Gonorrhea
Gonorrhea: Excerpt from Professional Guide to Diseases (Eighth Edition)
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 for 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 15 and 29. In these patients, suspect concomitant chlamydia infection.
Causes and incidence
Transmission of Neisseria gonorrhoeae, the organism that causes gonorrhea, usually 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.
The Centers for Disease Control and Prevention estimates that there are about 700,000 new cases of gonorrhea each year; only about half of these cases are reported to health care officials.
Signs and symptoms
Although many infected males may be 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 infection site. Most infected females remain asymptomatic but may develop inflammation and a greenish yellow discharge from the cervix — the most common gonorrheal symptoms in females. (See What happens in gonorrhea, page 996.)
Other clinical features vary according to the site involved:
❑ urethra: dysuria, urinary frequency and incontinence, purulent discharge, itching, and red and edematous meatus
❑ vulva: occasional itching, burning, and pain due to exudate from an adjacent infected area (symptoms tend to be more severe before puberty or after menopause)
❑ vagina (most common site in children older than age 1): engorgement, redness, swelling, and profuse purulent discharge
❑ liver: right upper quadrant pain in a patient with perihepatitis
❑ 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 a patient with salpingitis or PID.
Other possible symptoms include pharyngitis, tonsillitis, rectal burning and itching, and bloody mucopurulent discharge.
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, or 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
CONFIRMING DIAGNOSIS A culture from the infection site (urethra, cervix, rectum, or pharynx), grown on a Thayer-Martin or Transgrow medium, usually establishes the diagnosis by isolating N. gonorrhoeae. (See Neisseria gonorrhoeae.) A Gram stain showing gram-negative diplococci supports the diagnosis and may be sufficient to confirm gonorrhea in males.
Lipase chain reaction is an assay that can detect N. gonorrhoeae and Chlamydia trachomatis from urethral or cervical swabs. It allows for rapid diagnosis and offers improved sensitivity and specificity compared to swab specimen cultures.
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 dose of ceftriaxone; for presumptive treatment of concurrent C. trachomatis infection, doxycycline. Common alternative prescriptions may include ciprofloxacin, ofloxacin, spectinomycin, cefuroxime, cefpodoxime proxetil, or erythromycin. A follow-up visit 7 days after treatment to recheck cultures and confirm the cure of infection is recommended, especially for women who are asymptomatic or may not have symptoms associated with the infection. A single dose of ceftriaxone and erythromycin is recommended for pregnant patients and those allergic to penicillin.
Treatment of gonococcal conjunctivitis requires a single dose of ceftriaxone, and lavage of the infected eye with saline solution once.
Routine instillation of 1% silver nitrate drops or erythromycin ointment into the neonate’s eyes soon after delivery 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 drug reactions during therapy.
❑ Warn the patient that, until cultures prove negative, he’s still infectious and can transmit gonococcal infection.
❑ If the patient has 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 him 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 children of infected mothers.
❑ Routinely instill two drops of 1% silver nitrate solution or erythromycin ointment in the eyes of all neonates immediately after birth. Check the neonate of an infected mother for signs of infection. Take specimens for culture from the neonate’s eyes, pharynx, and rectum.
❑ To prevent gonorrhea, tell patients to avoid anyone suspected of being infected, to use condoms during intercourse, to wash genitals with soap and water before and after intercourse, and to avoid sharing washcloths or douche equipment. Also tell them that abstinence is the only sure way to prevent gonorrhea.
❑ Report all cases of gonorrhea in children to child abuse authorities.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 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)
- [ read ]
- 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.
» Next page: Vaginal discharge (Professional Guide to Signs & Symptoms (Fifth Edition))
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