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Gonorrhea. 1.Definition Gonorrhea is a kind of pyogenic infection of urogenital system caused by diplococcus gonorrhoeae ,including infections of eyes 、 pharynx 、 rectum 、 pelvic kidney and Disseminated gonococcal infection. 2.Etiology
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1.Definition Gonorrhea is a kind of pyogenic infection of urogenital system caused by diplococcus gonorrhoeae ,including infections of eyes、pharynx、rectum、pelvic kidney and Disseminated gonococcal infection .
2.Etiology Pathogen is Neisseria gonorrhoeae, calling diplococcus gonorrhoeae or gonococcus for short, found in discharge of patients in 1879 by Neisseria firstly.
2.1Form and staining： The gonococcus is a Gram-negative , diplococcal, pink bacterium ,appearing kidney or lima bean shape.
2．2 Growth propert： • For optimal growth, it requires a moist medium with temperature of 35 °C -36 °C, and a 3–5% CO2 atmosphere. • Gonococcus is fastidious organism that grow well in culture media including animal protein. • Gonococcus die easily in dry and hot circumstances • Normal disinfectant or soap can cause it lose motoricity.
2.3 Biochemical event： Gonococcus can create oxidase during growing process, so oxidase test is meaningful in initial diaganosis.
3.Drug resistance research of Gonococcus • It’s reported continuously that PPNG and non-PPNG resistance strains and spectinomycin、norfloxacin and ofloxacin resistance strains have been found in China in recent year. • Most of Gonococcus strains popular in China are sensitive to Ceftriazone
Mechanism of Drug resistance • Gonococcus create PPNG which can split Beta-Lactam cycle of penicillin through plasmid, that can cause it lose antibiotic effect. • Drug resistance strains caused by chromatosomemutation can change permeability of bacteria cell wall which cause the resistance to penicillin increase to 2-4 times • The Mechanisms above have cooperation action.
4. Epidemiology • Humans are the only natural hosts of Gonococcus, and the patients are the only sources of infection. • Transmission of adult gonorrhea is almost entirely by sexual contact,and transmission through nonsexual contact is • extremely rare. • Now epidemic tendency：Cases of gonorrhea in developed countries have been unchangeable or decreased, but increased year by year in many developing countries.Cases of gonorrhea are the first place of all STDs in our country.
5.1 Clinic typing • Uncomplicated gonococcal infection • Complicated gonococcal infection • Disseminated gonococcal infection .
5.1.1.Uncomplicated gonococcal infection • Refer to single infection of genitourinary tract orother local mucous membrane, including: • Gonococcal urethritis • Gonococcal cervicitis • Gonococcal conjunctivitis • Gonococcal pharyngitis • Gonococcal Proctitis • Child gonorrhea
5.1 .2.Complicated gonococcal infection With infections of other tissue and organs ,based on uncomplicated gonococcal infection. Male gonorrhea complications：gonococcal prostatitis、seminal vesiculitis、epididymitis、urethral stricture、balanitis、parafrenal glands adenitis、Skene's gland adenitis, and so on. Femal gonorrhea complications： gonococcal eustachian salpingitis、pelvic inflammation、abscess of fallopian tube or ovary、peritonitis、perihepatitis、bartholinitis and abscess, and so on.
5.1 .2.Disseminated gonococcal infection Refer to gonococcus spread to all over the body through blood to cause bacteremia.
5.2 .1. Gonococcal urethritis • Incubation period 3~5 days。 • Red swelling of urethral meatus，serous or pustular secretion。 • Pruritus and burning heat sensation in urethral tract, pain during micturition，without urgency of urination、urinary frequency. • Posterior urethral tract involved in 1-2 weeks in most of patients, characterized by urinary frequency ， urgency of urination and pain in urination, hematuria at the end of micturition.
5.2. 2． Gonococcal cervicitis • Cervix is the most common place involved in female patients, except urethritis . • Red swelling of cervix、haphalgesia. • Pustular leucorrhea increasing . • Incubation period is often unclear because of no symptoms.
6.Laboratory examination • Microscopic examination of smear • Culture of gonococcus
6.1．Microscopic examination of smear The diagnosis is confirmed by the presence of Gram-negative diplococci within polymorphonuclear leukocytes on stained smears of the male urethral discharge. These criteria have a sensitivity of 95% . The presence of Gram-negative diplococci within polymorphonuclear leukocyte on samples of female cervical discharge can suggest the diagnosis.
6.2．Gonococcus culture Being applied to all samples from male or female genitourinary tract and other area. It’s the only recommended method to finally diagnose gonorrhea . Doing initial identification according to the form of colony，Gram staining and oxidase test.
Processing general analysis according to the medical history，clinical symptoms and laboratory examination. The examinations of male urethral discharge have initial diagnosticsignificance，but the female samples only have reference. The latter should be cultured to confirm gonococcal infection.
8.Prevention and Therapy 1．Treating early andregularly, using correspondingtherapeutics according to different conditions. Follow-up and cure judgment after treatment. 2．Paying attention to co-infections ofchlamydia and other STD pathogens. Treating sexual partner at the same time. 3． Paying attention to genitalsanitation and insulation. Sexual intercourse being forbidden during treatment.
4．The treatment of gonococcal urethritis Spectinomycin 2g（cervicitis 4g），once IM. Ceftriazone250mg， once IM. 5．The treatment of complicated gonococcal infection Spectinomycin 2g ，once a day IM, for 10 days. Ceftriazone250mg， once a day IM, for 10 days.
6．The treatment of disseminated gonococcal infection . Ceftriazone1g，once a day IV, for 7 days.
7．Cure criterions：two weeks after the end of treatment ，without sexually contact： ①Extinction of all the symptoms and signs. ②Negative results of smear and culture at 4-7 days after the treatment.
