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Gonorrhea - Causes, Symptoms and Treatment

What is Gonorrhea?

A common sexually transmitted disease, gonorrhea is an infection of the genitourinary tract (especially the urethra and cervix) and, occasionally, the rectum, pharynx, and eyes. Untreated gonorrhea can spread through thc blood to the joints, tendons, meninges, and endocardinm; in females, it can also lead to chronic pelvic inflammatory disease (PID) and sterility. After adequate treatment, the prognosis in both males and females is excellent, although re-infection is common. Gonorrhea is especially prevalent among young people and in people with multiple sexual partners, particularly those between ages 19 and 25.

What are the Causes of Gonorrhea?

Transmission of Neisseria gonorrhoeae. the microbe that causes gonorrhea, almost exclusively follows sexual contact with an infected person. Children born of infected mothers can contract gonococcal ophthalmia neonatorum during passage through the birth canal. Children and adults with gonorrhea can contract gonococcal conjunctivitis by touching their eyes with contaminated hands.

What are the Signs and Symptoms of Gonorrhea?

Although many infected males are asymptomatic, after a 3- to 6-day incubation period, some develop symptoms of urethritis, including dysuria and purulent urethral discharge, with redness and swelling at the site of infection. Most infected females remain asymptomatic but may develop inflammation and a greenish yellow discharge from the cervix - the most common gonorrheal symptoms in females.

Other clinical features vary according to the site involved:

1. Urethra: dysuria, urinary frequency and incontinence, purulent discharge, itching, fed and edematous meatus

2. Vulva: occasional itching, burning, and pain due to exudate from an adjacent infected area. Vulval symptoms are more severe before puberty and after menopause.

3. Vagina (most common site in children over age 1): engorgement, redness, swelling, and profuse purulent discharge

4. Pelvis: severe pelvic and lower abdominal pain, muscle rigidity, tenderness, and abdominal distention. As the infection spreads, nausea, vomiting, fever, and tachycardia may develop in patients with salpingitis or PID.

5. Liver: right upper quadrant pain in patients with perihepatitis.

Other possible symptoms include pharyngitis, tonsillitis, rectal burning and itching, and bloody mucopurulent discharge.

Gonococcal septicemia is more common in females.then in males.lts characteristic signs include tender papillary skin lesions on the hands and feet; these lesions may be pustular, hemorrhagic, or necrotic. It may also produce migratory polyarthralgia and polyarthritis and tenosynovitis of the wrists, fingers, knees, and ankles. Untreated septic arthritis leads to progressive joint destruction.

Signs of gonococcal ophthalmia neonatorum include lid edema, bilateral conjunctival infection, and abundant purulent discharge 2 to 3 days after birth. Adult conjunctivitis, most common in men, causes unilateral conjunctival redness and swelling. Untreated gonococcal conjunctivitis can progress to corneal ulceration and blindness.

Diagnosis for Gonorrhea

A culture from the site of infection (urethra, cervix, rectum, or pharynx), grown on a Thayer-Martin or Transgrow medium, usually establishes the diagnosis by isolating N. gonorrhoeae. DNA probe analysis (which can also detect Chlamydia) has become the diagnostic method of choice. A Gram stain showing gram-negative diplococci supports the diagnosis and may be sufficient to confirm gonorrhea in males.

Confirmation of gonococcal arthritis requires identification of gram-negative diplococci on smears made from joint fluid and skin lesions. Complement fixation and immunofluorescent assays of serum reveal antibody titers four times the normal rate. Culture of conjunctival scrapings confirms gonococcal conjunctivitis.

Treatment for Gonorrhea

For adults and adolescents, the recommended treatment for uncomplicated gonorrhea caused by susceptible non-penicillinase-producing N. gonorrhoeae is a single 125-mg dose of ceftriaxone l.M. or a single oral dose of cefixime 400 mg P.O. Ciprofloxacin 500 mg P.O., or ofloxacin 400 mg P.O. are also recommended by the Centers for Disease Control and Prevention (CDC) for single dose oral therapy for gonorrhea. For presumptive treatment of concurrent Chlamydia trachomatis infection, the treatment is 100 mg of doxycycline P.O. twice daily for 7 days or azilhromycin (Zithromax) 1 g PO. in a single dose.

A single dose of ceftriaxone and erythromycin for 7 days is recommended for pregnant patients and those allergic to penicillin.

The recommended initial regimen for disseminated gonococcal infection in adults and adolescents is 1 g of ceftriaxone I.M. or I.V. every 24 hours or, for patients allergic to beta-lactam antibiotics, 2 g of spectinomycin I.M. every 12 hours.

All regimens should be continued for 24 to 48 hours after improvement begins; then therapy may be switched to one of the following regimens to complete 1 full week of anti microbial therapy: 400 mg of cefixime P.O. twice daily or 500 mg of ciprofloxacin P.O. twice daily. Ciprofioxacin is contraindicated in children, adolescents, and pregnant or lactating women. Gonorrhea may also be treated with a single 1-g dose of azithromycin (Zithromax), per CDC guidelines.

Treatment of gonococcal conjunctivitis requires a single 1-g dose of ceftriaxone I.M. and lavage of the infected eye once with normal saline solution.

Routine instillation of 1% silver nitrate drops, or erythromycin ointment, or tetracycline ointment into neonates' eyes has greatly reduced the incidence of gonococcal ophthalmia neonatorum.

Special Considerations and Prevention Tips for Gonorrhea

  • Before treatment, establish whether the patient has any drug sensitivities, and watch closely for adverse effects during therapy.
  • Warn the patient that until cultures prove negative, he's still infectious and can transmit gonococcal infection.
  • In the patient with gonococcal arthritis, apply moist heat to ease pain in affected joints.
  • Urge the patient to inform sexual contacts of his infection so that they can seek treatment, even if cultures are negative. Advise them to avoid sexual intercourse until treatment is complete.
  • Report all cases of gonorrhea to local public health authorities for follow-up on sexual contacts. Examine and test all people exposed to gonorrhea as well as newborn infants of infected mothers.
  • Routinely instill two drops of 1 % silver nitrate, or erythromycin ointment, or tetracycline ointment in the eyes of all neonates immediately after birth. Check newborn infants of infected mothers for signs of infection. Take specimens for culture from the infant's eyes, pharynx, and rectum.
  • Tell patients to avoid contact with anyone even suspected of being infected, to use condoms during intercourse, to wash their genitalia with soap and water before and after intercourse, and to avoid sharing washcloths or douche equipment.

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