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  Gonorhea
 
Author: Anne Marie Rompalo Last modified: December 19, 2001
DIAGNOSTIC CRITERIA

  EPIDEMIOLOGY

  • Still a significant public health problem in U.S.
  • Historically, rates rose steadily between 1960 and 1975, declined in 1975 after implementation of national gonorrhea control program, and continued to decline until 2000.
  • Rates have been declining since 1975, but have leveled in past 5 years and may now be increasing somewhat.
  • Numbers of reported cases underestimates of incidence.
  • Incidence remains high in some groups defined by geography, age and race/ethnicity or sexual orientation.
  • Highest rates reported from the South.
  • In the West, increasing rates among men having sex with men.
  • Age: peak incidence in men 20-24 years, women 15-19 years; >80% of cases occur between age 15-29 years.
  • Sex: male:female ratio = 1.2:1.
  • Race/ethnicity: disproportionately high rates in African-Americans, Hispanic and Native Americans compared with whites and Asians
  • Proportion of gonococcal infections caused by resistant organisms is increasing,

  RISK FACTORS

  • Multiple or new sex partners
  • Inconsistent condom use
  • Adolescence
  • Lower socio-economic status
  • Use of drugs
  • Exchange of sex for drugs or money

  SIGNS AND SYMPTOMS

  • Urethritis:
  • Asymptomatic (unrecognized) infection does occur and men can be infected, transmit the infection to sexual partners and have no symptoms.
  • Incubation period: usually takes 2 to 7 days to develop symptoms after having sex with someone who has gonorrhea, but may be longer.
  • Symptoms: purulent urethral discharge often with burning on urinating.
  • Clinical presentation: urethral discharge looks like yellow pus, but it may be clear or cloudy.
  • Epididymitis:
  • Not a common complication
  • Symptoms: unilateral testicular pain and swelling.
  • Usually associated with penile discharge or burning.
  • Testicular swelling, epididymal tenderness.
  • Uncommon complications include:
  • Penile swelling
  • Periurethral abscess or fistula
  • Urethral stricture
  • Anorectal infection:
  • Acquired by anal intercourse
  • Most cases asymptomatic, but occasional severe proctitis.
  • Symptoms: anal irritation, painful bowel movements, constipation, rectal bleeding and/or discharge
  • Pharyngeal infection:
  • May be only site of infection if oral sex is the only sexual exposure.
  • Most often asymptomatic
  • Sore throat with peritonsillar discharge is rare
  • Conjunctivitis:
  • In adults, a result of self-inoculation.
  • Symptoms/signs: purulent eye discharge

  DIFFERENTIAL DIAGNOSIS

  • Chlamydia infection
  • Trichomonas infection
  • Rare: intra urethral herpes infection, intraurethral venereal warts

  LABORATORY FINDINGS

  • Diagnostic Tests
  • Culture can be taken by collecting penile discharge or rectal or throat swabs and applying the specimen to a culture plate or into culture medium
  • Swabs taken from the infected area can also be sent to detect gonococcal proteins or nucleic acid products (called EIA tests or gene probes)
  • The first part of the urine stream can be collected to detect the parts of the DNA of the gonococcus
 
TREATMENT
ALL MEN DIAGNOSED WITH GC MUST ALSO BE TREATED FOR CHLAMYDIA INFECTION BECAUSE THE CO-INFEC
THERAPY IS WITH:
  • Cefixime 400 mg orally taken once, OR
  • Ceftriaxone 125 mg given as an intramuscular injection given once, OR
  • Ofloxacin 400 mg orally taken once, OR
  • Ciprofloxacin 500 mg orally taken once, OR
  • Levofloxacin 250 mg orally taken once
  • PLUS
  • Azithromycin 1 gram orally taken once, OR
  • Doxycycline 100 mg orally taken twice a day for 7 days

more...

 
IMPORTANT POINTS/RECOMMENDATIONS
  • You should be tested for gonorrhea if you are sexually active and:
  • have discharge from your penis or burning when you urinate
  • have a new or multiple sex partners
  • have sex with other men and have more than one sex partner or anonymous sex partners
  • you are diagnosed with any other sexually transmitted diseases
  • If you are diagnosed with gonorrhea, you should tell all your sex partner within the previous 60 days to be screened and treated
  • Condoms are 100% protective against gonorrhea if used correctly
 
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