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- 1. Gonorrhoea Presented by:- MeenakshiTadhiyal Roll No.:- 24 Batch:- 2018
- 2. What is gonorrhoea?? Asexually transmitted disease caused by gonococcal bacteria that affects the mucous membrane chiefly of the genital and urinary tracts and is characterized by an acute purulent discharge and painful or difficult urination, though women often have no symptoms.
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- 4. Neisseria gonorrhoeae agram-negative (coffee bean shaped) diplococcus shifting from 0.6 to 1.0 micrometer in diameter. It has 2069 genes, 2002 protein genes, and 67 structural RNAs. They grow on chocolate agar with Carbon Dioxide. It multiplies in warm and moist areas because it's easy to grow. Ex: reproductive tract, urine canal,
- 5. History: when &who discovered It? Neisseria Gonorroeae was discovered in 1879. By (and named after) a a German physician and bacteriologist, Albert Ludwig Sigesmund Neisser.
- 6. Modes of transmission Unprotected sex Oral sex When someone is infected, the bacteria can be easily spread by: rubbing your eyes. Mothers who are infected can give their baby the infection through delivery.
- 8. Pathogenesis Only mucousmembranes lined by columnar or cuboidal, noncornified epithelial cells are susceptible to gonococcal infection. N. gonorrhoeae adhere to mucosal cells , mediated by pili, Opa, and other surface proteins.
- 9. Steps of pathogenesis Invasion:-Organism is then pinocytosed by epithelial cells, which transport gonococci from mucosal surface to subepithelial spaces. Adherence :- initial event , N. gonorrhoeae adhere to mucosal cells , mediated by pili, Opa, and other surface proteins. Invasion :-Organism is then pinocytosed by epithelial cells, which transport gonococci from mucosal surface to subepithelial spaces.
- 10. Simultaneous withattachment of gonococci to nonciliated epithelial cells, gonococcal LOS(endotoxin) impairs ciliary motility and contributes to destruction of surrounding ciliary cells.
- 11. 3. Tissuedamage :-Progressive mucosal cell damage and submucosal invasion are accompanied by a vigorous neutrophil response, submucosal microabscess formation, and exudation of purulent material into lumen of the infected organ. This process may promote further attachment of additional organisms.
- 12. Dissemination:- abilityto resist the killing activity of antibodies and complement in normal human serum is closely related to the ability of gonococci to cause bacteremic illness with or without septic arthritis.
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- 15. Symptoms in men Symptoms begin:2 to 14 days Burning sensation while urinating. Testicular swelling and/or pale Green, yellow discharge.
- 17. Symptoms in women Symptoms begin: 7 to 21 days Pain and burning sensation while urinating. Spotting blood after sex. Irregular bleeding period. Yellow, green, and white discharge.
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- 21. Rectal infection Rectalmucosa is infected in 35–50% of women with gonococcal cervicitis. Only rectum is involved in 5% women. 40% in homosexual men. Symptoms range from minimal anal pruritus, painless mucopurulent discharge (often manifested only by a coating of stools with exudate),
- 22. or scantrectal bleeding, to symptoms of overt proctitis, including severe rectal pain, tenesmus, and constipation. External inspection :- only occasionally shows erythema and abnormal discharge . On Anoscopy:- mucoid or purulent exudate ( localized to anal crypts), erythema, edema, friability, or other inflammatory mucosal
- 23. Pharyngeal Infection 3–7%of heterosexual men. 10–20% of heterosexual women. and 10–25% of homosexually active men. acute pharyngitis or tonsillitis and occasionally is associated with fever or cervical lymphadenopathy. >90% are asymptomatic
- 24. Disseminated gonorrhoea With layngealinvolvement
- 25. Who are atrisk? Any sexually active person Ages between 15-29 years old have the highest rates of gonorrhea. In 1996, gonorrhea rates were high for men. 2010, women's rates are higher.
- 26. Laboratory diagnosis Gram’sstain:- Microscopic examination of stained smears shows gram –ve diplococci in PMN are seen. Culture:- antibiotic-containing selective media (e.g., modified Thayer- Martin medium) have diagnostic sensitivities of 80– 95% for promptly incubated specimens, depending in part on anatomic site being cultured. Small pinpoint colonies can be seen.
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- 29. Oxidase reaction:-aids to identify gonococci from mixed culture . A drop of tetra methyl-p-phenylene diamine hydrochloride is poured over suspected colonies, which turn pink and then dark blue.
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- 31. Non diagnostic techniques Nucleic acidamplification tests (NAATs):- polymerase chain reaction (PCR), transcription-mediated amplification (TMA), and other nucleic acid amplification technologies. More sensitive than culture for gonorrhea diagnosis and specificities are nearly as
- 32. Complications Pelvic inflammatorydisease (PID) Infertility Scarring or narrowing of the urethra Abscess (collection of pus around the urethra) Joint infections
- 33. Heart valveinfection Meningitis Pregnant women with severe gonorrhea may pass the disease to their baby while in the womb or during delivery. Premature delivery Spontaneous abortion Blindness, joint infection, or blood infection
- 34. Treatment While undertreatment, one must not have any sexual contact. – Must wait at least 7 days after medication. – Both partners must be tested & treated or else the infection will happen again. If failed, one must be tested for a gonorrhea culture (sample of body fluid),
- 35. Prophylaxis of Opthamia neonatorum Prevention is for all of preterm infants. It is done immediately after birth. Silver nitrate, 1% aqueous solution of a single dose of 2-3 drops in each eye. Erythromycin 0.5%, 1% eye ointment once Tetracycline 1% eye ointment
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- 37. Treatment of gonococcal infectionin childrens Ceftriaxone (Rocephin) / m single 125 mg (body weight less than 45kg) Alternative modes: Spektomitsetin 40 mg / kg dose. And children weighing over 45 kg, are treated like an adult.
- 38. Treatment of uncomplicatedgonococcal infection of urethra, cervix & rectum Single dose of Tab. cefixime 400mg, Inj. Ceftriaxone 125 mg IM, tab. Ciprofloxacin 500mg, tab. Ofloxacin 400mg, or tab. Levofloxacin 250mg PLUS If chlamydial infection is not ruled out- tab. Azithromycin 1 g single dose or tab. Doxycyclin 100mg BID x 7days.
- 40. “Fun fact” InFrance, gonorrhea was known as “La chaude pisse” (Hot piss) because of the burning sensation while urinating. It's also called as“The Clap!”Nickname from a treatment: clapped on both side of the penis for the discharge to come out.
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