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Gonorrhea
From Wikipedia, the free encyclopedia
Gonorrhea
Classification and external
resources
ICD-10 A54
ICD-9 098
Non-genital sites in which it thrives are in the rectum, the throat (oropharynx), and the
eyes (conjunctiva). The vulva and vagina in women are usually spared because they are
lined by stratified epithelial cells—in women the cervix is the usual first site of infection.
Gonorrhea typically spreads during sexual intercourse. It can also be vertically
transmitted, where infected mothers can pass gonorrhea to their newborn infants during
delivery. This causes conjunctivitis (eye infections) which, if left untreated, can lead to
blindness. As prophylaxis against this, many countries routinely treat infants with
eyedrops of erythromycin at birth. [3]
Contents
[hide]
• 1 Symptoms
• 2 Complications
• 3 Treatment
o 3.1 Antibiotics
o 3.2 United States recommendations
o 3.3 United Kingdom recommendations
o 3.4 Historically
• 4 Prevalence
• 5 Slang terms
• 6 References
Symptoms
The incubation period is 10 to 20 days with most symptoms occurring between the
fifteenth and twentieth days after being infected. A small number of people may be
asymptomatic for up to a lifetime. Between 30 and 60% of people with gonorrhea are
asymptomatic or have subclinical disease.[4] Women may complain of vaginal discharge,
difficulty urinating (dysuria), projectile urination, off-cycle menstrual bleeding, or
bleeding after sexual intercourse. The cervix may appear anywhere from normal to the
extreme of marked cervical inflammation with pus. Possibility of increased production of
male hormones is common in many cases. Infection of the urethra (urethritis) causes little
dysuria or pus. The combination of urethritis and cervicitis on examination strongly
supports a gonorrhea diagnosis, as both sites are infected in most gonorrhea patients.
Gonorrhea is caused by the Neisseria gonorrhoeae bacteria. The infection is transmitted
from one person to another through vaginal, oral, or anal sexual relations, though
transmission occurs rarely with "safe sex" practices of condom usage with lubrication.
Men have a 20% chance of getting the infection by having sexual relations with a woman
infected with gonorrhea. Women have a 50% chance of getting the infection by having
sexual relations with a man infected with gonorrhea. An infected mother may transmit
gonorrhea to her newborn during childbirth, a condition known as ophthalmia
neonatorum.[5]
Complications
In men, inflammation of the epididymis (epididymitis), prostate gland (prostatitis) and
urethral structure (urethritis) can result from untreated gonorrhea[5].
Treatment
Antibiotics
Penicillin is ineffective at treating rectal gonorrhea: this is because other bacteria within
the rectum produce β-lactamases that destroy penicillin. All current treatments are less
effective at treating gonorrhea of the throat, so the patient must be rechecked by throat
swab 72 hours or more after being given treatment, and then retreated if the throat swab
is still positive.
Although gonorrhea usually does not require follow-up (with the exception of rectal or
pharyngeal disease), patients are usually advised to phone for results five to seven days
after diagnosis to confirm that the antibiotic they received was likely to be effective.
Patients are advised to abstain from sex during this time.
The United States does not have a federal system of sexual health clinics, and the
majority of infections are treated in family practices. A third-generation cephalosporin
antibiotic such as ceftriaxone is recommended for use in most areas. Since some areas
such as Hawaii and California have very high levels of resistance to fluoroquinolone
antibiotics (ciprofloxacin, ofloxacin, levofloxacin) they are no longer used empirically to
treat infections originating in these areas.
Antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-
resistant strains of gonorrhea are increasing in many areas of the world, including the
United States, and successful treatment of gonorrhea is becoming more difficult. Because
many people with gonorrhea also have chlamydia, another sexually transmitted disease,
antibiotics for both infections are usually given together. Persons with gonorrhea should
be tested for other STDs. It is important to take all of the medication prescribed to cure
gonorrhea. Although medication will stop the infection, it will not repair any permanent
damage done by the disease. People who have had gonorrhea and have been treated can
get the disease again if they have sexual contact with persons infected with gonorrhea. If
a person's symptoms continue even after receiving treatment, he or she should return to a
doctor to be reevaluated.
Historically
Historically it has been suggested that mercury was used as a treatment for gonorrhea.
Surgeons tools on board the recovered English warship the Mary Rose included a syringe
that, according to some, was used to inject the mercury via the urinary meatus into any
unfortunate crewman suffering from gonorrhea. Silver nitrate was one of the widely used
drugs in the 19th century, but it became replaced by Protargol. Arthur Eichengrün
invented this type of colloidal silver which was marketed by Bayer from 1897 on. The
silver-based treatment was used until the first antibiotics came into use in the 1940s.[9][10]
Medieval public health physicians in the employ of their cities were required to treat
prostitutes infected with the "burning ", as well as lepers and other epidemic victims.[13]
After Pope Boniface completely secularized the practice of medicine physicians were
more willing to treat a sexually-transmitted disease. Municipalities would hire an official
to regulate the examination of infected patients and check the spread of this sexually
transmitted contagion. In Paris, this official was popularly known as the "King of
Whores". Also, during this time-period the female foot was sexualized, for the first time,
on a popular basis. In 1220 Bertold of Regensburg listed those anatomotical parts of
women's bodies he considered sexually sinful. For the first time a surviving Medieval
manuscript listed womens feet as an erotic focus He warned that, "...you must all send
your feet to Hell by special torments".[14] This sexual emphasis on feet was noted again in
the syphilis epidemics of the Sixteenth and Nineteenth Century and the AIDS epidemic of
the Twentieth Century.[15]
Prevalence
"Gonorrhea is a very common infectious disease. The CDC estimates that more than
700,000 persons in the United States get new gonorrheal infections each year. Only about
half of these infections are reported to CDC. In 2004, 330,132 cases of gonorrhea were
reported to the CDC. After the implementation of a national gonorrhea control program in
the mid-1970s, the national gonorrhea rate declined from 1975 to 1997. After a small
increase in 1998, the gonorrhea rate has decreased slightly since 1999. In 2004, the rate
of reported gonorrheal infections was 113.5 per 100,000 persons."[16]
Slang terms
Gonorrhea is also commonly known by the slang term the clap.
Suggested etymology:
• Reference to a traditional treatment used to clear the blockage in the urethra from
gonorrheal pus, where the penis would be "clapped" on both sides
simultaneously.[citation needed]
• Reference to the painful sting in the male urethra, which feels like the sting of a
clap (as in clapping hands) when infected with the disease.
• From the old French word "clapoir", meaning sexual sore. This word was derived
from the old French word "clapier", meaning "brothel".
The term the clap was replaced with the similar sounding the jack in the 1975 AC/DC
song The Jack, which used the metaphor of playing cards and poker as sexual innuendo
in the original LP version. However, live recordings of the song make direct references to
the disease.
References
1. ^ "CDC - STD Surveillance - Gonorrhea". Retrieved on 2008-08-21.
2. ^ "CDC Fact Sheet - Chlamydia". Retrieved on 2008-08-21.
3. ^ "Erythromycin ointment for ocular prophylaxis of neonatal chlamydial
infection". Retrieved on 2008-07-14.
4. ^ YT van Duynhoven (1999). "The epidemiology of Neisseria gonorrheae in
Europe". Microbes and Infection 1 (6): 455–464. doi:10.1016/S1286-
4579(99)80049-5. PMID 10602678.
5. ^ a b c Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N.
(2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 705-706 ISBN
978-1-4160-2973-1
6. ^ "CDC Update to Sexually Transmitted Treatment Guidelines". Retrieved on
2008-08-21.
7. ^ "CDC STD Treatment Regimens". Retrieved on 2008-08-21.
8. ^ Health Protection Agency. "The gonococcal resistance to antimicrobials
surveillance programme: Annual report 2005" (PDF). Retrieved on 2006-10-28.
9. ^ Max Bender (1898). "Ueber neuere Antigonorrhoica (insbes. Argonin und
Protargol)". Archives of Dermatological Research 43 (1): 31–36.
doi:10.1007/BF01986890.
10. ^ "MedlinePlus - Neonatal Conjunctivitis". Retrieved on 2008-08-28.
11. ^ W Sanger. History of Prostitution. NY,Harper, 1910 .
12. ^ P. LaCroix. The History of Prostitution--Vol. 2. NY,MacMillan, 1931.
13. ^ WE Leiky . History of European Morals. NY, MacMillan, 1926.
14. ^ L Coultan. Life in the Middle Ages. Cambridge, Cambridge U. Press, 1925.
15. ^ Giannini AJ, Colapietro G, Slaby AE, Melemis SM, Bowman RK (October
1998). "Sexualization of the female foot as a response to sexually transmitted
epidemics: a preliminary study". Psychological reports 83 (2): 491–8. PMID
9819924.
16. ^ "Gonorrhea - CDC Fact Sheet". Retrieved on 2008-07-31.
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