Previous studies have shown that a woman is more likely to be diagnosed with gonococcal (GC) infection during the first five days of her menstrual cycle (active menstruation) than during the rest of her cycle. However, no correlation has been established between risk of infection and the phase of a women’s menstrual cycle at the time of exposure. In this study, risk of GC infection was correlated to female menstrual cycle phase according to the woman’s stated date of last menstrual period and stated date of GC exposure.

Women ages 16–40 that presented to the Baltimore City Health Department STD Clinic as contacts of known GC positive sexual partners were enrolled. Risk of GC infection was compared to calculated phase of menstrual cycle: perimenstruational period (–5 to +5 days since LMP), late follicular (days 6–12), periovulatory (days 13–16), and early luteal (days 17 to –6 day since LMP).

58 female GC contacts were enrolled. Women who presented > 32 days after GC exposure or whose LMP was > 32 days at presentation where excluded. Of the 29 patients that met inclusion criteria, 11(38%) were GC negative and 18 (62%) were GC positive (by culture and subsequent NATs). Eighty percent (8/10) of women in the perimenstruational, 38% (3/8) in the late follicular, 80% (4/5) in the periovulatory, and 50% (3/6) in the early luteal phases were GC positive. Fifty-three percent (7/13) of HC users were GC positive.

Increased risk of GC infection during the perimenstrual period may be, in part, due to lower lactoferrin concentration, lower level of iron sequestration, and higher level of free iron in the female genital tract. Increased risk of GC infection surrounding ovulation may be due to higher lutropin receptor (known GC ligand) expression in the female GU tract at ovulation.