Infectious Disease Book

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Neisseria gonorrhoeae

Aka: Neisseria gonorrhoeae, Gonococcal Infection, Gonorrhea, Gonococcus, Gonococci, Gonococcemia
  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) 44:761-5
      2. Fox (1997) J Infect Dis 175: 1396-403
  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):332-6
    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 47:1-115
    5. Miller (2000) Am Fam Physician 61(2):379-86

Neisseria gonorrhoeae (C0027573)

Definition (NCI) Any bacterial organism that can be assigned to the species Neisseria gonorrhoeae.
Definition (MSH) A species of gram-negative, aerobic bacteria primarily found in purulent venereal discharges. It is the causative agent of GONORRHEA.
Definition (CSP) species of gram negative, aerobic bacteria primarily found in purulent venereal discharges; it is the causative agent of gonorrhea.
Concepts Bacterium (T007)
MSH D009344
SnomedCT 68704007
English Gonococcus, Neisseria gonorrhoeae, Neisseria gonorrheae, N. gonorrhoeae, NEISSERIA GONORRHOEAE, gonococcus, gonorrhoeae neisseria, neisseria gonorrheae, n. gonorrhoeae, neisseria gonorrhoeae, n gonorrhoeae, gonorrheae neisseria, Neisseria gonorrhoeae (Zopf 1885) Trevisan 1885, Diplococcus gonorrhoeae, Gonococcus neisseri, Merismopedia gonorrhoeae, Micrococcus der gonorrhoe, Micrococcus gonococcus, Micrococcus gonorrhoeae, GC - Gonococcus, Neisseria gonorrhoeae (organism)
French Gonococcus, Gonocoque, Neisseria gonorrhoeae
Swedish Neisseria gonorrhoeae
Czech Neisseria gonorrhoeae
Finnish Gonokokki
Russian GONOKOKKI, NEISSERIA GONORRHOEAE, ГОНОКОККИ
Spanish Neisseria gonorrhoeae, Neisseria gonorrheae, Neisseria gonorrhoeae (organismo), gonococo, Gonococcus
Italian Gonococco di Neisser, Neisseria gonorrhoeae
Polish Dwoinki rzeżączki, Gonokoki, Ziarenkowce rzeżączki, Neisseria gonorrhoeae
Japanese ナイセリア･ゴノレエ, 淋菌
German Gonococcus neisseri, Neisseria gonorrhoeae
Dutch Gonococcus, Gonococcus neisseri, Neisseria gonorrhoeae
Portuguese Gonococo, Neisseria gonorrhoeae
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Gonococcemia (C0275650)

Concepts Disease or Syndrome (T047)
SnomedCT 5085001, 186942006
English DISSEMINATED GONOCOCCEMIA, GONOCOCCEMIA, Complicated system gonorrhea, Complicated system gonorrhoea, DGI - Dissem gonococc infectn, Gonococcaemia NOS, Gonococcemia NOS, disseminated gonococcemia (diagnosis), disseminated gonococcemia, gonococcal septicemia, gonococcal septicemia (diagnosis), Gonococcal septicemia, Gonococcemia, Complicated systemic gonorrhea, Complicated systemic gonorrhoea, DGI - Disseminated gonococcal infection, Gonococcal septicaemia, Systemic gonococcal infection, Gonococcaemia, Gonococcemia (disorder), gonococcemia
Spanish Gonococcal septicemia, Gonococcaemia NOS, Gonococcemia NOS, Gonococcal septicaemia, gonococemia (trastorno), gonococemia, septicemia gonocócica
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Gonorrhea (C0018081)

Definition (MEDLINEPLUS)

Gonorrhea is a curable sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth or anus.

Gonorrhea does not always cause symptoms, especially in women. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause epididymitis, which affects the testicles and can lead to infertility. In women, gonorrhea can cause bleeding between periods, pain when urinating and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Gonorrhea can pass from mother to baby during pregnancy.

You can cure gonorrhea with antibiotics prescribed by your health care provider. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea.

Centers for Disease Control and Prevention
Definition (NCI) A common sexually transmitted bacterial infection caused by Neisseria gonorrhea. It is transmitted through vaginal, oral, or anal intercourse. Infected individuals may be asymptomatic. Symptoms in males include burning sensation during urination, discharge from the penis, and painful swelling of the testes. Symptoms in females include painful urination, vaginal discharge, and vaginal bleeding between periods. If untreated, the infection may lead to pelvic inflammatory disease.
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.
Concepts Disease or Syndrome (T047)
MSH D006069
ICD9 098
ICD10 A54, A54.9
SnomedCT 154387008, 187361005, 266142004, 15628003, 186943001
English Gonorrhea, Gonorrheas, CLAP, Gonococcal infections, GONOCOCCAL INFECTION, GONORRHEA, Gonococcal infection, NOS, Gonorrhea, NOS, Gonococcal infection, unspecified, Gonococcal infection,unspcf, Gonococcal infections NOS, [X]Gonococcal infection, unspecified, [X]Gonococcal infection,unspcf, Gonococcal, Gonorrhea NOS, gonococcal infections, gonococcal infections (diagnosis), E-120 GONORRHEA, gc, Gonococcal infection (disorder), The clap, Gonorrhoea NOS, GONOCOCCAL, [X]Gonococcal infection, unspecified (disorder), Gonococcal infections NOS (disorder), Gonorrhea [Disease/Finding], clap, claps, gonococcal infection, gonorrhoea, Infection due to Neisseria gonorrheae, Gonococcal infection, Infection due to Neisseria gonorrhoeae, Clap, GC - Gonococcus infection, GCI - Gonococcal infection, Gonorrhoea, Gonorrhea (disorder), gonorrhea, gonococcal; infection, gonococcal, gonorrhea; specified site not listed, infection; gonococcal, Gonococcal Infection
Dutch gonokokkeninfecties, gonorroe NAO, gonokokken; infectie, gonorroe; gespecificeerde lokalisatie niet vermeld, infectie; gonokokken, Gonokokkeninfectie, niet gespecificeerd, gonorroe, Gonokokkeninfectie, Gonorroe
French Infections gonococciques, Gonorrhée SAI, Gonorrhée, Blennorragie gonococcique, Blennorragie à Neisseria gonorrhoeae
German Gonokokkeninfektion, Gonorrhoe NNB, Gonokokkeninfektion, nicht naeher bezeichnet, Gonorrhoe, Tripper
Italian Infezione gonococcica, Gonorrea NAS, Gonorrea
Portuguese Gonorreia NE, Infecções gonocócicas, Gonorreia, Gonorréia
Spanish Gonorrea NEOM, Infecciones gonocócicas, Gonococcal infection, Gonococcal infections NOS, Gonorrhoea, Gonorrhea, [X]infección gonocócica, no especificada (trastorno), [X]infección gonocócica, no especificada, gonorrea (trastorno), gonorrea, infecciones gonococícas, SAI (trastorno), infecciones gonococícas, SAI, infecciones gonocócicas, SAI (trastorno), infecciones gonocócicas, SAI, infección gonocócica, infección por Neisseria gonorrhoeae, Gonorrea
Japanese 淋疾, 淋菌感染, 淋疾ＮＯＳ, ﾘﾝｼﾂ, ﾘﾝｷﾝｶﾝｾﾝ, ﾘﾝｼﾂNOS
Swedish Gonorré
Czech gonorea, kapavka, Kapavka, Gonokokové infekce, Gonorea, Gonorea NOS
Finnish Tippuri
Russian GONOREIA, ГОНОРЕЯ
Korean 상세불명의 임균성 감염, 임균성 감염
Croatian KAPAVAC, GONOREJA
Polish Zakażenie Neisseria gonorrhoeae, Rzeżączka
Hungarian gonorrhoea k.m.n., gonorrhoea, Gonococcalis fertőzések, Gonorrhoea
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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