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Source: Knodel LC. Sexually Transmitted Diseases. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th edition. http://accesspharmacy.com/content.aspx?aid=8004605. Accessed July 16, 2012.

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  • “Clap”

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  • Venereal disease involving inflammatory discharge from urethra or vagina.

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  • Neisseria gonorrhoeae is gram-negative diplococcus estimated to cause up to 600,000 infections per year in United States.
    • Humans only known host of this intracellular parasite.

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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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  • Difficult to control due to rapid incubation period and large numbers of asymptomatic individuals.
  • Sexually transmitted infection (STI)
  • Two-thirds of STIs occur in persons in teens and twenties.
  • Number of reported cases in United States stable over past 10 years.

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  • Mutually monogamous sexual relationship between uninfected partners
  • Barrier contraceptive methods

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

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  • Unprotected sex
  • Multiple sexual partners
  • Sexual preference
  • Age

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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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Means of Confirmation and Diagnosis

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  • Culture of infected fluids is diagnostic test of choice because of high specificity.

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Laboratory Tests

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  • Gram-stain smears
  • Culture of infected fluids
  • Methods based on detection of cellular components of gonococcus (e.g., enzymes, antigens, DNA, or lipopolysaccharide) in clinical specimens
  • Alternative methods of diagnosis:
    • Enzyme immunoassay
    • DNA probes
    • Nucleic ...

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