gonorrhea

A sexually transmitted infection caused by the gram-negative diplococcus Neisseria gonorrhoeae. The disease often causes inflammation of the urethra, prostate, cervix, fallopian tubes, rectum, and/or pharynx. Blood-borne infection may spread to the joints and skin, and congenitally transmitted infection to the eyes of a newborn during vaginal birth may cause neonatal conjunctivitis. Infection around the liver may result from peritoneal spread of the disease. Although members of either sex with urogenital gonorrhea may be asymptomatic, women are much less likely to notice burning with urination, urethral discharge, or perineal pain than men, in whom these symptoms are present 98% of the time. Coinfection with Chlamydia trachomatis is common in both sexes: some studies have shown simultaneous infection with both organisms to be as high as 30%. Even though syphilis rarely accompanies gonorrheal infection, patients with gonorrhea are routinely tested for this disease. Young, sexually active teenagers and young adults with multiple partners are at highest risk for contracting gonorrhea. In 2009 301,174 cases of gonorrhea were reported in the U.S., a rate of 99.1 cases per 100,000 population. Source: www.cdc.gov/std/tats09/gonorrhea.htm See: safe sex;

Symptoms

Urethral symptoms in men typically include discomfort with urination (dysuria) accompanied by a yellow, mucopurulent penile discharge. Painful induration of the penis may occur in some cases. Women may have urethral or vaginal, greenish-yellow discharge, dysuria, urinary frequency, lower abdominal pain, tender Skene and Bartholin glands, or fever, dyspareunia, and other symptoms of pelvic inflammatory disease. Most women are asymptomatic.

Diagnosis

In men, Gram stain of the urethral discharge is very accurate in diagnosing gonorrhea. In both men and women, urethral, cervical, or anal swabs, or urinary specimes are typically tested with nucleic acid testing that detects genetic sequences unique to the bacteria. Single specimens can be used to identify infections with gonorrhea and/or Chlamydia simultaneously.

Prophylaxis

Safe sexual practices limit the spread of gonorrhea and have decreased the incidence of the disease. To prevent gonorrhea in newborns, all babies are treated with a thin ribbon of either erythromycin or tetracycline ointment in the conjunctival sac of each eye. See: ophthalmia neonatorum

Treatment

Gonorrhea can be treated with cephalosporins (such as ceftriaxone, cefixime or cefpodoxime) or fluoroquinolones, although bacteria have evolved that are resistant to many of these antibiotics. Chlamydia coinfection is typical and is usually treated with doxycycline. For pregnant women and for those allergic to penicillin, a single dose of ceftriaxone and erythromycin is recommended (doxycycline is contraindicated in pregnancy). Patients should return for a follow-up visit 1 week after treatment for recheck of cultures to confirm that a cure has been effective. Updates on the treatment of gonorrhea and other sexually transmitted infections are available at www.cdc.gov/std.

Patient care

Antibiotics should be taken as prescribed and, if more than one dose is needed, the full course of therapy completed. Moist heat or sitz baths should be taken as directed to relieve discomfort. The patient should avoid contact with his or her genitourinary discharges and wash hands carefully so that the eyes do not become contaminated. Until a course of treatment and follow-up cultures are completed, the patient should abstain from sexual intercourse because he or she may still be infectious and able to transmit the infection.

The patient is taught to recognize and report adverse drug reactions. The need for testing for other sexually transmitted diseases is discussed, as well as prevention of future infections (using condoms, washing genitalia with soap and water preintercourse and postintercourse, avoiding sharing washcloths) and the importance of follow-up testing. All persons with whom the patient has had sexual contact should be tested and receive treatment, even if a culture is negative. The patient and known sexual contacts are reported to the local and public health department for appropriate follow-up.