GonorrheaIntroduction:
This form of VD is caused by Neisseria gonorrhea, a Gram negative intracellular
bacterium, which tends to grow in pairs of two ("diplococci"). It is
a fulminant form of venereal disease and wherever it grows, it is very destructive.
Most of the time gonorrhea is a local sexually transmitted disease. However,
when it is neglected, it can get spread, in which case it can lead to a high fever
with septicemia, joint involvement and occasionally also meningitis, pericarditis
or endocarditis. This is called disseminated gonococcal infection
(DGI).
Signs
and symptoms: In most cases the infection is affecting the genitals
directly. In men the incubation
time is 2 days to 2 weeks. There is a discomfort in the urethra, which is followed
just hours later with dysuria (painful urination) and a pussy yellow discharge.
Urination is now frequent and he has to go when he has to go (called "urgency"). The
examining physician will see redness of the opening of the urethra on the glans
of the penis with pus in the small pocket behind the outside opening ("meatus")
of the urethra.
In
women the disease is more varied. The incubation time
after exposure is 1 to 3 weeks. It can be milder with only a mild burning with
urination and a slight vaginal discharge. Or it can start with severe pain on
urination, urinary frequency and vaginal discharge. The doctor finds on pelvic
speculum examination that there is a lot of pus coming from the cervix, which
is infected. On pelvic examination it is evident that quite often there is a fulminant
infection in the fallopian tube on one or both sides. This is often the cause
for infertility later down the road when the infection has been cured. The infection
with Neisseria gonorrhea leaves scarring behind wherever it leads to inflammation
and this is why the fallopian tubes are glued to the ovaries when the pelvic inflammatory
disease (=PID or salpingitis) has occurred.
With
disseminated gonococcal infection (DGI) there are other
clinical signs of disease, for which the physician looks out such as joint swelling
and tenderness with joint involvement (gonococcal arthritis);
changed heart contours,heart sounds and murmurs with pericarditis or endocarditis;
neck stiffness and change of mentation with meningitis; high fever and shock with
septicemia.
Diagnostic
tests: In men Gram staining of smears from the meatus of the urethra
will show the characteristic Gram negative double cocci(=diplococcus) inside cells
in more than 90% of cases. In women using the same technique of smears from cervical
secretions will only be positive in roughly 60%. The negative cases in both sexes
need to be cultured or tested using genetic gonococcal RNA probing methods. Blood
cultures would be wise to get in any more seriously sick patient to rule out septicemia
with DGI. In newborns of women with active gonorrhea eye infections have to be
ruled out by cultures and prophylactic treatment is given.
Treatment:
Any treatment must take into consideration that chlamydia infections
are often coexisting with gonorrhea. As well, drug resistance of Neisseria
gonorrhea against penicillin and tetracycline has radically changed the previously
ussed treatment schedules. The presently recommended regimen is to give ceftriaxone
125 mg intramuscularly once for gonorrhea and to combine this with doxycyline
100 mg twice per day for 7 days to cover for chlamydia. There are other regimens
involving spectinomycin , ciprofloxacin, ofloxacin or cefixime. For disseminated
gonococcal infection (DGI) higher doses of ceftriaxone are needed
( 1 gram intramuscularly or intravenously daily) until the infection is gone,
often 3 to 7 days. Alternatives are cefotaxime or ceftizoxime. Usually the patient
with this disseminated form of gonorrhea is hospitalized and an infection specialist
will direct treatment. Fact
sheet from the CDC (Centers For Disease Control And Prevention, USA). | 
