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Gonorrhea

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SOURCE

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.

DEFINITION

  • Venereal disease involving inflammatory discharge from urethra or vagina.

ETIOLOGY

  • 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.

PATHOPHYSIOLOGY

  • 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.

EPIDEMIOLOGY

  • 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.

PREVENTION

  • Mutually monogamous sexual relationship between uninfected partners.

  • Barrier contraceptive methods.

SCREENING

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

RISK FACTORS

  • Unprotected sex.

  • Multiple sexual partners.

  • Sexual preference.

  • Age.

CLINICAL PRESENTATION

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

SIGNS AND SYMPTOMS

  • 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.

TABLE 1.Presentation of Gonorrhea Infections
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TABLE 1. Presentation of Gonorrhea Infections
  Men Women
General Incubation period 1–14 days Incubation period 1–14 days
  Symptom onset in 2–8 days Symptom onset in 10 days
Site of infection Most common—urethra Most common—endocervical canal
  Others—rectum (usually due to rectal intercourse in men who have sex with men), oropharynx, eye Others—urethra, rectum (usually due to perineal contamination), oropharynx, eye
Symptoms Commonly symptomatic, may be asymptomatic May be asymptomatic or minimally symptomatic
  Urethral infection—dysuria and urinary frequency Endocervical infection—usually asymptomatic or mildly symptomatic
  Anorectal infection—asymptomatic to severe rectal pain Urethral infection—dysuria, urinary frequency
  Pharyngeal infection asymptomatic to mild pharyngitis Anorectal and pharyngeal infection—symptoms same as for men
Signs Purulent urethral or rectal discharge can be scant to profuse Abnormal vaginal discharge or uterine bleeding; purulent urethral or rectal discharge can be scant to profuse
  Anorectal—pruritus, mucopurulent discharge, bleeding  
Complications Rare (epididymitis, prostatitis, inguinal lymphadenopathy, urethral stricture) Pelvic inflammatory disease and associated complications (i.e., ectopic pregnancy, infertility)
  Disseminated ...

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