infectious diseases
Gonorrhea
Introduction
Gonorrhea is caused by the bacteriumNeisseria gonorrhoeae. It typically infects epithelia of the urethra, cervix, rectum, pharynx, or conjunctivae, causing irritation or pain and purulent discharge. Dissemination to skin and joints, which is uncommon, causes sores on the skin, fever, and migratory polyarthritis or pauciarticular septic arthritis. Diagnosis is by microscopy, culture, or nucleic acid amplification tests (NAATs). Several oral or injectable antibiotics can be used, but drug resistance is an increasing problem. (See also Overview of Sexually Transmitted Infections .) N. gonorrhoeaeis a gram-negative diplococcus that occurs only in humans and is almost always transmitted by sexual contact. Urethral and cervical infections are most common, but infection in the pharynx or rectum can occur after oral or anal intercourse, and conjunctivitis may follow contamination of the eye. After an episode of vaginal intercourse, likelihood of transmission from women to men is approximately 22% ( Reference ), but from men to women, it may be higher. Neonates can acquire Etiology during passage through the birth canal, and children may acquire gonorrhea as a result of In 10 to 20% of women, cervical infection ascends via the endometrium to the fallopian tubes (salpingitis) and pelvic peritoneum, causing Pelvic Inflammatory Disease (PID) (PID). Chlamydiae or intestinal bacteria may also cause PID. Gonorrheal cervicitis is commonly accompanied by dysuria or inflammation of Skene ducts and Bartholin glands. In a small fraction of men, ascending urethritis progresses to Disseminated gonococcal infection(DGI) due to hematogenous spread occurs in<1% of cases, predominantly in women. DGI typically affects the skin, tendon sheaths, and joints. Pericarditis, endocarditis, meningitis, and perihepatitis occur rarely. Coinfection with Chlamydia and Mycoplasmal Mucosal Infections occurs in 15 to 25% of infected heterosexual men and 35 to 50% of women. 