Gonorrheal infection in men and women. Laboratory diagnosis and treatment.

Transmission of gonorrhoea

• sexual contact

• vertical transmission from infected mother to newborn

  • gonococcal conjunctivitis, pneumonia, vulvavaginal infection

Clinical manifestation of gonorrhoea in men

• incubation perid of 2-14 days → symptoms start around 2-5

• 10% asymptomatic

  • especially common in rectal and pharyngeal infections

• acute anterior urethritis w/ dysuria

• urethral discharge is purulent and profuse = Bonjour drop

Compliations of gonorrhoea in men

• inflammation of Cowper and Tyson glands

• gonococcal pyoderma

• ascending infection → epididymitis, prostatitis, vesiculitis

Characteristics of gonorrhoea in women

• 50% asymptomatic

• primary site of infection → endocervical canal

  • increased vaginal discharge, dysuria, intermenstrual bleeding, menorrhagia

  • purulent cervical discharge with erythema and edema

Complications of gonorrhoea in women

• salpingitis or pelvic inflamamtory disease due to ascension

  • may reuslt in infertility, chronic pelvic pain, ectopic pregnancy

• Bartholin’s abscess

• Fitzhugh-Curtis syndrome (gonorrheic perihepatitis) → adhesions bw liver capsule and peritoneum

  • inflammation of adjacent peritoneal area

Extragenital gonorrhea

• pharyngeal gonorrhea

• rectal gonorrhea → gonococcal proctitis

  • rectal discharge, anal pruritus, bleeding, tenesmus, constipation

• arthritis gonorrhoica - monoarthritis

• gonococcal ophthalmia → purulent conjunctivitis - if untreated severe keratitis

• ophthalmia neonatorum

  • gonococcal infection in newborns

  • inoculation during delivery through infected birth canal

  • purulent conjunctivitis

  • preventive application of antimicrobial ointment (erythromycin) immediately after birth

Disseminated gonococcal infection - complication in both sexes

• acute arthritis-dermatosis syndrome

• fever, joint pain and paucilesional eruption of hemorrhagic pustules

• tenosynovitis affectiving larger joints

• cutaneous lesions → scattered pustules, necrotic due to embolic septic vasculitis

  • primary on distal portions of extremities

Diagnosis of gonorrhoea

• samples → endocervical canal, urethra, pharynx, anus

• direct detection of Gram (-) diplococci

  • w/in neutrophils in Gram (-) or methylene blue stained smears

  • smears are not helpful in rectal and pharyngeal gonorrhea due to presence of other bacteria

• bacterial culture

• nucleic acid amplification techniques

  • advantage → detect chlamydia trachomatis and other STI

  • disadvantage → lack of antibiotic sensitivity testing

Treatment of gonorrhoea

• single dose of 500/1000mg of im ceftriaxon for uncomplicated gonococcal infection

• alternative regime → azithromycin, ciprofloxacin

• disseminatd gonococcal infection → iv ceftriaxon