5. GONORRHEA

Disease Status: One of the most prevalent sexually transmitted diseases.
Causative Agent: Bacteria known as Chlamydia trachomatis.
Mode of Transmission:
- Primarily through vaginal, anal, and oral sexual contact.
- Hand-to-eye contact.
- From mother to baby during childbirth.

Infection Sites:
- Cervix is the predominant infection site.
- Urethra infected in about 50% of cases.
Asymptomatic Cases: Approximately 80% of women are asymptomatic.
Symptoms When Present:
- Increased vaginal discharge and dysuria.
- Mild to yellow mucus-like vaginal discharge.
- Lower abdominal pain (LAP) and intermenstrual bleeding if the infection has progressed.
Examination Findings:
- May show mucopurulent cervicitis or contact bleeding.
- Cervix may appear normal in some cases.

Culture Tests:
- Definitive but difficult and costly.
- Results take 3-7 days.
Nucleic Acid Amplification Tests (NAATs):
- Most sensitive tests comparable to culture.
- Require specimen transport and test result handling.

Uncomplicated Chlamydia:
- Doxycycline 100mg twice daily for one week.
- Azithromycin 1g as a single dose.
Pregnant/Lactating Women:
- Erythromycin 500mg twice daily for 14 days.

Patients must abstain from sex until treatment is completed for both them and their partners.
Follow-up appointment to ensure:
- Completion of medication.
- Sexual abstinence.
- Partner has been treated.

Potential spread beyond lower and upper genital tract can cause:
- Inflammation/Abscess of Sken's and Bartholin's glands.
- Endometritis.
- Salpingitis.
- Perihepatitis.
May lead to:
- Tubal damage, resulting in tubal pregnancies and infertility.

Increased risk of:
- Miscarriage.
- Preterm birth.
- Postpartum infection.
Neonatal complications from mother’s infection may include:
- Pneumonia, conjunctivitis, and severe cases may lead to blindness.
Connection to increased HIV acquisition risk and cervical cancer.

Infection Rate: Less common than Chlamydia.
Causative Agent: Neisseria gonorrhea, a gram-negative intracellular diplococcus.
Common Age Group: Young, sexually active individuals.
Incubation Period: 2-7 days.

Infection Sites:
- Cervix and urethra (70-90% affected).
Asymptomatic Rate: 50% of women may be asymptomatic.
Common Symptoms: Increased vaginal discharge, dysuria, post-coital bleeding, LAP, and intermenstrual bleeding.
Examination Findings:
- May include purulent/mucopurulent cervicitis, and cervix may appear normal despite infection.

Culture Test:
- Primary method, useful for determining antibiotic susceptibility.
NAAT:
- Optimal test detecting genetic material, can be performed on urine or swab sample.

Uncomplicated Gonorrhea:
- Ciprofloxacin 500mg, Ofloxacin 400mg, Ampicillin 3g with Probenecid 1g, or
- Ceftriaxone 250mg IM.

Recommended Treatments:
- Ceftriaxone 250mg IM or Cefotaxime 500mg IM or
- Ampicillin 3g orally with Probenecid 1g.
Check for co-infection with Chlamydia in about 40% of females.

For treatment at any anatomical site:
- 250mg Ceftriaxone IM with 1g Azithromycin orally or
- 250mg Ceftriaxone IM with 100mg Doxycycline orally twice for 7 days.
Alternative treatments for patients allergic to cephalosporins include:
- 2g Azithromycin orally.
Patients needing alternatives must return for a cure test after one week.

Sexual abstinence until both partners have completed their treatments.
Follow-up to verify:
- Completion of medication.
- Abstinence maintained.
- Partner treatment confirmation.
- Swabs repeated to ensure infection clearance.

Spread can cause:
- Sken’s and Bartholin’s abscess, Endometritis, Salpingitis, and Perihepatitis.
Resulting risks include tubal pregnancy and infertility.

Risks include miscarriage, preterm birth, postpartum infection, and neonatal infection.
Rare complications: Gonococcal septicemia presenting as arthritis/dermatitis syndrome.
Increases women's risk of HIV infection significantly.