| What is gonorrhea? | • Gonorrhea is a purulent infection of the mucous membrane surfaces caused by Neisseria gonorrhoeae
• N gonorrhoeae is spread by sexual contact or through transmission during childbirth
• All patients with gonorrheal infection also be treated for presumed co-infection with Chlamydia trachomatis |
| What are S&S of Gonorrhea? | • In women, the major genitourinary symptoms of gonorrhea include the following:
• Vaginal discharge : The most common presenting symptom of gonorrhea, vaginal discharge from endocervicitis is usually described as thin, purulent, and mildly odorous; however, many patients have minimal or no symptoms from gonococcal cervicitis
• Dysuria
• Intermenstrual bleeding
• Dyspareunia (painful intercourse)
• Mild lower abdominal pain |
| How is presentation of gonorrhea in females? | •Vaginal discharge
•Dysuria
•Intermenstrual bleeding
•Dyspareunia
•Mild lower abdominal pain |
| What is PID caused by gonorrhea? | If the infection progresses to pelvic inflammatory disease (PID), symptoms may include the following:
• Lower abdominal pain: Most consistent symptom of PID
• Increased vaginal discharge or mucopurulent urethral discharge
• Dysuria: Usually without urgency or frequency
• Cervical motion tenderness
• Tender lymph nodes (usually bilateral) or mass
• Intermenstrual bleeding
• Fever, chills, nausea, and vomiting (less common) |
| How is presentation of gonorrhea in males? | The major genitourinary symptoms of gonorrhea include the following:
•Urethritis: The major manifestation of gonococcal infection in men; initial characteristics include burning upon urination and a serous discharge; a few days later, the discharge usually becomes more profuse, purulent, and, at times, tinged with blood
•Acute epididymitis: Usually unilateral and often occurs in conjunction with a urethral exudates |
| What are complications of gonorrhea infection? | Urethral strictures: Have become uncommon in the antibiotic era, but they can present with a decreased and abnormal urine stream, as well as with the secondary complications of prostatitis and cystitis
Rectal infection: May present with pain, pruritus, discharge, or tenesmus |
| How is classic presentation of gonorrhea? | • In males and females, the classic presentation of disseminated gonococcal infection (DGI) is an arthritis-dermatitis syndrome
• Joint or tendon pain is the most common presenting complaint in the early stage of infection
• The second stage of DGI is characterized by septic arthritis. The knee is the most common site of purulent gonococcal arthritis |
| How is gonorrhea in neonates? | • In neonates, in whom bilateral conjunctivitis (ophthalmia
neonatorum) often follows vaginal delivery from an untreated mother with a gonococcal infection, symptoms of gonococcal conjunctivitis include the following:
• Eye pain
• Redness
• Purulent discharge |
| How is dx of gonorrhea? | • Culture is the most common diagnostic test for gonorrhea, followed by the DNA probe and then the PCR assay and ligand chain reaction (LCR)
• The DNA probe is an antigen detection test that uses a probe to detect gonorrhea DNA in specimens |
| How is tx of gonorrhea? | • Gonococcal arthritis: Ceftriaxone 125 mg IM
• Gonococcal conjunctivitis: Ceftriaxone
• Gonorrhea contributing to PID: Cefoxitin 400 mg IM, ceftriaxone, doxycycline, metronidazole, cefotetan, clindamycin, gentamicin
• Gonococcal epididymitis: Ceftriaxone, doxycycline
• DGI: Ceftriaxone, cefotaxime, ceftizoxime
• Gonococcal meningitis and endocarditis: Ceftriaxone |
