Puyameha (Gonorrhoea) STI / STD

AYURVEDA, KAYACHIKITSA SYLLABUS (PAPER 2, PART B)

1. (Gonorrhoea)
ProfSriramChandraMishra
KayachikitsaDepartment
VYDSAyurvedMahavidyalaya,Khurja

2. Theseareinfectionsthatarepassedfromonepersontoanother
throughsexualcontact.ExamplesincludeGonorrhea,syphilis,genitalherpes,
humanpapillomavirusinfection,HIV/AIDS,chlamydiaetc.
Duetosocialstigma,thetermSTDsorVDwaschangedoutfor
sexuallytransmittedinfections(STIs)asbothvenerealdisease(VD)and
sexuallytransmitteddisease(STDs)usetheterm“disease.”

3. Theterm“sexuallytransmittedinfection”(STI)referstoapathogen
thatcausesinfectionthroughsexualcontactwhereasTheterm“sexually
transmitteddisease”(STD)referstoarecognizablediseasestatethathas
developedfromaninfection.
Sexuallytransmitteddisease(STD)firstbeginassexuallytransmitted
infections(STI)aftersexuallytransmittedbacteriaorvirusfirstentersthe
bodyandbeginsmultiplying.

4. •STIs/STDs/VD-GroupofCommunicableDiseases
•Modeoftransmission-PredominantlybySexualContact
•Agents-Bacterial,Viral,Protozoal,Fungal,Ectoparasites
•Spread-STIsarespreadpredominantlybysexualcontact,including
vaginal,analandoralsex.SomeSTIscanalsobetransmittedfrom
mother-to-childduringpregnancy,childbirthandbreastfeeding.
•5ClassicalSTDsbutnowmorethan30differentbacteria,virusesand
parasitesareknowntobetransmittedthroughsexualcontact.

5. 1.Gonorrhoea(PUYAMEHA)
2.Syphilis(PHIRANGA)
3.Chancroid/SoftChancre(UPADAMSHA)
4.LymphogranulomaVenereum(LGV)
5.GranulomaInguinale(Donovanosis)
Old
5 Classical STDs

6. A.Bacterial Agents
•Neisseriagonorrhoeae
•Chlamydia trachomatis
•Treponemapallidum
•Haemophilusducreyi
•Mycoplasmahominis
•Ureaplasmaurealyticum
•Calymmatobacteriumgranulomatis
•Shigella Sps.
More than 30 agents
Now
•Campylobacter spp.
•Group B streptococcus
•Bacterial vaginosis-associated
organisms

7. B.Viral Agents
•Human (alpha) herpes virus 1 or 2 (herpes simplex virus)
•Human (beta) herpesvirus5 (formerly cytomegalovirus)
•Hepatitisvirus B
•Human papillomavirus
•Molluscumcontagiosumvirus
•Human immunodeficiency virus (HIV)

8. C.Protozoalagents
•Entamoebahistolytica
•Giardialambia
•Trichomonasvaginalis
D.Fungal Agents
•Candida albicans
E.Ectoparasites
•Phthiruspubis
•Sarcoptesscabiei

9. •Outofthese,Eightpathogensarelinkedtothegreatestincidenceofsexually
transmitteddisease.
Ofthese,4aregenerallycurablewithexistingsingle-doseregimensofantibiotics.
(ThreebacterialSTIs-chlamydia,gonorrhoeaandsyphilisandoneparasiticSTI-trichomoniasis)
Theother4areviralinfectionswhichareincurable:hepatitisB,herpessimplexvirus
(HSVorherpes),HIVandhumanpapillomavirus(HPV).
•ApersoncanhaveanSTIwithoutshowingsymptomsofdisease.Common
symptomsofSTIsincludevaginaldischarge,urethraldischargeorburningin
men,genitalulcersandabdominalpain.
•Dependingonthedisease,someuntreatedSTIscanlead
toinfertility,chronicpainorevendeath.

10. (Gonorrhoea)
•PUYAMEHA
•NodescriptioninBrihatrayiorLaghutrayi
•BhaisajyaRatnavalichapter89(AupasargikaRogaChikitsa
prakarana)elaborateonPuyameha
•औपसर्गिकरोग-उपसगगितजगतःऔपसर्गिकः(उपसगि-संक्रमण​)

11. Synonym(पर्गिर्​)
औपसर्गिकमेहगख्र्ोगदोर्ःसभिषग्वर ः।
पूर्मेहोव्रणमेहआगन्तुमेहउच्र्ते॥
•पूर्मेहो-पुर्ंमेहर्तीत्र्तःपूर्मेहः।(pusinurine)
•व्रणमेह-व्रणवत्तस्र्लक्षणोपचगरौिवतइततव्रणमेहः।(symptomand
treatmentlikewound)
•आगन्तुमेह-बगहर्ोःकगरणववशेष ःप्रगप्नोतीत्र्गगन्तुकः।(externalcause)
•उष्णवगतकेलक्षणइसरोगमेंतीव्ररूपमेंउिड़तेहैं,इसभलएइसे'िृशोष्णवगत'कहते
हैं।(उष्णवगत-मूत्रगघगतकगएकिेदह )

12. Nidana
रजस्वलायाांबहुभूक्त्तवतयाांतथाऽऽर्द्रयोनौमनादरोयः।
प्रयातुमोहाद्कोऽपितर्हरध्रुवांगदांदारुणमेतमेतु॥(B.R.89/2)
बहुभूक्त्तवतयाां–toomanypartners
ऽऽर्द्रयोनौ–kledayuktaduetoanydisease
1.स्रीकीयोननकाअनेकरोगोंसेक्क्त्लन्नवकण्डुयुक्त्तहोना।
2.रजस्वलास्रीकाअनेकिुरुषोंसेसांभोगकरना।
3.िूयमेहग्रस्तिुरुषद्वारास्रीकेसाथमैथुनकरनेसेस्रीभीिूयमेहरोगसेग्रस्तहो
जातीहै

13. सम्प्प्रगप्प्तघटक
•दोष-वपत्तप्रधगनत्रत्रदोष
•दुष्र्-रक्त,लसीकग
•स्रोतस-मूत्रवहस्रोतस्
•अर्धष्ठगन-भलङ्ग,वृषण,बप्स्तआदद
•संचगर-रसगर्नीद्वगरग

14. लक्षण

15. उपद्रव
व्रणमेहेववतनददिष्टगआमनेत्रर्गददकगः।उपद्रवगववशेषेणनगशनीर्गभिषग्वर ः॥
(ि .र.89/10)
•आमवगत(Gonorrhealarthritis)
•औपसर्गिकनेत्रगभिष्र्न्द(Ophthalmianeonatorum)

17. MANAGEMENT
•Rasa/Bhasma–TrivangaBhasma,SwarnabangaBhasma,Purnachanda
Rasa,SwetaParpati,Rasakarpoora,Rasamanikya,GandhakaRasayana,
Mehamudgararasa,BrihatVangeswarrasa
•Vati–ChandraprabhaVati,ArogyavardhiniVati,SilajitwadiVati,
PuyamehaharaGutika,ChandanadiVati,
•Churna–Sphatikadi,Puyamehari/PuyamehaharaChurna(BHU/AFI)
•Avaleha-ChopchiniRasayan/MadhusnuhiRasayan
•Asavarista-Sarivadyasavam,Chandanasava,Vidangarista
•Ghrita–PanchatiktaGhrita

18. PUYAMEHAHARA CHURNA(BHU/AFI)
•SRIVESTAKASATWA(SARALA–PINUSROXBURGHII)
•KHADIRASATWA
•SORAKA(SU.-PURIFIEDPOTASSIUMNITRATE)
•SPHATIKASU.
•SWETACHANDANA
•PRAVALPISTI
•REWATCHINI(RHEUMEMODII)
•GILEARMANISU.(PURIFIEDREDARMENIANCLAY)
•DUGDHAPASANA
•GAIRIKASU.
•HAZRALYAHUD PISTI
•SITA
(REWATCHINI–Revandchini,indian
rhubarb, Amlaparni, Gandhini,
Pittamuli)

20. Def
n
ofGonorrhoea-
Gonorrhoeaisasexuallytransmittedinfection
causedbythebacteriumNeisseriaGonorhoeainwhich
contagious,purulentinflammationoftheurethraorthe
vaginaoccurs.
(THE CLAP DISEASE)

21. 21
Transmission
Efficientlytransmittedby:
•MaletoFemaleviasemen
•FemaletoMaleurethra
•Rectalintercourse
•Fellatio(pharyngealinfection)
•Perinataltransmission(Contactwithinfectedbodilyfluids,sothatamothercould
passoninfectiontohernewbornduringchildbirth.)
GonorrheaassociatedwithincreasedtransmissionofandsusceptibilitytoHIVinfection
Incubationperiod
•2to14days
Fellatio –Oral sex act

22. Agent–
Neisseriagonorrhoeae
(Gram-negativeintracellulardiplococcusbacteria)
•Growinthewarm,moistareasofthereproductivetract
•Female-Cervix,Uterus,Fallopiantubes,Urethra
•Male-Urethra
•Alsocangrowinthemouth,throatandanusofboth.
•Itinfectsthemucus-secretingepithelialcells.

23. Gonorrhea
(Gram Stain of Urethral Discharge)

24. ClinicalManifestations
Gonorrhoeasymptomsinmen
•Urethritis(Inflammationofurethra)
•Greenishyelloworwhitishdischargefromthe
penis
•Burningwhenurinating
•Epididymitis(Inflammationoftheepididymis)
•Painfulorswollentesticles

25. Gonorrhoeasymptomsinwomen
•Mostinfectionsareasymptomatic
•Cervicitis–inflammationofthecervix
•Urethritis–inflammationoftheurethra
•Greenishyelloworwhitishdischargefrom
thevagina
•Lowerabdominalorpelvicpain
•Burningwhenurinating
•Bleedingbetweenperiods
•Vulvitis-Swellingofthevulva

26. Othersymptoms
•Throat(duetooralsex)–
Sorethroat,Burningsensation,Swollenglands
•Rectum(duetorectalintercourse)
Analitching,puslikedischargefromrectum,brightredbloodspots,Strain
duringbowelmovement
•Eye(travellingthroughthebloodstream)
Conjunctivitis,Sensitivitytolight,Puslikedischargefromoneorbotheyes
•Joints(travellingthroughthebloodstream)
Septicarthritis
•Skinlesions(travellingthroughthebloodstream)
•Heart(Veryrarely)
Endocarditis(individualswithsuppressedimmunesystems)
•Thespinalcolumn(Veryrarely)
Meningitis(individualswithsuppressedimmunesystems)

27. GonorrhoeasymptomsinNeonates:
•Eye(blindness,infectionsoftheconjunctiva)
•Infectionsofthepharynx,respiratorytract
•Skininfections
•Jointinfection
•Life-threateningbloodinfectioninthebaby.

28. Untreated
Genital
Infection
Ectopic
pregnancy
Infertility
Chronic
pelvic pain
Acute PID
Silent PID
9%
14-20%
18%
20-50%
FEMALE
Babies –Blindness, Sores on the scalp, Infections
MALE Infertility
Complications

29. Investigations
•Urinetest
•Swabofaffectedarea
•Gramstainandculture
•NAAT,andPOCNAAT,suchasGeneXpert(Cepheid)
•VDRL
•Polymerasechainreaction(PCR)-basedtesting
•Urine/BloodCulture(todeterminesensitivitytoantibiotics)
•Allpeopletestingpositiveforgonorrhoeashouldbetestedforother
sexuallytransmitteddiseasessuchaschlamydia,syphilisandHIV.
•Partnerswithcontactduringthe60daysprecedingthediagnosisshouldbe
evaluated,testedandtreated.
NAAT -Nucleic Acid Amplification Test

30. Management
Antibiotic(oralorinjectable)
→CDC(2021)RecommendedRegimenforUncomplicatedGonococcalInfection
oftheCervix,Urethra,orRectumAmongAdultsandAdolescents
Ceftriaxone500mgIMinasingledoseforpersonsweighing<150kg(1gm
for>150kg)
Ifchlamydialinfectionhasnotbeenexcluded,treatforchlamydiawith
doxycycline100mgorally2times/dayfor7days.
CDC(2015)-Asingledoseof250mgofIMceftriaxoneAND1goforal
azithromycin

31. AlternativeRegimensifCeftriaxoneIsNotAvailable
•Gentamicin240mgIMinasingledoseplusAzithromycin2gorallyinasingle
dose
•orCefixime*800mgorallyinasingledose
*Ifchlamydialinfectionhasnotbeenexcluded,providersshouldtreatforchlamydia
withdoxycycline100mgorally2times/dayfor7days.

32. •DisseminatedGonococcalInfection(DGI)(Petechialorpustularacralskin
lesions,asymmetricpolyarthralgia,tenosynovitis,oroligoarticularsepticarthritis)
→Ceftriaxone1gIMorIVevery24hours
+Azithromycin1gorallyinasingledose
AlternativeRegimens
→Cefotaxime1gIVevery8hours OR
→Ceftizoxime1gIVevery8hours PLUS
Azithromycin1gorallyinasingledose
•GonococcalMeningitisandEndocarditis
→Ceftriaxone1–2gIVevery12–24hours PLUS
→Azithromycin1gorallyinasingledose

33. •OphthalmiaNeonatorum
→Prophylaxis
Erythromycin(0.5%)ophthalmicointmentineacheyeinasingle
applicationatbirth
→Treatment-Ceftriaxone25–50mg/kgIVorIMinasingledose,notto
exceed125mg
•DisseminatedGonococcalInfection(DGI)andGonococcalScalp
AbscessesinNeonates
→Ceftriaxone25–50mg/kg/dayIVorIMinasingledailydosefor7days,with
adurationof10–14daysifmeningitisisdocumented
OR
→Cefotaxime25mg/kgIVorIMevery12hoursfor7days,withadurationof
10–14daysifmeningitisisdocumented

34. •RecommendedRegimenforUncomplicatedGonococcalInfectionofthePharynx
AmongAdolescentsandAdults
Ceftriaxone500mgIMinasingledoseforpersonsweighing<150kg(1gmfor>
150kg)
•RecommendedRegimenforGonococcalConjunctivitisAmongAdolescentsand
Adults
Ceftriaxone1gIMinasingledose
Providersshouldconsiderone-timelavageoftheinfectedeyewithsaline
solution.
•RecommendedRegimenforGonococcal-RelatedArthritisandArthritis-Dermatitis
Syndrome
Ceftriaxone1gIMorIVevery24hours
Ifchlamydialinfectionhasnotbeenexcluded,providersshouldtreatfor
chlamydiawithdoxycycline100mgorally2times/dayfor7days.

35. •RecommendedRegimenforInfantsandChildrenWhoWeigh≤45kgandWhoHave
UncomplicatedGonococcalVulvovaginitis,Cervicitis,Urethritis,Pharyngitis,or
Proctitis
Ceftriaxone25–50mg/kgIVorIMinasingledose,nottoexceed125mgIM
•Recommended RegimenforChildrenWhoWeigh>45kgandWhoHave
UncomplicatedGonococcalVulvovaginitis,Cervicitis,Urethritis,Pharyngitis,or
Proctitis
Treatwithoneoftheregimensrecommendedforadults
•RecommendedRegimenforChildrenWhoWeigh≤45kgandWhoHaveBacteremia
orArthritis
Ceftriaxone50mg/kg(maximumdose:1g)IMorIVinasingledosedailyfor7
days
•RecommendedRegimenforChildrenWhoWeigh>45kgandWhoHaveBacteremia
orArthritis
Ceftriaxone1gIMorIVinasingledosedailyevery24hoursfor7days

36. GonococcalUrethritis
(Purulent Discharge)
Epididymitis
(Swelling)
Male

37. Female
GonococcalCervicitisBartholin’sAbscess

38. GonococcalOphthalmia
Skin Lesion
Male & Female

39. Recommended RegimensforFirstClinicalEpisodeof
GenitalHerpes
•Acyclovir400mgorally3times/dayfor7–10days
•orFamciclovir250mgorally3times/dayfor7–10days
•orValacyclovir1gorally2times/dayfor7–10days
Treatmentcanbeextendedifhealingisincompleteafter10daysoftherapy.
Acyclovir200mgorally5times/dayisalsoeffectivebutisnotrecommendedbecause
ofthefrequencyofdosing.

40. RecommendedRegimenforNongonococcalUrethritis
•Doxycycline100mgorally2times/dayfor7days
AlternativeRegimens
•Azithromycin1gorallyinasingledose
•orAzithromycin500mgorallyinasingledose;then250mgorallydailyfor4
days

41. RecommendedRegimenforCervicitis*
•Doxycycline100mgorally2times/dayfor7days
Considerconcurrenttreatmentforgonococcalinfectionifthepatientisat
riskforgonorrheaorlivesinacommunitywheretheprevalenceof
gonorrheaishigh
•AlternativeRegimen-Azithromycin1gorallyinasingledose

42. Recommended RegimenforChlamydialInfection
AmongAdolescentsandAdults
•Doxycycline100mgorally2times/dayfor7days
AlternativeRegimens
•Azithromycin1gorallyinasingledose
•orLevofloxacin500mgorallyoncedailyfor7days