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 putride secretion from the urethra is revealed, dolent Bartholin’s glands and yellow-framed pus from the cervical channel. 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 practise 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 were first discovered by Albert Neisser in a urethral, the description of the symptoms however, occurred much earlier in medical history. Be transmitted Neisseria gonorrhoeae (Gonococcal) during unprotected sexual intercourse, 5 % of those infected remain asymptomatic carriers. The pathogen detection of Gram-negative bacteria are produced microscopically or culturally after a smear. After an incubation period of 2-7 days following symptoms:
|Since gonococcal 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|
Extragenital manifestation is also possible, as in eyes, throat and anus. Although this is usually “silent” infection patterns, the risk of infection, however, also exists when untreated!
Gonorrhea in women is classified into lower (below the cervix) and upper gonorrhea (above the cervix). The lower gonorrhea, with little symptoms include cervicitis, proctitis, urethritis and bartholinitis. To upper one , with many symptoms include endometritis, salpingitis and peritonitis.
- Newborns can be infected during birth by the mother. The new-born-blenorrhoe occurs, a festering conjunctivitis. Your prophylactic measure immediately after birth is the dropping 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 hymen and tube can cause tube motility disturbances as a result sterility occurs.
Therapy of Gonorrhea
The treatment is relatively straightforward. You administer ceftriaxone once, at DGI and upper gonorrhea this must be given for at least 7 days. As with all STIs, you must treat the partner of the patient as well to prevent a ping-pong effect! In addition, indicate the use of condoms expressly in addition to existing contraceptives.