Urethritis, Vaginal Discharges, PID, Prostatitis, Inguinal and Scrotal Swellings Flashcards
What organism causes gonorrhea?
Neisseria gonorrhoeae
Gram negative intracellular diplococcus (intracellular in polymorps)
What is the infectivity rate of gonorrhea?
From men to women = 50% infectivity
20% from female to male
What percentage of males and females are asymptomatic with gonorrhea?
80% of females
10% of males
Many have signs though
How long is incubation period of gonorrhea?
2 - 5 days
What are the signs/symptoms of uncomplicated gonorrhea in males?
Urethritis
Epididymitis
Proctitis
Pharyngitis
What are the signs/symptoms of uncomplicated gonorrhea in females?
Cervicitis
Pelvic Inflammatory Disease
Disseminated disease
How is gonorrhea infection related to HIV risk?
Local inflammation results in 5 fold increase in HIV risk.
What are associated conditions with gonorrhea?
Associated rectal infection in 30% of women
Pharyngitis sole site in only 5%
Complications such as epididymitis and strictures in males are very rare
In females some complications can include infertility and adhesions
What factors affect likelihood of gonorrhea to spread?
Some types of GC more likely to spread
More common in women than in men
What symptoms are different in disseminated gonorrhea than the normal disease?
Less likely to cause urogenital symptoms
More likely sensitive to antibiotics in culture medium therefore negative cultures more common
Arthritis/dermatitis in 0.5 - 3% of untreated patients.
20% positive blood cultures
Tenosynovitis also commonly associated
Skin lesions (Typically necrotic on extremities but often atypical)
Which joints are affected most often by disseminated gonorrhea?
Wrist
MCP
Ankle
Knee
Often multiple
How is gonorrhea diagnosed?
Culture (80 - 95% sensitive and gives antibiotic sensitivity)
Slide is used for gram stain. (intracellular for diagnosis)
Nucleic acid detection can be done via PCR duplex testing for GC and CT.
Urine is very effective in men only (Almost as effective as urethral swabs)
In women urine must be combined with SOLVS
How sensitive is gonorrhea?
90% sensitive in urethritis
70% in cervicitis
What gonorrhea types can’t be tested for with nucleic acid tests?
Not validated for throat and rectum due to false positives like N cinerea and N subflava
What is SOLVS?
Self Obtained Low Vaginal Swab
What urine must be used for analysis in men for gonorrhea?
First 20ml
How is gonorrhea treated?
Ceftriaxone 500 mg IMI or IVI + Azithromycin 1g
In non-metro areas can be treated with amoxycillin 3g and probenecid 1g in north west
What must be a feature of antibiotics used to treat chlamydia?
It must have high cell penetrance.
What serovars cause trachoma and what serovars of chlamydia cause genital disease?
A - C trachoma
D - K Genital disease
L 1 - 3 Lymphogranuloma Venereum (LGV)
What kind of bacteria is chlamydia?
Obligate Intracellular Organism (intracellular reproductive phase and extracellular infective phase)
What are the sequelae of chlamydia infection?
Same as gonorrhea:
Males: Urethritis, epididymitis, infertility, etc)
Females: Infertility, Pelvic pain, Adhesions.
Who clears gonorrhea more quickly males or females?
Males clear it within 6 months
Females often need up to 4 years
How is chlamydia tested?
No culture so Nucleic Acid testing (PCR) [often tested for at the same time as gonorrhea]
How is chlamydia treated?
Azithromycin and doxycycline are both very effective with >95% clearance at 2 - 4 weeks
Resistance is rare.
