What is the typical color of discharge in gonococcal (Neisseria gonorrhoeae) infection?

Discharge Color in Gonococcal Infection

The typical discharge in gonococcal infection is yellow or green in color, often described as mucopurulent. 1

Clinical Presentation of Gonococcal Discharge

Gonococcal infection caused by Neisseria gonorrhoeae presents with characteristic discharge patterns that vary by anatomical site and gender:

In Men:

• Yellow or green purulent urethral discharge
• Often accompanied by dysuria
• Typically more symptomatic than in women 2
• Visible abnormal urethral discharge is a key diagnostic criterion 1

In Women:

• Yellow or green mucopurulent discharge from the endocervix
• Up to 50% of infections may be asymptomatic 3
• Mucopurulent secretion is specifically described as "yellow or green when viewed on a white, cotton-tipped swab" (positive swab test) 1
• May be accompanied by cervical inflammation with induced endocervical bleeding 1

Diagnostic Considerations

The color and consistency of discharge are important diagnostic indicators:

• Mucopurulent discharge: Yellow or green discharge is a hallmark sign of gonococcal infection
• Discharge should be examined microscopically:
  • Gram stain may show gram-negative diplococci
  • Presence of ≥5 white blood cells per high-power field on urethral smear indicates urethritis 1
• Laboratory confirmation is essential through:
  • Culture
  • Nucleic acid amplification testing (NAAT)
  • Urine NAAT has comparable sensitivity to cervical/urethral samples 2

Clinical Pitfalls and Caveats

1. Asymptomatic infections: Up to 50% of women with gonococcal infections may be asymptomatic, making screening crucial in high-risk populations 3

2. Differential diagnosis: Yellow-green discharge can also occur in:

   • Chlamydial infections
   • Mucopurulent cervicitis from other causes
   • Trichomoniasis (which typically has a more frothy appearance)

3. Disseminated infection: In rare cases, gonococcal infection can spread to the bloodstream causing disseminated gonococcal infection (DGI) with symptoms like rash, polyarthralgia, and tenosynovitis 4

4. Co-infections: Gonococcal infection frequently co-occurs with chlamydial infection, requiring treatment for both conditions 2

Management Implications

The characteristic yellow or green discharge should prompt:

1. Appropriate specimen collection for laboratory confirmation
2. Treatment with ceftriaxone (current first-line therapy) plus azithromycin or doxycycline to address likely chlamydial co-infection 2
3. Testing for other sexually transmitted infections
4. Partner notification and treatment
5. Follow-up testing in 3-6 months due to high reinfection rates 2

The color and character of discharge are essential diagnostic clues that help guide appropriate management of this common sexually transmitted infection.