Gonorrhea
Gonorrhea: Excerpt from Handbook of Diseases
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 the blood to the joints, tendons, meninges, and endocardium; 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 reinfection is common. Gonorrhea is especially prevalent among young people and people with multiple partners, particularly those between ages 19 and 25.
Causes
Transmission of Neisseria gonorrhoeae, the organism 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.
Signs and symptoms
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:
❑ urethra — dysuria, urinary frequency and incontinence, purulent discharge, itching, red and edematous meatus
❑ vulva — occasional itching, burning, and pain due to exudate from an adjacent infected area (vulval symptoms are more severe before puberty and after menopause)
❑ vagina (most common site in children over age 1) — engorgement, redness, swelling, and profuse purulent discharge
❑ 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)
❑ 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
Gonococcal septicemia is more common in females than in males. Its characteristic signs include tender papillary skin lesions on the hands and feet; these lesions may be pustular, hemorrhagic, or necrotic.
Gonococcal septicemia may also produce migratory polyarthralgia and polyarthritis and tenosynovitis of the wrists, fingers, knees, and ankles. Untreated septic arthritis leads to progressive joint destruction.
Eye involvement
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
A culture from the site of infection (urethra, cervix, rectum, or pharynx), grown on a medium, usually establishes the diagnosis by isolating the organism. 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 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 I.M.; for presumptive treatment of concurrent Chlamydia trachomatis infection, the treatment is 100 mg doxycycline by mouth (P.O.) twice daily for 7 days.
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 ceftriaxone I.M. or I.V. every 24 hours or, for patients allergic to beta-lactam antibiotics, 2 g 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 antimicrobial therapy: 400 mg cefixime P.O. twice daily or 500 mg ciprofloxacin P.O. twice daily. Ciprofloxacin is contraindicated in children, adolescents, and pregnant or lactating women.
Gonorrhea may also be treated with a single 1-g dose of azithromycin, per Centers for Disease Control and Prevention guidelines.
Treatment of gonococcal conjunctivitis requires a single 1-g dose of ceftriaxone I.M. and lavage of the infected eye with normal saline solution once.
Routine instillation of 1% silver nitrate or erythromycin drops into neonates’ eyes has greatly reduced the incidence of gonococcal ophthalmia neonatorum.
Special considerations
❑ 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.
❑ Practice standard precautions.
❑ 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.
Clinical tip 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 in the eyes of all neonates immediately after birth. Check neonates of infected mothers for signs of infection. Take specimens for culture from the infant’s eyes, pharynx, and rectum.
❑ To prevent gonorrhea, tell patients to avoid 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.
❑ Report all cases of gonorrhea in children to child abuse authorities.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
More About Gonorrhea
More Medical Textbooks Online about Gonorrhea
Review other book chapters online related to Gonorrhea:
Medical Books Excerpts
- Gonorrhea
- "Professional Guide to Diseases (Eighth Edition)" (2005)
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- Vaginal Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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