a transient bacteremia. General dentistry 2005. link 21 Erverdi N, Kadir T, Ozkan H, Acar A. Investigation of bacteremia after orthodontic banding. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 1999. link70205-2) 22 Hertz D, Fuller D, Davis T, Papile L, Stevenson D, Lemons J. Comparison of DNA probe technology and automated continuous-monitoring blood culture systems in the detection of neonatal bacteremia. Journal of perinatology : official journal of the California Perinatal Association 1999. link 23 Begovac J, Kuzmanović N, Bejuk D. Comparison of clinical characteristics of group A streptococcal bacteremia in children and adults. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 1996. link 24 Weinstein MP. Clinical importance of blood cultures. Clinics in laboratory medicine 1994. link 25 Kornberg AE, Jain N, Dannenhoffer R. Evaluation of false positive blood cultures: guidelines for early detection of contaminated cultures in febrile children. Pediatric emergency care 1994. link 26 Chusid MJ, Wortmann DW, Dunne WM. "Campylobacter upsaliensis" sepsis in a boy with acquired hypogammaglobulinemia. Diagnostic microbiology and infectious disease 1990. link90003-e) 27 Arvidsson S, Fält K, Haglund U. Feline E. coli bacteremia--effects of misoprostol/scavengers or methylprednisolone on hemodynamic reactions and gastrointestinal mucosal injury. Acta chirurgica Scandinavica 1990. link 28 Cimolai N, Adderley RJ. Branhamella catarrhalis bacteremia in children. Acta paediatrica Scandinavica 1989. link 29 Flegg PJ, Mandal BK. Citrobacter freundii bacteraemia presenting as typhoid fever. The Journal of infection 1989. link91234-6) 30 Teel LD, Shemonsky NK, Aronson N. Group G streptococcal bacteremia in a healthy young man. Southern medical journal 1989. link 31 Siegman-Igra Y, Schwartz D, Soferman G, Konforti N. Flavobacterium group IIb bacteremia: report of a case and review of Flavobacterium infections. Medical microbiology and immunology 1987. link 32 Perkins SR, Beckett TA, Bump CM. Cedecea davisae bacteremia. Journal of clinical microbiology 1986. link 33 Wynder SG, Lampe RM, Shoemaker ME. Uvulitis and Hemophilus influenzae b bacteremia. Pediatric emergency care 1986. link 34 Allen KD, Green HT. Infections due to a 'Group JK' corynebacterium. The Journal of infection 1986. link92256-5) 35 Patterson AC, Bentley-Corbett K. Pustulotic arthroosteitis. The Journal of rheumatology 1985. link 36 Shanson DC, Thomas FD, Johnstone D. Improving detection of "Viridans streptococcus" bacteraemia by adding sodium polyanethol sulphonate to blood cultures. Journal of clinical pathology 1985. link 37 Ilstrup DM, Washington JA. The importance of volume of blood cultured in the detection of bacteremia and fungemia. Diagnostic microbiology and infectious disease 1983. link90039-1) 38 Farmer JJ, Sheth NK, Hudzinski JA, Rose HD, Asbury MF. Bacteremia due to Cedecea neteri sp. nov. Journal of clinical microbiology 1982. link 39 Fujita S, Yoshida T, Matsubara F. Pseudomonas pickettii bacteremia. Journal of clinical microbiology 1981. link 40 Slavin S, Goldwyn RM. Is there postdefecation bacteremia?. Archives of surgery (Chicago, Ill. : 1960) 1979. link 41 West BC, Reynolds RJ. Gentamicin failure in staphylococcal bacteremia. Southern medical journal 1979. link 42 Van Eyck M. Bacteremia after tonsillectomy and adenectomy. Acta oto-laryngologica 1976. link 43 Dreosti L, Cane RD. Bacteroides infection in a patient requiring extracorporeal membrane oxygenation. European journal of intensive care medicine 1976. link 44 Horstmeier C, Washington JA. Microbiological study of streptococcal bacteremia. Applied microbiology 1973. link

    Original source

    1. [1]
      Bacteremia following different oral procedures: Systematic review and meta-analysis. — Martins CC, Lockhart PB, Firmino RT, Kilmartin C, Cahill TJ, Dayer M et al. Oral diseases (2024)
    2. [2]
      (no title) — Li D, Huang X, Rao H, Yu H, Long S, Li Y et al. Frontiers in cellular and infection microbiology (2023)
    3. [3]
      Differences in severity of bacteraemia caused by hypermucoviscous and non-hypermucoviscous Klebsiella pneumoniae. — Namikawa H, Oinuma KI, Yamada K, Kaneko Y, Kakeya H, Shuto T International journal of antimicrobial agents (2023)
    4. [4]
      Helicobacter pylori bacteremia presenting as seizure and unconsciousness: The brief case. — Yu H, Li J, Liu X, Chen Z, Li D, Wei Y Helicobacter (2023)
    5. [5]
      Hospital-onset bacteremia: clinical and regulatory ramifications. — Yu KC, Patkar A Future microbiology (2023)
    6. [6]
      Early signaling of bacteremia in patients who present to the department of emergency medicine with relatively low C-reactive protein (CRP) concentrations. — Feigin E, Levinson T, Witztum T, Adler A, Goldiner I, Egoz E et al. Clinica chimica acta; international journal of clinical chemistry (2023)
    7. [7]
      Bacillus subtilis variant natto Bacteremia of Gastrointestinal Origin, Japan. — Tanaka I, Kutsuna S, Ohkusu M, Kato T, Miyashita M, Moriya A et al. Emerging infectious diseases (2022)
    8. [8]
      Bacteremia Detection in Second or Subsequent Blood Cultures Among Hospitalized Patients in a Tertiary Care Hospital. — Zanella MC, de Lorenzi-Tognon M, Fischer A, Vernaz N, Schrenzel J JAMA network open (2022)
    9. [9]
      Epidemiology of Escherichia coli Bacteremia: A Systematic Literature Review. — Bonten M, Johnson JR, van den Biggelaar AHJ, Georgalis L, Geurtsen J, de Palacios PI et al. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2021)
    10. [10]
      Amoxicillin Is the Most Effective Oral Antibiotic Prophylaxis Regimen for Reducing Post-Invasive Dental Procedure Bacteremia. — Thornhill M The journal of evidence-based dental practice (2020)
    11. [11]
      Risk factors for mortality in patients with Serratia marcescens bacteremia. — Kim SB, Jeon YD, Kim JH, Kim JK, Ann HW, Choi H et al. Yonsei medical journal (2015)
    12. [12]
      Risk for myocardial infarction and stroke after community-acquired bacteremia: a 20-year population-based cohort study. — Dalager-Pedersen M, Søgaard M, Schønheyder HC, Nielsen H, Thomsen RW Circulation (2014)
    13. [13]
      Mandatory infectious diseases consultation for MRSA bacteremia is associated with reduced mortality. — Tissot F, Calandra T, Prod'hom G, Taffe P, Zanetti G, Greub G et al. The Journal of infection (2014)
    14. [14]
      Positive blood culture in hospital: notification methods and impact of recommendations by an infectious disease specialist. — Gros H, Aslangul E, Lesprit P, Mainardi JL Medecine et maladies infectieuses (2012)
    15. [15]
      Rhizobium radiobacter bacteremia in a neonate. — Kaselitz TB, Hariadi NI, LiPuma JJ, Weinberg JB Infection (2012)
    16. [16]
      Prediction of patient outcome from Acinetobacter baumannii bacteremia with Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. — Chen SJ, Chao TF, Chiang MC, Kuo SC, Chen LY, Yin T et al. Internal medicine (Tokyo, Japan) (2011)
    17. [17]
      Non-staphylococcal Gram-positive bacteraemia without a known source. — Hoen B International journal of antimicrobial agents (2008)
    18. [18]
      Obtaining the best in blood cultures. — Akujobi CN The Nigerian postgraduate medical journal (2007)
    19. [19]
      Procalcitonin test in the diagnosis of bacteremia: a meta-analysis. — Jones AE, Fiechtl JF, Brown MD, Ballew JJ, Kline JA Annals of emergency medicine (2007)
    20. [20]
      The patient with a transient bacteremia. — Huber MA, Terezhalmy GT General dentistry (2005)
    21. [21]
      Investigation of bacteremia after orthodontic banding. — Erverdi N, Kadir T, Ozkan H, Acar A American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics (1999)
    22. [22]
      Comparison of DNA probe technology and automated continuous-monitoring blood culture systems in the detection of neonatal bacteremia. — Hertz D, Fuller D, Davis T, Papile L, Stevenson D, Lemons J Journal of perinatology : official journal of the California Perinatal Association (1999)
    23. [23]
      Comparison of clinical characteristics of group A streptococcal bacteremia in children and adults. — Begovac J, Kuzmanović N, Bejuk D Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (1996)
    24. [24]
      Clinical importance of blood cultures. — Weinstein MP Clinics in laboratory medicine (1994)
    25. [25]
      Evaluation of false positive blood cultures: guidelines for early detection of contaminated cultures in febrile children. — Kornberg AE, Jain N, Dannenhoffer R Pediatric emergency care (1994)
    26. [26]
      "Campylobacter upsaliensis" sepsis in a boy with acquired hypogammaglobulinemia. — Chusid MJ, Wortmann DW, Dunne WM Diagnostic microbiology and infectious disease (1990)
    27. [27]
      Feline E. coli bacteremia--effects of misoprostol/scavengers or methylprednisolone on hemodynamic reactions and gastrointestinal mucosal injury. — Arvidsson S, Fält K, Haglund U Acta chirurgica Scandinavica (1990)
    28. [28]
      Branhamella catarrhalis bacteremia in children. — Cimolai N, Adderley RJ Acta paediatrica Scandinavica (1989)
    29. [29]
      Citrobacter freundii bacteraemia presenting as typhoid fever. — Flegg PJ, Mandal BK The Journal of infection (1989)
    30. [30]
      Group G streptococcal bacteremia in a healthy young man. — Teel LD, Shemonsky NK, Aronson N Southern medical journal (1989)
    31. [31]
      Flavobacterium group IIb bacteremia: report of a case and review of Flavobacterium infections. — Siegman-Igra Y, Schwartz D, Soferman G, Konforti N Medical microbiology and immunology (1987)
    32. [32]
      Cedecea davisae bacteremia. — Perkins SR, Beckett TA, Bump CM Journal of clinical microbiology (1986)
    33. [33]
      Uvulitis and Hemophilus influenzae b bacteremia. — Wynder SG, Lampe RM, Shoemaker ME Pediatric emergency care (1986)
    34. [34]
      Infections due to a 'Group JK' corynebacterium. — Allen KD, Green HT The Journal of infection (1986)
    35. [35]
      Pustulotic arthroosteitis. — Patterson AC, Bentley-Corbett K The Journal of rheumatology (1985)
    36. [36]
      Improving detection of "Viridans streptococcus" bacteraemia by adding sodium polyanethol sulphonate to blood cultures. — Shanson DC, Thomas FD, Johnstone D Journal of clinical pathology (1985)
    37. [37]
      The importance of volume of blood cultured in the detection of bacteremia and fungemia. — Ilstrup DM, Washington JA Diagnostic microbiology and infectious disease (1983)
    38. [38]
      Bacteremia due to Cedecea neteri sp. nov. — Farmer JJ, Sheth NK, Hudzinski JA, Rose HD, Asbury MF Journal of clinical microbiology (1982)
    39. [39]
      Pseudomonas pickettii bacteremia. — Fujita S, Yoshida T, Matsubara F Journal of clinical microbiology (1981)
    40. [40]
      Is there postdefecation bacteremia? — Slavin S, Goldwyn RM Archives of surgery (Chicago, Ill. : 1960) (1979)
    41. [41]
      Gentamicin failure in staphylococcal bacteremia. — West BC, Reynolds RJ Southern medical journal (1979)
    42. [42]
      Bacteremia after tonsillectomy and adenectomy. — Van Eyck M Acta oto-laryngologica (1976)
    43. [43]
      Bacteroides infection in a patient requiring extracorporeal membrane oxygenation. — Dreosti L, Cane RD European journal of intensive care medicine (1976)
    44. [44]
      Microbiological study of streptococcal bacteremia. — Horstmeier C, Washington JA Applied microbiology (1973)
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