N. Gonorrhoeae is a double spherical gram-negative bacterium that occurs only in the nest and is invariably transmitted through sexual contact. Infections of the urethra and cervix are the most common, but infections of the throat or rectum are more likely to occur after oral or anal sex, and eye inflammation seems to follow an unclean eye infection. .
After vaginal sex, the transmission function from girl to guy is about 20%, but from male to female, it seems to be higher. Newborns can develop conjunctival infections at birth (see Causes), and infants and gonorrhea can be sexually abused.
In 10 to 20% of women, the infection of the cervix spreads up through the endometrium to the fallopian tubes (ovarian inflammation) and pelvic peritoneum, developing pelvic inflammatory disease (PID). Chlamydiae or intestinal bacteria can also produce PID. Gonococcal cervicitis is often accompanied by dysuria or inflammation of the Skene ducts and Bartholin glands. In a small proportion of males, urethritis appears to progress to epididymitis.
Disseminated gonococcal infection (DGI) by hematogenous spread constitutes < 1% of cases, essential in the girl. DGI often affects domain authority, tendon sheaths and joints. Pericarditis, endocarditis, meningoencephalitis & pericarditis except liver are rare.
Co-infection with Chlamydia trachomatis occurs in 15 to 25% of heterosexual men and 35 to 1/2 of women.
symptoms & signs
About 10 to 20% of girls are infected and very few boys are infected, not including disease. Stage 25% he has minimal illness.
Urethritis in men includes an incubation period of 2 to 14 days. Onset is usually all about feeling anxious in the urethra, followed by worsening penile pain and tenderness, dysuria & pyuria. Urinary frequency and urgency appear to evolve as the infection spreads to the posterior urethra. Vaginal examination revealed yellow-green urethral pus, and the urinary opening may be inflamed.
Epididymitis often desgin solo scrotal pain, tenderness, and swelling. Rarely, in macho, it develops into an abscess of the Tyson and Littre glands, a perianal abscess, or infection of the Cowper's pathway, the prostatic pathway, or the seminal vesicles.
Cervicitis usually all incubation period > 10 days. Symptoms range from mild to severe & include all urinary difficulties and vaginal discharge. During the pelvic exam, the clinician may think of cervical mucus or pus, and the cervix looks red and bleeds easily on impact. Urethritis seems to be concurrent; Pus appears to ooze from the urethra when squeezing the pubic joint or from the Skene or Bartholin ducts. Rarely, infections in sexually abused adolescents develop dysuria, vaginal discharge and irritation, redness of the domain authority, and edema.
PID occurs in 10 to 20% of infected women. PID appears to include salpingitis, pelvic peritonitis, and pelvic abscess and resembles competition in the lower abdomen (usually bilateral), pain during intercourse, & pain on abdominal examination, part appendix, or cervix.
Fitz-Hugh-Curtis syndrome is an inflammatory disease of the gonococcal periphery of the liver (or chlamydia) that occurs mainly in women and causes lower upper quadrant pain, illness, nausea, and vomiting, often resembling biliary or hepatic disease.
Rectal gonorrhea usually does not include disease. It occurs mainly in men having welcome homosexual sex & probably occurs in girls engaging in anal sex. Symptoms include rectal itching, rectal discharge, bleeding, & apple constipation—all to a great extent differentiated. Screening with a bronchoscope is likely to reveal erythema or pus on the rectal wall.
Pharyngitis caused by gonococcal infection is usually not a disease but can cause a sore throat. N. Gonorrhoeae must be isolated from N. Meningitidis & many other closely related organisms that are commonly marketed in the pharynx but do not cause disease or harm.
Disseminated gonococcal infection (DGI), also known as domain authority arthritis-inflammatory syndrome, reflects a blood infection and is often symptomatic with fever, walking pain, or joint swelling (polyarthritis) and mild trauma to the skin pustules. In some patients, pain develops and tendons (eg, in the wrist or ankle) become red or swollen. Domain authority lesions usually occur in the arm or
legs, with a red base, and small, painful, and often pustular. Genital gonorrhea, a trivial source of transmission, may not include the disease. DGI seems to be associated with other disorders that cause colds, minor domain authority trauma, and polyarthritis (eg, hepatitis B or meningococcal status); A small number of other disorders also produce genitourinary disease (eg, reactive arthritis).
Gonorrhea (skin lesions)
Arthritis caused by gonococcal infection is the more general form of DGI that leads to painful arthritis with the disease, usually one or two large joints such as the knee, ankle, wrist, or elbow. 1 Some patients include or include a history of mild trauma to the domain authority of the DGI. Onset is usually extremely acute, often with colds, severe joint pain, and load exclusion. Many infected joints swell, and the skin next to them appears warm and red.
Gonorrhea is caused by the bacteria Neisseria gonorrhoeae. It usually infects the epithelium of the urethra, cervix, rectum, pharynx, or conjunctiva, causing irritation or pain and scattered bleeding. Diffusion to domain authority and joints, is not common, resulting in skin sores, disease, and migratory polyarthritis or infectious osteoarthritis. Diagnosis is by microscopy, culture, or nucleic acid amplification tests. Several oral or injectable antibiotics are available, although resistance is a growing problem.
N. Gonorrhoeae is a double spherical gram-negative bacterium that runs in your family and is almost always transmitted sexually. Infections of the urethra and cervix are most common, although throat or rectal infections are more likely to occur after oral or anal sex, and eye inflammation is probably behind an unclean eye infection. .
After having sex through the female genital tract, genius transmission from female to male is about 20%, but from male to female, it can be even higher. Newborns and conjunctival infections at birth (see Causes), and infants can be sexually abused with gonorrhea.
In 10 to 20% of women, cervical infection spreads up through the endometrium to the fallopian tubes (ovarian inflammation) and pelvic peritoneum, developing pelvic inflammatory disease (PID). Chlamydiae or intestinal bacteria can also release PID. Cervicitis due to gonorrhea is often accompanied by dysuria or inflammation of the Skene and Bartholin tracts. In one of the younger male populations, urethritis can progress to epididymitis.
Disseminated gonococcal infection (DGI) because of its hematogenous spread accounts for < 1% of cases, primarily in females. DGI usually affects the skin, tendon sheaths, and joints. Pericarditis, endocarditis, meningitis, and pericarditis have rarely occurred.
Co-infection with Chlamydia trachomatis occurs from 15 to 25% of heterosexual men & 35 to 50% of women.
symptoms and expressions
Stage 10 yields 20% infected women and very few infected men without all diseases. Stage 25% of men have minimal disease.
Urethritis in men has an incubation period of 2 to 14 days. Onset is usually a feeling of tension in the urethra, followed by more severe pain and tenderness of the male genitalia, dysuria syndrome, and pyuria. Urinary frequency & urgency seem to evolve as the infection spreads to the posterior urethra. Physical examination reveals yellow-green urethral pus, and the urinary opening may be inflamed.
Epididymitis often results in antagonistic scrotal pain, tenderness, and swelling. Rarely, in men it develops an abscess of the Tyson and Littre glands, a periurethral abscess, or infection of the Cowper's tract, prostate, or seminal vesicles.
Cervicitis usually includes an incubation period of > 10 days. Symptoms range from mild to severe and include difficulty urinating and diseases of the female reproductive organs. During the pelvic exam, the clinician is likely to be concerned with cervical mucus or pus, and the cervix may be red and bleed easily on palpation. Urethritis may be present at the same time; Purulent pus may drain from the urethra when squeezing the pubic joint or from the Skene ducts or the Bartholin gland. Rarely, infections in sexually abused adolescents produce symptoms of urinary incontinence, vulvar discharge & vaginal irritation, domain authority redness, and edema.
PID occurs in 10 to 20% of infected women. PID appears to include salpingitis, pelvic peritonitis & pelvic abscess and commensal-like pain in the lower abdomen (usually bilateral), pain during intercourse, & pain on abdominal examination, adnexa, or cervix.
Fitz-Hugh-Curtis syndrome is an inflammatory disease of the gonococcal capsule of the liver (or chlamydia) that occurs mainly in young women and causes compulsive upper quadrant pain, flu, nausea & vomiting, often resembling biliary or hepatic fluid.
Rectal gonorrhea often has no symptoms. It occurs in men including receptive homosexual sex and seems to occur in teenage girls engaging in anal sex. Illnesses include direct itching
bowel disease, rectal prolapse, bleeding, and apple constipation—all of varying degrees of severity. Evaluation using a bronchoscope seems to reveal erythema or purulent pus over the rectal wall.
Pharyngitis and gonococcal pharyngitis are usually not diseased and may cause a sore throat. The obligate N. Gonorrhoeae are transparent to the carriers of N. Meningitidis and many other closely related symbionts that often appear in the throat but have not yet caused disease or harm.
Disseminated gonococcal infection (DGI), also known as domain authority arthritis-inflammatory syndrome, reflects a blood infection and often has flu-like symptoms, joint pain, or swelling (polyarthritis). And minor trauma to pustular skin. In some patients, pain progresses and tendons (eg, in the wrist or ankle) become red or swollen. Skin lesions commonly occur on the arms or legs, include a red background, & are small, tender, and often pustular. Genital gonorrhea, the common source of transmission, does not appear to include disease. DGI may be associated with other disorders causing fever, minor skin trauma, & polyarthritis (eg, hepatitis B or meningococcal status); A number of other disorders also develop genitourinary disease (eg, reactive arthritis).
Gonorrhea (skin lesions)
Arthritis epidemics because gonococcal infection is a more localized form of DGI that leads to painful arthritis with disease overflow, usually one or two large joints such as the knee, ankle, wrist, or elbow. 1 Some patients have or have a history of compromised domain authority of DGI. The onset is often insidious, often with the flu, severe joint pain, and load exclusion. Infected joints are swollen, and the surrounding skin is probably warm and red.
Gram stain and graft
Nucleic Acid Test
Gonorrhea is diagnosed when syphilis is detected through Gram-stained imaging microscopy, culture, or genitourinary tract nucleic acid, blood, or joint fluid chemistry (obtained by aspiration aspiration). Kim).
Gram stain is sensitive and specific for gonorrhea in men with purulent urethral discharge; Gram-negative diplococci are commonly encountered. Gram staining is less reliable for cervical, pharyngeal, and rectal infections and is not sufficiently interesting to diagnose in this cluster of regions.
Cultures are sensitive and specific, but because gonococci are extremely fragile and difficult to graft, many swabs need to be quickly smeared over a preferred space (eg Thayer-Martin) & loaded. To the laboratory by multiple travel boxes all containing CO2. The recommended blood & joint sample is brought to the laboratory with a signal that gonococcal infection is suspected. Because nucleic acid amplification tests still represent culture in most laboratories, the choice of a laboratory can provide a challenging culture and sensitivity test that can be extremely burdensome. Should consult with a herd health or infectious disease specialist.
Nucleic acid amplification tests (NAATs) are the same as those used on genital, rectal, or oral plague. Many tests simultaneously detect gonorrhea and chlamydia infections and then differ between them in the next specific test. Sensitization-enhanced NAATs provide urine symbols for both sexes.
In the United States, many cases of gonorrhea, chlamydia & syphilis infections are required to be brought to the public health apparatus. Multiple serological tests for syphilis (STS) and HIV and NAAT to screen for chlamydia infection must also be performed.
Men with urethritis
Men with marked leakage are likely to be artificially treated if there is a possibility of prolonged follow-up or if more hospital-based diagnostic legislation is not yet available.
Sample clusters for Gram staining are the same as those obtained by touching a toothpick or sliding to the end of the penis to collect waste chemistry. Gram stain does not agree with Chlamydiae, so urine sample or SWAB should be taken to NAAT.
women including genital symptoms or signs
a sample of the proposed cervical disease is cultured or NAAT. If a pelvic exam is required, the NAAT of a self-collected urinalysis or vulva swab sample is likely to detect gonococcal (and chlamydial) infections quickly, safely and reliably.
Throat or rectal exposure (both sexes)
Epidemic swabs of the affected area are sent to culture or NAAT.
Arthritis, DGI, or both
An affected joint is recommended to be drained, and joint disease requires culture transfer and specialized analysis (arthropathy drainage). Patients with mild domain authority trauma, systemic illness, or both should have all blood, urethral, cervical, and rectal cultures or NAAT. In about 30, up to 40% of patients with DGI, the physical plane blood culture during the first week of the disease. If you have gonococcal arthritis, blood cultures are usually low-positive, although rheumatic diseases are positive. Osteoarthritis is often cloudy with large numbers of WBCs (usually > 20,000/μL).
Although all diseases including high-risk sexually transmitted diseases (STDs) appear to be filtered by NAAT urine samples, it is not yet an invasive procedure to obtain samples from organs. Genital.
non-pregnant girls (including all women who have sex with women) are selected every year if we
sexually active and 24 years old
including history of STD
engaging in high-risk sexual behavior (eg, having an intimate partner or multiple lovers, engaging in prostitution, infrequent use of raincoats)
have a sexual partner who engages in high-risk behavior
Pregnant wives are questioned at their first prenatal visit and again during the third trimester if they are ≤ 24 years old or have risk factors.
Family members of boys who are heterosexual are not routinely screened unless they are considered to involve high risk (eg as well as close family members who have sex with men, sick people in youth or STD hospital, he went to many correctional stores).
Men who have sex with men who have sex with men are screened if we have had sexual intercourse in 2014 (for incoming members, urine collection, with welcome intercourse, rectal swab and for oral intercourse, pickling. Throat).
(See also share the recommendation cluster of the American preventive trade group screening for gonorrhea.)
For unmodified infection, a single dose of ceftriaxone plus azithromycin
For DGI with arthritis, an even longer course of oral antibiotics
Chlamydia co-infection treatment
Unmodified gonococcal infections of the cervix, rectum & pharynx are treated as follows:
Preferred: 1 single dose of ceftriaxone 250 mg intramuscularly plus azithromycin 1 g orally once (alternatively to azithromycin is doxycycline 100 mg po twice a day for 7 days)
second choice: single dose of cefixime 400 mg orally plus azithromycin 1 g orally once
Patients who are allergic to cephalosporins are treated with one of the following drugs:
Gemifloxacin 320 mg orally with azithromycin 2 g orally
Gentamicin 240 mg intramuscular plus azithromycin 2 g orally
Monotherapy and multiple oral fluoroquinolones (eg, ciprofloxacin, levofloxacin, ofloxacin) or cefixime were not noted because of increased resistance. Demographic remission is of interest only to patients treated with a regimen that represents a pharyngeal infection.
DGI with epidemic gonococcal arthritis is initially treated with IM or IV antibiotics (eg, ceftriaxone 1 g intramuscularly or intravenously every 24 hours, ceftizoxime 1 g IV every 8 hours, cefotaxime 1 g intravenously every 8 hours 8 hours) continue for 24 to 48 hours once the illness subsides, followed by 4 to 7 days of oral medication. Medications to prevent chlamydia are also commonly used.
Gonococcal arthritis usually does not require drainage of the joint disease. At first, the joint is tightened and fixed in a magnanimous position. Alcohol-passive exercises should be initiated as soon as the patient seems tolerable. After the pain kicks, it is necessary to exercise more, stand firm and strengthen the muscles. Over 95% of patients treated for arthritis and gonococcal disease recover fully. Since the accumulation of sterile synovial fluid (synovial effusion) can persist for a long time, anti-inflammatory drugs appear to be useful.
Post-treatment bacterial culture is not necessary if disease is predominant. In addition, for patients with symptoms for > 7 days, specimens should be obtained, cultured, and antibiotic susceptibility tested.
The sick person is forced to abstain from sexual activity until the treatment is finished to avoid infecting the sex itself.
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