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Gonorrhoea

Title               

Ñ    Gonorrhoea

Definition

Ñ    Sexually transmitted disease

Caused by:

Ñ    Neisseria gonorrhoeae                        

Pathogenesis

Organism

Ñ    Neisseria gonorrhoeae:

Gram-negative intracellular diplococcus

Transmission

Ñ    Sexual contact

Pathological Process

Ñ    Exudative and purulent reactions initially

Ñ    Followed by formation of granulomatous tissue, plasma cell infiltration and scarring with chronic disease

Clinical Features

History

Sex

Ñ    Females:

50 % asymptomatic

Ñ    Males:

10 % asymptomatic

Incubation period

Ñ    2-14 days:

Most symptoms 2-5 days

RAG

Females

Ñ    Vaginal discharge

Ñ    Pelvic pain

Ñ    Dysuria

Ñ    Intermenstrual bleeding

Males

Ñ    Anterior urethritis

Ñ    Prostatitis

Ñ    Epididymo-orchitis

GIT

Ñ    Pharyngeal infection:

Asymptomatic

Ñ    Proctitis:

Homosexual men

Ñ    Rectal infection in females:

Usually asymptomatic

Examination

RAG

Ñ    Urethral discharge:

Males

Complications

IS

Ñ    Papular or pustular rash, erythematous base, fever, malaise

GIT

Ñ    Perihepatitis in females:

Fitzhugh-Curtis syndrome

RAG

Females

Ñ    Pelvic inflammatory disease

Ñ    Bartholin’s abscess

Ñ    Female infertility

Ñ    Obstetric complications:

Abortion

Premature labour

LMS

Ñ    Mono-articular or pauci-articular arthritis

Investigations

Fluids

Urethral smear/endocervical swab

Ñ    Microscopy:

Gram stain shows intracellular gram-negative diplococci

Blood culture

Ñ    Disseminated infection

Synovial fluid culture

Ñ    Arthritis

Management

Cure

Drugs

Ñ    Ciprofloxacin

Ñ    Amoxycillin with probenecid

Ñ    Ceftriaxone

Ñ    Spectinomycin

Prevention

Ñ    Follow up:

Follow up after treatment. Repeat culture 72 hours after completion of treatment

Ñ    Contact tracing:

All sexual contacts should be examined and treated if necessary

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