diease

Gonorrhoea


OVERVIEW OF Gonorrhoea :

Gonorrhoea is a sexually transmitted infection (STI) .   It is caused by the bacterim Neisseria gonnoehoea. It tends to target warm, moist areas of the body including the:

Urethra, eyes, throat, vagina, anus and female reproductive tract such as fallopian tubes, cervix and uterus.

Gonorrhoea passes from person to person through oral,anal, vaginal sex without a condom or other barrier method. The best protections against transmission are abstinence and proper condom or barrier method usage.


STRUCTURE of Gonorrhoea :

It is gram negative diplococci discovered by Albert Neisser. It is obligate aerobic bacteria and it shows catalase negative. It is cultured in the Thayer Martin Medium which is enriched with the 3-7 % of the carbon dioxide. The new York city agar is the special medium for the growth of the bacterium


CAUSES :

Unsafe sexual practices

Multiple sexual practices

Transfer of the virus from mother to foetus

Also spreads by break in the skin surface.

Anal intercourse

Oral sex

Sexual  Transmission:

About 80% of infections worldwide are transmitted through sexual transmission. The risk of transmission depends on various factors including - sexual partner's bacterial load, the type of sexual exposure, coinfection with other conditions like HSV and genital inflammation or damage.

 


PATHOPHYSIOLOGY :

  • The pathophysiology of N gonorrhoeae and the relative virulence of different subtypes depend on the antigenic characteristics of the respective surface proteins. Certain subtypes are able to evade serum immune responses and are more likely to lead to disseminated (systemic) infection.

    Well-characterized plasmids commonly carry antibiotic-resistance genes, most notably penicillinase. Plasmid and nonplasmid genes are transmitted freely between different subtypes. The ensuing exchange of surface protein genes results in high host susceptibility to reinfection. The exchange of antibiotic resistance genes has led to extremely high levels of resistance to beta-lactam antibiotics. Fluoroquinolone resistance has also been documented on multiple continents and in widespread populations within the United States. [6]

    Infection of the lower genital tract, the most common clinical presentation, primarily manifests as male urethritis and female endocervicitis. Infection of the pharynx, rectum, and female urethra occur frequently but are more likely to be asymptomatic or minimally symptomatic. Retrograde spread of the organisms occurs in as many as 20% of women with cervicitis, often resulting in pelvic inflammatory disease (PID), with salpingitis, endometritis, and/or tubo-ovarian abscess. Retrograde spread can lead to frank abdominal peritonitis and to a perihepatitis known as Fitz-Hugh-Curtis syndrome.

    Long-term sequelae of PID, such as tubal factor infertility, ectopic pregnancy, and chronic pain, may occur in up to 25% of affected patients. Epididymitis or epididymo-orchitis may occur in men after gonococcal urethritis. Lower genital infection is a risk factor for the presence of other sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV).

    Infertility in women:

Gonorrhea can spread into the uterus and fallopian tubes, causing pelvic inflammatory disease (PID). PID can result in scarring of the tubes, greater risk of pregnancy complications and infertility. PID requires immediate treatment.

  • Infertility in men:

Gonorrhea can cause a small, coiled tube in the rear portion of the testicles where the sperm ducts are located (epididymis) to become inflamed (epididymitis). Untreated epididymitis can lead to infertility.

  • Infection that spreads to the joints and other areas of your body:

The bacterium that causes gonorrhea can spread through the bloodstream and infect other parts of your body, including your joints. Fever, rash, skin sores, joint pain, swelling and stiffness are possible results.

  • Increased risk of HIV/AIDS:

Having gonorrhea makes you more susceptible to infection with human immunodeficiency virus (HIV), the virus that leads to AIDS. People who have both gonorrhea and HIV are able to pass both diseases more readily to their partners.

  • Complications in babies:

Babies who contract gonorrhea from their mothers during birth can develop blindness, sores on the scalp and infections.


ROUTES OF TRANSMISSION :

Sexual route

The main route of transmission is by sexual route such as vaginal , oral and anal sex.

Sometimes by blood products.

Touching or exposure arears of the infected person.

 


COMMON CLINICAL SIGNS AND SYMPTOMS :

Inflammation of the urethra- urethritis

Vaginal discharge

Pain

Small tiny blisters

Scabs – the ulcers which forms and heal by itself leaving a scar like tissue

Bleeding in the sore

Dysuria- A condition caused by the urethral discharge


DIAGNOSTIC :

  • Urine test:

This can help identify bacteria in your urethra.

  • Swab of affected area:

 A swab of your throat, urethra, vagina or rectum can be  collected and bacteria that can be identified in a lab

  • Gonorrhea nucleic acid amplification (NAAT) testing: 

NAAT testing detects the genetic material (DNA) of the gonorrhea bacteria and is considered the optimal test for gonorrhea infection. This type of test can be performed on a urine sample or a swab taken from a site of potential infection.

  • Gram stain: 

Gram stains look for certain types of cells that are characteristic of a gonorrhea infection under a microscope. This test is performed on urethral swabs and is used primarily in men who are experiencing urinary symptoms.

  • Gonococcal culture: 

Gonococcal cultures attempt to grow the gonorrhea bacteria from swabs taken from sites of potential infection. Cultures are the only tests that detect the infection’s susceptibility to antibiotics. Doctors may order a gonococcal culture if they suspect that a patient has an antibiotic-resistant strain of gonorrhea.

  • Rapid gonorrhea tests: While rapid testing for gonorrhea isn’t common, several tests are being developed to allow health care professionals to give same-day gonorrhea testing results.


TREATMENT AND PROGNOSIS :

Ceftriaxone given as injection and Azithromycin is given orally.

Gemifloxacin or Gentamicin combined with oral azithromycin provides a better relief in the patients who is allergic to ceftriaxone.


PROGNOSIS :

gonorrhoea if left untreated might persists for months or weeks. The complication occurring in the gonorrhoea is very mild nearly 0.6-3 % of the cases.


PREVENTION :

  • Limiting or reducing the number of sexual partners
  • using protection during sexual contact or intercourse at all times
  • regularly checking the genital region for signs of abnormal bumps, sores, or swollen lymph nodes
  • talking with sexual partners about testing for STIs or their STI status before engaging in sexual contact
  • asking sexual partners about any unusual sores or bumps in their genital region
  • talking with a doctor about unexplained groin pain
  • getting regular STI testing
  • avoiding or limiting alcohol use and avoiding recreational drug use as these may impair judgment in making healthy choices
  • screening of the blood and other products before transfusion


REFERENCE :

https://labtestsonline.org/tests/gonorrhea-testing

https://www.webmd.com/sexual-conditions/gonorrhea#1

https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea-detailed.htm

https://www.britannica.com/science/gonorrhea

https://www.frontiersin.org/articles/10.3389/fimmu.2018.02710/ful