Table of Contents
Gonorrhea Case Studies
Two patients could present themselves to you like this….
A 23-year-old student (Nulligravida, nulliparous) comes to you in the surgical emergency with a fever and severe abdominal pain. As she also complains of dysuria and purulent vaginal discharge, you request a gynecological case conference. During the physical examination, a putrid secretion from the urethra is revealed, as well as dolent Bartholin’s glands and yellow-framed pus from the cervical canal. There is a pronounced Portio-pushing pain, the adnexal are thickened and highly dolent on both sides. The urine-examination on the elevated concentration of hCG is negative. What suspicions do you have ?
A 32-year-old man comes to your general medical practice due to urogenital complaints. He reports that he had pain during urination. Especially in the morning, he often notices a drop of pus in the urethra output. Now he worries that he “caught something”…
Discovery, Symptoms and Diagnosis of Gonorrhea
In 1879, gonococcal bacteria were first discovered by Albert Neisser in a urethral; the description of the symptoms, however, occurred much earlier in medical history. Neisseria gonorrhoeae (Gonococcal) transmits during unprotected sexual intercourse, with 5 % of those infected remaining asymptomatic carriers. The pathogen detection of Gram-negative bacteria is done microscopically or culturally, after a smear. After an incubation period of 2-7 days, the following symptoms are observed:
|Since gonococcal bacteria prefer epithelium/urothelium, usually no vaginitis (squamous) develops!||Purulent discharge with urethritis (Bonjour-drops in the morning therefore >> naming “Tripper” from drippen = drop).|
|yellowish fluorine formation on cervical canal||Dysuria|
|Pelvic inflammatory disease|
|Fever + acute abdomen pain|
Extragenital manifestation is also possible, in the area of the eyes, throat and anus. Although this is usually a “silent” condition, the risk of actual infection also exists when untreated!
Gonorrhea in women is classified into lower (below the cervix) and upper gonorrhea (above the cervix). Lower gonorrhea displays with few symptoms including cervicitis, proctitis, urethritis and bartholinitis. Upper gonorrhea presents with many symptoms, including endometritis, salpingitis and peritonitis.
- Newborns can be infected during birth by the carrier-mother. The newborn-blenorrhoe occurs, a.k.a. festering conjunctivitis. The prophylactic measure immediately after birth is administering of erythromycin/tetracyclin-containing eye drops into the conjunctival sac (formerly silver nitrate, the so-called Credé prophylaxis).
- Complicated history: Disseminated gonococcal infection (DGI). DGI is classically associated with the clinical triad high fever, arthritis and acral hemorrhagic pustules and petechiae. Left untreated, patients can develop sepsis with meningitis, endocarditis and pneumonia. In women, the formation of synechiae on the hymen and tube can cause tube motility disturbances resulting in sterility.
Therapy of Gonorrhea
The treatment is relatively straightforward with administration of ceftriaxone once; at DGI and upper gonorrhea this must be given for at least 7 days. As with all STDs, the partner of the patient must also be treated to prevent a ping-pong effect! In addition, stress on the use of condoms in addition to existing contraceptives.