Diagnostic Tests for Gonorrhea
Gonorrhea: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Gonorrhea
includes:
- Discharge swab tests
- Urine tests
- Cervix swab test
- Throat swab
- Bacterial cultures - to confirm diagnosis and determine response of the bacteria to antibiotics
Gonorrhea Tests: Book Excerpts
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Gonorrhea Diagnosis: Book Excerpts
Tests and diagnosis discussion for Gonorrhea:
Gonorrhea: DSTD (Excerpt)
Several laboratory
tests are available to diagnose gonorrhea. A health care provider can
obtain a sample of fluid from the infected mucus membrane (cervix,
urethra, rectum, or throat) and send the specimen to a laboratory for
analysis. Gonorrhea that is present in the male or female genital tract
can be diagnosed in a laboratory by using a urine specimen from an
infected person. A quick laboratory test for gonorrhea that can be done in
the clinic or doctor’s office is a Gram stain. The Gram stain allows the
doctor to see the gonorrhea bacteria under a microscope. This test works
better for men than for women. (Source: excerpt from Gonorrhea: DSTD)
Gonorrhea, NIAID Fact Sheet: NIAID (Excerpt)
Doctors or other health care
workers usually use three laboratory techniques to diagnose
gonorrhea: staining biological samples directly for the bacterium,
detection of bacterial genes or nucleic acid (DNA) in urine, and
growing the bacteria in laboratory cultures. Many doctors prefer to
use more than one test to increase the chance of an accurate
diagnosis.
The staining test involves placing a smear of the
discharge from the penis or the cervix on a slide and staining the
smear with a dye. Then the doctor uses a microscope to look for
bacteria on the slide. You usually can get the test results while in
the office or clinic. This test is quite accurate for men but is not
good in women. Only one in two women with gonorrhea have a positive
stain.
More often, doctors use urine or cervical swabs for a
new test that detects the genes of the bacteria. These tests are as
accurate or more so than culturing the bacteria, and many doctors
use them.
The culture test involves placing a sample of the
discharge onto a culture plate and incubating it up to two days to
allow the bacteria to multiply. The sensitivity of this test depends
on the site from which the sample is taken. Cultures of cervical
samples detect infection approximately 90 percent of the time.
The doctor also can take a culture to detect gonorrhea in
the throat. Culture allows testing for drug-resistant bacteria.
(Source: excerpt from Gonorrhea, NIAID Fact Sheet: NIAID)
Diagnosis of Gonorrhea: medical news summaries:
The following medical news items
are relevant to diagnosis of Gonorrhea:
Diagnostic Tests for Gonorrhea: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Gonorrhea.
VAGINAL DISCHARGE:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The most important test is microscopic examination of a saline and potassium hydroxide preparation. This will diagnose most cases of trichomoniasis and candidiasis.
Gardnerella
vaginalis
can be diagnosed if clue cells are found, and the pH of the discharge will be greater than 4.7. If this is unrevealing, a Gram stain for gonorrhea and cultures for trichomoniasis, candidiasis, chlamydia,
Gardnerella vaginalis
, and gonorrhea may be done. A Pap smear should be done to rule out malignancy. Polyps or inflamed areas of the cervix should be biopsied. Colposcopy may help further differentiate a cervical lesion. A dilation and curettage may be necessary to diagnose endometrial carcinoma and hydatidiform mole. Occasionally, pelvic ultrasound and CT scans are necessary. However, before ordering these expensive diagnostic tests, a gynecologist should be consulted. Patients with documented evidence of gonorrhea should have a VDRL test and HIV testing.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Vaginal discharge:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient to describe the onset, color, consistency, odor, and texture of her vaginal discharge. How does the discharge differ from her usual vaginal secretions? Is the onset related to her menstrual cycle? Also, ask about associated symptoms, such as dysuria and perineal pruritus and burning. Does she have spotting after coitus or douching? Ask about recent changes in her sexual habits and hygiene practices. Is she or could she be pregnant? Next, ask if she has had vaginal discharge before or has ever been treated for a vaginal infection. What treatment did she receive? Did she complete the course of medication? Ask about her current use of medications, especially antibiotics, oral estrogens, and hormonal contraceptives.
Examine the external genitalia and note the character of the discharge. (See Identifying causes of vaginal discharge.) Observe vulvar and vaginal tissues for redness, edema, and excoriation. Palpate the inguinal lymph nodes to detect tenderness or enlargement, and palpate the abdomen for tenderness. A pelvic examination may be required. Obtain vaginal discharge specimens for testing.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Vaginal discharge:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient to describe the onset, color, consistency, odor, and texture of her vaginal discharge. How does the discharge differ from her usual vaginal secretions? Is the onset related to her menstrual cycle? Also, ask about associated symptoms, such as dysuria and perineal pruritus and burning. Does she have spotting after coitus or douching? Ask about recent changes in her sexual habits and hygiene practices. Is she or could she be pregnant? Next, ask if she has had a vaginal discharge before or has ever been treated for a vaginal infection. What treatment did she receive? Did she complete the course of medication? Ask about her current use of medications, especially antibiotics, oral estrogens, and hormonal contraceptives.
Examine the external genitalia and note the character of the discharge. (See Identifying causes of vaginal discharge, page 792.) Observe vulvar and vaginal tissues for redness, edema, and excoriation. Palpate the inguinal lymph nodes to detect tenderness or enlargement, and palpate the abdomen for tenderness. A pelvic examination may be required. Obtain vaginal discharge specimens for testing.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Vaginal Discharge:
Physical examination (4)
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A general physical examination should be performed if systemic illness is suspected. Record vital signs, including temperature, blood pressure, and pulse.
In most cases, a genital examination with the patient in the lithotomy position is adequate.
The external genitalia is carefully inspected for evidence of trauma, blisters, lymph nodes excoriations, swelling, erythema, ulcerations, tenderness or pain.
The amount, color, texture, odor, and location of the discharge should be noted. A complete pelvic examination should be performed with particular attention given to the cervix for evidence of friability or inflammation and a cervical motion test which may indicate pelvic inflammatory disease.
Testing (5)
A. Vaginal fluid pH. Immersing pH paper in the vaginal discharge or the lateral wall of the vagina will give the vaginal pH.
A pH greater than 4.5 indicates BV or T. vaginalis.
B. Saline wet mount. Obtain a drop of vaginal discharge from the posterior fornix; place it on a slide with a drop of saline and apply a cover slip.
1. Clue cells, which are bacteria-coated, stippled epithelial cells, are characteristic of BV.
2. Trichomonads, which are mobile, oval flagellated parasites, confirm the presence of trichomoniasis.
C. Potassium hydroxide (KOH) preparation. Place a second drop of vaginal secretions on a slide containing a drop of KOH; “a positive whiff test” indicates the presence of BV. Threadlike hyphae and budding yeast observed microscopically are characteristic of a candidal infection.
D. Cultures for gonorrhea and chlamydia are not routinely indicated, but should be taken with a history of a new sexual partner, prurulent cervical discharge, or cervical motion tenderness.
Diagnostic assessment
BV causes 40% to 50% of vaginitis, followed by candidiasis (20% to 25%) and trichomoniasis (15% to 20%). Together, these infections account for more than 90% of vaginitis diagnoses.
When evaluating a woman with a vaginal complaint, be sure to hear her true concern. Evaluate and treat appropriately those with acute symptoms (e.g., pain or swelling) and be careful to understand the effect of pretreatment with OTC preparations in the presumptive diagnosis. It is wise to be mindful of the possibility of sexually transmitted diseases with any vaginal complaint and to test appropriately for these diseases. If a vaginitis, presumably infectious, does not respond to initial therapy, consider other causes including trauma, herpes, menopause, contact dermatitis, toxic shock syndrome, steroid-responsive inflammatory vaginitis, and collagen-vascular or other systemic disease.
References
1. Lash DJ, Garcia TA. Diagnosis and treatment of vaginitis. The Female Patient 1998;23:25–41.
2. Carr PL, Majeroni BA, Robinson JC, Talarico LD. Vaginitis: solid diagnosis means effective treatment. Patient Care 1999;33(2):86–106.
3. Miller KE. Sexually transmitted diseases. Prim Care 1997;24(1):179–193.
4. Chan PD, Winkle CR, eds. Gynecology and obstetrics’ 1999–2000 edition. Laguna Hills, CA: Current Clinical Strategies Publishers, 1999:73–79.
5. Sabel JD. Vaginitis. N Engl J Med 1997;337:1896–1903.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Vaginal Discharge:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Symptoms of vaginitis include vaginal discharge, pruritis, irritation, soreness, odor, and less commonly bleeding, dysuria, or pain with intercourse. It is important to distinguish burning on urination due to cystitis, which is internal and accompanied by irritative signs (urinary frequency), from dysuria due to vaginitis, which feels external as the urine passes over an inflamed vulva. Similarly, it is important to distinguish vaginitis, characterized by discharge and pruritus, from cervicitis, with discharge and pelvic pain.
On examination, the vulva appears normal in bacterial vaginosis, while erythema, edema or fissures suggest candidiasis, trichomonas or dermatitis. An erythematous, friable cervix with a mucopurulent discharge is consistent with cervicitis rather than vaginitis. This must be distinguished from ectropion (normal endocervical glandular tissue visible on the exocervix), which is not friable.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Vaginal discharge:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Examine the external genitalia and note the character of the discharge. (See Identifying causes of vaginal discharge, page 680.) Observe vulvar and vaginal tissues for redness, edema, and excoriation. Palpate the inguinal lymph nodes to detect tenderness or enlargement. Palpate the abdomen for tenderness. A pelvic examination may be required. Obtain vaginal discharge specimens for testing.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vaginal Discharge:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Nonspecificvulvovaginitis is most common cause of vaginal discharge in prepubertal girls.If discharge fails to improve with good perineal hygiene or if itis purulent, specific bacterial infection, sexually transmittedinfection, or foreign body should be suspected. Wet mounts (salineand KOH), Gram stain, and vaginal cultures should be performed.Exam under anesthesia may be necessary for suspected foreign body.In pubertal girls who are not sexuallyactive, most common causes of vaginal discharge are physiologicleukorrhea, bacterial vaginosis, and C. albicans. Wet preparations(saline and KOH) and Gram stain should be performed. Bacterial andfungal cultures also should be considered.In girls who are sexually active, thesame diagnoses described for pubertal nonsexually active femalesare possible, but sexually transmitted infections also are likely.In addition to wet preparations and Gram stain, cultures for C.trachomatis, N. gonorrhoeae, and other aerobic and anaerobic bacteria shouldbe performed. In some centers nucleic acid amplification technologyis available for detection of C. trachomatis and N. gonorrhoeaefrom endocervical and urine specimens. Laparoscopy may provide definitivediagnosis in suspected pelvic inflammatory disease with negativecervical cultures.If sexual abuse is suspected at anyage, vaginal, rectal, and throat cultures for N. gonorrhoeae andvaginal and rectal cultures for C. trachomatis should be performed,even in an asymptomatic child. HIV testing should be considered.So should pregnancy prophylaxis, which depends on whether menarche hasbeen reached and on nature of abuse.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Vaginal discharge:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Ask the patient to describe the onset, color, consistency, odor, and texture of her vaginal discharge. How does the discharge differ from her usual vaginal secretions? Is the onset related to her menstrual cycle? Ask about associated symptoms, such as dysuria and perineal pruritus and burning. Does she have spotting after coitus or douching? Ask about recent changes in her sexual habits and hygiene practices. Is she or could she be pregnant? Ask if she has had vaginal discharge before or has ever been treated for a vaginal infection or sexually transmitted disease. What treatment did she receive? Did she complete the course of medication and were all sexual contacts treated? Ask about her current use of medications, especially antibiotics, oral estrogens, and hormonal contraceptives.
Examine the external genitalia and note the character of the discharge. (See Identifying causes of vaginal discharge.) Observe vulvar and vaginal tissues for redness, edema, and excoriation. Palpate the inguinal lymph nodes to detect tenderness or enlargement, and palpate the abdomen for tenderness. A pelvic examination may be required. Obtain vaginal discharge specimens for testing.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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