Neisseria gonorrhoeae - Revision history

Aidan at 14:34, 9 February 2022

2022-02-09T14:34:38Z

← Older revision		Revision as of 14:34, 9 February 2022
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	===Microbiology===		===Microbiology===

	*[[Stain::Gram-negative]] [[Shape::diplococcus]]		*[[Stain::Gram-negative]] [[Shape::diplococcus]] within the genus [[Genus::Neisseria]]
	*Resistance		*Resistance
	**MDR gonorrhea: resistance to one of [[azithromycin]] or a [[cephalosporin]]		**MDR gonorrhea: resistance to one of [[azithromycin]] or a [[cephalosporin]]

Aidan at 14:10, 9 February 2022

2022-02-09T14:10:06Z

← Older revision		Revision as of 14:10, 9 February 2022
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	*Occurs in about 1% of patients with gonorrhea, and most strains do not cause urethritis		*Occurs in about 1% of patients with gonorrhea, and most strains do not cause urethritis
			**Risk factors include female sex, menstruation, pregnancy, and [[terminal complement deficiency]]
	*Classically presents with either septic arthritis, or with a triad of tenosynovitis (often of wrists) dermatitis (with pustular lesions), and arthritis		*Classically presents with either septic arthritis, or with a triad of tenosynovitis (often of wrists) dermatitis (with pustular lesions), and arthritis
	*Diagnosed with genital testing for gonorrhea, ± blood cultures or arthrocentesis		*Diagnosed with genital testing for gonorrhea, ± blood cultures or arthrocentesis

Aidan at 14:05, 9 February 2022

2022-02-09T14:05:27Z

← Older revision		Revision as of 14:05, 9 February 2022
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	==Clinical Manifestations==		==Clinical Manifestations==

			=== Genital Infections ===
⚫	===Anorectal Gonorrhea===

			* Causes [[cervicitis]] and [[urethritis]]
			* In women, up to 70% are asymptomatic
			** In symptomatic women, the incubation period is about [[Usual incubation period::10 days]], followed by vaginal pruritis or mucopurulent discharge
			** May have intermenstrual bleeding or menorrhagia
			* In men and women with [[urethritis]], it is usually asymptomatic
			** Incubation period is usually about [[Usual incubation period::3 to 5 days]], followed by urethral discharge and dysuria
			* [[Epididymitis]] in men is more commonly caused by [[Chlamydia trachomatis]]

			=== Pelvic Inflammatory Disease ===

			* See [[Pelvic inflammatory disease]], of which about 40% of cases are caused by ''Neisseria gonorrhoeae''
			* Pelvic and abdominal pain, vaginal bleeding, and [[dyspareunia]]
			* May be febrile and acutely unwell

			=== Fitz-Hugh-Curtis Syndrome ===

			* Aka perihepatitis, with inflammation of Glisson's capsule around the liver
			* More often associated with [[Chlamydia trachomatis]]

			=== Bartholinitis ===

			* Inflammation of Bartholin's glands, which are behind the labia
			* Labial pain, swelling, tenderness, and discharge

		⚫	=== Anorectal Gonorrhea ===
	*Often asymptomatic		*Often asymptomatic
	*Can cause anorectal pain, discharge, and pruritis		*Can cause anorectal pain, discharge, and pruritis
	*Anal intercourse not required, especially in women		*Anal intercourse not required, especially in women

			=== Pharyngitis ===

	===Disseminated Gonococcal Infection===		===Disseminated Gonococcal Infection===

			*Occurs in about 1% of patients with gonorrhea, and most strains do not cause urethritis
	*Classically presents with tenosynovitis (often of wrists) ~~or frank arthritis,~~ with pustular lesions		*Classically presents with either septic arthritis, or with a triad of tenosynovitis (often of wrists) dermatitis (with pustular lesions), and arthritis
	*Diagnosed with genital testing for gonorrhea, ± blood cultures or arthrocentesis		*Diagnosed with genital testing for gonorrhea, ± blood cultures or arthrocentesis
			*Other (rare) sites of dissemination include [[endocarditis]], [[meningitis]], and [[osteomyelitis]]

			=== Conjunctivitis ===

			* Occurs in infants born to untreated, infected mothers, and rarely from spread by fomites or flies

	==Differential Diagnosis==		==Differential Diagnosis==

	*Other causes of [[urethritis]] or [[septic arthritis]]		*Other causes of [[urethritis]] or [[septic arthritis]] or [[proctitis]]

	==Management==		==Management==

Aidan at 13:47, 9 February 2022

2022-02-09T13:47:06Z

← Older revision		Revision as of 13:47, 9 February 2022
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	==Clinical Manifestations==		==Clinical Manifestations==

	===Anorectal ~~gonorrhea~~===		===Anorectal Gonorrhea===

	*Often asymptomatic		*Often asymptomatic
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	*Anal intercourse not required, especially in women		*Anal intercourse not required, especially in women

	===Disseminated ~~gonococcal~~ ~~infection~~===		===Disseminated Gonococcal Infection===

	*Classically presents with tenosynovitis (often of wrists) or frank arthritis, with pustular lesions		*Classically presents with tenosynovitis (often of wrists) or frank arthritis, with pustular lesions

Aidan: /* Management */

2020-12-03T16:03:44Z

Management

← Older revision		Revision as of 16:03, 3 December 2020
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	**First-line: [[ceftriaxone]] 250 mg IM once plus [[azithromycin]] 1 g PO once		**First-line: [[ceftriaxone]] 250 mg IM once plus [[azithromycin]] 1 g PO once
	**Second-line: [[gentamicin]] 240 mg IM once (in 2 doses) plus [[azithromycin]] 2 g PO once		**Second-line: [[gentamicin]] 240 mg IM once (in 2 doses) plus [[azithromycin]] 2 g PO once
	**Second-line: [[ciprofloxacin]] 500 mg PO once plus azithromycin 2 g PO once		**Second-line: [[ciprofloxacin]] 500 mg PO once plus [[azithromycin]] 2 g PO once
	*Disseminated gonococcal infection		*Disseminated gonococcal infection
	**Arthritis: [[ceftriaxone]] 2 g IV q24h for 7 days, plus [[azithromycin]] 1 g PO once		**Arthritis: [[ceftriaxone]] 2 g IV q24h for 7 days, plus [[azithromycin]] 1 g PO once

Aidan: Text replacement - "[[Cellular shape::" to "[[Shape::"

2020-10-11T04:02:47Z

Text replacement - "[[Cellular shape::" to "[[Shape::"

← Older revision		Revision as of 04:02, 11 October 2020
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	===Microbiology===		===Microbiology===

	*[[Stain::Gram-negative]] [[~~Cellular shape~~::diplococcus]]		*[[Stain::Gram-negative]] [[Shape::diplococcus]]
	*Resistance		*Resistance
	**MDR gonorrhea: resistance to one of [[azithromycin]] or a [[cephalosporin]]		**MDR gonorrhea: resistance to one of [[azithromycin]] or a [[cephalosporin]]

Aidan: /* Mechanisms of Resistance */

2020-09-22T14:48:41Z

Mechanisms of Resistance

← Older revision		Revision as of 14:48, 22 September 2020
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	**XDR gonorrhea is still rare in Canada [[CiteRef::martin2019mu]]		**XDR gonorrhea is still rare in Canada [[CiteRef::martin2019mu]]

	=== Mechanisms of Resistance ===		===Mechanisms of Resistance===

	* [[β-lactamases]], most commonly a TEM-1-type contained on a Pc<sup>R</sup> plasmid		*[[β-lactamases]], most commonly a TEM-1-type contained on a Pc<sup>R</sup> plasmid
			*Altered [[penicillin-binding protein]] PBP-2, encoded by ''penA''
			*Altered or downregulated porins, encoded by ''penB''
			*Increased efflux pump, encoded by ''mtr''

	==Clinical Manifestations==		==Clinical Manifestations==

Aidan at 14:47, 22 September 2020

2020-09-22T14:47:32Z

← Older revision		Revision as of 14:47, 22 September 2020
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	**Rates of MDR gonorrhea is increasing in Canada, mostly driven by [[azithromycin]] resistance		**Rates of MDR gonorrhea is increasing in Canada, mostly driven by [[azithromycin]] resistance
	**XDR gonorrhea is still rare in Canada [[CiteRef::martin2019mu]]		**XDR gonorrhea is still rare in Canada [[CiteRef::martin2019mu]]

			=== Mechanisms of Resistance ===

			* [[β-lactamases]], most commonly a TEM-1-type contained on a Pc<sup>R</sup> plasmid

	==Clinical Manifestations==		==Clinical Manifestations==

Aidan: /* Management */

2020-09-10T20:26:43Z

Management

← Older revision		Revision as of 20:26, 10 September 2020
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	== Background ==		==Background==

	*Causes '''gonorrhea'''		*Causes '''gonorrhea'''

	=== Microbiology ===		===Microbiology===

	* [[Stain::Gram-negative]] [[Cellular shape::diplococcus]]		*[[Stain::Gram-negative]] [[Cellular shape::diplococcus]]
	* Resistance		*Resistance
	**MDR gonorrhea: resistance to one of [[azithromycin]] or a [[cephalosporin]]		**MDR gonorrhea: resistance to one of [[azithromycin]] or a [[cephalosporin]]
	**XDR if resistance to both [[azithromycin]] and a [[cephalosporin]]		**XDR if resistance to both [[azithromycin]] and a [[cephalosporin]]
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	==Management==		==Management==

			*Anogenital and pharyngeal infection in people ≥9 years of age
	*Urethritis
	**First-line: [[ceftriaxone]] 250 mg IM once plus [[azithromycin]] 1 g PO once		**First-line: [[ceftriaxone]] 250 mg IM once plus [[azithromycin]] 1 g PO once
	**Second-line: [[gentamicin]] 240 mg IM once (in 2 doses) plus [[azithromycin]] 2 g PO once		**Second-line: [[gentamicin]] 240 mg IM once (in 2 doses) plus [[azithromycin]] 2 g PO once
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	*Repeat screening at 6 months		*Repeat screening at 6 months

	=== Test of Cure ===		===Test of Cure===

	* Done at 3 to 7 days if by culture or 14 to 21 days if NAAT		*Done at 3 to 7 days if by culture or 14 to 21 days if NAAT
	* Indications include:		*Indications include:
	** Pharyngeal infection		**Pharyngeal infection
	** Persistent signs or symptoms		**Persistent signs or symptoms
	** Treated without ceftriaxone		**Treated without ceftriaxone
	** Treated with fluoroquinolone, without susceptibility testing		**Treated with fluoroquinolone, without susceptibility testing
	** Epidemiologic link to a resistant case		**Epidemiologic link to a resistant case
	** Documented microbiologic resistance		**Documented microbiologic resistance
	** Epidemiologic link to treatment failure		**Epidemiologic link to treatment failure
	** Previous treatment failure		**Previous treatment failure
	** Uncertain adherence to treatment		**Uncertain adherence to treatment
	** Reexposure to untreated partener		**Reexposure to untreated partener
	** Pregnancy		**Pregnancy
	** Disseminated gonococcal infection		**Disseminated gonococcal infection
	** Pediatric patient		**Pediatric patient
	** [[Pelvic inflammatory disease]] with documented gonorrhea		**[[Pelvic inflammatory disease]] with documented gonorrhea
	** Therapeutic abortion (increased risk of developing PID)		**Therapeutic abortion (increased risk of developing PID)

	==Further Reading==		==Further Reading==

Aidan at 22:35, 28 August 2020

2020-08-28T22:35:41Z

@@ Line 1: / Line 1: @@
 *Causes '''gonorrhea'''
 *Resistance
@@ Line 21: / Line 30: @@
 *Diagnosed with genital testing for gonorrhea, ± blood cultures or arthrocentesis
-== Differential Diagnosis ==
+==Differential Diagnosis==
-* Other causes of [[urethritis]] or [[septic arthritis]]
+*Other causes of [[urethritis]] or [[septic arthritis]]
-==Diagnosis==
+==Management==
-**MDR gonorrhea: resistance to one of azithromycin or a cephalosporin
+**First-line: [[ceftriaxone]] 250 mg IM once plus [[azithromycin]] 1 g PO once
-== Management ==
+=== Test of Cure ===
 ==Further Reading==