Neisseria Gonorrhoeae - Gonorrhea Disease
Gram (-) is diplococcus. Also referred to as gonococcus. There are strains that form various clinical syndromes. Infection is so common in the world that it is claimed that one person gets infected every 30 seconds in the USA. Those infected are highly infectious within the incubation period of 2-5 days.
The vast majority of gonococcal infections remain at the primary infection focus. It does not produce symptoms in 80-85% of women. Carriage during pregnancy is especially frequent. In women, it most often settles on the endocervix (cervical canal). A purulent, odorless discharge is accompanied by an erythema in the cervix. Other foci of infection in the lower genital organs are the urethra (urinary hole), bartolin and skene glands. Frequent urination, burning while urinating, discharge, burning of the vulva and redness are at the forefront. Purulent discharge comes from the skene guds and urethra. Bartolin gud is generally kept unilaterally. Symptoms such as pain, swelling and redness are quite uncomfortable. It can also hold the vaginal mucosa in the post-menopausal and pre-menarche periods.
10-20% of gonococcal infections in the cervix progress to the upper genital organs. In this case, abnormal bleeding, fever, pelvic and abdominal pain are major symptoms.
Disseminated gonococcal infections are general infections caused by hematogenous (blood) spread of bacteria. Mobile polyarthritis, arthralgia and tenosynovitis are the most common findings. Arthritis is the most common component of disseminated gonococcal infection. There are skin lesions that start as fever, chills, papules and become pustular. Endocarditis (infection in the heart) is seen in 1-2% of cases. In rectal (intestinal end section) gonorrhea, pain, discharge and bleeding occur in the rectum. Sometimes the infection also settles in the pharynx, in this case it usually progresses asymptomatically. Patients located in the pharynx and rectum are known to be more resistant to treatment. Perihepatitis (Fitz-Hugh-Curtis endromu) should be considered in patients who develop complaints of pain, fever, nausea and vomiting that increase with coughing, bending forward and deep breathing and hitting the right shoulder.
While the gram smear of urethral discharge in men has a sensitivity close to 100%, this rate was found to be 80% in the samples taken from the cervix. The simplest diagnostic method is to see intracellular gonococcus in PNLs by staining smears made from cervical and urethral discharge in grams or methylene blue. However, the diagnosis must be confirmed, and cultured to determine the antibiotic susceptibility of the resistant strain must be performed. For culture, Thayer-Martin medium is planted. It gives results in 48 hours. The reproduction rate in culture is between 80-95%. In recent years, methods such as antigen detection (ELISA) and DNA probe have been developed in diagnosis (PCR).
Most gonococci are sensitive to penicillin, cephaloporin, tetracycline, macrolides, quinolones and rifampicin. After the 1970s, penicillin-resistant gonococcal strains began to appear quite frequently. After the proliferation time of gonococci was 29 minutes, single-dose treatment was recommended in uncomplicated cases. There are also those who recommend single dose 250 mg ceftriaxone and quinolone group antibiotics in the treatment. week by urea).