Gonococcal urethritis
Prepared by: Assistant Professor Dr. Zhenya Stoyanova
Department of Dermatovenereology
MU-Varna
DEFINITION:
Infectious and highly contagious disease, transmitted mainly sexually, rarely
– non-sexually or indirectly. It flows with a purulent discharge from the
urethra in men and from the cervical canal in women. Incubation - 2-14 days
Cause:
Neiseria gonorrhoeae
• Gram-negative bacteria with a kidney shape.
• Diplococci facing the concave part towards each other.
• They do not form capsules, fringes and spores, but have hair-like pili on
the surface of the gonococcal cell, improving the attachment of bacteria to
host cells.
• In acute gonorrhea, the bacteria are located intracellularly in leukocytes,
epithelial cells, trichomoniasis (endocytobiosis), and in preparations for
chronic gonorrhea – extracellularly.
Course:
Increase in the frequency of asymptomatic forms:
- acute or chronic / in men, in women /
- gonococcus in newborns
Clinical picture:
- there is a purulent discharge, more pronounced in men and difficult to
determine in women.
Diagnosis:
- microscopic examination;
- smear of purulent exudate on a glass slide, stained with methylene blue or
Gram;
- Cultural research;
- DNA (PCR).
Localization and clinical forms of gonococcal infection:
1. Infection of the lower urogenital tract:
1.1. Urethritis;
1.2. Abscesses of the glands adjacent to the vagina;
1.3. Cervicitis.
2. Upper urogenital tract infections:
2.1. Endometritis;
2.2. Epididymitis;
2.3. TVB (infection of the fallopian tubes (salpingitis), ovaries and adnexa).
3. Extragenital forms:
3.1. Neonatal ophthalmia and conjunctivitis in adults;
3.2. Pharyngitis;
3.3. Proctitis.
4. Disseminated gonococcal infections:
4.1. Monoarticular arthritis;
4.2. Endocarditis or meningitis;
4.3. Benign gonococcal sepsis;
4.4. Gonococcal perihepatitis;
4.5. Skin manifestations.
Gonococcus in men:
Acute urethritis:
- Itching, burning in the anterior urethra;
- Excretion of scarce mucous exudate -> after a day -> thick and mucous,
abundant, yellow-green exudate;
- Erythemo-edematous orifice;
- Painful urination;
- Painful nocturnal erections;
- Rapid spread to the back of the urethra
- the urine in Thomson's sample is cloudy in both cups.
!!! Places for "hidden" reproduction of gonococci: paraurethral glands and
their ducts.
Chronic urethritis:
* "Morning discharge" after squeezing the urethra.
Complications:
• Balanoposthitis; * Paraurethritis;
• Tizonite; * Litreite;
• Cavernitis; * Periurethral abscess;
• Vesiculitis; * Prostatitis;
• Coliculitis * Epididymitis;
• Urethral strictures.
Gonococcus in women:
- The surest sign of gonococcus in women is urethritis in men!
- Burning and itching in the urethra with leakage of purulent exudate coming
from the cervical canal.
- Acute gonococcus may not impress a woman if she has a "white flow" of
another nature;
- Chronic gonococcus is more common and with scarce symptoms.
Complications:
• Skeneitis
• Bartolinitis
• Endometritis
• Slapingo-oophoritis
Gonococcus in children:
- Conjunctivitis
- Vulvovaginitis
- Urethritis - extremely rare - in a domestic way
Extragenital gonococcus:
- The infection comes exogenously:
• transmission from the partner to the eyes, pharynx, rectum
• transfer from the patient's body by touch or personal toilet
Disseminated gonococcal infection:
When covering the infection of organs and systems by blood or
hematogenous route - "endogenous route of infection"
• arthritis
• endocarditis - perforation of the aortic valves
• benign gonococcal sepsis - blood culture
• skin rash - distal to limbs and joints - maculopapular rash to hemorrhagic
pustular
• perihepatitis
• muscles, bones, NS- rarely
Therapy:
Patients infected with N. gonorrhea are often co-infected with C.
trachomatis - therefore combination therapy is recommended in these
patients.
• Fractional mode - multiple application daily for several days
• One-moment mode
Guideline for treatment of sexualy transmitted diseases 2015:
https://www.cdc.gov/std/tg2015/gonorrhea.htm
Therapy of uncomplicated gonococcus:
Dual therapy per day:
• Ceftriaxone 250 mg IM in a single dose
• Azithromycin 1g p.o. in a single dose
Alternative therapy:
• Cefixime 400 mg p.o. in a single dose
• Azithromycin 1 g p.o. in a single dose
Therapy for disseminated gonococcus:
Recommended dual therapy:
• Ceftriaxone 1 g IM or IV every 24 hours.
• Azithromycin 1 g p.o. single dose
Alternative therapy:
• Cefotaxime 1 g IV for 8 hours.
Or
• Ceftizoxime 1 g IV for 8 hours.
and
• Azithromycin 1 g p.o. in a single dose
Thank you for your attention!
