Gonococcal endocarditis: a case report and review of the literature

Despite the increasing incidence of gonococcal urethritis and cervicitis, endocarditis has become an infrequent consequence of infection with Neisseria gonorrhoeae. However, we recently had the opportunity to diagnose and treat a patient with this uncommon infection. He presented with febrile illness and a history of dysuria. After six days of incubation, cultures of blood yielded an isolate of N. gonorrhoeae. Treatment with penicillin plus streptomycin led to rapid resolution of the fever. Sequelae included left ventricular dilatation and aortic valve insufficiency. The latter was corrected by surgery. Our experience with this patient, as well as the 33 other cases reported in the literature since 1949, indicate that the diagnosis of gonococcal endocarditis should be suspected for any sexually active adult who presents with fever and a heart murmur.