8- Gonorrhoeal infection in men, complications of infection

What is gonorrhea

• Gonorrhea is the most common reportable STI in high income countries

What is the transmission of G

• Primarily by sexual contact

  • Exception is indirect contact among prepubescent girls sharing contaminated objects

• Vertical transmission can occur from infected mother to newborn-> gonococcal conjunctivitis, pneumonia, vulvovaginal infection

Describe the microbiological characteristics of G

• Gram neg diplococci

• Cannot tolerate drying or low temperatures

• Growth optimal in 35-37C 5% CO2 environment

• Gonococci are able to multiply and divide intracellularly- immune to host defence

Describe the general infection in men

• Incubation is short- 2-5days

• 10% of infected men and 50% of women lack clinical symptoms

  • Common in rectal and pharyngeal infections

What is the clinical presentation in men

• Acute anterior urethritis with dysuria

• Urethral discharge is typical in purulent and profuse

• 1/4 of infected men

  • Urethral symptoms are less

  • Without treatment, clinical symptoms disappear after 6 months

What are the local complications

• Inflammation of Cowper and tyson glands and gonococcal pyoderma

• Ascension of infection ->

  • Epididymitis, prostatitis, vesiculitis

  • Epididymitis present with unilateral testicular pain and swelling accompanied by urethritis, infertility

What are the complications in both sexes

• Acute arhtritis dermatosis syndrome

  • Most common clinical manifestation of gonococcal bacteremia

  • Fever, joint pain, paucilesional eruption of hemorrhagic pustules

  • Gonococca tenosynovitis affects primarily larger joints- knee, elbow, wrists

  • Cutaneous lesions constist of scattered pustules

    • Often necrotic- due to embolic septic vasculitis

    • Occur primarily on distal portions of extremities