Before starting with the onset of gonorrhea, one should know what is gonorrhea? Gonorrhea is a sexually transmitted disease caused by gram-negative intracytoplasmic bacilli. It is never found as a common diner, although anyone who gets infected can sometimes remain asymptomatic.
The most common manifestation in males is acute urethritis. There is purulent discharge from the urethra. There may be impairment of the prostate, seminal vesicle and epididymis.
Gonococcal Infection in Women-
- It mainly affects the cervical orifice, but may also involve nearby areas due to the presence of columnar cells in the surrounding areas.
- No vaginal involvement due to presence of stratified squamous epithelium
- It is part of Reiter’s triad, which includes conjunctivitis , urethritis, and arthritis .
- There are several complications of cervicitis, which include infertility, endometritis, peritonitis, ectopic pregnancy, salpingitis.
What does Gonorrhea look like?
Gonorrhea affects the epididymis but does not affect the testicles, although slight swelling may be present.
When it comes to the onset of gonorrhea, lesions usually appear in areas involved in sexual contact, lesions usually appear on the cervix, penis, around the anus, and sometimes pharyngeal lesions are observed, usually when there is a history of oral sex.
Ocular gonorrhea occurs in cases where the mother has the infection and the newborn is exposed to the infection at birth. This condition is known as Ophthalmia neonatorum. The newborn has a milky white discharge from the eyes. The condition can be diagnosed when there is excessive discharge of the eyes within 30 days after birth. Prophylactic treatment in which the mother should be treated before labor begins is required. Sometimes there is a need for systemic antibiotics.
There are many conditions under which eye gonorrhea can occur. This is due to self-inoculation and has markedly swollen eyelids, hyperemia, chemosis and purulent eye discharge.
In addition to localized lesions, the spread of infection can often occur. The most common route of spread is through the blood. Gonococcal arthritis may occur due to bacteremia. There is joint involvement mainly knees, elbows, wrist. There is suppuration of joints along with tendonitis. The most common cause of disseminated infection is due to MAC complex deficiency. Thus, gonorrhea is responsible for multiple diseases besides sexually transmitted diseases . The conjunctivitis, urethritis, and arthritis triad constitute Reiter’s triad.
How to treat gonorrhea?
Ceftriaxone is the drug of choice. Chlamydia infection usually accompanies gonococcal infection. Azithromycin and doxycycline are administered together with ceftriaxone to cover chlamydia infection. And in patients who are allergic to penicillin, the drug to be administered is quinolones (ciprofloxacin). And for those who cannot tolerate ciprofloxacin, the drug of choice is spectinomycin.
What are the investigations that need to be done to diagnose the infection?
Microscopic Examination – Gram stain should be performed. The presence of intracellular diplococci confirms the gonococcal infection.
Culture and sensitivity tests should also be done. A single sample of endocervical discharge and performance culture helps in making a differential diagnosis.
What are the different ways a person can get an infection?
Following are the modes of infection transmission that include
- Sexual contact – intercourse without contraception.
- The infection can also be transmitted by infected blood. This is usually witnessed in people who need multiple transfusions.
- Transmissão de mãe para filho (transmissão vertical) – causa a oftalmia neonatal. Inicialmente, o gonococo era considerado o principal organismo causador, mas atualmente a clamídia é o principal organismo patológico da doença. O tratamento inclui tratamento profilático que deve ser administrado antes do início do trabalho de parto. Recomenda-se até que o canal do parto seja verificado antes da concepção. O exame de Papanicolaou e exames vaginais são recomendados.
- Pode ocorrer autoinoculação, que é responsável pela manifestação ocular associada à infecção gonocócica.
In summary, gonorrhea lesions do not come from any gallbladder. These lesions are commonly seen in places that are involved during the sexual act. Purulent discharge from the lesions is released. In addition to the cervix and epididymis, there is involvement of other organs. Joint and conjunctival involvement can occur and this forms a triad name like Reiter’s triad. Research includes microscopy and culture and the drug of choice is ceftriaxone.