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Transcript
Internal Medicine
The quantity and appearance of the discharge can be used to distinguish accurately gonococcal
and nongonococcal urethritis in about 75-80% of patients who have not urinated recently. It
can’t, of course, be used to diagnose dual infection with N.gonorrhea and C.trachomatis. Milking
of the urethra may be necessary to get a good amount of discharge sample.
Laboratory
•
Microscopy of urethral discharge stained with methylene blue or safranin or Gram’s
stain shows pus cells with characteristic intracellular coffee bean shaped diplococci
Æ N.gonorrhea.
•
Pus cells without intracellular diplococci = NGU.
Treatment:
When the accurate etiologic diagnosis is made
•
Gonococcal Urethritis:
Ceftriaxone 250mg IM stat
OR
Ciprofloacin 500mg PO stat
OR
Spectinomycin 2mg IM stat.
• NGU: Doxycycline 100mg PO BID for 7 days or Tetracycline 500mg PO QID for 7 days
OR Erythromycin 500mg PO QID for 7 days if the patent has contraindication for TTC..
When there is no Etiologic diagnosis: Treatment should cover both gonococccal and
chlamydial infections (combine the above treatments)
2. Vaginal Discharge:
Etiology
1. N.gonorrhea
2. Chlamydia trachomatis
3. Trichomonas vaginalis,
4. Gardnerella vaginalis
5. Candida albicans
6. Vaginal anaerobes (“bacteria vaginosis”)
•
The first three are sexually acquired and the last three are endogenous infections.
•
The first two cause cervicitis while the last four cause vaginitis.
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