Gonorrhea

Gonorrhea is a second most commonly reported notifiable sexually transmitted disease effecting male 1.5 times more than females (Chlamydia is most common) . Gonorrhea is also transmitted perinatal and perinatal infection is a major cause of morbidity. In most of the countries prophylaxis for neonatal eye infection is mandatory.

Follow up:

Causative Organism & features:
• Neisseria gonorrhoeae
• Gram negative, Diplococcus
• Found inside the polymorphonuclear cells
• Virulence factors depends on Pili & Protein II

Toxins: Endotoxin- Lipopoly saccharide

High incidence: Between 15years to 29 years

Incubation period: 2 to 8 days

Pathophysiology:
• Infects almost all the mucous membrane
• Urethral infections can ascend up to involve epididymis & prostate in men. Vagina & fallopian tube in women

Risk factors
• Unprotected sexual intercourse
• Anal sex
• Baby born to infected mother

Classification
• Urethritis & Cervicitis
• Disseminated Disease
• Conjunctivitis

Urethritis & Cervicitis
1. Asymptomatic- no symptoms with infection, common in both the sex
2. Symptomatic- symptoms presents with the infections

Symptoms & Signs
• Fever
• Burning on urination
• Urethral discharge- First serous to milky discharge, 2 to 3 days later yellowish creamy discharge, contains tinge of blood

MEN
Truly asymptomatic infection is rare in male. However up to 5% of the patient will have asymptomatic infection. The urethral infection if not treated will infect epididymitis & prostatitis. At this time patient will have pain in the testis and scrotal area.

WOMEN
Asymptomatic infection is very high. Up to 50% of the patients are asymptomatic. The primary source of infection is usually endocervical canal. The infection if not treated spreads to the uterus & uterine tube. Rarely causes Fitzhugh-curtis syndrome (perihepatitis).

Disseminated Disease
Disseminated disease is more common in women The primary infection spreads to other part of the body via blood stream. The infection can spread to skin- causing maculopapular lesions, joints- leading to arthritis, rarely to the heart causing endocarditis and meninges (brain covering)- causing meningitis.

Conjunctivitis
Infants born to infected women may suffer from eye infection and if not treated may lead to blindness. Prophylaxis for neonatal eye infection is mandatory in most of the countries. In adult autoinoculation to the eye is the commonest mode of infection.

Differential diagnosis
Chlamydia Urinary tract infection Vaginal Candidiasis

Lab works
• Gram staining & Culture of the urethral specimen in men- 90% sensitive and endocervical specimen in women- 50% sensitive.

Treatment
• CDC recommend cephalosporins group of drugs.
• Ceftriaxone injection for all kind of gonorrheal infection
• Cefixime 400mg single dose for uncomplicated urethral & rectal infection