Gonorrhoea Case Study

1. Aetiology: Gonorrhoea is a specific disease caused by a Neisseria Gonorrhoeae, a Gram Negative diplococcus which can infect a variety of mucosal surfaces lined by columnar epithelial cells. Those sites mostly affected are the urethra in men, uterine cervix and urethra in women. Rectal infection is common in both in women and men that have sex with men. Gonococcal pharyngitis can occur following oro-genital contact in both sexes, but is found more frequently in men that have sex with men .Although adult gonococcal infections are usually sexually transmitted, vulvo-vaginitis can occur in pre- pubertal girls as a results of contact with fomites. However, sexual transmission is the most frequent cause of infection, even in young children. An

Men: The clinical features of gonococcal urethritis in men are urethra discharge, which is of profuse and purulent, dysuria and frequency of micturition. Dysuria usually precedes the development of purulent discharge by approximately 24hrs. The onset of symptoms is often sudden following an incubation period of 24hrs -10 days. Untreated cases of gonococcal urethritis usually resolve over the course of several weeks, with the majority of cases becoming asymptomatic within 6 months. Among the MSM, the rectum is the only site of gonococcal infection. Rectal infection may occur through direct inoculation by receptive anal intercourse and is usually asymptomatic. The symptoms include pruritus, rectal pain, painless rectal discharge, and in severe cases, bloody mucopurulent discharge. Pharyngeal infection may occur may occur in up to 10% of Men who engage in oral-genital contact with infected

Tests include culture and non-culture diagnostics. Newer non-culture tests are nucleic acid detection tests, which include amplified and non-amplified tests.
0. Culture tests ) Thayer-Martin medium is one example of medium used for culture. Direct inoculation with swab specimen is best; inoculated culture plate should be promptly placed into CO2-enriched (3%-10%) environment and incubated at 35º-37º C. The advantages are low cost, suitability for a variety of specimen sites and antimicrobial susceptibility can be performed.
a) Anatomic sites to test: test in response to exposure history in persons at significant risk of gonococcal infection, complaints, or clinical findings.
0) In men: test urethra in all men; and pharynx and rectum, depending on symptoms and exposure history (including history of receptive anal sex or performing fellatio or cunnilingus).
1) In women: cervix should be tested; also test pharynx and rectum, if there is a history of receptive anal sex or performing fellatio or cunnilingus; vagina may be tested if cervix is absent. Bartholin’s or Skene’s glands may be cultured if overt exudate is