Pathophysiology
1) cause is infection with Neisseria gonorrhoeae (gonococcus) 2) attacks mucous membranes of the genitourinary and GI tracts, eye, and throat 3) causes tissue suppuration with chronic inflammation and fibrosis 4) disseminated form – causes bacteremia 5) more localized form – arthritis and skin lesions 6) neonates – ophthalmia neonatorum and blindness results 7) adult ocular form – swollen eyelid, purulent discharge, and inflamed conjunctiva 8) chronic infection can be asymptomatic
Signs and Symptoms
Men – 1) yellow creamy discharge from penis 2) painful urination 3) epididymitis Women – 4) mucopurulent discharge from vagina and urethra 5) salpingitis/tuboovarian abscess 6) cystitis 7) endometritis 8) perihepatitis with resulting Fitz-Hugh-Curtis syndrome 9) peritonitis 10) dypareunia 11) fever 12) cervical motion tenderness
Characteristic Test Findings
Laboratory – 1) leukocytosis 2) increases sed rate 3) positive Gram stain for organisms in urethral discharge
Histology/Gross Pathology
1) gram-negative cocci, usually in pairs 2) typically found in or associated with PMNs 3) shaped like a coffee bean 4) requires Thayer-Marting agar for culture
Associated Conditions
1) untreated in men – urethral fibrosis and strictures 2) untreated in women – fibrosis of fallopian tubes and infertility in 20% of cases 3) if bactermia occurs, can lead to skin lesions, tenosynovitis, and suppurative arthritis 4) endocarditis 5) meningitis 6) considered an HIV coinfection
Biochemistry
surface antigens – piklin, opa (protein 1), lipo-oligosaccharide
Inheritance/Epidemiology
1) repeat infections occur because of the antigenic variety of gonococcus 2) spread by sexual contact, especially via asymptomatic infections 3) more common in lower socioeconomic groups 4) more efficient transmission from males to females 5) 600,000 cases in USA each year 6) correct use of condoms prevents transmission
Treatment
Adults – 1) tetracyclines and penicillin G 2) if resistance occurs, use ceftriaxone or fluoroquinolones Neonates – 3) application of silver nitrate to eyes in first hours of life to prevent blindness
Tips for USMLE
1) can cause Fitz-Hugh-Curtis syndrome 2) if a 23 year-old sailor returns from shore leave during which he had contact with a prostitute and 5 days later reports that he has burning pain on urination and a milky discharge from his penis, think gonorrhea
Leave a Reply