Gonorrhea

GONORRHEA – COMPLETE NOTES

1. Introduction

• Gonorrhea is a sexually transmitted infection (STI) caused by
  Neisseria gonorrhoeae
• Gram-negative, non-motile diplococcus
• Affects warm, moist mucosal surfaces:
• Genital tract
• Rectum
• Oropharynx
• Eyes

2. Incubation Period

• 1–14 days
• Symptoms appear:
• Men: 2–8 days
• Women: ~10 days (often asymptomatic early)

3. Sites of Infection

Men

• Urethra (most common)
• Rectum
• Oropharynx

Women

• Endocervix (most common)
• Urethra
• Rectum
• Oropharynx
• Eyes

4. Clinical Features

A. In Men

Symptoms

• Urethral discharge:
• Initially clear/milky → yellow, creamy, purulent
• May be blood-tinged
• Dysuria (painful urination)
• Frequency of urination
• Anal symptoms:
• Itching, discharge, bleeding
• Rare:
• Sore throat
• Conjunctivitis

Complications

• Epididymitis
• Prostatitis
• Urethral stricture
• Inguinal lymphadenopathy

B. In Women

(Often asymptomatic → higher risk of complications)

Symptoms

• Dysuria
• Abnormal vaginal discharge
• Intermenstrual or postcoital bleeding
• Lower abdominal pain
• Dyspareunia (painful intercourse)
• Anal itching/discharge
• Fever, malaise
• Bartholin gland swelling

Complications

• Pelvic Inflammatory Disease (PID)
• Infertility
• Ectopic pregnancy

5. Pathophysiology

• Organism attaches to mucosal epithelium via pili
• Invades epithelial cells → inflammation
• Neutrophil infiltration → purulent discharge

6. Diagnosis

Laboratory Tests

1.     Culture (Gold standard)

• Medium: Thayer-Martin agar
• CO₂ incubation required

2.     Gram Stain

• Men: Gram-negative intracellular diplococci in urethral smear
• Women: Less sensitive → culture preferred

3.     NAAT (PCR / LCR)

• Highly sensitive and specific
• Detects genetic material

7. Treatment

A. Non-Pharmacological

• Avoid sexual contact during treatment
• Treat all sexual partners
• Use condoms

B. Pharmacological (Current Standard Concept)

(Important: older regimens in your text updated for accuracy)

First-line

• Ceftriaxone IM (single dose)
  +
• Azithromycin (single oral dose)
  (or doxycycline if Chlamydia suspected)

Alternative

• Cefixime (if ceftriaxone unavailable)

Cephalosporin Allergy

• High-dose azithromycin (less preferred now)

Disseminated Infection

• IV ceftriaxone → followed by oral therapy

Neonatal Prophylaxis

• Erythromycin eye ointment at birth
• For infection: ceftriaxone (dose adjusted by weight)

8. Counseling Points

• Use condoms consistently
• Avoid multiple partners
• Complete full antibiotic course
• Screen for other STIs:
• HIV
• Hepatitis B
• Syphilis
• Educate about:
• Pregnancy risk
• Emotional and social aspects

9. Prevention

• Safe sex practices
• Abstain until treatment completed
• Test and treat all partners
• Follow-up testing to confirm cure

Exam Tips (Very Important)

• Gram-negative diplococci inside neutrophils → Gonorrhea
• Most common site:
• Men → urethra
• Women → cervix
• Major complication in females → PID
• Drug of choice → Ceftriaxone