Gonorrhea is a common sexually transmitted disease caused by Neisseria gonorrhoeae that differs in presentation between males and females. It has been known throughout human civilization. Diagnosis involves gram staining, culturing, and rapid tests to identify the bacteria. Treatment primarily involves large doses of penicillin or related antibiotics, though resistance has emerged. Prevention focuses on abstinence, condom use, treating infected mothers and partners, and ocular prophylaxis of newborns.

1. GONORRHOEA
V.JAGAN MOHAN RAO M.S.Pharm., MED.CHEM
NIPER-KOLKATA
Asst.Professor, MIPER-KURNOOL
EMAIL- jaganvana6@gmail.com

2. Gonorrhea:
Gonorrhea is one of the common and highly
contagious sexually transmitted diseases
caused by Neisseria gonorrhoeae which differ in
males and females in course, severity and ease
of recognition and can lead to different
systemic complication if left untreated.

3. Historical Background
• Ancient disease known in human civilization
• First scientific observation done by Hippocrates, he
dissected the infected urethra
• The name gonorrhea use first time by Greek
doctor Galen in 130 BC
• Gono means seed and rhoia means flow
• He mistakenly thought that the abnormal
discharge was semen
• Slang named as “Clap”, “Drip”

4. Distribution
World wide in distribution.
Affects both sexes.
Most prevalent in lower socio economic condition and poor
hygiene practices.
it one of the classical sexually transmitted disease.
In most of the developed countries the incidence have
decreased during the past two decades
Resistance to penicillin and tetracycline is widespread.
WHO collaborating centers for development of gonococcal
antimicrobial surveillance program

5. Epidemiological features
1). Agent factors
a) Agent
b) Reservoir of infection
c) Sources of infection
d) Period of Communicability
2). Host factors
a) Age
b) Sex
c) High risk groups
d) susceptibility and resistance

6. Mode of transmission
1) Sexual transmission
2) Congenital or Vertical transmission
3) Transmission from fomites
4) Materno - foetal transmission

7. Incubation Period
Usually 3-8 days with a range of 1-14 days in men and within
10 days for women

11. Pathogenesis
The common method of transmission is by sexual intercourse.
The risk of men contracting infection varies with the number of
exposures with infectious female. It has been estimated 19% for one
exposures and rising to 57% for >= to 4 exposures.
The risk of infection to female from the infected male have no been
thoroughly investigated but it have been found in those who have been
exposed on more than one occasion have infection rates of between 92%
and 59%.
Similarly, it has also been found that males were probably at greatest risk
from menstruating females.
From experimental research it has been found that 103 cfu are required
reliably to infect male urethra where as the number of gonococci found in
vagina seems to be highly variable. However, 4.0 x 102 to 1.8 x 107 cfu have been
estimated to infect female.

15. Laboratory diagnosis
Specimen collection: specimen are collected from genital sources, rectum in case
of homosexuals, throat specimen as appropriate as well as for other
extragenital infection such as oropharynx, skin lesion, inflamed joints, blood,
and pelvic inflammatory disease
The routine laboratory diagnosis of gonorrhea proceeds as follows:
1) Gram stain microscopy.
2) Culture on enriched selective medium.
3) Examine colonies for suspected colonies and perform oxidase test.
4) Perform Rapid carbohydrate utilization test (RCUT) along with beta lactamase
prodution.
5) Slide agglutination test with commercially available monoclonal antibody kit.
6) Conduct antimicrobial susceptibility test
7) In suspected DGI perform blood cultures in Biphasic medium and incubate in a
CO2 incubator with a cotton wool plug. And perform immunofluorescence
staining.

16. Treatment
Primarily large dose of intramuscular penicillin or oral
ampicillin or doxycycline is used as the treatment
therapy for gonorrhea but due to the penicillin resistance
other alternatives such as cefuroxime, cefotaxime.
Erythromycin, spectinomycin, or ciprofloxacin are
used.

17. Prevention and control
Sexually transmitted diseases can be prevented by
abstinence or condom use. Ophthalmia neonatorum may be
prevented by third-trimester treatment of cervically
infected mothers and their sexual partners. Ocular
prophylaxis of all newborns with ointments of 1 percent
tetracycline or 0.5 percent erythromycin is recommended.
Thus the control of gonorrhea can be listed as:
• Rapid diagnosis
• Use of effective antibiotics
• Tracing, examination and treatment of contacts