This one of the commonest STD's and can lead to complications that may severely affect sexual function.
Epidemiology
Causative Organism : Neisseria gonorrhoea
Incubation Period : 2 to 10 days
Pathogenesis
The organisms attach to the glands of Skene, Bartholin, Urethra and it Glands, Cervix and fallopian tubes.
They get attached to the sperms and travel to the fallopian tubes.
Principal Sites of Invasion :
- Columnar epithelium of the Genital Track
- Transitional epithelium.
Infection Rates: 35% for men and 75% for women.
Clinical Features and Diagnosis
Asymptomatic in many cases.
Vulvovaginal infection may result in inflammation, discharge and irritation.
On examination it can be seen that the external genitalia are red and swollen. They are painful. There is purulent vaginal discharge, dysuria, vaginitis and endocervicitis.
Late Clinical features include Bartholinitis, abscess, Bartholins cyst, Tubo-Ovarian Abscess, Pyosalphinx, Hydrosalphinx and Blocked tubes.
In the past this was one of the prime causes of neonatal ophthalmitis occurring in newborns born to infected mothers. Instilling all neonates with sulphacetamide/antibiotic eye drops has led to a decline in this condition.
Investigations
- Gram stain prepared from the smear.
- Culture on Thayer-Martin Medium or blood agar.
Complications
- Pelvic Inflammatory Disease
- Pyosalpinx
- Tubo-ovarian absecess
- Pelvic Abscess
- Hydrosalpinx
- Infertility
- Menstrual Disturbances
- Chronic Pelvic Pain
- Dysmenorrhoea
- Dyspareunia
Treatment
( Consult your Doctor for the latest drug Regimes and Dosages )
- Inj Cefoxitin IM + Probenecid
- Ceftriaxone IM + Probenecid
- Oral ofloxacin
- Treat the male partner as well.
Brief History of the Disease
Historically it has been suggested that mercury was used as a treatment for gonorrhea. Surgeons tools on board the recovered English warship the Mary Rose included a syringe that, according to some, was used to inject the mercury via the urinary meatus into any unfortunate crewman suffering from gonorrhea. The name "the clap", in reference to the disease, is recorded as early as the sixteenth century.
Silver nitrate was one of the widely used drugs in the 19th century, but it became replaced by Protargol. Arthur Eichengrün invented this type of colloidal silver which was marketed by Bayer from 1897 on. The silver-based treatment was used until the first antibiotics came into use in the 1940s.
The exact time of onset of gonorrhea as prevalent disease or epidemic cannot be accurately determined from the historical record. One of the first reliable notations occur in the Acts of the (English) Parliament, In 1161 this body passed a law to reduce the spread of "...the perilous infirmity of burning." The symptoms described are consistent with, but not diagnostic of, gonorrhea. A similar decree was passed by Louis IX in France in 1256, replacing regulation with banishment. Similar symptoms were noted at the siege of Acre by Crusaders.
Coincidental to, or dependent on, the appearance of a gonorrhea epidemic, several changes occurred in European medieval society. Cities hired public health doctors to treat afflicted patients without right of refusal. Pope Boniface rescinded the requirement that physicians complete studies for the lower orders of the Catholic priesthood.
Medieval public health physicians in the employ of their cities were required to treat prostitutes infected with the "burning", as well as lepers and other epidemic victims. After Pope Boniface completely secularized the practice of medicine, physicians were more willing to treat a sexually transmitted disease.
