Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrheae, commonly known as gonococcus.
This bacterium is an intracellular pathogen, which infects the urethra and endocervix, rectum, pharynx, and conjunctiva.
Up to 50% of infected women, and 10% of infected men are asymptomatic.
Co infection with chlamydia trachomatis is common occurring in 20% of men and 40% of women with gonococcal infection.
Period between the initial infection and symptom onset is about 2 to 14 days, and most symptoms in males occur between day two and day 5.
In men, gonorrhea can cause anterior urethritis with mucopurulent, or purulent urethral discharge.
And pain during urination, also known as dysuria.
The discharge can be profuse, even causing staining of underwear.
Persistent infection can cause ascending infection in the testis as a complication.
In women, symptoms may include increased vaginal discharge.
Painful urination.
Bleeding after intercourse, or intermenstrual bleeding.
And lower abdominal pain.
Complications include Bartholin’s abscesses, and ascending infection into the uterus and fallopian tubes, causing endometritis, and pelvic inflammatory disease.
In pregnancy, gonorrhea is associated with preterm birth.
Postpartum infection.
And neonatal purulent conjunctivitis due to vertical transmission during vaginal delivery.
Rectal infection through repetitive anal sex may be asymptomatic, but can cause rectal inflammation, also known as proctitis.
Gonococcal septicemia is a rare complication of gonorrhea infection, presenting as fever; tendon inflammation; arthritis; and characteristic erythematous skin lesions.
Nucleic acid amplification tests are the diagnostic test of choice for Neisseria gonorrhea as they have a better sensitivity than culture.
However, as Neisseria gonorrhea antimicrobial resistance is increasing, culture on selective media should be performed prior to antibiotic therapy.
Mainly used antibiotic in the treatment of gonorrhea is ceftriaxone.
Alternatives include azithromycin & gentamicin.
Longer courses of antibiotics are required for complicated infections, such as inflammation in the testis, and pelvic inflammatory disease.
Patients should have abstained from sex for at least seven days, or until the treatment has been completed. All sexual contacts should be notified, tested, and treated if positive.
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