GONORRHOEA
Gonorrhea is the commonest venereal disease caused by the gram negative diplodocus Neisseria gonorrhoeae' typically found inside the polymorpho-nuclear cells, which infects columnar epithelium in the lower genital tract. It is mostly transmitted during sexual activity. Besides, it may infect eyes, rectum and throat also. The incubation period is about 2 to 10 days.
Clinical features:
In the male - the infection starts in the anterior urethra and tend to spread to the posterior urethra and epidermis. There is dysurea and a white or yellow purulent discharge from the urethra but symptoms may be mild or absent.
In females - in females the lower cervical canal is commonly infected but the urethra and rectum are also involved in 50% of patients. There may be vaginal discharge and dysurea but 50% of infected women have no symptoms.
Diagnosis:
1. History - history of exposure may be present.
2. Clinical features - stated above.
3. Laboratory investigation -
a. Gram staining -gram negative intracellular diplococci may be seen in stained secretion from infected tracts.
b. Culture of exudates - growth of N. gonorrhoeae on an appropriate media confirms the diagnosis.
Complications:
In case of male -
1. Urethritis
2. Stricture urethra
3. Epididymo - orchitis
4. Bacteraemia , septicaemia ( rare & causes fever )
Incase of female -
1. Cervicitis
2. Salpingitis
3. Oophoritis
4. Pelvic infection
In case of infant -
Ophthalmia neonatorum - acute purulent conjunctivitis in infants born to infected mothers may progress to impairment of vision or blindness.
Management :
A. Uncomplicated gonorrhea -
A single adequate dose of a suitable antibiotic (listed below) is usually sufficient.
< Procaine penicillin 2.4 gm i.m plus probenecid i am orally .Or
< Ampicllin 2gm plus probenecid I gm by mouth and in patients allergic to penicillin-
< Co-trimoxazole 8 (480mg) dispersible tablets in a single does. Or
< Co-trimoxazole 5 (480mg) tablets 12 hourly for 3 doses.
B. Complicated gonorrhea
Relatively resistant -
< Procaine penicillin 4.8 gm I.M. plus probenecid one gram by mouth. Or
< Ampicillin 3.5 gm plus probenecid I gm by mouth. Or
< Spectinomycin 2 or 4gm i.m. for penicillin allergic patients.
Totally penicillin resistant isolates-
< Cefotaxime 0.5 to I gm i.m. or,
< Ciprofloxacin 250 mg orally. or
< Spectinomycin 2 or 4 gm i.m. for penicillin allergic patients.
Multiple does therapy for patients with complications need-
< Ampicillin 2gm plus probenecid I gm followed by
< Ampicillin 500 mg plus probenecid 500 mg 4 times daily for 14 days.
C. For ophthalmia neonatorum - both systemic and local penicillin should be given.
Posts
