GONORRHEA
Gonorrhea is caused by Neisseria gonorrhoeae, a gram-negative diplococcus.
The long-term sequelae arise from pelvic adhesions, causing chronic pain and
infertility. When the active infection becomes symptomatic, it is known as acute
pelvic inflammatory disease (acute PID). Systemic infection can occur.
Lower genital tract infection may lead to vulvovaginal discharge, itching, and
burning with dysuria or rectal discomfort. Upper genital tract infection leads to
bilateral abdominal-pelvic pain. Disseminated gonorrhea is characterized by
dermatitis, polyarthralgia, and tenosynovitis.
Vulvovaginitis is seen on inspection. Mucopurulent cervical discharge is seen on
speculum exam. Cervical motion tenderness is common with bimanual pelvic
exam. Petechial skin lesions, septic arthritis, and, rarely, endocarditis or
meningitis, may demonstrate with disseminated gonorrhea.
Diagnosis. Nucleic acid amplification test (NAAT) of either cervical discharge
or urine is used.
Management. Single dose of IM ceftriaxone plus a single oral dose of
azithromycin (CDC recommends dual therapy for gonococcus and chlamydia
because of the frequency of coinfection). A Bartholin abscess needs to undergo
incision and drainage with a Word catheter.