Causes and Treatment of Gonorrhea - Essay Example

Gonorrhea Introduction Gonorrhea is a common venereal or sexually transmitted disease which is known in common terminology as Cupid’s disease, Cupid’s Itch, ‘drip’ or ‘clap’. A venereal disease is one, which is of/or related to external sex organs. The occurrence of the diseases has gone down considerably but it still afflicts about 600,000 men and women in the United States every year (Planned Parenthood website). Etiology & Pathogenesis Gonorrhea is caused by a bacterium called Neisseria gonorrhoeae which is Gram negative and aerobic. The causative agent of gonorrhea was first described by A. Neisser in 1879, in the pustular exudate from a case. The organism was grown as a pure culture in 1885, and its etiological relationship to human disease was later established using human volunteers (Todar, 2004). Infections are acquired by sexual contact and usually affect the mucous membranes of the urethra in males and the endocervix and urethra in females, although the infection may disseminate to a variety of tissues. The pathogenic mechanism involves the attachment of the bacterium to nonciliated epithelial cells of the host. The bacteria adhere to columnar epithelial cells of the mucous membranes in the reproductive tract in both males and females and after penetration multiply on the basement membrane. Adherence is mediated through fimbriae and certain proteins. Nonspecific factors such as surface charge and hydrophobicity may play a role. Fimbriae undergo both phase and antigenic variation. The bacteria attach only to microvilli of nonciliated columnar epithelial cells. The disease is usually transmitted through sexual contact but it can also be transmitted from the mother to the unborn fetus. Anal sex with an infected partner may result in gonorrhea of the rectum and may cause discomfort around the anus and a discharge from the rectum. The area around the anus may become red and raw, and the stool may be coated with mucus and pus. Oral sex with an infected partner may result in gonorrhea of the throat (gonococcal pharyngitis). Usually, the infection produces no symptoms, but sometimes it causes a sore throat and discomfort during swallowing. If infected fluids come into contact with the eyes, gonococcal conjunctivitis may develop causing swelling of the eyelids and a discharge of pus from the eyes. A pregnant woman with gonorrhea can infect the eyes of her baby after birth. In adults, often only one eye is affected. Newborns usually have infection in both eyes. Blindness may result if the infection is not treated early. Gonorrhea in infant and young girls is usually the result of sexual abuse by adults or teens. In some people, gonorrhea spreads through the bloodstream to one or more joints, causing them to become swollen, tender, and extremely painful. A bloodstream infection may also cause fever, pain in the joints and the formation of red pus-filled spots on the skin (arthritis-dermatitis syndrome). Heart may become infected (endocarditis). Infection of the covering of the liver (perihepatitis) causes pain in the upper right part of the abdomen similar to that of gallbladder disease. Symptoms In men, symptoms usually appear after 2-7 days post infection. There is mild discomfort in the urethra initially followed by mild to severe pain during urination. Pus is excreted in urine and there is an increased frequency of urination. The penile opening usually reddens and there is a swelling in the area. However, in women, the symptoms are mild and may not appear for weeks or months. If any symptoms occur, they usually appear 7 to 21 days post infection and are mild. Some women may experience severe symptoms like frequent urination, pain while urinating, discharge from the vagina and fever. Female reproductive organs like the cervix, uterus, fallopian tubes, ovaries, urethra, and rectum may be infected, causing tenderness and severe deep pelvic pain, especially during intercourse. Pus, which appears to come from the vagina, usually comes from the cervix, urethra, or glands near the vaginal opening. Diagnosis N. gonorrhoeae is a relatively fragile organism, susceptible to temperature changes, drying, uv light, and other environmental conditions. It can be diagnosed by growing strains of N. gonorrhoeae in media plated on modified Thayer-Martin (MTM) agar or New York City (NYC) agar. These media are selective for the growth of N. gonorrhoeae. MTM is chocolate agar (heated sheep blood agar) containing colistin to inhibit the growth of gram negative bacilli, Nystatin or Anisomycin to inhibit yeast, Vancomycin to inhibit growth of gram-positive bacteria, and Trimethoprim to inhibit Proteus spp. NYC agar contains Amphotericin B instead of Nystatin and consists of clear proteose-peptone supplemented agar. In addition, the sample is plated on either 5% sheep blood agar or Columbia agar with 5% sheep blood and Colistin and Nalidixic acid to isolate Candida albicans which causes a yeast infection in the vagina and Gardnerella vaginalis which causes vaginosis as well. Plates are incubated at 96.8°F in 5–10% carbon dioxide. MTM or NYC agar are examined for growth at 24 hours and if negative again at 48 hours. After 24 hours, any suspicious colonies are Gram-stained and tested for oxidase which provides presumptive identification of Neisseria if positive (enotes.com). Resistance Not everyone exposed to the causative organism acquires the disease (Todar, 2004). This may be due to variations in the size or virulence of the inoculum, to natural resistance, or to specific immunity. Nonspecific factors have been implicated in natural resistance to gonococcal infection. In women, changes in the genital pH and hormones may increase resistance to infection at certain times of the menstrual cycle. Urine contains bactericidal and bacteriostatic components against Neisseria gonorrhoeae. Factors in urine that may be important are pH, osmolarity, and the concentration of urea. The variability in the susceptibility of gonococcal strains to the bactericidal and bacteriostatic properties of urine is thought to be one of the reasons some males apparently do not develop a gonorrhea infection when exposed. Treatment Gonorrhea is a readily preventable as well as treatable disease provided it is diagnosed early and treatment initiated at the earliest. It is readily treated by the administration of a single injection of Ceftriaxone, Cefixime, Levofloxacin, Ciprofloxacin, Ofloxacin antibiotics (Merck.com). As Gonorrhea infection is usually accompanied by concurrent infection with Chlamydia, a fungal infection, it might require a week long treatment with the oral antibiotic like Doxycycline or Levofloxacin. A single dose of Azithromycin is very effective in treating both infections. If gonorrhea has spread through the bloodstream, the person usually is treated in the hospital with intravenous antibiotics. Recurrence can occur and needs thorough treatment with antibiotics. References: Gonorrhea, Available at: http://www.merck.com/mmhe/sec17/ch200/ch200c.html Gonorrhea, Available at: http://www.plannedparenthood.org/health-topics/stds-hiv-safer-sex/gonorrhea-4269.htm Sexually Transmitted Diseases > Gonorrhea, Available at: http://www.cdc.gov/std/Gonorrhea/default.htm Sexually Transmitted Diseases Cultures. Available at: http://www.enotes.com/nursing-encyclopedia/sexually-transmitted-diseases-cultures Todars Online Textbook of Bacteriology. Available at: http://www.textbookofbacteriology.net/neisseria.html Read More