Gonorrhea

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.