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. [...]
[...] PATHOGENESIS, IMMUNOLOGY, AND ANTIMICROBIAL RESISTANCE The importance of humoral immunity in host defenses against neisserial infections is best illustrated by the predisposition of persons deficient in terminal complement components (C5 through C9) to recurrent bacteremic gonococcal infections and to recurrent meningococcal meningitis or meningococcemia. Gonococcal porin induces T cell-proliferative responses in persons with urogenital gonococcal disease. A significant increase in porin-specific interleukin 4-producing CD4+ as well as CD8+ lymphocytes is seen in individuals with mucosal gonococcal disease. PATHOGENESIS, IMMUNOLOGY, AND ANTIMICROBIAL RESISTANCE A portion of these lymphocytes that show a porin-specific TH2-type response could traffic to mucosal surfaces and play a role in immune protection against the disease. [...]
[...] For example, in Kenya, it was estimated in 1987 that 10% of all live births were adversely affected by STDs, and gonococcal ophthalmia neonatorum reportedly affected of all live-born infants. EPIDEMIOLOGY The median prevalence of gonorrhea in unselected populations of pregnant women has been estimated at 10% in Africa in Latin America, and in Asia. Studies in Africa have clearly demonstrated that nonulcerative STDs such as gonorrhea are an independent risk factor for the transmission of HIV1. Gonorrhea is transmitted from males to females more efficiently than in the opposite direction. [...]
[...] CLINICAL MANIFESTATIONS After a decline in gonococcal infections among homosexual men early in the era of AIDS, a disturbing increase in gonorrhea was observed among young homosexual men in the 1990s, probably related to decreased condom use. Gonococcal Infections in Females GONOCOCCAL CERVICITIS Mucopurulent cervicitis is the most common STD2 diagnosis in American women and may be caused by N. gonorrhoeae, C. trachomatis, and other organisms. Cervicitis may coexist with candidal or trichomonal vaginitis. N. gonorrhoeae primarily infects the cervical os but can also infect more peripheral areas of the cervix where columnar epithelium meets stratified squamous epithelium. [...]
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