Persons with deficiency of complement C6-C9 are at risk for disseminated infections. The bacteria are very sensitive to cold and dry conditions, and is almost always transmitted through vaginal, oral, and anal sex. Gonorrhea is usually symptomatic in men but often asymptomatic in women. The mucosal surface is usually infected. Whether or not they the bacteria are piliated determines virulence.
Piliated bacteria are virulent while the nonpiliated ones are avirulent.
The bacteria use the pili to attach to the mucosal surface. They also produce an IgA protease that blocks IgA's action of disrupting cellular attachment. A mother can pass the organism to her baby during childbirth resulting in conjunctivitis. Two weeks after the initial infection, the bacteria may ascend the prostate, seminal vesicles, and epididymis causing pain. Gonococci usually infect the endocervix.