Efi. Gelerstein 2011 Topic 27. Diagnosis and treatment of gonorrhoea Neisseria Gonorrhea Gonorrhea = abnormal flow of semen (Galen) gonos = “seed”, rhoea = “flow” Hunter: autoinoculation with gonococci urethral exudate Neisser: identification of the diplococcal 400,000 cases in the USA in 1995 ↑ resistance to antibiotics Etiologic Agent and Pathogenesis Bacterial infection Only natural reservoir is humans Almost exclusively by sexual intercourse Pathogen : Neisseria gonorrhea (gram (-) diplococci) Demonstration by methylene blue or Gram staining (IC gonococci, kidney shaped in pairs) Clinical Manifestations in Men Incubation time : 2-10 days Symptoms : 1. acute gonococci urethritis (discomfort, dysuria, purulent discharge) 2. 15% asymptomatic → disease spreading 3. Local complications: epididymitis, seminal vesiculitis, prostatitis 4. Chronic gonococci urethritis 5. Extra-genital complications: rectal, oropharyngeal gonorrhea 6. Gonococci ophthalmia neonatorum → 1% silver nitrate eye drops Clinical Manifestations in Women Incubation time : days – weeks Portal entry : urethral orifice, periurethral crypts, Skene’s ducts, Bartholin glands, uterus orifice. Symptoms : 1. Acute salpingitis or dysuria, increased discharge, abnormal bleeding