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SOURCE

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Source: Knodel LC, Duhon B, Argamany J. Sexually transmitted diseases. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146072585. Accessed March 8, 2017.

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DEFINITION

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  • Venereal disease involving inflammatory discharge from urethra or vagina.

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ETIOLOGY

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  • Neisseria gonorrhoeae is gram-negative diplococcus estimated to cause up to 600,000 infections per year in the United States.

    • Humans only known host of this intracellular parasite.

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PATHOPHYSIOLOGY

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  • Gonococci attach to mucosal cell membranes via surface pili.

  • Mucosal damage leads to tissue invasion by polymorphonuclear leukocytes followed by formation of submucosal abscesses and secretion of purulent exudates.

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EPIDEMIOLOGY

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  • Difficult to control due to rapid incubation period and large numbers of asymptomatic individuals.

  • Sexually transmitted infection (STI)

  • Half of STIs occur in persons in teens and twenties.

  • Number of reported cases in the United States stable over past 10 years.

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PREVENTION

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  • Mutually monogamous sexual relationship between uninfected partners.

  • Barrier contraceptive methods.

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SCREENING

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  • Patients who seek STI testing should be screened for syphilis and HIV.

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RISK FACTORS

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  • Unprotected sex.

  • Multiple sexual partners.

  • Sexual preference.

  • Age.

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CLINICAL PRESENTATION

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  • Infected individuals may be symptomatic or asymptomatic, have complicated or uncomplicated infections, and have infections involving several anatomical sites.

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SIGNS AND SYMPTOMS
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  • Most common clinical features of gonococcal infections presented in Table 1

  • Gonococci invade bloodstream in 0.5–3% of patients and produce disseminated disease.

  • Clinical manifestations of disseminated gonococcal infection:

    • Tender, necrotic skin lesions.

    • Tenosynovitis.

    • Monoarticular arthritis.

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Table Graphic Jump Location
TABLE 1.Presentation of Gonorrhea Infections

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