Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:11

Gonorrhea 641

have sex with men [MSM]), unmarried persons, lower socioeco-

nomic status, urban residence, lower education level, illicit drug use,

prostitution

■Infected carriers with absent or mild symptoms are primary trans-

mitters.

Signs & Symptoms

■Male urethral infection (symptomatic in <95%)

➣Incubation period 2–5 days, typically≤14 days

➣Symptoms: urethral discharge (scant to purulent), dysuria

■Female urogenital infection (symptomatic in 60–80%)

➣Incubation period estimated at 10 days

➣Symptoms: vaginal discharge, dysuria, vaginal bleeding

➣Signs: mucopurulent cervical discharge, friable cervix, urethral

or accessory gland purulence

■Rectal infection

➣Usually asymptomatic, but severe proctitis occurs

➣Symptoms: anal pruritus, anorectal pain, tenesmus, mucopuru-

lent discharge, rectal bleeding

■Pharyngeal infection

➣Majority asymptomatic but exudative pharyngitis occurs

➣Symptoms: fever, sore throat, lymphadenopathy

■Conjunctivitis

➣Ophthalmia neonatorum in neonates, autoinoculation in adults

➣Symptoms: purulent conjunctival discharge

■Disseminated Gonococcal Infection (DGI)

➣Occurs in 0.5–3% of GC infections, mostly in women

➣Caused by organisms that tend to be more resistant to lysis by

complement; AHU auxotype; sensitive to penicillin

➣Symptoms: fever, skin lesions, arthritis, asymptomatic genital

infection

tests

Basic Tests

■Urogenital infection: urinalysis – pyuria, hematuria

Specific Diagnostic Tests

■Gram-stained smears: positive=gram-negative intracellular diplo-

cocci present within leukocytes; specificity of 95–100%; sensitiv-

ity 90–95% in males with symptomatic urethritis; lower in females,

asymptomatic men; not useful for pharyngeal infection