Gonorrhea is a common venereal disease that usually starts as an infection of the genitourinary tract, especially the urethra and cervix. It also can begin in the rectum, pharynx, or eyes. Left untreated, gonorrhea spreads through the blood to the joints, tendons, meninges, and endocardium; in women, it also can lead to chronic pelvic inflammatory disease (PID) and sterility.
Among sexually active individuals, incidence rates are highest in teenagers, nonwhites, the poor, poorly educated, city dwellers, and unmarried people who live alone. It's also prevalent in people with multiple partners. With adequate treatment, the prognosis is excellent, although reinfection is common.
Causes and pathophysiology
Transmission of N. gonorrhoeae, the organism that causes gonorrhea, occurs almost exclusively through sexual contact with an infected person. A child born to an infected mother can contract gonococcal ophthalmia neonatorum during passage through the birth canal. A person with gonorrhea can contract gonococcal conjunctivitis by touching his eyes with a contaminated hand.
On exposure, the gonococci infect mucus-secreting epithelial surfaces. They attach to the columnar or transitional epithelium and penetrate through or between the cells to the connective tissue. This causes inflammation and spread of the infection.
Signs and symptoms
Gonorrhea may affect the genitals, rectum, or throat. Many women and men with gonorrhea have no noticeable symptoms, especially with infection of the rectum or throat.
When symptoms in women do occur, these can include:
Symptoms of gonorrhea in men
Men are more likely to experience the following symptoms:
In men, complications can affect the prostate, testicles, and surrounding glands. Inflammation, tissue death and pus formation (abscesses), and scarring can occur and result in sterility.
A culture from the infection site (the urethra, cervix, rectum, or pharynx), grown on a Thayer-Martin medium, usually establishes the diagnosis. A culture of conjunctival scrapings confirms gonococcal conjunctivitis. In a male patient, a Gram stain that shows gram negative diplococci may confirm gonorrhea.
For uncomplicated gonorrhea in adults, the recommended treatment is ceftriaxone given I.M. in a single dose plus 100 mg of doxycycline hyalite given orally twice a day for 7 days. Alternatively, the patient can receive azithromycin 2 g orally in a single dose. For patients who can't take doxycycline or azithromycin, such as pregnant women, treatment consists of 500 mg of oral erythromycin for 7 days.
Disseminated gonococcal infection requires 1 g of ceftriaxone given I.M. or I.V. every 24 hours until asymptomatic, followed by 400 mg of cefepime b.i.d. or 500 mg of ciprofloxacin b.i.d. for 7 days. Adult gonococcal ophthalmia requires 1 g of ceftriaxone given I.M. in a single dose.
Because many strains of antibiotic-resistant gonococci exist, follow-up cultures are necessary 4 to 7 days after treatment and again in 6 months. (For a pregnant patient, final follow-up must occur before delivery.)
Routine instillation of 1 % silver nitrate drops or erythromycin ointment into the eyes of neonates has greatly reduced the incidence of gonococcal ophthalmia neonatorum.
To prevent the spread of gonorrhea, use latex condoms and avoid oral sex. Gonorrhea is highly contagious, and yet may cause no signs or symptoms.
If you have gonorrhea, avoid sexual contact until a course of antibiotics completely eliminates your infection. Having had gonorrhea once doesn't provide you immunity from getting it again.
Schedule a follow-up examination with your doctor after you have completed the course of antibiotics so that your doctor can check to see if your infection has been completely eliminated.
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