GONORRHEA A common STD that affects men and women, causing cervicitis in women and urethritis in men; teens

and young adults are the most affected. It is caused by the gram-negative diplococci Neisseria gonorrhoeae. Neisseria gonorrhoeae is a pyogenic (pus-forming), gram-negative diplococcus that evokes inflammatory reactions characterized by purulent exudates.HUMANS are the only natural host for N. gonorrhoeae.It grows best in warm, mucus-secreting epithelia. Portal of entry can be the genitourinary tract, eyes, oropharynx, anorectum or skin. It is a nonmotile diplococcal bacterium usually seen microscopically as flattened pairs within the cytoplasm of neutrophils. Infection results from contact with an infected person or with secretions containing the causative organism and occurs through sexual transmission, causing cervicitis in women, and possible conjunctivitis (autoinoculation of the organism to the conjunctiva is possible -- neonates born to infected mothers can acquire the infection during passage through the birth canal and are in danger of developing gonorrheal conjunctivitis), pharyngitis, and proctitis. DIAGNOSIS Gram stain of cervical secretions and culture on Thayer Martins agar. DNA testing of cervical secretions (quicker and accurate, can be done simultaneously for Chlamydia) Pharyngeal or conjunctival secretions can be tested if pharyngitis or conjunctivitis is suspected. Joint aspiration and blood cultures may be necessary if disseminated infection is suspected. Infection commonly manifests 2 to 7 days after exposure. Typically begins in the anterior urethra , accessory urethral glands, Bartholins or Skenes glands and the cervix.

CLINICAL MANIFESTATIONS MEN Urethral pain Creamy yellow, sometimes bloody discharge Burning sensation during urination Painful swollen testicles

WOMEN Usually asymptomatic Unusual genital or urinary discharge Dysuria Dyspareunia Pelvic pain or tenderness Unusual vaginal bleeding Fever Proctitis Complications of Gonorrhea Infertility Women- cause pelvic inflammatory disease (PID), which may result in scarring of the tubes, greater risk of pregnancy complications and infertility Men- experience epididymitis, which is the inflammation of the rear portion of the testicles where the sperm ducts are located Infection that spreads to the joints and other areas of the body Manifestations includes fever, rash, skin sores, joint pain, swelling and stiffness are possible results. Increased risk of HIV/AIDS

Having gonorrhea makes someone more susceptible to infection with human immunodeficiency virus (HIV), the virus that leads to AIDS. Complications in babies Babies who contract gonorrhea from their mothers during birth can develop blindness, sores on the scalp and infections. Management Patients should be given a detailed explanation of their condition with particular emphasis on the long-term implications for the health of themselves and their partner(s). Patients should be advised to abstain from sexual intercourse until they and their partner(s) have completed; if azithromycin is used, this will be 7 days after treatment was given. A culture should be taken in all cases of gonorrhoea prior to giving of antibiotics, so that susceptibility testing can be performed and resistant strains identified.

Treatment y Uncomplicated gonorrhea infection in adults - Ceftriaxone 500mg IM as a single dose with Azithromycin 1g oral as a single dose y Most resistant infections - Extended spectrum cephalosporins as the preferred treatment of gonorrhea Azithromycin is recommended as co-treatment if onset of cephalosporin resistance occurs

Complicated infections Gonococcal pelvic inflammatory disease (PID) - Ceftriaxone 500 mg IM stat followed by oral Doxycycline 100 mg bd plus Metronidazole 400 mg bid for 14 days Gonococcal Epididymitis - Ceftriaxone 500 mg IM plus Doxycycline 100 mg bid for 10-14 days Gonococcal Conjunctivitis

The eye should be irrigated with saline/water Ceftriaxone 500 mg IM daily for 3 days If history of penicillin anaphylaxis or established Cephalosporin allergy: Spectinomycin 2 g IM stat daily for 3 days or Azithomycin 2 g oral stat plus Doxycycline 100 mg bid for 1 week plus Ciprofloxacin 250 mg daily for 3 days Pregnancy and Breastfeeding Pregnant and breast-feeding women should not be treated with quinolone or tetracycline antimicrobials.

Alternative Medical Regimen All the drugs below should be accompanied by Azithromycin 1g oral as a single dose. Cefixime 400mg oral as a single dose. Only advisable if an intramuscular injection is contra-indicated or refused by the patient. Spectinomycin 2g IM as a single dose Other single dose cephalosporin regimes, notably Cefotaxime 500mg IM as a single dose

Quinolones cannot generally be recommended for the treatment of gonorrhea because of the high prevalence of quinolone resistance worldwide. When an infection is known before treatment to be quinolone sensitive, ciprofloxacin 500mg orally as a single dose or ofloxacin 400mg orally as a single dose have proven efficacy. Medical Management The recommended treatment for uncomplicated infections is a thirdgeneration cephalosporin. y Administration of antimicrobial agents y If the patient is pregnant, give amoxicillin y Serologic Testing for syphilis and HIV Nursing Management Obtain patients history Assess for signs and symptoms of STIs

Encourage treatment and follow up care Identify patients sexual contacts Administer antimicrobial agents as ordered Advise on safe sex practices through the use of condoms Instruct on proper hygiene of genitalias. Psychological Aspect of Care

Health education and counseling to prevent spread and recurrence.

Sources: Medical-surgical Nursing 3rd Ed 1997 Cassmeyer et.al