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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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- 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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- 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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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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- 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 ...