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Published by: jobinbionic on Nov 01, 2008
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(August 2008)
Classification and external resources
), caused by the bacteria 
, is acommonsexually transmitted disease. In the US, itsincidenceis second
 only tochlamydia.
 Non-genital sites in which it thrives are in therectum, thethroat (oropharynx
), and theeyes (conjunctiva). Thevulvaandvaginain women are usually spared because they are lined bystratified epithelial cells —in women the cervixis the usual first site of infection. Gonorrhea typically spreads during sexual intercourse. It can also bevertically transmitted, where infected mothers can pass gonorrhea to their newborn infantsduring delivery. This causesconjunctivitis (eye infections) which, if left untreated, can lead to  blindness. As prophylaxisagainst this, many countries routinely treat infants with eyedrops of erythromycinat birth.
The incubation period is 10 to 20 days with most symptoms occurring between thefifteenth and twentieth days after being infected. A small number of people may beasymptomatic for up to a lifetime. Between 30 and 60% of people with gonorrhea areasymptomatic or havesubclinicaldisease.
Women may complain of vaginal discharge,difficulty urinating (dysuria), projectile urination, off-cyclemenstrual  bleeding, or   bleeding after sexual intercourse. The cervix may appear anywhere from normal to theextreme of marked cervical inflammation with pus. Possibility of increased production of male hormones is common in many cases. Infection of the urethra (urethritis) causes littledysuria or pus. The combination of urethritis and cervicitis on examination stronglysupports a gonorrhea diagnosis, as both sites are infected in most gonorrhea patients.Gonorrhea is caused by the
 Neisseria gonorrhoeae
bacteria. The infection is transmittedfrom one person to another through vaginal, oral, or anal sexual relations, thoughtransmission 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 womaninfected with gonorrhea. Women have a 50% chance of getting the infection by havingsexual relations with a man infected with gonorrhea. An infected mother may transmitgonorrhea to her newborn during childbirth, a condition known as ophthalmianeonatorum.
Less advancedsymptoms, which may indicate development of   pelvic inflammatory disease(PID), includecrampsand pain, bleeding betweenmenstrual periods,vomiting,  or fever . It is not unusual for men to have asymptomatic gonorrhea. Men may complainof  pain on urinatingand thick, copious,urethralpus discharge (also known as
) is themost common presentation. Examination may show a reddened externalurethral meatus.Ascending infection may involve theepididymis,testicles or  prostate glandcausing symptoms such as scrotal pain or swelling. Instances of blurred vision in one eye mayoccur in adults.
In men, inflammation of the epididymis (epididymitis
), prostate gland ( prostatitis
) andurethral structure (urethritis) can result from untreated gonorrhea
.In women, the most common result of untreated gonorrhea is pelvic inflammatorydisease, a serious infection of the uterus that can lead to infertility. Further on,
 perihepatitis may develop
. This rare complication is associated withFitz-Hugh-Curtissyndrome. Additionally, septic arthritisin the fingers, wrists, toes, and ankles is also common. This should be evaluated promptly with a culture of thesynovial fluid, blood,cervix, urethra, rectum, skin lesion fluid, or pharynx. The underlying gonorrhea should betreated; if this is done then usually a good prognosis will follow.
This section does notciteanyreferences or sources.
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(August 2008)
Antibiotics that may be used to treat gonorrhea include:
Amoxicillin2 g plus probenecid 1 g orally
Ampicillin2 to 3 g plus probenecid1 g orally
Azithromycin2 g orally
Cefixime400 mg orally
Cefotaxime500 mg by intramuscular injection
Cefoxitin2 g by intramuscular injection, plus probenecid1 g orally
Cefpodoxime(Vantin) 400 mg orally
Ceftriaxone(Rocephin) 125 to 250 mg by intramuscular injection
Ciprofloxacin500 mg orally
Levofloxacin250 mg orally
Ofloxacin400 mg orally
Spectinomycin2 g by intramuscular injectionThese drugs are all given as a single dose.The level of tetracyclineresistance in
 Neisseria gonorrhœae
is now so high as to make itcompletely ineffective in most parts of the world.The fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) cannot be used in pregnancy. It is important to refer all sexual partners to be checked for gonorrhea to prevent spread of the disease and to prevent the patient from becoming re-infected withgonorrhea. Patients should also be offered screening for other sexually transmittedinfections. In areas where co-infection with chlamydiais common, doctors may prescribe a combination of antibiotics, such as ceftriaxone with doxycycline or azithromycin, to treat both diseases.Penicillin is ineffective at treating rectal gonorrhea: this is because other bacteria withinthe rectum produce β-lactamases that destroy penicillin. All current treatments are lesseffective at treating gonorrhea of the throat, so the patient must be rechecked by throat

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