Download 5.1 .2. Disseminated gonococcal infection

Gonorrhea
1.Definition
Gonorrhea is a kind of pyogenic infection of urogenital
system caused by diplococcus gonorrhoeae ,including
infections of eyes、pharynx、rectum、pelvic kidney and
Disseminated gonococcal infection .
2.Etiology
Pathogen is Neisseria gonorrhoeae, calling diplococcus
gonorrhoeae or gonococcus for short, found in discharge of
patients in 1879 by Neisseria firstly.
2.1 Form and staining：
The gonococcus is a Gram-negative , diplococcal, pink
bacterium ,appearing kidney or lima bean shape.
2．2 Growth propert：
• For optimal growth, it requires a moist medium with temperature
of 35 °C -36 °C, and a 3–5% CO2 atmosphere.
• Gonococcus is fastidious organism that grow well in culture
media including animal protein.
• Gonococcus die easily in dry and hot circumstances
•Normal disinfectant or soap can cause it lose motoricity.
2.3 Biochemical event：
Gonococcus can create oxidase during growing process, so
oxidase test is meaningful in initial diaganosis.
3.Drug resistance research of
Gonococcus
•It’s reported continuously that PPNG and non-PPNG resistance
strains and spectinomycin、norfloxacin and ofloxacin
resistance strains have been found in China in recent year.
•Most of Gonococcus strains popular in China are sensitive to
Ceftriazone
Mechanism of Drug resistance
•Gonococcus create PPNG which can split Beta-Lactam cycle
of penicillin through plasmid, that can cause it lose antibiotic
effect.
•Drug resistance strains caused by chromatosome mutation can
change permeability of bacteria cell wall which cause the
resistance to penicillin increase to 2-4 times
•The Mechanisms above have cooperation action.
4. Epidemiology
•Humans are the only natural hosts of Gonococcus, and the
patients are the only sources of infection.
•Transmission of adult gonorrhea is almost entirely by sexual
contact,and transmission through nonsexual contact is
extremely rare.
•Now epidemic tendency：Cases of gonorrhea in developed
countries have been unchangeable or decreased, but increased
year by year in many developing countries. Cases of
gonorrhea are the first place of all STDs in our country.
5. Clinical symptoms
5.1 Clinic typing
•Uncomplicated gonococcal infection
•Complicated gonococcal infection
•Disseminated gonococcal infection .
5.1 .1.Uncomplicated gonococcal infection
Refer to single infection of genitourinary tract or
other local mucous membrane, including:
•Gonococcal urethritis
•Gonococcal cervicitis
•Gonococcal conjunctivitis
•Gonococcal pharyngitis
•Gonococcal Proctitis
•Child gonorrhea
5.1 .2. Complicated gonococcal infection
With infections of other tissue and organs ,based on
uncomplicated gonococcal infection.
Male gonorrhea complications：gonococcal
prostatitis、seminal vesiculitis、epididymitis、urethral stricture、
balanitis、parafrenal glands adenitis、Skene's gland adenitis, and
so on.
Femal gonorrhea complications：
gonococcal
eustachian salpingitis、pelvic inflammation、abscess of fallopian
tube or ovary、peritonitis、perihepatitis、bartholinitis and
abscess, and so on.
5.1 .2. Disseminated gonococcal
infection
Refer to gonococcus spread to all over the body
through blood to cause bacteremia.
5.2 Clinic
characteristics
5.2 .1. Gonococcal urethritis
•Incubation period 3~5 days。
•Red swelling of urethral meatus，serous or pustular secretion。
•Pruritus and burning heat sensation in urethral tract, pain during
micturition，without urgency of urination、urinary frequency.
•Posterior urethral tract involved in 1-2 weeks in most of patients,
characterized by urinary frequency ， urgency of urination and pain
in urination, hematuria at the end of micturition.
5.2. 2． Gonococcal cervicitis
•Cervix is the most common place involved in female
patients, except urethritis .
•Red swelling of cervix、haphalgesia.
•Pustular leucorrhea increasing .
•Incubation period is often unclear because of no
symptoms.
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急性淋菌性尿道炎
急性淋菌性尿道炎
阴茎系带旁脓肿
急性淋菌性尿道炎
淋菌性宫颈炎
尿道口脓性分泌物
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淋菌性结膜炎
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6.Laboratory examination
•Microscopic examination of smear
•Culture of gonococcus
6.1．Microscopic examination of
smear
The diagnosis is confirmed by the presence of Gramnegative diplococci within polymorphonuclear leukocytes
on stained smears of the male urethral discharge. These
criteria have a sensitivity of 95% .
The presence of Gram-negative diplococci within
polymorphonuclear leukocyte on samples of female
cervical discharge can suggest the diagnosis.
淋病双球菌
6.2．Gonococcus culture
Being applied to all samples from male or female
genitourinary tract and other area. It’s the only
recommended method to finally diagnose gonorrhea .
Doing initial identification according to the form of
colony，Gram staining and oxidase test.
淋球菌培养
7. Diagnosis and Differential Diagnosis
Processing general analysis according to the medical
history，clinical symptoms and laboratory examination.
The examinations of male urethral discharge have initial
diagnostic significance ，but the female samples only have
reference. The latter should be cultured to confirm
gonococcal infection.
8.Prevention and Therapy
1． Treating early and regularly, using corresponding
therapeutics according to different conditions. Follow-up
and cure judgment after treatment.
2．Paying attention to co-infections of chlamydia and
other STD pathogens. Treating sexual partner at the same
time.
3． Paying attention to genital sanitation and insulation.
Sexual intercourse being forbidden during treatment.
4．The treatment of gonococcal urethritis
Spectinomycin 2g（cervicitis 4g），once IM.
Ceftriazone250mg， once IM.
5．The treatment of complicated gonococcal infection
Spectinomycin 2g ，once a day IM, for 10 days.
Ceftriazone250mg， once a day IM, for 10 days.
6．The treatment of disseminated gonococcal
infection .
Ceftriazone1g，once a day IV, for 7
days.
7．Cure criterions：two weeks after the end of
treatment ，without sexually contact：
①Extinction of all the symptoms and signs.
②Negative results of smear and culture at 4-7 days
after the treatment.