Gonorrhea - Clinicals, Diagnosis, and Management

Infectious diseases

Clinicals - History

Fact Explanation
Purulent urethral discharge in males and vaginal discharge in females. Lipooligosaccharides expressed by gonococci are associated with the formation of leukorrhoea . Purulent urethral discharge in males and vaginal discharge in females.
Lipooligosaccharides expressed by gonococci are associated with the formation of leukorrhoea .
Dysuria. Due to urethral inflammation . Dysuria.
Due to urethral inflammation .
Lower abdominal pain and dyspareunia in the female. Due to pelvic inflammatory disease which occurs as a complication . Lower abdominal pain and dyspareunia in the female.
Due to pelvic inflammatory disease which occurs as a complication .
Labial pain and swelling. Bartholin's abscess occurs as a complication . Labial pain and swelling.
Bartholin's abscess occurs as a complication .
Scrotal pain and swelling. Due to epididymo-orchitis which occurs as a complication . Scrotal pain and swelling.
Due to epididymo-orchitis which occurs as a complication .
Suprapubic and/or perineal pain in the male. Due to prostatitis which occurs as a complication . Suprapubic and/or perineal pain in the male.
Due to prostatitis which occurs as a complication .
Blood stained, purulent discharge from rectum and painful defecation. Due to gonococcal infection of the rectum during anal sex . Blood stained, purulent discharge from rectum and painful defecation.
Due to gonococcal infection of the rectum during anal sex .
Painful joints and skin rash. Occurs due to hematogenous dissemination of gonococcal infection . Painful joints and skin rash.
Occurs due to hematogenous dissemination of gonococcal infection .

Clinicals - Examination

Fact Explanation
Bead of pus at external urethral meatus in males and a thick yellowish discharge from the vagina in females. Due to the leukorrhoea associated with lipooligosaccharides expressed by gonococci . Bead of pus at external urethral meatus in males and a thick yellowish discharge from the vagina in females.
Due to the leukorrhoea associated with lipooligosaccharides expressed by gonococci .
Tender, boggy prostate on digital rectal examination. Due to prostatitis which occurs as a complication . Tender, boggy prostate on digital rectal examination.
Due to prostatitis which occurs as a complication .
Tender scrotum. Due to epididymo-orchitis which occurs as a complication . Tender scrotum.
Due to epididymo-orchitis which occurs as a complication .
Inflamed cervix on speculum examination. Due to cervicitis which occurs as a complication . Inflamed cervix on speculum examination.
Due to cervicitis which occurs as a complication .

Investigations - Diagnosis

Fact Explanation
Gram stain of urethral/vaginal discharge. Appearance of gram negative diplococci is characteristic . Gram stain of urethral/vaginal discharge.
Appearance of gram negative diplococci is characteristic .
Culture of discharge using Thayer-Martin meduim. This medium inhibits the growth of other organisms via the incorporation of various antibiotics . Culture of discharge using Thayer-Martin meduim.
This medium inhibits the growth of other organisms via the incorporation of various antibiotics .
Oxidase test. Neisseria gonorrhoeae is an oxidase positive organism, having the ability to produce indophenol by the oxidation of dimethyl-p-phenylenediamine and alpha naphthol . Oxidase test.
Neisseria gonorrhoeae is an oxidase positive organism, having the ability to produce indophenol by the oxidation of dimethyl-p-phenylenediamine and alpha naphthol .

Investigations - Management

Fact Explanation
Culture of urethral secretions 7 days after treatment. It is a 'test of cure' so that treatment failure as well as future risk of spread of gonococcal infection from the patient can be ascertained . Culture of urethral secretions 7 days after treatment.
It is a 'test of cure' so that treatment failure as well as future risk of spread of gonococcal infection from the patient can be ascertained .
Screening for other sexually transmitted infections including VDRL for syphilis and ELISA for HIV. Many patients with a sexually transmitted disease(STD) are usually co-infected with other STD's so screening and treatment of these would prevent further spread of such infections . Screening for other sexually transmitted infections including VDRL for syphilis and ELISA for HIV.
Many patients with a sexually transmitted disease(STD) are usually co-infected with other STD's so screening and treatment of these would prevent further spread of such infections .

Management - Supportive

Fact Explanation
Advice patient to use barrier methods (eg: condoms) during sexual intercourse with high risk partners. Condoms provide a physical barrier through which infection cannot be transmitted to either partner . Advice patient to use barrier methods (eg: condoms) during sexual intercourse with high risk partners.
Condoms provide a physical barrier through which infection cannot be transmitted to either partner .
Trace and treat sexual partners of the patient. To prevent repeat infection . Trace and treat sexual partners of the patient.
To prevent repeat infection .

Management - Specific

Fact Explanation
Ceftriaxone (intramuscular) as a single dose. Cephalosporins are the best alternatives since resistance to fluoroquinolones and penicillin is now wide spread . Ceftriaxone (intramuscular) as a single dose.
Cephalosporins are the best alternatives since resistance to fluoroquinolones and penicillin is now wide spread .
Azithromycin single dose therapy. It is active against Chlamydia trachomatis and Treponema pallidum, both of which could cause co-infection along with Gonorrhoea. Azithromycin single dose therapy.
It is active against Chlamydia trachomatis and Treponema pallidum, both of which could cause co-infection along with Gonorrhoea.

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