Gonorrhoea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. It is transmitted through sexual contact and can infect the genital tract and other areas. Common symptoms include discharge from the genitals and burning during urination. If left untreated, it can lead to complications like pelvic inflammatory disease, infertility and ectopic pregnancy in women. Diagnosis is made through tests of genital secretions and treatment involves antibiotics. Public health efforts focus on screening and treatment to control spread.

1. (Gonorrhoea)
Prof Sriram Chandra Mishra
Kayachikitsa Department
VYDS Ayurved Mahavidyalaya, Khurja

2. These are infections that are passed from one person to another
through sexual contact. Examples include Gonorrhea, syphilis, genital herpes,
human papillomavirus infection, HIV/AIDS, chlamydia etc.
Due to social stigma, the term STDs or VD was changed out for
sexually transmitted infections (STIs) as both venereal disease (VD) and
sexually transmitted disease (STDs) use the term “disease.”

3. The term “sexually transmitted infection” (STI) refers to a pathogen
that causes infection through sexual contact whereas The term “sexually
transmitted disease” (STD) refers to a recognizable disease state that has
developed from an infection.
Sexually transmitted disease (STD) first begin as sexually transmitted
infections (STI) after sexually transmitted bacteria or virus first enters the
body and begins multiplying.

4. • STIs / STDs / VD - Group of Communicable Diseases
• Mode of transmission - Predominantly by Sexual Contact
• Agents - Bacterial, Viral, Protozoal, Fungal, Ectoparasites
• Spread - STIs are spread predominantly by sexual contact, including
vaginal, anal and oral sex. Some STIs can also be transmitted from
mother-to-child during pregnancy, childbirth and breastfeeding.
• 5 Classical STDs but now more than 30 different bacteria, viruses and
parasites are known to be transmitted through sexual contact.

5. 1. Gonorrhoea (PUYAMEHA)
2. Syphilis (PHIRANGA)
3. Chancroid / Soft Chancre (UPADAMSHA)
4. Lymphogranuloma Venereum (LGV)
5. Granuloma Inguinale (Donovanosis)
Old
5 Classical STDs

6. A. Bacterial Agents
• Neisseria gonorrhoeae
• Chlamydia trachomatis
• Treponema pallidum
• Haemophilus ducreyi
• Mycoplasma hominis
• Ureaplasma urealyticum
• Calymmatobacterium granulomatis
• Shigella Sps.
More than 30 agents
Now
• Campylobacter spp.
• Group B streptococcus
• Bacterial vaginosis-associated
organisms

7. B. Viral Agents
• Human (alpha) herpes virus 1 or 2 (herpes simplex virus)
• Human (beta) herpesvirus 5 (formerly cytomegalovirus)
• Hepatitis virus B
• Human papilloma virus
• Molluscum contagiosum virus
• Human immunodeficiency virus (HIV)

8. C. Protozoal agents
• Entamoeba histolytica
• Giardia lambia
• Trichomonas vaginalis
D. Fungal Agents
• Candida albicans
E. Ectoparasites
• Phthirus pubis
• Sarcoptes scabiei

9. • Out of these, Eight pathogens are linked to the greatest incidence of sexually
transmitted disease.
 Of these, 4 are generally curable with existing single-dose regimens of antibiotics.
(Three bacterial STIs - chlamydia, gonorrhoea and syphilis and one parasitic STI - trichomoniasis)
 The other 4 are viral infections which are incurable: hepatitis B, herpes simplex virus
(HSV or herpes), HIV and human papillomavirus (HPV).
• A person can have an STI without showing symptoms of disease. Common
symptoms of STIs include vaginal discharge, urethral discharge or burning in
men, genital ulcers and abdominal pain.
• Depending on the disease, some untreated STIs can lead
to infertility, chronic pain or even death.

10. (Gonorrhoea)
• PUYAMEHA
• No description in Brihatrayi or Laghutrayi
• Bhaisajya Ratnavali chapter 89 (Aupasargika Roga Chikitsa
prakarana) elaborate on Puyameha
• औपसर्गिक रोग - उपसगगित जगतः औपसर्गिकः (उपसगि - संक्रमण​)

11. Synonym (पर्गिर्​)
औपसर्गिकमेहगख्र्ो गदो र्ः स भिषग्वरः ।
पूर्मेहो व्रणमेह आगन्तुमेह उच्र्ते ॥
• पूर्मेहो - पुर्ं मेहर्तीत्र्तः पूर्मेहः । (pus in urine)
• व्रणमेह - व्रणवत् तस्र् लक्षणोपचगरौ िवत इतत व्रणमेहः । (symptom and
treatment like wound)
• आगन्तुमेह - बगहर्ोः कगरणववशेषः प्रगप्नोतीत्र्गगन्तुकः । (external cause)
• उष्णवगत क
े लक्षण इस रोग में तीव्र रूप में उिड़ते हैं, इसभलए इसे 'िृशोष्णवगत' कहते
हैं । (उष्णवगत - मूत्रगघगत कग एक िेद ह)

12. Nidana
रजस्वलायाां बहुभूक्त्तवतयाां तथाऽऽर्द्रयोनौमनादरो यः ।
प्रयातु मोहाद् कोऽपि तर्हर ध्रुवां गदां दारुणमेतमेतु ॥ (B.R. 89/2)
बहुभूक्त्तवतयाां – too many partners
ऽऽर्द्रयोनौ – kleda yukta due to any disease
1. स्री की योनन का अनेक रोगों से क्क्त्लन्न व कण्डु युक्त्त होना ।
2. रजस्वला स्री का अनेक िुरुषों से सांभोग करना ।
3. िूयमेह ग्रस्त िुरुष द्वारा स्री क
े साथ मैथुन करने से स्री भी िूयमेह रोग से ग्रस्त हो
जाती है

13. सम्प्प्रगप्प्त घटक
• दोष - वपत्त प्रधगन त्रत्रदोष
• दुष्र् - रक्त , लसीकग
• स्रोतस - मूत्रवह स्रोतस ्
• अर्धष्ठगन - भलङ्ग , वृषण , बप्स्त आदद
• संचगर - रसगर्नी द्वगरग

14. लक्षण

15. उपद्रव
व्रणमेहे ववतनददिष्टग आमनेत्रर्गददकगः । उपद्रवग ववशेषेण नगशनीर्ग भिषग्वरः ॥
(ि.र. 89 / 10)
• आमवगत (Gonorrheal arthritis)
• औपसर्गिक नेत्रगभिष्र्न्द (Ophthalmia neonatorum)

17. MANAGEMENT
• Rasa / Bhasma – Trivanga Bhasma, Swarnabanga Bhasma, Purnachanda
Rasa, Sweta Parpati, Rasa karpoora, Rasamanikya, Gandhaka Rasayana,
Mehamudgara rasa, Brihat Vangeswar rasa
• Vati – Chandraprabha Vati, Arogyavardhini Vati, Silajitwadi Vati,
Puyamehahara Gutika, Chandanadi Vati,
• Churna – Sphatikadi, Puyamehari / Puyamehahara Churna (BHU/AFI)
• Avaleha - Chopchini Rasayan / Madhusnuhi Rasayan
• Asavarista - Sarivadyasavam, Chandanasava, Vidangarista
• Ghrita – Panchatikta Ghrita

18. PUYAMEHAHARA CHURNA (BHU/AFI)
• SRIVESTAKA SATWA (SARALA –PINUS ROXBURGHII)
• KHADIRA SATWA
• SORAKA (SU.- PURIFIED POTASSIUM NITRATE)
• SPHATIKA SU.
• SWETA CHANDANA
• PRAVAL PISTI
• REWAT CHINI (RHEUM EMODII)
• GILE ARMANI SU. (PURIFIED RED ARMENIAN CLAY)
• DUGDHA PASANA
• GAIRIKA SU.
• HAZRALYAHUD PISTI
• SITA
(REWAT CHINI – Revand chini, indian
rhubarb, Amlaparni, Gandhini,
Pittamuli)

20. Defn of Gonorrhoea -
Gonorrhoea is a sexually transmitted infection
caused by the bacterium Neisseria Gonorhoea in which
contagious, purulent inflammation of the urethra or the
vagina occurs.
(THE CLAP DISEASE)

21. 21
Transmission
Efficiently transmitted by:
• Male to Female via semen
• Female to Male urethra
• Rectal intercourse
• Fellatio (pharyngeal infection)
• Perinatal transmission (Contact with infected bodily fluids, so that a mother could
pass on infection to her newborn during childbirth.)
Gonorrhea associated with increased transmission of and susceptibility to HIV infection
Incubation period
• 2 to 14 days
Fellatio – Oral sex act

22. Agent –
Neisseria gonorrhoeae
(Gram-negative intracellular diplococcus bacteria)
• Grow in the warm, moist areas of the reproductive tract
• Female - Cervix, Uterus, Fallopian tubes, Urethra
• Male - Urethra
• Also can grow in the mouth, throat and anus of both.
• It infects the mucus-secreting epithelial cells.

23. Gonorrhea
(Gram Stain of Urethral Discharge)

24. Clinical Manifestations
 Gonorrhoea symptoms in men
• Urethritis (Inflammation of urethra)
• Greenish yellow or whitish discharge from the
penis
• Burning when urinating
• Epididymitis (Inflammation of the epididymis)
• Painful or swollen testicles

25.  Gonorrhoea symptoms in women
• Most infections are asymptomatic
• Cervicitis – inflammation of the cervix
• Urethritis – inflammation of the urethra
• Greenish yellow or whitish discharge from
the vagina
• Lower abdominal or pelvic pain
• Burning when urinating
• Bleeding between periods
• Vulvitis - Swelling of the vulva

26.  Other symptoms
• Throat (due to oral sex) –
Sore throat, Burning sensation, Swollen glands
• Rectum (due to rectal intercourse)
Anal itching, pus like discharge from rectum, bright red blood spots, Strain
during bowel movement
• Eye (travelling through the blood stream)
Conjunctivitis, Sensitivity to light, Pus like discharge from one or both eyes
• Joints (travelling through the blood stream)
Septic arthritis
• Skin lesions (travelling through the blood stream)
• Heart (Very rarely)
Endocarditis (individuals with suppressed immune systems)
• The spinal column (Very rarely)
Meningitis (individuals with suppressed immune systems)

27.  Gonorrhoea symptoms in Neonates:
• Eye (blindness, infections of the conjunctiva)
• Infections of the pharynx, respiratory tract
• Skin infections
• Joint infection
• Life-threatening blood infection in the baby.

28. Untreated
Genital
Infection
Ectopic
pregnancy
Infertility
Chronic
pelvic pain
Acute PID
Silent PID
9%
14-20%
18%
20-50%
FEMALE
Babies – Blindness, Sores on the scalp, Infections
MALE Infertility
Complications

29. Investigations
• Urine test
• Swab of affected area
• Gram stain and culture
• NAAT, and POC NAAT, such as GeneXpert (Cepheid)
• VDRL
• Polymerase chain reaction (PCR)-based testing
• Urine / Blood Culture (to determine sensitivity to antibiotics)
• All people testing positive for gonorrhoea should be tested for other
sexually transmitted diseases such as chlamydia, syphilis and HIV.
• Partners with contact during the 60 days preceding the diagnosis should be
evaluated, tested and treated.
NAAT - Nucleic Acid Amplification Test

30. Management
Antibiotic (oral or injectable )
→ CDC (2021) Recommended Regimen for Uncomplicated Gonococcal Infection
of the Cervix, Urethra, or Rectum Among Adults and Adolescents
 Ceftriaxone 500 mg IM in a single dose for persons weighing <150kg (1gm
for > 150kg)
 If chlamydial infection has not been excluded, treat for chlamydia with
doxycycline 100 mg orally 2 times/day for 7 days.
 CDC (2015) - A single dose of 250mg of IM ceftriaxone AND 1g of oral
azithromycin

31. Alternative Regimens if Ceftriaxone Is Not Available
• Gentamicin 240 mg IM in a single dose plus Azithromycin 2 g orally in a single
dose
• or Cefixime* 800 mg orally in a single dose
* If chlamydial infection has not been excluded, providers should treat for chlamydia
with doxycycline 100 mg orally 2 times/day for 7 days.

32. • Disseminated Gonococcal Infection (DGI) (Petechial or pustular acral skin
lesions, asymmetric polyarthralgia, tenosynovitis, or oligoarticular septic arthritis)
→ Ceftriaxone 1 g IM or IV every 24 hours
+ Azithromycin 1 g orally in a single dose
Alternative Regimens
→ Cefotaxime 1 g IV every 8 hours OR
→ Ceftizoxime 1 g IV every 8 hours PLUS
Azithromycin 1 g orally in a single dose
• Gonococcal Meningitis and Endocarditis
→ Ceftriaxone 1–2 g IV every 12–24 hours PLUS
→ Azithromycin 1 g orally in a single dose

33. • Ophthalmia Neonatorum
→ Prophylaxis
 Erythromycin (0.5%) ophthalmic ointment in each eye in a single
application at birth
→ Treatment - Ceftriaxone 25–50 mg/kg IV or IM in a single dose, not to
exceed 125 mg
• Disseminated Gonococcal Infection (DGI) and Gonococcal Scalp
Abscesses in Neonates
→ Ceftriaxone 25–50 mg/kg/day IV or IM in a single daily dose for 7 days, with
a duration of 10–14 days if meningitis is documented
OR
→ Cefotaxime 25 mg/kg IV or IM every 12 hours for 7 days, with a duration of
10–14 days if meningitis is documented

34. • Recommended Regimen for Uncomplicated Gonococcal Infection of the Pharynx
Among Adolescents and Adults
 Ceftriaxone 500 mg IM in a single dose for persons weighing <150kg (1gm for >
150kg)
• Recommended Regimen for Gonococcal Conjunctivitis Among Adolescents and
Adults
 Ceftriaxone 1 g IM in a single dose
 Providers should consider one-time lavage of the infected eye with saline
solution.
• Recommended Regimen for Gonococcal-Related Arthritis and Arthritis-Dermatitis
Syndrome
 Ceftriaxone 1 g IM or IV every 24 hours
 If chlamydial infection has not been excluded, providers should treat for
chlamydia with doxycycline 100 mg orally 2 times/day for 7 days.

35. • Recommended Regimen for Infants and Children Who Weigh ≤45 kg and Who Have
Uncomplicated Gonococcal Vulvovaginitis, Cervicitis, Urethritis, Pharyngitis, or
Proctitis
 Ceftriaxone 25–50 mg/kg IV or IM in a single dose, not to exceed 125 mg IM
• Recommended Regimen for Children Who Weigh >45 kg and Who Have
Uncomplicated Gonococcal Vulvovaginitis, Cervicitis, Urethritis, Pharyngitis, or
Proctitis
 Treat with one of the regimens recommended for adults
• Recommended Regimen for Children Who Weigh ≤45 kg and Who Have Bacteremia
or Arthritis
 Ceftriaxone 50 mg/kg (maximum dose: 1 g) IM or IV in a single dose daily for 7
days
• Recommended Regimen for Children Who Weigh >45 kg and Who Have Bacteremia
or Arthritis
 Ceftriaxone 1 g IM or IV in a single dose daily every 24 hours for 7 days

36. Gonococcal Urethritis
(Purulent Discharge)
Epididymitis
(Swelling)
Male

37. Female
Gonococcal Cervicitis Bartholin’s Abscess

38. Gonococcal Ophthalmia
Skin Lesion
Male & Female

39. Recommended Regimens for First Clinical Episode of
Genital Herpes
• Acyclovir 400 mg orally 3 times/day for 7–10 days
• or Famciclovir 250 mg orally 3 times/day for 7–10 days
• or Valacyclovir 1 g orally 2 times/day for 7–10 days
Treatment can be extended if healing is incomplete after 10 days of therapy.
Acyclovir 200 mg orally 5 times/day is also effective but is not recommended because
of the frequency of dosing.

40. Recommended Regimen for Nongonococcal Urethritis
• Doxycycline 100 mg orally 2 times/day for 7 days
Alternative Regimens
• Azithromycin 1 g orally in a single dose
• or Azithromycin 500 mg orally in a single dose; then 250 mg orally daily for 4
days

41. Recommended Regimen for Cervicitis*
• Doxycycline 100 mg orally 2 times/day for 7 days
 Consider concurrent treatment for gonococcal infection if the patient is at
risk for gonorrhea or lives in a community where the prevalence of
gonorrhea is high
• Alternative Regimen - Azithromycin 1 g orally in a single dose

42. Recommended Regimen for Chlamydial Infection
Among Adolescents and Adults
• Doxycycline 100 mg orally 2 times/day for 7 days
Alternative Regimens
• Azithromycin 1 g orally in a single dose
• or Levofloxacin 500 mg orally once daily for 7 days