GONORRHEA

DEFINITION

Gonorrhea is a disease of sexually transmitted infections (STI) caused by the bacterium Neisseria gonorrhoeae, gram negative bacteria diplokokkus who made man as the intermediary. For several centuries, a variety of names have been used to describe infections caused by N.




This gonorrhoeae, including; 'strangury' used by Hippocrates, the naming of gonorrhea itself given by Galen (130 BC) to describe the nature of urethral exudate as the tears flow (flow of seed) and M. Neisser, introduced by Albert Neisser, who discovered it in 1879 micro-organisms from staining smears taken from the vagina, urethra and conjunctival exudate.
Cultures of bacterial N. gonorrhoeae was first reported by Leistikow and Löffler in 1882 and was developed in 1964 by Thayer and Martin, who found a selective culture medium for special. Thayer-Martin media is selective media to isolate gonokok. Containing vancomycin to suppress growth of Gram-positive bacteria, kolimestat to suppress the growth of Gram-negative bacteria and nystatin to suppress the growth of fungi.
In most cases of transmission through unprotected sex is a genito-genital, oro-genital and ano-genital. But in addition it can also occur manually through the tools, clothing, towels, thermometer.
N. gonorrhoeae knows no racial, social, economic or geographical conditions. Men, women both adults and children can be infected with this disease. The global spread of this infection is supported by human habits that helped the move to increase resistance factor.


EPIDEMIOLOGY
The infection is transmitted through sexual intercourse, can also be transmitted to the fetus during the birth process in progress. Although all groups vulnerable to infection of this disease, but its highest incidence in the age range 15-35 years. Among the female population in 2000, the highest incidence occurred at age 15 -19 years (715.6 per 100,000) opposite to the male average of the highest incidence occurred at age 20-24 years (589.7 per 100,000).
N. Epidemiology gonorrhoeae is different in each - each developing country. In Sweden, the incidence of gonorrhea reported 487/100.000 as many people who suffer in 1970. In 1987, reportedly as many as 31/100.000 people who suffer, in 1994 reported gonorrhea patients declining at only about 31/100.000 people who suffer.
In the United States, the incidence of gonorrhea cases decreased. In 1975 reported 473/100.000 people who suffer, where the figures show that cases of gonorrhea in the United States has decreased until 1984.
Risk factors:
- Sexual relations with patients without protection
- Have many sexual partners
- In infants - while passing through the birth from an infected mother
- In children - sexual abuse (sexual abuse) by the infected patient.

ETIOLOGY
N. gonorrhoeae is a bacteria that can not move, no spores, types of gram-negative diplococcus with size from 0.8 to 1.6 micro. Gonococcus bacteria are not resistant to moisture, which tends to affect sexual transmission.
These bacteria are resistant to oxygen but usually requires 2-10% in growth in atmospheric CO2. These bacteria need iron to grow and get it through transferrin, lactoferrin and hemoglobin. These organisms can not live in dry areas and low temperatures, grows optimally at 35-37o and pH 7.2 to 7.6 for optimal growth.
Gonococcus consists of 4 morphology, type 1 and 2 are pathogenic and type 3 and 4 non-pathogenic. Type 1 and 2 have pili that are virulent and there on the surface, while type 3 and 4 do not have filli and non-virulent. Pili will be attached to the mucosal epithelium and will cause an inflammatory reaction.

Neisseria Gonorrhoeae

PATHOGENESIS
Despite a considerable increase in knowledge about the pathogenesis of microorganisms, the exact molecular mechanisms of invasion gonococcus into the host cell remains unknown. There are several virulence factors involved in the mechanism of adhesion, and invasion of mucosal inflammation. Pili play an important role in the pathogenesis of gonorrhea. Pili enhance adhesion to host cells, which may be the reason why gonococcus who do not have pili are less able to infect humans. Antibodies antipili block epithelial adhesion and enhance the ability of phagocytic cells. Also note that the expression of transferrin receptor plays an important role and expression of full-length lipo-Oligosaccharides (LOS) appears necessary for maximal infection.
The area is most easily infected columnar epithelial area of the urethra and endocervix, glands and ducts parauretra in men and women, Bartolini glands, eye conjunctiva and rectum. Primary infection occurring in women who have puberty occurs in squamous epithelium of the vagina.

DIAGNOSIS
Gonorrhea incubation period is very short, varying between 2-10 days, occasionally longer, with most symptoms usually appear 2-5 days after being infected by patients. In a small number of cases can be asymptomatic for several months. Signs, symptoms and complications differ in men and women. Unknown 10% of men and 50% of women are asymptomatic.

In the male genitourinary tract can be found:
a. urethral infection in the urethra which usually cause discharge mukopurulen or purulent (> 80%) and / or dysuria (> 50%)
b. epidydymal unilateral tenderness and edema
c. anal infection: itching in the anal region
d. Oral infections: possible without symptoms or sore throat
At the bottom of the female genitourinary tract:
a. discharge mukopurulen or purulent cervical
b. discharge vagina or bleeding; vulvaginitis in children
At the top female genitourinary tract:
a. PID (Pelvic inflamatory Diseases)
b. lower stomach pain
c. fever
Other symptoms:
a. discharge who mukopurulen or purulent rectal
b. oropharyngeal-pharyngitis
c. purulent conjunctivitis eyes
d. GDI (Gonorrheal Disseminated Infection):
- Fever (usually <390c)> 45 kg: same as adult dose
c. Ciprofloxacin 500 mg orally as a single dose. In children not recommended.
The recommended treatment for gonorrhea clamidia accompanied by infection, because of the possibility of simultaneously clamidia infection with gonorrhea, patients were also given a single dose of azithromycin 1 gram or doxycycline 100 mg can be given for 7 days. For pregnant women, given erythromycin 500 mg 4 times daily for 7 days or if erythromycin not tolerated to diberian amoxicillin 500 mg 3 times daily for 7-10 days.
Treatment in special situations, for example:
a. Pregnant / lactating
In pregnant women can not be given drug class quinolones and tetracyclines. The recommended is the provision of cephalosporin class of drugs (Ceftriaxone 250 mg IM as single dose). If a pregnant woman is allergic to penicillin or cephalosporins can not be tolerated should be given Spektinomisin 2 g IM as single dose. In pregnant women can also be given Amoxicillin 2 g or 3 g orally with the addition of probenecid 1 g orally as a single dose given during isolation N. gonorrhoeae that are sensitive to penicillin. Amoxicillin is recommended fatherly treatment if accompanied by infection of C. trachomatis.
b. Disseminated Gonococcal Infection (DGI)
Given parenteral therapy 24-48 hours, after no improvement was replaced with oral regimens given for 1 week:
- Initial regimen given Ceftriaxone 1 g IM or IV per 24 hours
- Alternative regimens that can be given as follows:
§ Sefotaksim 1 g IV per 8 hours
§ Seftisoksim 1 g IV per 8 hours
§ Ciprofloxacin 400 mg IV per 12 hours
§ Olflosaksin 400 mg IV per 12 hours
§ levofloxacin 250 mg IV per 24 hours
§ Spektinomisin 2 g IM per 12 hours
- Oral regimen given after a repair:
§ cefixime 400 mg 2 times a day
§ Ciprofloxacin 500 mg 2 times a day
§ ofloxacin 400 mg 2 times a day
§ levofloxacin 500 mg once daily
c. Ophtalmia neonatorum
The recommended regimen is Ceftriaxone 25-50 mg / kg IV or IM as a single dose, dose no more than 125 mg.

COMPLICATIONS
Complications are:
a. urethra is scarred or spots on the possibility of leading to a decline in male fertility or bladder obstruction
b. grated or spots on the upper reproductive tract in women with PID (pelvic inflammatory disease) may lead to infertility, chronic pelvic pain and ectopic pregnancy
c. the possibility of premature birth, neonatal infection and miscarriage due to infection in pregnant women gonococcus
d. the grater in the cornea and permanent blindness due to infection in the eye gonococcus
e. of sepsis in newborns because of gonorrhea in women
f. advanced neurologic abnormalities due to meningitis gonococcal
g. destruction of the articular joint surface
h. destruction of heart valves
i. CHF or death from meningitis

PROGNOSIS
Prognosis in patients with gonorrhea depend quickly detected and treated disease. Patients may recover completely if done early and complete treatment. But if treatment is given too late, it's likely to cause further complications.

CONCLUSION
Gonorrhea is a bacterial infectious disease caused by bacteria N. gonorrhoeae. The disease is classified as Sexually Transmitted Diseases (STDs) because in most cases these infections occur through sexual contacts. In men generally causes temporary acute urethritis in women is usually asymptomatic. Diagnosis by elementary anamnesis, clinical examination, examination of smear preparation and examination of bacterial culture. Usually the group of patients treated with antibiotics and a good prognosis if therapy is quickly given.

Refferences

1. http://www.handsofhopegallup.com

2. http://www.irwanashari.com

3. http://www.soc.ucsb.ed

4. http://www.emedicinehealth.com