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Neisseria Gonorrhea

by Carlo Raj, MD
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    00:01 Our next organism here is Neisseria gonorrhoeae.

    00:04 Look, this is a gram-negative organism.

    00:06 It’s a diplococci.

    00:08 It begins in the vestibular, that is your outside portion of the female genital tract.

    00:16 Keep that in mind.

    00:19 Remember, we began female reproductive pathology by looking at Bartholin's cyst.

    00:23 Bartholin, where is it located? If you were to take a look at a second hand clock, can you picture 4 and 8 o’clock for me? If you can.

    00:32 I know that you’re an entire generation younger than me, so many of you might not even ever have used a second hand-hand clock.

    00:39 That’s okay.

    00:39 The point is 4 o’clock and 8 o’clock would be the inferior portion, either left or right, okay? And we talked about a condition called a Bartholin's gland cyst.

    00:51 And during that time, I said that there’s every possibility that there might be infection and gonorrhea could be part of that.

    00:58 Don’t underestimate the fact that I’m telling you vestibular, huh? And then also periurethral glands.

    01:04 And your periurethral glands tend to be more of your Skene glands.

    01:08 So if you’re unfamiliar with the glands in the vestibular area and the periurethral, probably a good time for you to quickly review it because these things will show up on your Step.

    01:17 And you need to make sure that you know as to what they look like and how they present.

    01:20 Both these patients -– the glands here in the vestibular area, my goodness, she’s going to be absolutely uncomfortable.

    01:30 Lower tract symptoms, acute suppurative reaction.

    01:34 Ascends up the mucosa surface to the tract and once again here, we have another bacteria that then may present with pelvic inflammatory disease.

    01:45 Unfortunately, may also be transmitted sexually and could also be part of transmission as well.

    01:53 And at some point in microbiology, we’ve talked about retinitis or you’ve heard of ophthalmia neonatorum, right? Or ophthalmoplegia neonatorum.

    02:04 And it might be either Neisseria or Chlamydia.

    02:07 Oftentimes, you’ll find your Chlamydia responsible for it.

    02:11 The extragenital infections that you want to keep in mind for Neisseria are the following: If there’s felacio or oral sex involved, cunnilingus and such, pharyngitis.

    02:22 If there’s anal sex, then you’re thinking about infection in the rectum, proctitis.

    02:29 Sometimes the infection moves away from the genital tract and if you take your hand -- The patient comes to you and says, “Doc, you see my knee? I’m having a hard time in moving around.

    02:42 Definitely having a hard time jogging.

    02:43 Sometimes I even have a hard time walking.” One or two? Both knees? How many? One.

    02:50 One.

    02:50 Oh, okay, monoarticular.

    02:53 Take the back of your hand and you place the back of your hand on the knee and, whew, it feels a little warm to the touch.

    03:00 This is septic arthritis, isn’t it? Or purulent arthritis.

    03:04 Keep that in mind, please. Very important.

    03:07 Be able to identify that issue.

    03:10 And here’s the eye issue in a neonate with vertical transmission, and this is so unfortunate.

    03:18 Here’s a sexually transmitted infection that should have treated.

    03:21 Instead, the pregnant lady’s delivering and affecting the neonate.

    03:26 That always makes me feel – I mean it just doesn’t make me feel good at all.

    03:29 This is ophthalmia neonatorum, a neonatal conjunctival infection and it is severe.


    About the Lecture

    The lecture Neisseria Gonorrhea by Carlo Raj, MD is from the course Sexually Transmitted Diseases (STDs).


    Included Quiz Questions

    1. Infected Bartholin Cysts
    2. A single painful ulcer on vulva
    3. Multiple painless ulcers on vulva
    4. Painless grayish growth on vulva
    5. Multiple painful red vesicles on vulva
    1. Conjunctivitis
    2. Neonatal Jaundice
    3. Encephalitis
    4. Cardiac anomalies
    5. Deafness
    1. Sexually transmitted Gonococcus can be a cause of arthritis.
    2. It is a standard question, unrelated to your current condition.
    3. I am a medical student, and I am required to take a complete history of every patient.
    4. Since you are in the office today, it would be convenient for you to be tested for STDs during this visit.
    5. It is recommended by CDC to screen patients of your age group for STDs.

    Author of lecture Neisseria Gonorrhea

     Carlo Raj, MD

    Carlo Raj, MD


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