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Wednesday, April 15, 2009

Female Gonorrhea

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Gonorrhea is a curable disease, primarily spread by sexual contact. Gonorrhea is a major cause of pelvic inflammatory disease (PID), infertility, and tubal (ectopic) pregnancy. Gonorrhea may also spread through the blood stream and cause life-threatening illness, or blindness in a newborn that acquires the infection during vaginal delivery. In children, gonorrhea may be the first sign of sexual abuse.


The Neisseria gonorrhea (N. gonorrhea) bacteria cause gonorrhea. These bacteria grow and multiply quickly in the mucous membranes of the male and female genital tract, the mouth, and the rectum. The cervix and the penile urethra are the most common sites of initial infection. However, throat and rectal infection can occur during oral sex and rectal intercourse, allowing N. gonorrhea to spread to many different tissues.


# Cervicitis (infection of the cervix)
a. Vaginal discharge may or may not be present.
b. Bleeding associated with vaginal intercourse
c. Urinary symptoms, usually more severe in males (see Urethritis below)
# Pelvic inflammatory disease, an infection in the uterus, fallopian tube, ovaries or other areas in the pelvis, that causes severe pelvic pain and tenderness and may lead to permanent scarring of the fallopian tubes and surrounding structures.
# Urethritis
a. Initially: burning on urination, clear or milky penile discharge
b. 2-3 days later: pain in the urethra (tube where urine exits), yellow, creamy penile discharge
# Prostatitis (infection of the prostate)
# Epididymitis (infection of the tubes above the testicles)
# Proctitis (infection of the rectum), sometimes associated with a rectal discharge. Most common in male homosexuals.
# Sore throat from throat infections
# Septicemia (blood infection) leading to disseminated disease (disease in the rest of the body), joint pain and swelling, fever, chills, and a diffuse rash. Meningitis (infection of membranes that surround the brain) may occur.
# Conjunctivitis, an infection of the mucous membrane covering the eyes, is associated with eye pain, redness, and discharge. It occurs when a person with gonorrhea rubs his/her eyes after touching infected body fluids, or in the newborn that has passed through an infected cervix.


Microscopic examination of the discharge from the male urethra and cervix (females) reveals Gram-negative rod-shaped bacteria inside white blood cells.
DNA probes of urethral or cervical discharge
Culture of throat, rectum, urethra, blood, and joint fluid may grow N. gonorrhea.


# Uncomplicated: In many areas, N. gonorrhea is resistant to penicillin, which previously was the drug of choice, so depending on the local sensitivity of N. gonorrhea in your area, one of the following medications will be used:
# Ceftriaxone 250 mg-one injection only
# Oral ciprofloxacin: Some strains of bacteria are resistant to this drug.
# Spectinomycin injection
# Pelvic inflammatory disease: Many treatments are available, for example:
# Cefoxitin
# Clindamycin+gentamicin
# Cefoxitin+ doxycycline
# Chlamydia infections often co-exist with gonorrhea, so treat by adding another antibiotic such as Doxycycline, Erythromycin and/or Azithromycin.
# Check for other sexually transmitted diseases, such as syphilis, hepatitis, and HIV-1 and HIV-2, the viruses associated with AIDS, at time of treatment and 1 and 6 months later, or earlier if sick, since these diseases may take weeks after infection to detect.
# All sexual partners must be located and treated.
# Screen for N. gonorrhea in pregnant women.
# Use of eye drops in the newborn is effective in preventing most N. gonorrhea infections.

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