GONORRHOEA

GONORRHOEA

Human is the only natural reservoir of infection

 Commonest STD in the world ¤ Most important STD in Bangladesh ¤ Gono à seeds, rhoea à flow. So gonorrhoea  means abnormal flow of semen

AETIOLOGY : Neisseria gonorrhoea, Gram negative  intracellular Diplococci

 Infects the columnar epithelium in the lower genital tract , rectum, pharynx, conjunctiva

 In severe and recurrent cases à late complement  deficiency C5, C6, C7, C8 should be investigated

Incubation period : Ave . 5 days ( 2 to 10 days

Mode of Transmission:

 Mostly by sexual intercourse with an infected person

 Accidental non-venereal genital tract infection in adult  (contaminated towels, toilet papers, clothings etc )

PATHOGENESIS :  Gonococci à get attached by  Pilli à  to columnar epithelial cells  (urethra )

 Ò⠠

Produce marked polymorphonuclear response  in the submucosa  (Anterior urethra )

Ò椠

Purulent exudates  fill up the anterior urethra (male )

 Ò映

Inflammatory process extends to the posterior urethra

 Ò硥

Granular tissue formed  in mucosa and submucosa

 Ò潦

Eventual fibrosis and scarring

 Ò摮

 Stricture urethra ( complication )

Urethritis is uncommon in females because of small urethra

Both transitional and stratified squamous epithelium  are highly resistant to the organism, therefore in adult  vaginal canal is not affected

CLINICAL FEATURES (Written)

In male – Acute urethritis                           In female –  Cervicitis

MALE FEMALE
Purulent Urethral discharge (anterior urethra is commonly  infected)  Burning sensation during micturition  Painfulness or difficulty in micturition Asymptomatic (5% to 10% may be )  Asymptomatic mostly (60 %)  Increased vaginal discharge ( due to profuse cervical secretion from  cervicitis)  Low backache or vague feeling of lower abdominal discomfort  Intermenstrual bleeding  Dysuria (uncommon) , since short urethra usually not lead to urethritis

COMPLICATIONS OF GONORRHOEA (FEMALE  >  MALE ) 

LOCAL COMPLICATIONS

MALE FEMALE BOTH SEX
Urethral stricture Salpingo Oophoritis Proctitis (Anogenital sex)
Periurethral abscess Periurethral abscess Pharyngitis (Oragenital sex )
Prostatitis Bartholein abscess Neonate Ophthalmia neonatum
Prostatic abscess Pelvic peritonitis  
Seminal vasiculitis Parametritis  
Epidedymitis    
Orchitis  

Remote / Metastatic complications (Both sex)

Septicaemia/ Disseminated Gonococcal Infection (DGI)

Gonococcal arthritis

Perihepatitis

Gonococcal Dermatitis

Investigations :

1. Smear Preparation for Gram’s Stain & M / E

vCollection of specimen

 Male : Morning urethral discharge  before passing urine  (acute case) Prostatic smear  (chronic case)

Female : Cervical swab / High vaginal swab

Microscopic examination ( M/E) reveals Gram negative intracellular diplococci

2. Specimen culture : ¥Urethral discharge (male); cervical smear (female)

 5 -10% CO2  necessary for initial growth of gonococci àCandle jar technique

 ¥Temperature, 370 C ; Time, 48 hrs; media, Chocolate agar media/ Thayer Martin media / Modified Newyork city media

3.NAAT  (Nucleic acid amplification test): Latest, 97% cases effective & specific

            Specimen taken : Urethral discharge , vaginal discharge , Urine

4.PCR (Polymerase chain reaction) specific test  for antigen detection

5.APTIMA Test more specific than PCR

MANAGEMENT OF GONORRHOEA

General measures :

¤Reassurance and patient’s education about the disease  and its complication

Plenty of water intake

Safe sex practice

Specific measures :

Both sex partners should be treated  at a time

 Inj. Ceftriaxon 250 mg 1 vial I/V slowly stat.

 or tab. Azithromycin  1 gm orally stat

 or Inj. Spectinomycin 2 gm deep I/M stat.