Neisseria gonorrhoeae in Gynecological Practice: A Systematic Review from Clinical Microbiology and Obstetrics-Gynecology Perspectives

Abstract

This systematic review summarizes evidence on Neisseria gonorrhoeae in gynecological practice from clinical microbiology and obstetrics-gynecology perspectives, covering mucopurulent cervicitis, pelvic inflammatory disease (PID), tubo-ovarian abscess, infertility, the relevance of IVF, IUD use, diagnosis, presumptive therapy, and antimicrobial resistance. Literature searches followed PRISMA 2020 and included PubMed, Embase, and Cochrane Library publications from 2020 to 2025. Of 1,247 records, seven publications met the eligibility criteria, comprising five primary studies and two systematic reviews/meta-analyses; the five primary studies were appraised using MMAT. Gonorrhea in women is often asymptomatic or resembles nonspecific vaginal discharge, but may cause mucopurulent cervicitis through cervical inflammation and neutrophil recruitment. Ascending infection may progress to endometritis, salpingitis, PID, and tubo-ovarian abscess, with ciliary damage, fibrosis, and tubal adhesions contributing to tubal-factor infertility and ectopic pregnancy. Evidence indicates an epidemiological association between GC/ CT infection and female infertility, but the included publications do not establish an independent effect of gonorrhea on IVF outcomes or improved pregnancy rates after screening and treatment. IVF therefore remains an evidence gap requiring prospective research. POC-NAAT may reduce antibiotic overtreatment, while sampling should reflect clinical presentation and sexual practices. Integration between obstetrics-gynecology and clinical microbiology supports accurate diagnosis, stewardship, and prevention of reproductive complications.