Gonorrhea

Gonorrhea is a common venereal disease that usually starts as an infection of the genitourinary tract, especially the urethra and cervix. It also can begin in the rectum, pharynx, or eyes. Left untreated, gonorrhea spreads through the blood to the joints, tendons, meninges, and endocardium; in women, it also can lead to chronic pelvic inflammatory disease (PID) and sterility.

Among sexually active individuals, incidence rates are highest in teenagers, nonwhites, the poor, poorly educated, city dwellers, and unmarried people who live alone. It's also prevalent in people with multiple partners. With adequate treatment, the prognosis is excellent, although reinfection is common.

Causes

The infection is transmitted from one person to another through vaginal, oral, or anal sexual relations.

• Men have a 20% chance of getting the infection by having sexual relations with a woman infected with gonorrhea.
• Women have a 50% chance of getting the infection by having sexual relations with a man infected with gonorrhea.
• An infected mother may transmit gonorrhea to her newborn during vaginal childbirth.

Symptoms and Signs

Signs and symptoms of septic arthritis include:

• Fever
• Shaking chills
• Severe pain in the affected joint, especially when you move that joint
• Swelling of the affected joint
• Warmth in the area of the affected joint

Diagnostic tests

A culture from the infection site (the urethra, cervix, rectum, or pharynx), grown on a Thayer-Martin medium, usually establishes the diagnosis. A culture of conjunctival scrapings confirms gonococcal conjunctivitis. In a male patient, a Gram stain that shows gramnegative diplococci may confirm gonorrhea.

Diagnosis of gonococcal arthritis requires identification of gram-negative diplococci on smear from joint fluid and skin lesions. Complement fixation and immunofluorescent assays of serum reveal antibody titers four times the normal rate.

Treatment

For uncomplicated gonorrhea in adults, the recommended treatment is ceftriaxone given I.M. in a single dose plus 100 mg of doxycycline hyalite given orally twice a day for 7 days. Alternatively, the patient can receive azithromycin 2 g orally in a single dose. For patients who can't take doxycycline or azithromycin, such as pregnant women, treatment consists of 500 mg of oral erythromycin for 7 days.

Disseminated gonococcal infection requires 1 g of ceftriaxone given I.M. or I.V. every 24 hours until asymptomatic, followed by 400 mg of cefepime b.i.d. or 500 mg of ciprofloxacin b.i.d. for 7 days. Adult gonococcal ophthalmia requires 1 g of ceftriaxone given I.M. in a single dose.

Because many strains of antibiotic-resistant gonococci exist, follow-up cultures are necessary 4 to 7 days after treatment and again in 6 months. (For a pregnant patient, final follow-up must occur before delivery.)

Routine instillation of 1 % silver nitrate drops or erythromycin ointment into the eyes of neonates has greatly reduced the incidence of gonococcal ophthalmia neonatorum.

Prevention

The surest way to avoid transmission of STIs is to abstain from sexual contact or be in a long-term mutually monogamous relationship with a partner who has been tested and is not infected.

By using latex condoms correctly and consistently during vaginal or rectal sexual activity, you can reduce your risk of getting gonorrhea and developing complications.

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