Acute epididymitis is the most common complication of urethral gonorrhea. It is characterized by a swollen and inflamed scrotum, localized epididymal pain, fever, and pyuria.8
Penile edema (“bull-headed clap”) is another common complication.8 It may be limited to the meatus or extend to the distal penile shaft and prepuce and may occur in the absence of other inflammatory signs.
Urethral stricture, once thought to be a common complication, is actually relatively rare, occurring in just 0.5% of cases.6 Urethral strictures attributed to gonorrheal urethritis during the pre-antibiotic era may have actually resulted from the caustic treatments administered during that time.
Acute prostatitis with sudden onset of chills, fever, malaise, and warmth and swelling of the prostate can also develop, although it is more commonly caused by gram-negative rods, such as Escherichia coli or Proteus mirabilis.8
Chronic prostatitis, usually caused by recurrent urinary tract infections, has also been documented as a complication of gonorrheal infection.9
Infection of the Cowper’s, or bulbourethral glands, can occur, leading to perineal swelling.10
Periurethral abscess results when an infected Littre’s or Tyson’s gland ruptures and the infection extends into the deeper tissues.11
Seminal vesiculitis has previously been described as an uncommon complication of gonorrheal infection. However, a recent small study showed ultrasonographic evidence of vesiculitis in 46% of patients with urethritis due to gonorrhea or chlamydia.12
Penile sclerosing lymphangitis presents as an acute, firm, cordlike lesion of the coronal sulcus. A quarter of reported cases have been linked to sexually transmitted infections, including gonorrhea.13