Most common bacterial STD.Incidence highest among adolescents and youngadults.Causes a range of clinical syndromes
 Adolescents > age 20-25 years > older Black/Hispanic > White/API Multiple sex partners Inconsistent use of barrier me...
Can be acquired from asymptomatic partnerIt is greater from male to femaleMale to female: 50 - 90%Female to male: 20 - 8...
Observed intracellularly in PMNs on Gram stainGram-negative diploccocusInfects non-cornified epitheliumCervix, Urethra , R...
GC are ingested,evade host defenses,and spread throughsubepithelial tissuesAttachment mediatedby pili and dividesevery 20-...
 Cervicitis Urethritis Proctitis Accessory gland infection (Skene, Bartholin) Pelvic inflammatory disease (PID) Peri...
Complications of GC Infectionsin WomenCongenital InfectionUpper TractInfectionGenitalInfection Infertility Ectopic Pregn...
Incubation 3-10 daysSymptoms:Vaginal dischargeDysuriaVaginal bleedingCervical signs :ErythemaFriabilityPurulent exudate
 Tender swollenBartholin’s glandwith purulentdischarge.
 Painful swollen Bartholin’sglands Fluctuant, tender May have expressiblepurulent discharge
 Sx: lower abdominal painAdhesionsTube Laparoscopy may showhydrosalpinx,inflammation, abscess,adhesions Signs: uterine/...
 Urethritis Epididymitis Proctitis Conjunctivitis Abscess of Cowper’s/Tyson’s glands Seminal vesiculitis Prostatiti...
 Incubation 2-7 days Most urethral infectionssymptomatic Purulent urethral discharge Abrupt onset of severe dysuria
 Swollen painful epididymis Urethritis Epididymal tenderness or masson examEpididymitis
 Urethritis Proctitis Pharyngeal infections Conjunctivitis DisseminatedGonococcal Infection
 Marked chemosisand tearing Typically purulentdischarge, Erythema
 Conjunctival erythema and discharge
 Gonococcal bacteremia Patients with congenital deficiency of C7, C8, C9 areat high risk More common in females Occurs...
 “Dermatitis-arthritis syndrome”Arthritis: 90%Characterized by fever, chills, skin lesions,arthralgias, tenosynovitisL...
 Necrotic, grayishcentral lesion onerythematous base
 Papular and pustularlesions on the foot
 Small painful midpalmarlesion on an erythematousbase
 Pustular erythematouslesions
 Papular erythematousskin lesion
 Meningococcemia Staphylococcal sepsis or endocarditis Other bacterial septicemias Acute HIV infection Thrombocytopen...
 Postpartum endometritis Septic abortions Post-abortal PIDPossible role in:Gestational bleedingPreterm labor and deli...
Overall vertical transmission rate ~30%Neonatal complications include:Ophthalmia neonatorumDisseminated gonococcal infec...
 Lid edema, erythemaand marked purulentdischarge Preventable withophthalmic ointment
Culture should be obtainedAll cases should be considered possibleevidence of sexual abuse Vulvovaginits Urethritis Proc...
 Gram stain smear Culture Antigen Detection Tests. Nucleic Acid Detection Tests◦ Probe Hybridization◦ Nucleic Acid Amp...
Gram stain(male urethra exudate)DNA probeCultureNAATs *Sensitivity90-95%85-90%80-95%90-95%Specificity> 95%> 95%> 99%> 98%*...
Accessory gland infection: similar to male urethritisNot useful in pharyngeal infectionsIn cervicitis & Proctitis :50-70%s...
 Numerous PMNs Gram negativeintracellulardiplococci
 PMN with Gramnegativeintracellulardiplococci
In cases of suspected sexual abuse, culture is the onlytest accepted for legal purposesRequires prompt placement in high-C...
Recommended regimens:Cefixime 400 mg PO x 1 orCeftriaxone 125 mg IM x 1 orCiprofloxicin 500 mg PO x 1 orOfloxacin 400 mg P...
Alternative regimens: Ceftizoxime 500 mg IM x 1 Cefotaxime 500 mg IM x 1 Cefoxitin 2 g IM x 1 + probenecid 1 g PO x 1 ...
Pharyngeal infection:Ceftriaxone 125 mg IM x 1 orCiprofloxicin 500 mg PO x 1 orConjunctivitis:Ceftriaxone 1 g IM x 1 doseP...
Must avoid quinolones & tetracyclineRecommended regimens: Cefixime 400 mg PO x 1 Ceftriaxone 125 mg IM x 1PLUS if chlamy...
Ophthalmia neonatorum prophylaxis:Silver nitrate 1% aqueous solution topical x 1Erythromycin 0.5% ointment topical x 1T...
Prophylaxis for maternal GC infection:Ceftriaxone 25-50 mg/kg IV or IM x 1 NTE 125 mgDisseminated Gonococcal Infection:C...
Uncomplicated genital infection:◦ ≥ 45 kg: same as adults◦ < 45 kg: ceftriaxone 125 mg IM x 1 (alternativespectinomycin 40...
Recommended regimen:◦ Ceftriaxone 1g IV or IM q 24 hAlternative Regimens:Cefotaxime 1 g IV q 8 hCeftizoxime 1 g IV q 8 hCi...
Recommended Regimes:◦ Cefixime 400 mg PO BID◦ Ciprofloxacin 500 mg PO BID◦ Ofloxacin 400 mg PO BIDOral therapy for total t...
 Resistance in 20%-30% of gonococcal isolates Plasmid mediated◦ B - Lactamase production◦ High-level tetracycline resist...
Gonorrhea
Gonorrhea
Gonorrhea
Gonorrhea
Gonorrhea
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Gonorrhea

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Gonorrhea

  1. 1. Most common bacterial STD.Incidence highest among adolescents and youngadults.Causes a range of clinical syndromes
  2. 2.  Adolescents > age 20-25 years > older Black/Hispanic > White/API Multiple sex partners Inconsistent use of barrier methods
  3. 3. Can be acquired from asymptomatic partnerIt is greater from male to femaleMale to female: 50 - 90%Female to male: 20 - 80%Vaginal & anal intercourse more efficient than oralIncreases transmission and susceptibility to HIV 2-5foldEfficiently transmitted by sexual contact
  4. 4. Observed intracellularly in PMNs on Gram stainGram-negative diploccocusInfects non-cornified epitheliumCervix, Urethra , Rectum , Pharynx , Conjunctiva
  5. 5. GC are ingested,evade host defenses,and spread throughsubepithelial tissuesAttachment mediatedby pili and dividesevery 20-30 min.Leads to formation of submucosalabscessesand accumulation of exudate in lumenGC toxins damagecells
  6. 6.  Cervicitis Urethritis Proctitis Accessory gland infection (Skene, Bartholin) Pelvic inflammatory disease (PID) Peri-hepatitis (Fitz-Hugh-Curtis) Pregnancy morbidity Conjunctivitis Pharyngitis DGI
  7. 7. Complications of GC Infectionsin WomenCongenital InfectionUpper TractInfectionGenitalInfection Infertility Ectopic Pregnancy Chronic Pelvic Pain PsychosocialHIV InfectionLocal InvasionSystemic Infection
  8. 8. Incubation 3-10 daysSymptoms:Vaginal dischargeDysuriaVaginal bleedingCervical signs :ErythemaFriabilityPurulent exudate
  9. 9.  Tender swollenBartholin’s glandwith purulentdischarge.
  10. 10.  Painful swollen Bartholin’sglands Fluctuant, tender May have expressiblepurulent discharge
  11. 11.  Sx: lower abdominal painAdhesionsTube Laparoscopy may showhydrosalpinx,inflammation, abscess,adhesions Signs: uterine/ adnexaltenderness, +/- fever
  12. 12.  Urethritis Epididymitis Proctitis Conjunctivitis Abscess of Cowper’s/Tyson’s glands Seminal vesiculitis Prostatitis Pharyngitis DGI Urethral stricture Penile edema
  13. 13.  Incubation 2-7 days Most urethral infectionssymptomatic Purulent urethral discharge Abrupt onset of severe dysuria
  14. 14.  Swollen painful epididymis Urethritis Epididymal tenderness or masson examEpididymitis
  15. 15.  Urethritis Proctitis Pharyngeal infections Conjunctivitis DisseminatedGonococcal Infection
  16. 16.  Marked chemosisand tearing Typically purulentdischarge, Erythema
  17. 17.  Conjunctival erythema and discharge
  18. 18.  Gonococcal bacteremia Patients with congenital deficiency of C7, C8, C9 areat high risk More common in females Occurs in < 5% of GC-infected patients Sources of infection include symptomatic andasymptomatic infections of pharynx, urethra, cervix
  19. 19.  “Dermatitis-arthritis syndrome”Arthritis: 90%Characterized by fever, chills, skin lesions,arthralgias, tenosynovitisLess commonly, hepatitis, myocarditis,endocarditis, meningitis Rash characterized as macular or papular, pustular,hemorrhagic or necrotic, mostly on distal extremities
  20. 20.  Necrotic, grayishcentral lesion onerythematous base
  21. 21.  Papular and pustularlesions on the foot
  22. 22.  Small painful midpalmarlesion on an erythematousbase
  23. 23.  Pustular erythematouslesions
  24. 24.  Papular erythematousskin lesion
  25. 25.  Meningococcemia Staphylococcal sepsis or endocarditis Other bacterial septicemias Acute HIV infection Thrombocytopenia & arthritis Hepatitis B prodrome Reiter’s Syndrome Juvenile Rheumatoid Arthritis Lyme disease
  26. 26.  Postpartum endometritis Septic abortions Post-abortal PIDPossible role in:Gestational bleedingPreterm labor and deliveryPremature rupture of membranes
  27. 27. Overall vertical transmission rate ~30%Neonatal complications include:Ophthalmia neonatorumDisseminated gonococcal infection (sepsis, arthritis,meningitis)Scalp abscess (if fetal scalp monitor used)Vaginal and rectal infectionsPharyngeal infections
  28. 28.  Lid edema, erythemaand marked purulentdischarge Preventable withophthalmic ointment
  29. 29. Culture should be obtainedAll cases should be considered possibleevidence of sexual abuse Vulvovaginits Urethritis Proctitis
  30. 30.  Gram stain smear Culture Antigen Detection Tests. Nucleic Acid Detection Tests◦ Probe Hybridization◦ Nucleic Acid Amplification Tests (NAATs)◦ Hybrid Capture
  31. 31. Gram stain(male urethra exudate)DNA probeCultureNAATs *Sensitivity90-95%85-90%80-95%90-95%Specificity> 95%> 95%> 99%> 98%* Able to use URINE specimens
  32. 32. Accessory gland infection: similar to male urethritisNot useful in pharyngeal infectionsIn cervicitis & Proctitis :50-70%sensitivity, 95% specificityIn symptomatic male urethritis:>95% sensitivity and specificity: reliable to diagnose and exclude GC
  33. 33.  Numerous PMNs Gram negativeintracellulardiplococci
  34. 34.  PMN with Gramnegativeintracellulardiplococci
  35. 35. In cases of suspected sexual abuse, culture is the onlytest accepted for legal purposesRequires prompt placement in high-CO2environment(candle jar, CO2 incubator)Sensitive to oxygen and cold temperatureRequires selective media with antibiotics to inhibitcompeting bacteria (Modified Thayer Martin Media, NYCMedium)
  36. 36. Recommended regimens:Cefixime 400 mg PO x 1 orCeftriaxone 125 mg IM x 1 orCiprofloxicin 500 mg PO x 1 orOfloxacin 400 mg PO x 1 orLevofloxacin 500 mg PO x 1All sex partners within past 60 days need evaluation andtreatmentPLUS if chlamydia is not ruled out:Azithromycin 1 g PO x 1 orDoxycycline 100 mg PO BID x 7 d
  37. 37. Alternative regimens: Ceftizoxime 500 mg IM x 1 Cefotaxime 500 mg IM x 1 Cefoxitin 2 g IM x 1 + probenecid 1 g PO x 1 Gatifloxacin 400 mg PO x 1 Lomefloxacin 400 mg PO x 1 Norfloxacin 800 mg PO x 1 Spectinomycin 2 g IM x 1
  38. 38. Pharyngeal infection:Ceftriaxone 125 mg IM x 1 orCiprofloxicin 500 mg PO x 1 orConjunctivitis:Ceftriaxone 1 g IM x 1 dosePLUS if chlamydia is not ruled out:Azithromycin 1 g PO x 1 orDoxycycline 100 mg PO BID x 7 d
  39. 39. Must avoid quinolones & tetracyclineRecommended regimens: Cefixime 400 mg PO x 1 Ceftriaxone 125 mg IM x 1PLUS if chlamydia is not ruled out: Azithromycin 1 g PO x 1  Other appropriate chlamydial regimenTest of cure in 3-4 weeks
  40. 40. Ophthalmia neonatorum prophylaxis:Silver nitrate 1% aqueous solution topical x 1Erythromycin 0.5% ointment topical x 1Tetracycline 1% ointment topical x 1Ophthalmia neonatorum treatment:Ceftriaxone 25-50 mg/kg IV or IM x 1 NTE 125mg
  41. 41. Prophylaxis for maternal GC infection:Ceftriaxone 25-50 mg/kg IV or IM x 1 NTE 125 mgDisseminated Gonococcal Infection:Ceftriaxone 25-50 mg/kg/d IV or IM QD x 7 d(use 50 mg/kg/d for older children,treat for 10-14 d if child weighs ≥ 45 kg)Cefotaxime 25 mg/kg IV or IM q12h x 7 d
  42. 42. Uncomplicated genital infection:◦ ≥ 45 kg: same as adults◦ < 45 kg: ceftriaxone 125 mg IM x 1 (alternativespectinomycin 40 mg/kg IM x 1)Disseminated Gonococcal Infection:Ceftriaxone 25-50 mg/kg/d x 7 dUse 50 mg/kg/d for older childrenTreat for 10-14d if child weighs ≥ 45 kg
  43. 43. Recommended regimen:◦ Ceftriaxone 1g IV or IM q 24 hAlternative Regimens:Cefotaxime 1 g IV q 8 hCeftizoxime 1 g IV q 8 hCiprofloxacin 400 mg IV q 12 hOfloxacin 400 mg IV q 12 hLevofloxacin 250 mg IV q 24 hSpectinomycin 2 g IM q 12 hBegin IV therapy for 24-48 hrs, switch to oral therapy for atotal of 1 week
  44. 44. Recommended Regimes:◦ Cefixime 400 mg PO BID◦ Ciprofloxacin 500 mg PO BID◦ Ofloxacin 400 mg PO BIDOral therapy for total treatment of 1 week
  45. 45.  Resistance in 20%-30% of gonococcal isolates Plasmid mediated◦ B - Lactamase production◦ High-level tetracycline resistance Chromosomal mediated◦ Confers resistance to PCN, tetracycline, spectinomycin,erythromycin, fluoroquinolones, and/or cephalosphorins

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