8-10. Gonorrhoea

transmission of gonorrhoea

- sexual contact

- contaminated objects sharing (prepubescent girls vaginal epithelium can only be infected before puberty)

- vertical transmission during delivery

features of N. gonorrhoea

- gram negative diplococci

- intracellular bacteria

- sensitive: 37 degrees, 5% CO2

8. MEN

incubation time of gonorrhoea (in men)

- 2-5 days

- no clinical symptoms during this time

clinical presentation of gonococcal infection (men)

- acute anterior urethritis, dysuria

- urethral discharge: purulent, profuse

complications of gonorrhoea infection (men)

- inflammation of Cowper and Tyson glands

-> gonococcal pyoderma

- ascension: epididymitis, prostatitis, vesiculitis, infertility

- unilateral testicular pain

9. WOMEN

clinical presentation of gonococcal infection (women)

- 50% remain asymptomatic

- increased vaginal discharge, dysuria, intermenstrual bleeding

- purulent cervical discharge with erythema and oedema

primary site of gonococcus infection in women

endocervical canal

complications of gonorrhoea in women

- pelvic inflammatory disease (-> infertility, ectopic pregnancy)

- gonorrheic perihepatitis (inflammation of adjacent peritoneum)

symptoms of pelvic inflammatory disease

- lower abdominal pain

- adnexal tenderness

- elevation of ESR

- leukocytosis, fever

types of extragenital gonorrhoea

- pharyngeal gonorrhoea

- rectal

- arthritis gonorrhoica

- opthalmy

- ophthalmia neonatorum

pharyngeal gonorrhoea

- usually asymptomatic

- can cause urethral gonorrhoea in the sexual partner

rectal gonorrhoea

- asymptomatic in 50%

- gonococcal proctitis: rectal discharge, pruritus, tenesmus, bleeding

arthritis gonorrhoica

monoarthritis

gonococcal ophthalmia

purulent conjunctivitis, if untreated -> severe keratitis

ophthalmia neonatorum

- infection during delivery

- purulent conjunctivitis

- preventative application of erythromycin immediately after birth

disseminated gonococcal infection

acute arthritis-dermatosis syndrome

- occurs in 1% of patients with mucosal gonorrhoea

- fever, joint pain (large joints), haemorrhagic pustule eruption on distal part of extremities

- cutaneous: necrotic pustules due to embolic septic vasculitis

10. LAB DIAGNOSIS

appearance of gonococcus under microscope

- gram negative/methylene blue

- intracellular in WBCs

- diplococci

detection methods for gonococcus

- direct light microscopy

- PCR

- bacterial culture

swab samples for gonorrhoea diagnosis

- women: endocervical canal

- men: urethra

- other: pharynx, anus

direct detection with microscope

why is bacterial culture important in gonorrhoea diagnosis?

to check antibiotic sensitivity!

advantage and disadvantage of PCR

- detection of coinfections

- cannot test antibiotic sensitivity

treatment of gonorrhoea

- uncomplicated: single dose of intramuscular ceftriaxone

- or azithromycin/ciprofloxacin

- disseminated: intravenous ceftriaxone