Efi. Gelerstein 2011

Topic 27. Diagnosis and treatment of gonorrhoea

Neisseria Gonorrhea Gonorrhea = abnormal flow of semen (Galen) gonos = “seed”, rhoea = “flow” Hunter: autoinoculation with gonococci urethral exudate Neisser: identification of the diplococcal 400,000 cases in the USA in 1995 ↑ resistance to antibiotics

Etiologic Agent and Pathogenesis Bacterial infection Only natural reservoir is humans Almost exclusively by sexual intercourse Pathogen : Neisseria gonorrhea (gram (-) diplococci) Demonstration by methylene blue or Gram staining (IC gonococci, kidney shaped in pairs)

Clinical Manifestations in Men Incubation time : 2-10 days Symptoms :

1. acute gonococci urethritis (discomfort, dysuria, purulent discharge)2. 15% asymptomatic → disease spreading3. Local complications: epididymitis, seminal vesiculitis, prostatitis4. Chronic gonococci urethritis5. Extra-genital complications: rectal, oropharyngeal gonorrhea6. Gonococci ophthalmia neonatorum → 1% silver nitrate eye drops

Clinical Manifestations in Women Incubation time : days – weeks Portal entry : urethral orifice, periurethral crypts, Skene’s ducts, Bartholin glands, uterus orifice. Symptoms :

1. Acute salpingitis or dysuria, increased discharge, abnormal bleeding2. 30-60% asymptomatic or minimally affected – carriers3. PID (pelvic inflam. disease) → ascending infection: endometritis, salpingitis, peritonitis →

infertility

Miscellaneous Manifestations Disseminated gonococci infection (arthritis-dermatitis syndrome)

1. 85% women2. Intermittent febrile attacks3. Migratory joint pain4. Skin lesions (isolated flea bite-like papules, hemorrhagic pustules on acral areas)

Gonococci ophthalmia neonatorum – 1% silver nitrate eye drops.

Treatment of Gonorrhea

Efi. Gelerstein 2011

Ideal drug for gonorrhea: 1. Cure urethritis2. Given as a single dose3. Abort co-incubating syphilis4. Cure coexisting chlamydial infections

Historically : 3x106 IU Penicillin G i.m. + 1 g of Probenecid Ceftriaxone 250 mg IM (3rd gen. Ceph.) Cefixime 400 mg PO (3rd Gen. Ceph) Ofloxacin 400 mg PO (Fluoroquinolones) in a single dose Ciprofloxacin 500 mg PO (Fluoroquinolones) Azithromycin 1 g PO (Macrolide) Chronic gonorrhea: 3-5 days of treatment Follow-up :

1. Microscopic exam 7 days after therapy2. Syphilis? – serology3. HIV? – test

Post-gonococci urethritis:1. Irritated mucous membrane – secondary colonization with mycoplasmas and chlamydias2. Tetracycline for 14 days