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Gonorrhea

Gonorrhea. Neisseria Gonorrhoeae. https://www.youtube.com/watch?v=Eww8tGkqGRw. Cause and Transmission. Caused by the bacterium Neisseria gonorrhoeae Sometimes called gonococcus

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Gonorrhea

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  1. Gonorrhea Neisseria Gonorrhoeae

  2. https://www.youtube.com/watch?v=Eww8tGkqGRw

  3. Cause and Transmission • Caused by the bacterium Neisseria gonorrhoeae • Sometimes called gonococcus • Affects the male and female mucosa primarily but can affect other body areas such as skin, gums, tongue and the throat • Mucosa is the lining of the genital organs • 40% transfer from pregnant woman to her baby

  4. Background • Galen • A physician in early Rome first wrote about this disease • He noticed a discharge from his patients and thought it was semen or Gonos • Gonorrhea means the flow of seed • Other names for this disease • The clap • Came from clappoir or the Parisian houses of prostitution in the middle ages

  5. Background • For almost 300 years syphilis and gonorrhea were thought to be the same disease • The characteristic discharge of gonorrhea was considered to be the first symptoms of syphilis • John Hunter, a physician in 1767 obtained pus from a patient with gonorrhea and injected himself • Hunter fell victim to the effects of Syphilis and Gonorrhea since the pus was infected with both diseases • He died from Syphilitic heart disease in 1793

  6. Lesson I: Epidemiology: Disease in the U.S.

  7. Background • Many physicians considered Syphilis and Gonorrhea the same disease for the next 50 years

  8. Neisseria gonorrhoeae • Gram-negative diplococcus • Infects non-cornified epithelium • Cervix • Urethra • Rectum • Pharynx • Conjunctiva

  9. Neisseria gonorrhoeae • Second most common bacterial STD • Estimated >1 million US cases per year • Incidence highest among adolescents and young adults • Causes a range of clinical syndromes • Many infections are asymptomatic

  10. Neisseria gonorrhoeae • Neisseria gonorrhoeae described by Albert Neisser in 1879 • Observed in smears of purulent exudates of urethritis, cervicitis, opthalmia neonatorum • Thayer Martin medium enhanced isolation of gonococcus in 1960

  11. Incidence and Prevalence • Significant public health problem in U.S. • Urban and low SES populations • Adolescents > age 20-25 years > older • Black/Hispanic > White/API • Multiple sex partners • Increasing proportion of gonococcal infections caused by resistant organisms

  12. GC Sexual Transmission • Efficiently transmitted by sexual contact • Greater efficiency of transmission from male to female • Male to female: 50 - 90% • Female to male: 20 - 80% • Vaginal & anal intercourse more efficient than oral • Can be acquired from asymptomatic partner • Increases transmission and susceptibility to HIV 2-5 fold

  13. Gonorrhea — Rates: United States, 1970–2003 and the Healthy People 2010 target Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population. Source: CDC/NCHSTP 2003 STD Surveillance Report

  14. Gonorrhea — Rates by state: United States and outlying areas, 2003 Note: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico and Virgin Islands) was 114.7 per 100,000 population. The Healthy People 2010 target is 19.0 cases per 100,000 population. Source: CDC/NCHSTP 2003 STD Surveillance Report

  15. Gonorrhea — Rates by sex: United States, 1981–2003 and the Healthy People 2010 target Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population. Source: CDC/NCHSTP 2003 STD Surveillance Report

  16. Gonorrhea — Rates by race and ethnicity: United States, 1981–2003 and theHealthy People 2010 target Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population. Source: CDC/NCHSTP 2003 STD Surveillance Report

  17. Gonorrhea — Age- and sex-specific rates: United States, 2003 Source: CDC/NCHSTP 2003 STD Surveillance Report

  18. Risk Factors • Multiple or new sex partners or inconsistent condom use • Urban residence in areas with disease prevalence • Adolescents, females particularly • Lower socio-economic status • Use of drugs • Exchange of sex for drugs or money

  19. Transmission • Efficiently transmitted by: • Male to female via semen • Female to male urethra • Rectal intercourse • Fellatio (pharyngeal infection) • Perinatal transmission (mother to infant)

  20. Lesson II: Pathogenesis

  21. Microbiology • Etiologic agent: Neisseria gonorrhoeae • Gram-negative intracellular diplococcus • Infects mucus-secreting epithelial cells

  22. Gonorrhea: Gram Stain of Urethral Discharge Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

  23. Lesson III: Clinical Manifestations

  24. Asymptomatic Gonorrhea • Most infections are asymptomatic • More women(75%) as asymptomatic than men (1%) • Asymptomatic prevents elimination of this disease

  25. Symptomatic Gonorrhea • In women, • Signs and Symptoms usually make their appearance after incubation of two weeks or longer • Symptoms are frequently mild or nonspecific and can be overlooked • Symptoms in women may include: • Burning sensation upon urination • Presence of unusual vaginal discharge • Backache • Vaginal bleeding • Pain in lower abdomen

  26. Gonococcal Infections in Women • Cervicitis • Inflammation of the cervix • Urethritis • Inflammation of the urethra • Proctitis • Inflammation of the rectum • Accessory gland infection (Skene, Bartholin) • Pelvic inflammatory disease (PID) • Peri-hepatitis (Fitz-Hugh-Curtis) • Pregnancy morbidity • Conjunctivitis Many infections asymptomatic • Pharyngitis • DGI

  27. Complications of GC Infections in Women • Infertility • Ectopic Pregnancy • Chronic Pelvic Pain • Psychosocial Upper Tract Infection Local Invasion Systemic Infection Genital Infection Congenital Infection HIV Infection

  28. Gonococcal Cervicitis • Incubation 3-10 days • Symptoms: • Vaginal discharge • Dysuria • Vaginal bleeding • Cervical signs : • Erythema • Friability • Purulent exudate STD Atlas, 1997

  29. Cervicitis • Non-specific symptoms: abnormal vaginal discharge, intermenstrual bleeding, dysuria, lower abdominal pain, or dyspareunia • Clinical findings: mucopurulent or purulent cervical discharge, easily induced cervical bleeding • 50% of women with clinical cervicitis have no symptoms • Incubation period unclear, but symptoms may occur within 10 days of infection

  30. Gonococcal Cervicitis Source: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides

  31. Urethritis • Symptoms: dysuria, however, most women are asymptomatic • 40%-60% of women with cervical gonococcal infection may have urethral infection

  32. Complications in Women • Accessory gland infection • Bartholin’s glands • Skene’s glands • Pelvic Inflammatory Disease (PID) • Fitz-Hugh-Curtis Syndrome • Perihepatitis

  33. Bartholin’s and Skene’s Glands • The Bartholin's glands (also called Bartholin glands or greater vestibular glands) are two pea sized glands located slightly posterior to the opening of the vagina. • The glands secrete mucous to lubricate the vagina • During sexual arousal, the Skene's gland becomes swollen with blood, stimulating nerve fibers associated with it. Ongoing stimulation of the area can produce an orgasm

  34. Gonococcal Bartholinitis • Tender swollen Bartholin’s gland with purulent discharge • Infection at other sites common STD Atlas, 1997

  35. Bartholin’s Abscess • Painful swollen Bartholin’s glands • Tender • May have expressible purulent discharge

  36. Pelvic Inflammatory Disease (PID) • 10 – 15% of gonorrhea cases have PID • At times women may experience pain during sexual intercourse, sterility and ectopic pregnancy

  37. Pelvic Inflammatory Disease Adhesions • Sx: lower abdominal pain • Signs: CMT, uterine/ adnexal tenderness, +/- fever • Laparoscopy may show hydrosalpinx, inflammation, abscess, adhesions Tube PID often silent STD Atlas, 1997

  38. Fitz-Hugh-Curtis Syndrom • Failure to diagnose PID can result in acute morbidity, including tuboovarian abscess, endometritis, Fitz-Hugh-Curtis syndrome (perihepatitis), and other chronic sequelae. • Perihepatitis secondary to gonorrhea presents as right upper quadrant pain and nausea.

  39. Syndromes in Men and Women • Anorectal infection • Pharyngeal infection • Conjunctivitis • Disseminated gonococcal infection (DGI)

  40. Symptomatic Gonorrhea • Signs and Symptoms in men appear 3 to 5 days after sexual intercourse with an infected partner • Symptoms include: • Burning sensation on urination • Pus-like creamy white or yellow discharge from the penis

  41. Gonococcal Infections in Men • Pharyngitis • DGI • Urethral stricture • Penile edema • Urethritis • Epididymitis • Proctitis • Conjunctivitis • Abscess of Cowper’s/Tyson’s glands • Seminal vesiculitis • Prostatitis Many infections asymptomatic

  42. Male Urethritis • Symptoms • Typically purulent or mucopurulent urethral discharge • Often accompanied by dysuria • Discharge may be clear or cloudy • Asymptomatic in 10% of cases

  43. Gonococcal Urethritis • Incubation 2-7 days • Abrupt onset of severe dysuria • Purulent urethral discharge • Most urethral infections symptomatic STD Atlas, 1997

  44. Gonococcal Urethritis: Purulent Discharge Source: Seattle STD/HIV Prevention Training Center at the University of Washington: Connie Celum and Walter Stamm

  45. STD Atlas, 1997 Epididymitis Epididymitis • Swollen painful epididymis • Urethritis • Epididymal tenderness or mass on exam • Symptoms: • Unilateral testicular pain and swelling

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