Infectious Disease Book

http://www.fpnotebook.com/

Neisseria gonorrhoeaeAka: Gonococcal Infection, Gonorrhea, Gonococcus, Gonococci, Gonococcemia

Advertisement

  1. See Also
    1. Sexually Transmitted Disease
    2. Pelvic Inflammatory Disease
  2. Epidemiology
    1. Much less common than Chlamydia
    2. Incidence: 500-700,000 cases per year
      1. Decreasing except in inner city, Drug Abuse (crack)
    3. Highly contagious: 50% transmission
    4. Chlamydia coexists in 45-50% of patients with gonorrhea
  3. Pathophysiology
    1. Incubation: 2-7 days
  4. Symptoms and Signs: General
    1. Urinary Symptoms
      1. Urinary frequency
      2. Urinary urgency
      3. Dysuria
    2. Copious urethral discharge
      1. Green, yellow, or sanguinous discharge
    3. Meatus and anterior urethra inflammation
    4. Conjunctivitis
      1. Direct inoculation
      2. Copious exudate
      3. Beefy Conjunctiva
      4. Serious complications
        1. Corneal Ulceration or opacification
        2. Visual loss
        3. Globe Perforation
    5. Pharyngitis
      1. Rarely the only site of infection
      2. Usually asymptomatic or only mild
      3. Associated with anterior cervical adenopathy
    6. Acute Diarrhea
  5. Symptoms and Signs: Women (often asymptomatic)
    1. Mucopurulent Cervicitis
      1. Odorless Vaginal Discharge (observed from os)
      2. Vaginal Bleeding or spotting
      3. Friable Cervix bleeds easily
    2. Bartholin's Gland inflammation
    3. Skene's gland inflammation
  6. Symptoms and Signs: Men (Usually symptomatic)
    1. Symptom onset within 2-6 days of exposure
    2. Dysuria
    3. Epididymitis (unilateral Testicular Pain)
    4. Purulent discharge from urethra meatus
    5. Proctitis (in men who have anal intercourse)
      1. Receptive anal intercourse or vaginal secretions
      2. Mild anal irritation or itching
      3. Painful Defecation or tenesmus
  7. Symptoms and Signs: Disseminated Infection (1-3%)
    1. High fever may be present (variable)
    2. More common in pregnancy
    3. Dermatitis
      1. Rash over trunk, extremities, palms and soles
      2. Present as Papules (bullae, Petechiae may be found)
      3. Necrotic Pustule on red base over distal extremity
      4. May progress into hemorrhagic Pustules
      5. Usually less than 20 total lesions
    4. Polyarticular Tenosynovitis
      1. Wrists and hands
      2. Ankles and feet
    5. Gonococcal Arthritis
    6. Endocarditis risk
  8. Symptoms and Signs: Children
    1. Age >1 year
      1. Nearly always associated with sexual abuse
    2. Age <1 year (esp. day of life 2-5)
      1. Attributed to Vaginal Delivery
      2. Pharyngitis
      3. Neonatal Conjunctivitis (Ophthalmia Neonatorum)
        1. Conjunctival inflammation
        2. Mucopurulent Eye Discharge
        3. Evaluation
          1. Gram Stain of Conjunctival discharge
          2. Gonococcal culture
  9. Complications
    1. Pelvic Inflammatory Disease (PID) in 10-20% of cases
    2. Fitz-Hugh Curtis Syndrome
    3. Systemic Gonorrhea
    4. Chronic Arthritis
    5. Neonatal Gonorrhea
      1. Gonorrheal Conjunctivitis
    6. Preterm Labor
  10. Labs
    1. Gram Stain: Urethral or Cervical Smear
      1. Numerous White Blood Cells
      2. Gram Negative biscuit-shaped diplococci
        1. False positive Gram Stain (saprophytic Neisseria)
    2. Gonorrhea Culture and Sensitivity
    3. Nucleic Acid Amplification Test (DNA probe)
      1. Reliable alternative to culture
      2. Sample
        1. Men: Urethra or urine
        2. Women: Cervical swab is preferred
      3. Rapid: 30 minutes
      4. Test Sensitivity: 92-96%
      5. Test Specificity: 94-99%
  11. Diagnostic Studies
    1. Endoscopy in suspected Gonococcal Diarrhea
      1. Nonspecific findings limited to rectum
      2. Biopsy and Culture show superficial exudates
  12. Management: Drug Resistance
    1. Tetracycline resistance: 17-23%
    2. Penicillin resistance 15-19%
    3. Emerging Fluoroquinolone resistance
    4. No resistance to Third Generation Cephalosporins
      1. Ceftriaxone (Rocephin)
      2. Cefixime (Suprax)
    5. Azithromycin requiring higher dosages for some GC
    6. References
      1. MMWR Morb Mortal Wkly Rep (1995) 44:761
      2. Fox (1997) J Infect Dis 175:1396
  13. Management: Uncomplicated Gonorrhea
    1. Refer all sexual exposures for treatment
    2. See Pelvic Inflammatory Disease for that protocol
    3. Treat for Chlamydia also if Gonorrhea positive
      1. Doxycycline 100 mg PO bid for 7 days OR
      2. Azithromycin 1 g PO for 1 dose
    4. Uncomplicated gonorrhea in non-pregnant patient
      1. Ceftriaxone 125 mg IM for 1 dose (99% cure)
      2. Cefotaxime 500 mg IM for 1 dose
      3. Cefixime (Suprax) 400 mg PO for 1 dose (97% cure)
      4. Spectinomycin 2 g IM for 1 dose
      5. Quinolones should no longer be used for Gonorrhea in U.S. due to high resistance
        1. (2007) MMWR Morb Mortal Wkly Rep 56(14):332
    5. Uncomplicated gonorrhea in pregnant patient
      1. Ceftriaxone (Rocephin) 125 mg IM
      2. Combined regimen 1
        1. Cefixime 400 mg PO for one dose and
        2. Erythromycin base 500 mg PO tid for 7 days
      3. Azithromycin 2 grams PO for 1 dose
        1. High-dose related GI intolerance is common
        2. One gram dose may not be effective for gonorrhea
      4. Amoxicillin 3 g PO AND Probenecid 1 gram PO
      5. Spectinomycin 2 g IM (if Penicillin allergic)
        1. Cures 52% of cases
    6. Pharyngeal Gonorrhea
      1. Ceftriaxone
      2. Bactrim DS
  14. Management: Disseminated Gonorrhea
    1. Do not use Quinolones for Gonorrhea in U.S. due to high resistance (see above)
    2. Parenteral Treatment Course
      1. Typical Course: 7 days
      2. Meningitis: 10-14 days
    3. Initial Inpatient dosing until symptoms resolve
      1. Ceftriaxone sodium 1.0 g (25-50mg/kg) IV/IM qd or
      2. Cefotaxime sodium 1.0 g (25 mg/kg) IV/IM q8 hours or
      3. Ceftizoxime sodium 1.0 g q8 hours or
      4. Spectinomycin 2 grams IM every 12 hours
    4. Then followed by outpatient 7 day antibiotic course
      1. Cefuroxime axetil 500 mg bid or
      2. Cefixime 400 mg PO bid or
      3. Amoxicillin 500 mg bid plus Probenecid 1 g/day or
  15. Prevention
    1. Screen sexually active patients under age 25
  16. Follow-up
    1. Test for reinfection at 1-2 months after treatment
  17. References
    1. Apgar (2003) AAFP Board Review, Seattle
    2. Mandell (2000) Infectious Disease, Churchill, p.2249-55
    3. (2000) AAP Redbook p. 254-60
    4. (1998) MMWR Morb Mortal Wkly Rep 47:1
    5. Miller (2000) Am Fam Physician 61(2):379

Gonorrhea (C0018081)

Definition (MSH)Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, NEISSERIA GONORRHOEAE, was isolated by Neisser in 1879.
Definition (CSP)acute infectious disease characterized by primary invasion of the urogenital tract; the etiologic agent is Neisseria gonorrhoeae.
ConceptsDisease or Syndrome (T047)
ICD9098, 098.0
MSHD006069
EnglishClap, GC - Gonococcus infection, GCI - Gonococcal infection, Gonococcal infection, Gonococcal infections, Gonorrhea, Gonorrheas, Gonorrhoea, Infection due to Neisseria gonorrheae, Infection due to Neisseria gonorrhoeae
Spanishgonorrea, infeccion gonococica, infeccion por Neisseria gonorrhoeae
Parent ConceptsBacterial Infections (C0004623), Sexually Transmitted Diseases (C0036916), Syphilis and other venereal diseases (C0178243), Sexually Transmitted Diseases, Bacterial (C0036917), Neisseriaceae Infections (C0085396), Gonorrhea (C0018081), Disease due to Gram-negative cocci (C1444086), Disease due to Neisseria (C1444087), Duplicate concept (C1274013)
SourcesAOD, COSTAR, CSP, DXP, ICD9CM, LCH, MEDLINEPLUS, MSH, MTH, MTHICD9, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Neisseria gonorrhoeae (C0027573)

Definition (CSP)species of gram negative, aerobic bacteria primarily found in purulent venereal discharges; it is the causative agent of gonorrhea.
Definition (MSH)A species of gram-negative, aerobic bacteria primarily found in purulent venereal discharges. It is the causative agent of GONORRHEA.
ConceptsBacterium (T007)
MSHD009344
EnglishDiplococcus gonorrhoeae, GC - Gonococcus, Gonococcus, Gonococcus neisseri, Merismopedia gonorrhoeae, Micrococcus der gonorrhoe, Micrococcus gonococcus, Micrococcus gonorrhoeae, N. gonorrhoeae, Neisseria gonorrheae, Neisseria gonorrhoeae
Spanishgonococo
Parent ConceptsNeisseriaceae (C0027576), Neisseria (C0027571), Gram-negative diplococcus (C0314755)
SourcesAOD, CSP, LCH, LNC, MSH, MTH, NCBI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Gonococcemia (C0275650)

ConceptsDisease or Syndrome (T047)
ICD9098.89
EnglishComplicated systemic gonorrhea, Complicated systemic gonorrhoea, DGI - Disseminated gonococcal infection, Gonococcaemia, Gonococcal septicaemia, Gonococcal septicemia, Gonococcemia, Systemic gonococcal infection
Spanishgonococemia, septicemia gonococica
Parent ConceptsGonorrhea (C0018081)
SourcesCOSTAR, MTHICD9, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree