23. COMMONLY OCCURRING COMMUNICABLE DISEASES – GONORRHEA

Gonorrhea is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. It is a gram-negative, non-motile, non-spore-forming organism that grows quickly in warm and moist parts of the body such as the cervix, urethra, rectum, throat and eyes. Both men and women can get infected, and many infected people may not show symptoms, which helps the disease spread silently.

Etiology

  • Men have about a 20% chance of getting gonorrhea from an infected female partner.
  • Women have a 50% chance of getting infected from an infected male partner.
  • The risk increases with multiple partners and unprotected sex.

Pathophysiology

  • The bacteria primarily infect the mucous membranes of the genital tract but can also affect the eyes, throat and anus.
  • Gonococci attach to epithelial cells using hair-like structures called pili.
  • They enter the cells (pinocytosis) and cause tissue damage.
  • The body responds with neutrophils (polymorphonuclear leukocytes), leading to the formation of thick, purulent discharge.
  • Without treatment, infection can spread to reproductive organs, joints and bloodstream.

Clinical Presentation

Infected individuals may be symptomatic or asymptomatic. Symptoms differ between men and women and may be classified as uncomplicated or complicated disease.

Symptoms in Men

  • Burning sensation during urination
  • Thick yellow or green urethral discharge
  • Testicular pain or swelling
  • Rectal pain or discharge (if rectal infection)

Symptoms in Women

  • Vaginal discharge
  • Painful urination
  • Lower abdominal pain
  • Bleeding between periods
  • Rectal symptoms in case of anal involvement

Women often have mild or no symptoms, which increases the risk of complications like pelvic inflammatory disease (PID).

Laboratory Studies / Diagnosis

Culture Testing

  • Most common and reliable method.
  • Samples are grown on Thayer–Martin plates.
  • Plates must be stored cold, warmed to room temperature before collecting specimens and incubated in a CO₂-rich atmosphere.

PCR & Ligase Chain Reaction (LCR)

  • More sensitive than culture.
  • Detects organisms even when present in very small numbers.
  • Not always available in basic laboratories due to cost and infrastructure.

Microscopy

  • Men: Gram stain of urethral discharge shows gram-negative diplococci inside neutrophils.
  • Women: Cervical culture is preferred, as microscopy is less reliable.

Treatment

Non-Pharmacological Measures

  • Avoid sexual contact until treatment is completed.
  • Treat all sexual partners to prevent reinfection.
  • Use condoms consistently.

Pharmacological Treatment

Due to rising antibiotic resistance, older drugs like penicillins, tetracyclines and sulfonamides are no longer preferred.

CDC-recommended treatment for uncomplicated gonorrhea:

  • Ceftriaxone 250 mg IM (single dose) PLUS Azithromycin 1 g orally (single dose) OR Doxycycline 100 mg orally twice daily for 7 days.

If Ceftriaxone Is Unavailable

  • Cefixime 400 mg orally (single dose) PLUS azithromycin 1 g (single dose) or doxycycline 100 mg twice daily for 7 days.

If Patient Is Allergic to Cephalosporins

  • Azithromycin 2 g orally (single dose).

Other Treatment Notes

  • Cefixime is effective for urethral infections.
  • Fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) are effective but contraindicated in pregnancy and in children under 18.

Disseminated Gonococcal Infection (DGI)

  • Treated with IV antibiotics such as ceftriaxone, cefotaxime or ceftizoxime.
  • Continue IV treatment for 24–48 hours after improvement, then switch to oral therapy for 7 more days.

Prevention of Eye Infections in Newborns

  • Topical 1% silver nitrate, 1% tetracycline or 0.5% erythromycin after birth helps prevent neonatal conjunctivitis.
  • For neonatal infection: ceftriaxone 25–50 mg/kg IM/IV (maximum 125 mg single dose).

Counseling Points

  • Educate about the dangers of unprotected sex.
  • Condoms should be used consistently; abstinence is safest.
  • Patients must understand the risk of other STIs like HIV, hepatitis B and herpes.
  • Emotional and social aspects of sexual relationships should be discussed, especially with teenagers.

Prevention

  • Practice safe sex.
  • No sexual activity until the full course of treatment is completed.
  • Sex partners must be tested and treated even if asymptomatic.
  • A follow-up test ensures successful treatment.
  • Screening for other STIs is advisable.

Detailed Notes:

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