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.
