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Friday, September 3, 2021

Gonorrhea Sexually Transmitted Disease (STD): Treatment, Complications, Signs and Symptoms by Nurses Note

 Gonorrhea Sexually Transmitted Disease (STD)

Gonorrhea is a sexually transmitted disease (STD) that can infect both men and women. It can cause infections in the genitals, rectum, and throat. The causative organism is Neisseria gonorrheae- a Gram-negative diplococcus.

The incubation period of Gonorrhea: 3-7days

The principal site of invasion is the columnar and transitional epithelium of the genitourinary tract. As such, Skene's gland, and Bartholin's gland. The organism may be localized in the lower genital tract to produce urethritis, bartholinitis, or cervicitis. Other sites of infection are oropharynx anorectal region and conjunctiva. As squamous epithelium is resistant to gonococcal invasion, vaginitis in an adult is not possible, but vulvovaginitis is possible in childhood. In about 15% of untreated cervicitis, gonococcal Infection may ascend up to produce acute pelvic inflammatory disease (PID). Rarely, it may produce septicemia with distant involvement to cause tenosynovitis and septic arthritis. Upper genital organs are involved as the Infection spreads along the spermatozoa. Gonococci attach to the spermatozoa and are being carried up. Endometritis and salpingitis are common. It should be remembered that is often present with other sexually transmitted disease and women with gonorrhea are considered to be at risk for incubating syphilis. One-third of such cases are associated with chlamydial infection.

Clinical Features in Adult  Gonorrhea

About 50% of patient's with gonorrhea are asymptomatic and even when the symptoms are present, they are non-specific. The clinical features of acute gonococcal infection are described as follows:

  1. Local.
  2. Distant or metastatic.
  3. PID.

Symptoms of Gonorrhea Sexually Transmitted Disease (STD)

  1. Urinary symptoms such as dysuria.
  2. Excessive irritant vaginal discharge.
  3. Acute unilateral pain and swelling over the labia due to involvement of Bartholin's gland.
  4. There may be rectal discomfort due to associated proctitis from genital contamination.
  5. Others: pharyngeal infection, intermenstrual bleeding.

Signs of Gonorrhea Sexually Transmitted Disease (STD)

  1. Labia may be swollen and look inflamed.
  2. The vaginal discharge is mucopurulent.
  3. The external urethral meatus and the openings of the Bartholin's ducts look congested. On squeezing the urethra and giving pressure on the Bartholin's glands, purulent exudate escapes out through the openings. Bartholin's gland may be palpably enlarged, tender with fluctuation, suggestive of formation of abscess.
  4. Speculum examination reveals congested ectocervix with increased mucopurulent cervical secretions escaping out through the external os.

Distant or Metastatic

There may be features of perihepatitis and septicemia. Perihepatitis results from spread of infection to the liver capsule. There is formation of adhesions with the abdominal wall. This is not infrequently (5-10%) associated with acute PID.

Septicemia is characterized by low-grade fever, polyarthralgia, tenosynovitis, septic arthritis, perihepatitis, meningitis, endocarditis, and skin rash.

Complications of Gonorrhea Sexually Transmitted Disease (STD)

Acute pelvic inflammation leads to chronic pelvic inflammatory disease unless adequately treated. Infertility, ectopic pregnancy (due to tubal damage), dyspareunia, chronic pelvic pain, tubo-ovarian mass, and Bartholin's gland abscess are commonly seen.

Diagnosis of  Gonorrhea Sexually Transmitted Disease (STD)

Nucleic acid amplication testing (NAAT) of urine or endocervical discharge is done. First void morning urine sample (preferred) or at least one hour since the last void sample should be tested. NAAT is very sensitive and specific (95%).

In the acute phase, secretions from the urethra, Bartholin's gland, and endocervix are collected for Gram stain and culture.

A presumptive diagnosis is made following detection of Gram-negative intracellular diplococci on staining. Culture of the discharge in Thayer-Martin medium further confirms the diagnosis. Drug sensitivity test is also to be performed.

Treatment of  Gonorrhea Sexually Transmitted Disease (STD)

  1. Adequate therapy for gonococcal infection and meticulous follow up are to be done till the patient is declared cured.
  2. To treat adequately the male Sexual partner simultaneously.
  3. To avoid multiple sex partners.
  4. To use condom till both the sexual partners are free from disease.
Curative: The specific treatment for gonorrhea is single-dose regimen of any one of the following drugs
  1. Ceftriaxone 125 mg IM
  2. Ciprofloxacin- 500 mg PO
  3. Ofloxacin- 400 mg PO
  4. Cefixime- 400 mg PO
  5. Levofloxacin- 250 mg PO
It should be borne in mind that the patient with gonorrhea must be suspected of having syphilis or chlamydial infection. As such, treatment should cover all the three.

Follow Up

Cultures should be made 7 days after the therapy. Repeat cultures are made at monthly intervals following menses for three months. If the reports are persistently negative, the patient is declared cured.

Reference dutta textbook of gynecology

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