Can gonorrhoea cause peritonsillar abscesses?

Gonorrhea and Peritonsillar Abscesses

Gonorrhea is not typically associated with peritonsillar abscesses, as these infections are primarily caused by other bacterial pathogens including Group A Streptococcus and oral anaerobes.

Etiology of Peritonsillar Abscesses

Peritonsillar abscess (PTA) is the most common deep infection of the head and neck, occurring primarily in young adults 1. These infections are typically polymicrobial in nature with specific causative organisms:

• Most commonly caused by Group A Streptococcus (GAS)
• Fusobacterium necrophorum is a significant and prevalent pathogen (found in up to 58% of cases) 2
• Other common pathogens include:
  • Anaerobic bacteria (Prevotella, Peptostreptococcus, Bacteroides)
  • Various streptococcal species
  • Other oral flora 3, 4

Gonorrhea and Oropharyngeal Infections

While Neisseria gonorrhoeae can cause pharyngeal infections, the evidence does not support it as a common cause of peritonsillar abscesses:

• Gonococcal infections of the pharynx are documented in the CDC guidelines, but they typically present as pharyngitis rather than progressing to peritonsillar abscess 5
• Gonococcal pharyngeal infections are more difficult to eradicate than infections at urogenital and anorectal sites 5
• The CDC guidelines do not list peritonsillar abscess as a common complication of pharyngeal gonorrhea 5

Typical Microbiology of Peritonsillar Abscesses

Research specifically examining the microbiology of peritonsillar abscesses has consistently found:

• Polymicrobial infections with predominance of streptococcal species and anaerobes 4
• In a study of PTA patients, Fusobacterium necrophorum was the most prevalent (23%) bacterial strain in pus specimens 2
• A case report of a peritonsillar abscess that extended to the neck showed cultures yielding Prevotella, Lactobacillus, Peptostreptococcus, Fusobacterium, and other organisms - but not N. gonorrhoeae 4

Risk Factors for Peritonsillar Abscess

The primary risk factors for developing peritonsillar abscess include:

• Acute tonsillitis (PTA is considered a complication of tonsillitis)
• Smoking (significantly increases risk across all age groups) 2
• Age (teenagers and young adults are most commonly affected) 2
• Male gender (may predominate over females) 2
• Poor oral hygiene and periodontal disease 3

Clinical Implications

For clinicians evaluating patients with peritonsillar abscess:

• Standard treatment includes drainage (needle aspiration, incision and drainage, or acute tonsillectomy) plus antibiotics effective against streptococci and anaerobes 6
• Recommended antibiotic regimens typically include penicillin, clindamycin, cephalosporins, or metronidazole 6
• Testing for gonorrhea is not routinely indicated in peritonsillar abscess unless there are specific risk factors or clinical suspicion for gonococcal pharyngeal infection

Conclusion

While N. gonorrhoeae can cause pharyngeal infections, there is no substantial evidence in the medical literature supporting it as a common or typical cause of peritonsillar abscesses. The microbiology of peritonsillar abscesses is predominantly characterized by streptococcal species and anaerobic bacteria from the oral flora.