Gonorrhea Gonorrhea Cause Neisseria gonorrhea Neisser 1879 Microscopic

Gonorrhea

Gonorrhea Cause Neisseria gonorrhea (Neisser 1879) Microscopic: gram stain gram –ve intracellular kidney shape diplococci Culture: Thyer Martin Test: Oxidase, Fermentation, fluorescent AB

Mode of infection Sexual 95% Accidental Direct Towels Toilets Underwear's Instruments Indirect

Incubation period 3 -5 days (2 -14 d) Infection spread along mucosal surface (columnar epith)

Acute anterior urtheritis Symptoms Signs Burning mict. Red oedmat. Meatus oozing pus Profuse Yellowish green discharge Turbid urine Stained underwear Untreated Posterior urethritis

Acute posterior urtheritis Symptoms Constitutional manifestations frequent mict. Urgency Dysuria Terminal hematuria Untreated Complication

Differntial diagnosis Urethral discarge Organismal Physiological Gonorrhea Chlamydia Urethorrhea Mycoplasma Prostatorrhea Candida Trichomonas vaginalis Spermatorhea Viral (wart, HSV) Chancre Non specific Non Pathological organismal Instrumentation Non organismal Catheterization Organismal Urinary stone Urethral lavage Urine retention

Gonorrhea female • • Urethra St sq epith healing Vulva & vagina St sq/ acidic Cervix source of infection. Bartholin gland chronicity Skene’s gland chronicity Uterus by instrument, labour Fallopian tubes vaginal douch

50% Asymptomatic Urethral Dysuria, discharge, burning, frequency Vulval Cervical Discharge, sorness Discharge, heaviness

Signs 1 - Purulent discharge soaking vulva, entroitus, vaginal pouch 2 - Edema, redness of mucosa. 3 - pus coming from urethra, cervix

Differntial diagnosis Vaginal discarge Organismal Gonorrhea Physiological Trichomons vaginalis Chlamydia Sexual activity Gardenlla vaginalis Around menstruation Mycoplasma Pregnancy, lactation Candida Viral. Puberty (wart, HSV) Chancre OCP Non specific Non organismal Pathological Instrumentation Non organismal Foreign body Organismal Chemical vaginitis Erosion, polyp Neoplasm

A- History B- Examination C- Investigation 1 - Urine analysis & culture 2 - Discharge direct smear & culture 3 -HIV & Syphilis serology 4 -Culture for chlamydia, mycoplasma

Complications A-Urogenital C-Accidntal Proctitis or Conjunctivitis B-Metastatic Artheritis Periartheritis Tendomyositis Skin rash maculopapular Myocarditis, endocarditis Iritis, iridocyclitis Menigitis Speticaemia

Complications A-Urogenital Female A-Urogenital Male Bartholin abscess Balanitis Skenitis & cystitis Litteritis, cowperitis Periurethral abscess Periurethritis Periurethral abscess Salpingitis, pyosalpinx Urethral fistula, stricture. PID Prostatitis, vesiculitis, epididymitis Infertility

Treatment

Treatment • • Education Partner treatment Condoms Drug therapy

Treatment Cefatriaxone 250 mg IM single dose Cefexime 500 mg oral single dose Ciprofloxacine 500 mg oral single dose Spectinomycine 2 gm IM single dose

Gonorrrhea in children • • • Female> male Acute gonococcal vulvovaginitis Vulva & vagina ( thin st sq epith & decreased acidity) Rectum could be affected Other glands are underdeveloped Direct infection or indirect Soreness of vulva increased by walking or urination Pus discharge from vagina soak underwear Dysuria, frequency.

Gonorrrhea in children • Edema, redness, tenderness, purulent discharge • Prognosis good drainage early symptoms rapid healing • Complication metastatic or extragenital • Penicillin 400000 IU/day procaine for 4 -5 days • Cephalosporin in a suitable dose.

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