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Gonococcal Infections

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  1. Definition
  2. Epidemiology
  3. Pathogenesis, immunology and antimcrobial resistance
  4. Clinical manifestations
  5. Gonococcal Infections in Females
  6. Laboratory diagnosis
  7. Ttreatment
  8. Recommendations

Gonorrhea is a sexually transmitted infection of epithelium and commonly manifests as cervicitis, urethritis, proctitis, and conjunctivitis. If untreated, infections at these sites can lead to local complications such as endometritis, salpingitis, tuboovarian abscess, bartholinitis, peritonitis, and perihepatitis in the female; periurethritis and epididymitis in the male; and ophthalmia neonatorum in the newborn. Disseminated gonococcemia is an uncommon event whose manifestations include skin lesions, tenosynovitis, arthritis, and (in rare cases) endocarditis or meningitis. Neisseria gonorrhoeae is a gram-negative, nonmotile, non-spore-forming organism that grows in pairs (diplococci). Each individual organism is shaped like a coffee bean, with adjacent concave sides seen on Gram's stain. Gonococci, like all other Neisseria spp., are oxidase positive. They are distinguished from other neisseriae by their ability to grow on selective media and to utilize glucose but not maltose, sucrose, or lactose...

[...] The 2002 CDC19 treatment guidelines for gonococcal infections are summarized in Table 128-1; the recommendations for uncomplicated gonorrhea apply to HIV1-infected as well as HIV-uninfected patients. The third-generation cephalosporins cefixime (given orally) and ceftriaxone (given intramuscularly), both as a single dose, have been the mainstay of therapy with this class of antibiotics for uncomplicated gonococcal infection of the urethra, cervix, rectum, or pharynx. TREATMENT The recent discontinuation of cefixime production in the United States has prompted further examination of alternative oral options for urogenital and pharyngeal gonococcal infections. [...]

[...] A single 1-g dose of azithromycin, which is effective therapy for uncomplicated chlamydial infections, results in an unacceptably low cure rate for gonococcal infections and should not be used alone. TREATMENT Uncomplicated gonococcal infections in penicillin-allergic persons who cannot tolerate quinolones may be treated with a single dose of spectinomycin. Persons with uncomplicated infections who receive a recommended regimen need not return for a test of cure. Cultures for N. gonorrhoeae should be performed if symptoms persist after therapy with an established regimen, and any gonococci isolated should be tested for antimicrobial susceptibility. [...]

[...] Gonococcal Infections in Females Although the incubation period of gonorrhea is less well defined in women than in men, symptoms usually develop within 10 days of infection and are more acute and intense than those of chlamydial cervicitis. The physical examination may reveal a mucopurulent discharge (mucopus) issuing from the cervical os. Gonococcal Infections in Females The examiner may check for mucopurulent discharge by swabbing a sample of mucus from the endocervix and observing its color against the white background of the swab; yellow or green mucus suggests mucopus. [...]

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