Gonorrhea

This presentation will give a brief overview of one of the sexually transmitted diseases, which is more often found in the community, its main causative organism, symptoms, how to detect, prevent and treat, and rehabilitation.

1. GONORRHEA MR. SNEL G. ALWARIS MGMNBCON, Navi Mumbai , Kamothe First Year M.Sc. Nursing

2. Definition It is an acute infection sexually transmitted disease of mucous membrane of the genitourinary tract , eyes , rectum & throat.

3. Causative agent Neisseria gonorrhoeae   is a species of  Gram-negative , coffee bean-shaped  diplococci   bacteria  responsible for the  sexually transmitted infection  gonorrhea.

4. Mode of Transmission Genital – genital Genital – anorectal Oro – genital Oro – anal contact Mother to child transmission during delivery

5. Incubation Period Usually 2 – 10 day following exposure

6. Causes Multiple Sex Partners Unprotected Sex – Vaginal , Anal , Oral Primary / 1 st line Infection Previous history od STD During Child birth - mother with Gonorrhoea

7. Causes Multiple Sex Partners Unprotected Sex – Vaginal , Anal , Oral Primary / 1 st line Infection Previous history od STD During Child birth - mother with Gonorrhoea

8. Clinical Features Male

9. Females Pustules Urethritis Vaginitis Dyspareunia Cervicitis PID

10. Common Arthritis Meningitis Tenosynovitis Children's Meningitis Ophthalmia Neonatorum Sepsis

11. Classification Anorectal and Pharyngeal Gonorrhea :- are usually asymptomatic . Ocular Gonorrhea :- Gonococcal conjunctivitis is an uncommon. It may be present with purulent discharge from the eyes. Inflammation of conjunctiva and edema of eyelids, pain and photophobia. Conjunctivitis must be treated early to prevent conjunctiva damage.

12. 3. Disseminated gonococcal Infection ( DGI ) :- N. gonorrhoeae  commonly affects mucosal surfaces of the genital tract, rectum, or pharynx in sexually active adults resulting in localized infection. In some instances, gonococcus can spread to the bloodstream, resulting in systemic manifestations which are called DGI. Common manifestations of DGI are mild fever, rash, tenosynovitis, and polyarthralgia. 4. Acute Perihepatitis ( Fitz-huge curits syndrome ) :- A rare complication of PID , and is thought to occur by extension of N. gonorrhea from fallopian tube to liver capsule and peritoneum. Patient present with sharp, pleuritic right upper quadrant pain.

13. LABORATORY DIAGNOSIS Gram Staining :- Microscopic examination of stained smears shows gram - ve diplococci. Culture :- Antibiotic containing selected media have diagnosed sensitivities of 80-95% for promptly incubated specimen. Oxidase reaction :- Aids to identify gonococci from mixed culture. PCR , TMA ( Transcription mediated amplification ) NAAT ( Nucleic Acid Amplification Test ) Sterile Pyuria : - Urine may show polymorphonuclear leukocytes with negative urine culture report.

14. COMPLICATIONS MALE Peri urethritis Epididymis Epididymorchitis Prostitis FEMALE PID Endometritis Salpingitis Tubo – ovarian abscess Bartholinitis Peritonitis Perihepatitis Newborn :- Ophthalmia neonatorum, Blindness, Sepsis

15. TREATMENT / MEDICAL MANAGEMENT Uncomplicated Gonococcal infection of cervix , urethra and rectum :- Single dose of Tab. Cefixime 400mg Tab. Ciprofloxacin 500mg Tab. Ofloxacin 400mg or Tab. Levofloxacin 250mg If Chlamydia infection is not ruled out – Tab. Azithromycin 1gm Single dose or Tab. Doxycycline 100mg BD for 7 days

16. Uncomplicated Gonococcal infection of Pharynx Single dose of Inj. Ceftriaxone 125mg IM or Tab. Ciprofloxacin 500 mg. If Chlamydia infection is not ruled out - Tab. Azithromycin 1gm Single dose or Tab. Doxycycline 100mg BD for 7 days

17. Disseminated Gonococcal Infection ( DGI ) Inj. Ceftriaxone 1gm IM / IV Alternative Regimens Drug Dose Route Frequency Inj. Cefotaxime 1 gm IV TDS Inj. Ceftizoxime 1 gm IV TDS Inj. Ciprofloxacin 400mg IV BD Inj. Ofloxacin 400 mg IV BD Inj. Levofloxacin 250 mg IV Daily or Inj. Spectinomycin 2 gm IM BD

18. Gonococcal Conjunctivitis :- Inj. Ceftriaxone 1 g. IM Single Dose Gonococcal Meningitis :- Inj. Ceftriaxone 1-2 g. IV every 12 hourly for 12 -14 days. Gonococcal Endocarditis :- Inj. Ceftriaxone 1 – 2 g. IV every 12 hourly for 4 weeks. Ophthalmia Neonatorum :- Inj. Ceftriaxone 25-50mg/kg IV/ IM single dose ( Not more than 125mg )

19. Management of Sexual partner :- All sex partner of patient who have N. gonorrhea infection should be evaluated and treated for N. gonorrhea if their last sexual contact with patient was within 60 days before onset of symptom or diagnosis. Management of Pregnant Partner Inj. Cefixime 400 mg Stat or Inj. Ceftriaxone 125 mg IM stat with Tab. Erythromycin 500 mg QID for 7 days or Cap. Amoxicillin 500 mg TDS for 7 days.

20. NURSING MANAGEMENT Administer ceftriaxone IM as ordered. Emphasize the need for regular Pap smears and pelvic examinations because of the family history of ovarian cancer. Discuss feelings and concerns about the diagnosis of gonorrhea. Stress that such a diagnosis does not reflect on one’s self-worth as a person. Teach how to talk with a future sexual partner about preventive measure. Sexual restrictions till completion of treatment