Thursday, May 7, 2009
GONORRHEA VENEREAL INFECTIONS
GONORRHEA VENEREAL DISEASES
Gonorrhea is estimated the most prevalent of the acute sexual transmitted infectious diseases. Among the venereal diseases it is by far the most prevalent, occurring seven times more frequently than syphilis. Gonorrhea involves not only the infected person,but often the innocent in tragic consequence.
In any consideration of gonorrhea from the medical or public health standpoint, the facts logically arrange themselves into 4 distinct categories:
.Gonorrhea in the male;  gonorrhea in the adult female; gonorrhea vulvo-vaginitis in children; and  gonorrhea ophthalmia neonatorium. The cause or etiology of gonorrhea is gram-negative diplococcus, Neisseria gonorrhea, non-motile, non-spore-forming bacteria that grow in pairs and are shaped like coffee beans.
Epidemiology or the spread of the diseases:
In fiscal 1949 there were reported to the United States Public Health Services 331 700 cases of gonorrhea ; and 362 000 cases reported in the United States in 2002; actual case numbers higher. This, in spite of its great incidence and in view of the fact that the prevalence and complications of the disease have not much change
· U.S. incidence of 120 cases per 100 000 population—the highest among industrialized nations
· 75 % of cases in 20-24 age group, highest risk among sexually active 15-19 year-old women and among African Americans.
· Efficient male to female transmission; 40-60 % rate with a single unprotected encounter; 20 % rate to women who practice fellatio with infected partners.
· Drug-resistant strains are widespread. Penicillin, ampicillin, and tetracycline are no longer reliable agents.
Source: Dennis L. Kasper, MD et al. Harrison’s Manual of Medicine, McGraw Hill, International Edition, 2005, p 399.
Symptoms and signs :
Gonorrhea in the adult male is characterized by an acute urethritis with painful urination and purulent urethral discharge. The incubation period is 2-7 days. Uncommon complications include epidydimitis, proctitis, penile edema, balanitis in uncircumcised men.
Gonorrhea in female begins in the urethra, vagina, and vaginal glands and is characterized by painful urination and purulent discharge. Commonly the infection spreads to the uterus, tubes and other pelvic structures. Incubation period is about 10 days. Co-infection with Chlamydia trachomatis is seen up to 40 % of genital gonorrhea infections.
Anorectal gonorrhea: spreads from cervical exudates in women; rates in homosexual men decreasing in the last era. Strains in this population tend to be more resistant to antibiotics.
Pharyngeal gonorrhea: usually resulting from oral-genital sexual exposure; almost always coexist with genital infection.
Ocular gonorrhea: caused by auto-inoculation; swollen eye lids, hyperemia, profuse purulent discharge, occasional corneal ulceration and perforation.
Gonorrhea in pregnancy: Salpingitis and pelvic inflammatory diseases in first trimester can cause fetal loss, Third trimester can cause premature delivery, neonatal sepsis and death.
Gonorrheal arthritis: Arthritis presents with painful joints in conjunction with tenosynovitis, skin lesions, and poly-arthritis of knees, elbows and distal joints. Suppurative arthritis affects one or two joints most often knees, wrists, ankles, and elbows.
Gonorrhea vulvovaginitis in children: This in an inflammatory process involving the urogenital tract in female,chiefly the vulva and vagina,characterized by swelling and redness of the mucous membranes and by purulent discharges of varying degree.
Ophthalmia Neonatorium: It includes every type of purulent inflammation of the conjunctiva which occurs during the first 3 weeks of a baby's life. This is an acute infection caused by a variety of infectious agents. In the past a great of majority of this infections was due to the gonococcus.The incidense of gonorrhea ophthalmia neonatorium is difficult to find to day, since the introduction of the Crede silver nitrate method of prophylaxis.
Diagnosis: Laboratory examinations: male, smear and culture of material obtained from the urethral meatus [opening] will demonstrate the causative organism; intracellular gram-negative diplococcus. Smear and culture of urethral and vaginal discharges should be performed.
Treatment for gonorrheal infections:
· Treatment of uncomplicated infection of the cervix, urethra, pharynx, or rectum:
Ceftriaxone [125 mg IM, single dose]or; Ciprofloxacin [500 mg per oral, single dose] or: Ofloxacin [400 mg per oral, single dose] or Doxycycline [100 mg per oral twice daily for 7 days]
· Treatment of complicated infections: Ceftriaxone [one gram IM, single dose] or; Ofloxacin [400 mg per oral twice daily for 14 days].