A54.21 Gonococcal infection of kidney and ureter

Name of the Condition

• Gonococcal infection of kidney and ureter

Summary

Gonococcal infection of the kidney and ureter is a sexually transmitted infection caused by Neisseria gonorrhoeae. It involves inflammation of the renal pelvis, calyces, and ureter, typically resulting from ascending spread of the bacteria from the lower genitourinary tract. The condition may present with or without symptoms and is characterized by localized infection and potential systemic involvement.

Causes

The infection is caused by Neisseria gonorrhoeae, a bacterium transmitted through sexual contact. The bacteria colonize the mucosal surfaces of the genitourinary tract, leading to infection and potential spread to the upper urinary tract, including the kidney and ureter. Transmission occurs via unprotected vaginal, oral, or anal sex with an infected partner.

Risk Factors

• Unprotected sexual activity with multiple partners
• History of prior gonococcal infections
• Young age (15–24 years)
• Presence of other sexually transmitted infections
• Lack of consistent condom use
• Recent genitourinary instrumentation or surgery

Symptoms

• Flank pain or tenderness
• Fever or chills
• Dysuria (painful urination)
• Urinary urgency or frequency
• Hematuria (blood in urine)
• Nausea or vomiting

Diagnosis

Diagnosis involves clinical evaluation and laboratory testing. Nucleic acid amplification tests (NAATs) on urine or genital swabs are used to detect Neisseria gonorrhoeae. Imaging studies, such as ultrasound or CT, may be performed to assess kidney and ureter involvement. Urine cultures and blood tests may also be utilized to confirm infection and rule out complications.

Treatment Options

Treatment typically involves antibiotics effective against Neisseria gonorrhoeae, such as ceftriaxone, often combined with azithromycin. The choice of regimen depends on local resistance patterns and patient factors. Follow-up testing is recommended to ensure resolution of infection.

Prognosis and Follow-Up

With appropriate treatment, the prognosis is generally good, though complications may occur if the infection is untreated or recurrent. Follow-up care includes monitoring for symptom resolution and repeat testing to confirm eradication of the bacteria. Patients should be advised to avoid sexual contact until treatment is completed and partners are evaluated.

Complications

• Pyelonephritis (kidney infection)
• Ureteral obstruction
• Chronic kidney disease
• Sepsis
• Infertility (if associated with pelvic inflammatory disease)

Lifestyle & Prevention

• Consistent use of condoms during sexual activity
• Limiting number of sexual partners
• Regular screening for sexually transmitted infections
• Prompt treatment of gonococcal infections to prevent spread
• Avoiding genitourinary instrumentation when possible

When to Seek Professional Help

Seek medical attention if experiencing persistent flank pain, fever, dysuria, or other symptoms of urinary tract infection, especially if there is a history of gonococcal infection or unprotected sexual contact.

Tips for Medical Coders

When coding for gonococcal infection of the kidney and ureter (A54.21), ensure documentation specifies the involvement of these structures. Verify that the infection is attributed to Neisseria gonorrhoeae and that the diagnosis is supported by clinical findings and laboratory results. Avoid coding for unrelated conditions or complications unless explicitly documented.