Medical Archive

Definition

Microbiology

Gonococci metabolize glucose, produce IgA protease. 
Capsule(-), pilus(+)
No vaccine d/t antigenic variation of pilus

GRAM : WBC ? intracellular G(-) diplococci, Ab? false negative??
Culture: gold standard. By Thayer-Martin medium
Inhibit G+ with Vancomycin / G- with  and Colistin / Fungi with Nystatin
Antigenic variation? ??? vaccine??? ???. 

Epidemiology

Pathogenesis, immunology, and antimicrobial resistance

Clinical manifestations

Genitourinary infections are often asymptomatic, which increases the risk of spread through the bloodstream, leading to disseminated disease.

• Triad of dissemination
  • Migratory polyarthralgia
  • Tenosynovitis
  • Vesiculopustular skin rash
    • Nontender, surrounding erythematous rim
• Gram stain is only positive in <25% of cases.
• Genitourinary manifestations in only <25% of cases.

Gonococcal infections in men

Dysuria without urinary frequency or urgency + ??? ?? ??

Gonococcal infections in women

Gonococcal cervicitis
Gonococcal vaginitis

Anorectal gonorrhea

• Transmission
  • Receptive anal intercourse
  • Direct spread from the vagina
• Manifestations
  • Mucopurulent anal discharge, occasional rectal bleeding
  • Tenesmus, constipation
  • Pruritus, rectal pain, rectal fullness
• Diagnosis
  • NAAT of rectal swab
• Treatment
  • Ceftriaxone + doxycycline (to cover Chlamydia)

Pharyngeal gonorrhea

Occurs d/t inoculation of the pharynx during orogenital contact.
Although typically asymptomatic, it may present with pharyngeal edema and nontender cervical lymphadenopathy.

Ocular gonorrhea in adults

Gonorrhea in pregnant women, neonates, and children

Gonococcal arthritis (DGI)

Conjunctivitis, preceding UTI is more consistent with reactive arthritis.

Gonococcal infections in HIV-infected persons

Laboratory diagnosis

• Gram stain and culture
  • Highly specific but insensitive; >50% have negative results.
• Nucleic acid amplification testing (NAAT)

Treatment

• 1? ?? : ceftriaxone, cefixime single dose
• Chlamydia ????? ???? doxycycline (7?) or azithromycin (1?) ???? ?.
• ???: spectinomycin + macrolide (eg, erythromycin, azithromycin)
• ?? ??? Syphills, HIV ?????

Prevention and control