Before beginning with the appearance of gonorrhea, one should know what is gonorrhea? Gonorrhea is a sexually transmitted disease caused by gram-negative intracytoplasmic bacilli. It is never found as common commensal, although whosoever gets infected may remain asymptomatic at times.
Gonococcal Infection in Males-
The most common manifestation in males is acute urethritis. There is purulent discharge from the urethra. There may involvement of prostate, seminal vesicle, and epididymis.
Gonococcal Infection in Females-
- It primarily affects the cervical os, but can also involve nearby areas as well due to the presence of columnar cells in surrounding areas.
- There is no vaginal involvement due to the presence of stratified squamous epithelium
- It is part of Reiter’s triad, which includes conjunctivitis, urethritis, and arthritis.
- There are several complications of cervicitis which includes infertility, endometritis, peritonitis, ectopic pregnancy, salpingitis.
How Does Gonorrhea Look Like?
Gonorrhea affects epididymis, but does not affect the testes, although mild swelling may be present.
When it comes to the appearance of gonorrhea usually the lesions appear in areas involved in sexual contacts, thus usually lesions appear on cervix, penis, around the anus and at times pharyngeal lesions are seen which usually occurs when there is a history of oral sex.
Ocular gonorrhea occurs in cases where the mother has the infection and neonate is exposed to the infection at the time of delivery. This condition is known as Ophthalmia neonatorum. The neonate has white milky discharge from the eyes. The condition can be diagnosed when there is excessive discharge from the eyes within 30 days after birth. Prophylactic treatment is required in which mother should be treated before the onset of labor. At times there is need of systemic antibiotics.
There are many conditions in which ocular gonorrhea may occur. This occurs due to autoinoculation and presents with markedly swollen eyelids, hyperaemia, chemosis and purulent discharge from the eyes.
Besides localized lesions, many times dissemination of infection may occur. The commonest route of dissemination is through blood. Gonococcal arthritis may occur due to bacteraemia. There is involvement of joints mostly knees, elbows, wrist. There is suppuration of joints along with tendinitis. The most common cause of disseminated infection is due to the deficiency of MAC complex. Thus, gonorrhea is responsible for multiple diseases besides sexually transmitted diseases. Triad of conjunctivitis, urethritis, and arthritis constitutes the Reiter’s triad.
How to Treat Gonorrhea?
Ceftriaxone is the drug of choice. Usually, chlamydial infection accompanies the gonococcal infection. Azithromycin and doxycycline are given along with the ceftriaxone to cover the chlamydial infection. And in patients who are allergic to penicillin the drug to be given is quinolones (ciprofloxacin). And to those who cannot even tolerate ciprofloxacin the drug of choice is spectinomycin.
What are the investigations that need to be done to diagnose the infection?
Microscopic examination- Gram staining should be done. Presence of intracellular diplococci confirms the gonococcal infection.
Culture and sensitivity testing should also be done. A single sample of the endocervical discharge and performing culture helps in making a differential diagnosis.
What are the Different Ways By Which A Person Can Acquire An Infection?
Following are the modes of transmission of infection which includes-
- Sexual Contact- performing coitus without making use of contraceptives.
- Infection can also be transmitted by infected blood. This is usually witnessed in people who require multiple transfusions.
- Mother to child transmission (vertical transmission) – this causes ophthalmia neonatorum. Initially, gonococcus was considered the main causative organism, but nowadays Chlamydia is the leading pathological organism of the disease. Treatment includes prophylactic treatment which should be given before the onset of labor. It is even recommended to get birth canal checked before the conception. Pap smear and per vaginal examinations are recommended.
- Autoinoculation may occur which is responsible for ocular manifestation associated with gonococcal infection.
In short, gonorrhea lesions do not come form any vesicles. These lesions are commonly seen in places which are involved during sexual act. There is release of purulent discharge from the lesions. Apart from cervix and epididymis, there is involvement of other organs. Involvement of joints and conjunctiva may occur and this forms a triad name as Reiter’s triad. The investigation includes microscopy and culture and drug of choice is ceftriaxone.