Gonorrhea

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 * inkubační doba = 1-10 days
 * klinický obraz = gonorrhea in men: anterior urethritis (dysuria, discharge), posterior urethritis (urinary retention, hematuria, painful erections); gonorrhea in women: asymptomatic, cervicitis, urethritis, conjunctivitis: photophobia, eye pain, soft tissue swelling, discharge, corneal ulcer to blindness; gonococcal pharyngitis; disseminated infection
 * diagnostika = microscopic finding, culture, PCR
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 * léčba = doxycycline, macrolides in pregnant women, 3rd generation cephalosporins in complications and disseminated infections
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Gonorrhea (gonorrhoea, gonorrhea; from Greek: gonos = semen, rhoia = flow - description of the fact that even without an erection a yellowish-white fluid flows out of the penis) is a bacterial infection caused by the gram-negative diplococcus Neisseria gonorrhoeae, abbreviated gonococcus. It primarily affects the epithelium of the urogenital tract (attachment of gonococci by fimbriae) with possible dissemination by blood or lymph. It is transmitted mainly through the sexual route (the location of the occurrence on the patient's body depends on the method of unprotected sexual intercourse), transmission during the birth from an infected mother to a newborn is also possible. Asexual transmission to children is caused by poor hygiene in the family. The course of the disease varies in men, women and newborns.

Epidemiology
Gonorrhea mainly affects young sexually active individuals - symptomatic infection is more common in men (often asymptomatic in women), pharyngeal and anus are more common in homosexuals. It also affects newborns (conjunctival disorders) and sexually abused children. Also vulvovaginitis - only in girls and pregnancy.

Incubation
90% of men develop urethritis within 5 days, women have an incubation for more than 2 weeks (with a symptomatic course, up to 75% asymptomatic).

The clinical picture of men
300px|thumb|Kapavka – výtok z uretry u muže

Urethritis

 * urethral discharge (first serous, then purulent), burning and cutting when urinating, edema and redness of the mouth
 * complications - paraurethral inflammation, inflammation of the Littre glands, Cowper's glands
 * inflammation can go into chronicity, move to the back of the urethra (forced urination, painful erections)

it can spread ascendant

Prostatitis

 * temperature
 * pain when urinating and defecating
 * painful erections, poles

Epididymitis

 * he most common complications
 * the epididymis is swollen, painful, stiff, the scrotum red
 * the pain radiates along the cremasters

The clinical picture of women
300px|thumb|Kapavka – hnisavý výtok z ženského genitálu

Urethritis

 * edema and redness of the urethral orifice, purulent discharge, burning when urinating
 * symptoms are not usually acute, in 50% they are not recognized and become chronic (ascending spread)

Cervicitis

 * swelling of the cervix, inflammatory erosions of the cervix, discharge from the cervix (not from the vagina)
 * complications: abscess of the periurethral glands, peritonitis, endocervicitis , endosalpingitis , endometritis , inflammatory diseases of the small pelvis, or may result in perihepatic abscess (Fitz-Hugh-Curtis syndrome) or infertility

Disseminated gonococcal infection

 * about 1% infected
 * it is a hematogenous distribution of gonococci to the skin, tendons, joints
 * it is accompanied by fever, chills, arthritis, especially of the large joints, hemorrhagic pustules on the acral parts

The clinical picture in neonates

 * Newborn gonorrhea conjunctivitis ( conjunctivitis gonorrhoica neonatorum )


 * mother-to-newborn transmission through infected birth canals;
 * clinical picture: bilateral purulent discharge from the conjunctiva and swelling of the eyelids, usually onset within the first 24 hours, but in a milder form may occur at any time in the first month of life;
 * complications: corneal damage → blindness;
 * diagnosis: conjunctival smear culture (Gram-negative intracellular diplococci);
 * traditional treatment: penicillin systemically and locally;
 * treatment currently recommended: ceftriaxone parenterally in a single dose;
 * necessary isolation of mother and newborn;
 * treatment of the mother and her contacts;
 * growing antibiotic resistance;
 * past prophylaxis: instillation of 1% silver nitrate into the conjunctival sac immediately after delivery according to Credé ("creditation");
 * Prophylaxis now: Immediately giving birth, for example, 1-2 drops of Ophthalmo-Septonex into the conjunctival sac of the newborn.

Extragenital gonorrhea

 * Rectum (most often) - discharge, painful defecation;
 * pharynx - usually asymptomatic, tonsils may settle and streptococcal angina- like symptoms ;
 * conjunctivitis in adults - rare (occurs mainly by autoinoculation).


 * Neisseria gonorrhoeae attacks the conjunctival sac;
 * gonnorhobic conjunctivitis - purulent discharge, periorbital edema leading to corneal perforation and blindness;
 * prevention - dripping of an antibacterial agent (septonex, AgNO 3 ) into the conjunctival sac of each newborn.

Diagnosis

 * Isolation of the agent is necessary!
 * Swab - orifice of the urethra, cervix, rectum, or larynx;
 * transferring the sample to slightly heated agar to prevent heat shock and sample degradation; cultivation; microscopy;
 * serology - determination of antibodies ( IgG, IgM , IgA ) - significant only in chronic, asymptomatic or disseminated forms of gonorrhea;
 * ELISA, DNA-diagnostics PCR , LCR (ligase chain reaction), direct immunofluorescence;
 * disseminated infections - blood culture.

Differential diagnosis
A distinction must be made between non-gonococcal urethritis (herpes progenitalis, candida, chlamydia, ureaplasmata, trichomonads) and cervicitis (other STD agents ).

Therapy
Mostly outpatient, bed rest is suitable, anti-inflammatory compresses are recommended for epididymitis. Furthermore, ATB - ceftriaxone, spectinomycin , ciprofloxacin , aztreonam, doxycycline. However, bacterial resistance to ATB is growing.

Prevention

 * Everyone with gonorrhea is being tested for HIV and syphilis at the same time ;
 * barrier contraception, sexual abstinence;
 * prevention of keratitis in newborns - dripping carbetopendecin (Ophtalmo-Septonex) after childbirth.

Epidemiology
Gonorrhea is one of the 4 most common sexually transmitted diseases in the world (along with syphilis, chlamydia and trichomoniasis ).

The situation in the Czech Republic
The incidence of gonorrhea has a declining tendency in the Czech Republic as well as in the world. The worst situation is Prague, where there are about 23 infected per 100,000 inhabitants (data for 2010). The disease most often occurs in the age group 15-34 in both men and women.

Related articles

 * Sexually Transmitted Infections : Syphilis • HIV
 * Urethritis: Chlamydial infections of the genitals • Mycoplasma infections of the genitals
 * Vulvovaginitis • Balanitis

Source

 * BENEŠ, Jiří. Study materials  [online]. [feeling. 24.02.2010]. < http://jirben.wz.cz >.



Category: Infectious diseases, Microbiology, Dermatovenerology