This document discusses sexually transmitted diseases (STDs), including gonorrhea. It notes that STDs are transmitted through intimate contact involving mucous membranes. Common bacterial STDs are gonorrhea, syphilis, chancroid, and vaginitis. Viral STDs include genital herpes, genital warts, HIV, hepatitis, and molluscum contagiosum. It then focuses on gonorrhea, describing it as an STD caused by Neisseria gonorrhoeae affecting mucocutaneous surfaces. Symptoms, signs, risk factors, investigations, treatment, and prognosis of gonorrhea are outlined.

1. DR. BIJAY Kr. Yadav
Holy Vision Technical Campus
Shankhmul, Kathmandu
Dermatology Department

2. STD STD are group of contagious condition whose principle mode of
transmission is by intimate several activity & involving the moist
mucous membrane of penis, vulva, cervix, anus, rectum, mouth,
pharynx & their adjacent skin surfaces.
 Common sexually transmitted diseases are :
A. Bacterial
• Gonorrhoea : Neisseria gonorrhoeae
• Syphilis : Treponema Pallidum
• Chancroid : Haemophillis ducreyi
• Vaginitis : Gardnerella vaginalis & Anaerobic bacteria

3. B. Chlamydia :
C. Viral :
• Genital herpes : Herpes simplex I & II
• Genital warts : Human papilloma virus
• AIDs : HIV I & II
• Hepatitis : Hep B virus
• Molluscum contagiosum : Pox virus
• Non-Specific Urethritis
• Chlamydia trachomatis
• Ureaplasma urealyticum

4. D. Fungal :
E. Protozoal :
F. Parasites :
• Candidiasis : Candida albicans
• Trichomoniasis : Trichomonas vaginalis
• Vaginitis
• Urethritis
• Balanoposthitis
• Pediculosis : Pthirus pubis
• Scabies : Sarcoptes scabeii

5. GONORRHOEA :
 It is ssexually transmitted disease caused by
“Neisseria gonorrhoea”
 Common STD affecting the mucocutaneous surfaces
of the lower genitourinary tract.
 Incubation period is 24 hours to 10 days
Males: 90% develop urethritis within 5 days of exposure.
Females: Usually >2 weeks. However, up to 75% of
women are asymptomatic.

6. Mode of Transmission :
 Male to female via semen
 Female to male urethra
 Rectal intercourse
 Pharyngeal infection
 Perinatal transmission ( mother to infant)

7. Pathogenesis
 Gonococcus has affinity for columnar epithelium
 Stratified and squamous epithelium are more resistant
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8. Risk factors :
 Multiple or change of sex partners
 Not using condoms
 Casual sex
 Sex with CSW ( commercial sex workers ) & Partners
 Urban residence in areas with disease prevalence
 Adolescent , female particularly
 Low socio-economic status
 Alcohol & substance use
 Poverty

9. Clinical features :
1. In Male :
Symptoms:
• Pain & burning sensation in urethra during micturation
• Copious, thick, yellow purulent discharge from urethra
• Fever
• Frequency of micturation
• Malaise

10. Signs:
• Copious, thick, yellow purulent discharge from
urethra
• External urethral meatus may become red,
swollen & tender
• Tenderness

12. 2. In Female :
Symptoms :
• Purulent discharge
• The infection can become much more as
 Bartholinitis
 Cervicitis
 Vulvitis
 Salphingitis
 Lower abdominal pain
 Cervical discharge
 Contact bleeding
 Dyspareunia
 Fever

13. Signs :
• Pus may be from urethra, bartholin duct
• Cervix :
• Inflammed with mucopurulent discharge
• Bleed to touch
• Sign of PID:
• Lower abdominal tenderness

14. 3. Rectal involvement
• Common in homosexual
• Purulent discharge
4. Pharyngeal gonorrhoea
• Result of oral sex
5. Gonococcal conjunctivitis
• Purulent discharge from eyes
• Severe inflammation of conjunctivitis
• Oedema of eyelids
• Pain
• photophobia

15. 6. Disseminated Gonococcal infection
• Arthritis
• Myocarditis
• Endocarditis
• Pericarditis
• Meningitis
• Fever
• Cutaneous lesion

16. Investigations
 The specimens are taken from urethra & rectum in
males
1. Gram staining :
kidney shaped Gram –ve non motile,
non sporing, aerobic bacteria ( Neisseria
gonorrhoea) can be demonstrated.
2. Culture in Thayer martin medium :
Neisseria gonorrhoea can be cultured &
demonstrated.
3. Biochemical test
4. Cutaneous biopsy

17. Treatment
 Prevention : use of condom should be encouraged.
 There is high frequency of Chlamydia infection in
persons with gonorrhea and should be treated for both.
1. For uncomplicated cases:
Procaine penicillin G 4.8 million IU IM.
+
Probenecid 1 gm orally stat.
&
Doxycycline 100 mg BD for 7 days

18. Ampicillin / Amoxicillin 2gm or 3 gm orally stat
+
Probenecid 1 gm orally stat
&
Doxycycline 100 mg BD for 7 days
 If patient is allergic to penicillin then give
• Ciprofloxacin 500 mg orally stat
• Ofloxacin 400 mg orally stat ( contraindicated in
pregnancy)
• Azithromycin 1000 mg stat &
• Doxycycline 100 mg BD for 7 days

19.  If pregnancy & lactation
• Ceftriaxone 250 mg im stat
• Cefixime 400 mg orally as a single dose
• Spectinomycin 2 gm im stat

20. 2. For complicated infection :
 Ceftriaxone 1 gm IV or IM daily for 7-10 days
or
Spectinomycin 2 gm IM BD for 7-10 days
 Note : The inportant part of management is
that both partner should be treated at the
same time.

21. Course and Prognosis
 In men symptoms are usually acute and seek relief .
 In women initial symptoms are usually mild and
often ignored.
 Often women present with Pelvic Inflammatory
Disease.
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22. THANK YOU