All time low reported cases in 2004 at 330,132.

In 2019 there was 616,392 cases of gonoccal infections corresponding to a rate of 188.4 cases per hundred thousand persons.

A declining cause of sexually transmitted disease.

Rate of infection in blacks 19 times greater than whites in 2004.

Second most commonly reported notifiable disease in the U.S.

Neisseria gonorrhoeae a Gram negative diplococci.

Most common cause is sexual contact.

A major cause of pelvic inflammatory disease, ectopic pregnancy, and infertility.

A common cause of urethritis in men and cervicitis in women.

Can facilitate human immunodeficiency virus transmission.

Disseminated gonococcal infection is reported in 1 to 3% of patients with gonorrhea.

Cutaneous findings are reported in 50 to 75% of patients with bacteria.

Individuals at highest risk are sexually active persons under the age of 30 years.

Highest rates of infection in men occur between 20-24 years of age and in women 15-24 years of age.

At an all time low at this time but it is endemic in low socioeconomic areas.

Affects populations such as minorities who are marginalized because of race, sexual orientation or ethnic group.

High prevalence in female sex workers.

Recommended to screen all sexually active women at risk for infection.

Screening is with a nucleic acid amplification test and patients at risk include those with new or multiple sex partners, inconsistent condom use and people not in a monogamous relationship, previous or concurrent sexual transmitted infection and exchanging sex for money.

Not recommended to screen men or women at low risk for infection.

N gonorrhoeae often found in intracellularly in purulent discharges.

Untreated disease can cause pelvic inflammatory disease in women and epididymitis in men.

Men with history of infection have a 2 fold increased risk of bladder cancer.

Infections typically involve the urinary tract they can involve the mouth, rectum and joints.

Uncommon complication includes prostatitis.

Usually asymptomatic and often discovered on screening tests and when a sexual partner has symptoms.

Gonorrhea may infect the oral pharynx, rectum, eye, and urogenital tract in both sexes.

Dissemination beyond genital and extra genital sites may occur.

Between 86 and 92% of urogenital infections among women with gonorrhea may be asymptomatic, and a similar number are asymptomatic among men.

Among men and women 53 to 100% of extra genital infections are asymptomatic.

Symptoms can take up to 30 days to manifest.

An incubation period  generally 2 to 8 days.

In men urethritis symptoms typically occur 1-14 days after exposure with complaints of dysuria and urethral discharge.

In approximately one third of patients not treated for the disease can develop epididymitis and can involve other surrounding genitourinary structures.

Epididymitis can lead to infertility.

Symptoms of disease often mild in female patients.

Symptomatic women may report vaginal discharge, vaginal pruritus, intermenstrual bleeding, or menorrhagia, and abdominal pain and dyspareunia suggest pelvic inflammatory disease.

Can cause symptoms in women from the outer to inner genitourinary tract.

One of the most frequent causes of Bartholin gland abscesses.

Rectal gonorrhea is caused by Neisseria gonorrhoeae, also Neisseria meninigitidis, is a condition is usually asymptomatic.

Rectal gonorrhea symptoms can include rectal discharge, which can be creamy, purulent or bloody, pruritus ani, tenesmus, and possibly constipation.

When symptomatic, these usually appear 5-7 days post exposure.

Discharge is the most common symptom, and it is usually a brownish mucopurulent consistency.

Gonococcal conjunctivitis occurs in infants born to infected mothers.

In adults gonococcal conjunctivitis is frequently due to auto inoculation.

Symptomatic gonococcal pharyngitis because sore throat, exudates and cervical lymphadenitis.

Gonococcal proctitis can cause pain, bleeding, tenesmus mucopurulent discharge.

Disseminated gonococcal infection can cause purulent arthritis or tenosynovitis, dermatitis, and polyarthralgias.

Nucleic acid amplification tests have sensitivities of more than 90% and specificities of 98% for detecting gonorrhea on genital an extra genital sites, respectively.

In women, the preferred specimen is a vaginal swab, but endocervical swabs and first catch urine are acceptable.

In men the preferred specimen is a first catch urine, but urethral swabs are also acceptable.

Among men who have sex with men, there is a high percentage of infection only at extragenital sites, recommendation is to test for gonorrhea in MSM at all sites of exposure.

Among women 6 to 50% of G gonococcal infections are only detected in extra genital sites.

Culture sensitivity protecting gonorrhea infection is 50 to 85%, with lower sensitivity and extra genital sites in among people who are asymptomatic.

Cultures are necessary to test for antimicrobial susceptibility.

Annual screening for gonorrhea is recommended for sexually active women younger  than 25 years and for other groups based on selective characteristics or risk factors.

Increased resistance to fluoroquinolones has resulted in withdrawal of the recommendation for its use in gonococcal infections.

Cephalosporins previously recommended for treatment.

Cephalosporin therapy with adjuvant azithromycin or doxycycline is recommended for treatment of gonorrhea.

Cefixime is the only oral cephalosporin recommended for gonorrhea treatment, but it is no longer recommended as front-line therapy due to the development of resistance and clinical failure.

Declining cephalosporin susceptibility and increasing treatment failures are being reported in Asia, Europe and now the US, with minimum inhibitory concentrations increasing.

The proportion of isolates for which minimal inhibitory concentration of cefixime is elevated as increased by 17 times from 0.1% in 2006 to 1.7% in the 1st 6 months of 2011.

Reduced susceptibility to cephalosporins is a result of chromosomal gene mutations, including mutations in penA, the gene that encodes penicillin binding protein 2 (PBP2), penB affecting drug entry through and out of protein channel (PorB1b) and mtrR, a repressor of the MtrCDE- encoded pump.

Presently ceftriaxone and azithromycin are recommended agents for treatment.

Gentamicin is recommended for those intolerant to cephalosporins.

Presently, ceftriaxone 250 mg parentally is the most effective agent in curing gonococcal infections at genital and extra general sites, and should be given with 1 g of oral azithromycin to cover other copathogens and to provide another antimicrobial with activity against N gonorrhoeae at a different molecular target.

In patients with allergies to cephalosporins 2 g of azithromycin orally is adequate.

All patients treated for gonorrhea should be utilizing condoms, referred  for risk reduction counseling and retested for gonorrhea 3 months later.

Sexual partners of patients with whom the patient had sexual contact in the previous 2 months should be treated with ceftriaxone and azithromycin.

Gonorrhea is a risk marker for HIV infection, and all patients treated for gonorrhea and tested for HIV, and for those who are negative retesting should occur in 3 to 6 months.

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