Gonorrhea Pathophysiology and Diagnosis

Gonorrhea

• Caused by Neisseria gonorrhoeae, a gram-negative bacterium.
• Risk factors include multiple sexual partners, unprotected sex, and previous STIs.
• Often asymptomatic, but can present with dysuria, increased vaginal or penile discharge, and pelvic pain.
• Diagnostic workup includes NAAT from urine or swabs (vaginal, cervical, urethral).
• Manage with dual antibiotic therapy: ceftriaxone IM and oral azithromycin.
• Emphasize partner notification, condom use, and abstinence until cleared.
• Retest in 3 months due to high reinfection rates.

Chlamydia

• Caused by Chlamydia trachomatis, can lead to pelvic inflammatory disease (PID) if untreated.
• Risk factors consist of unprotected sex and multiple sexual partners.
• Subjective presentations often include abnormal vaginal discharge and dysuria; asymptomatic cases are common.
• Focused physical exam may reveal cervical motion tenderness (CMT) and abnormal discharge.
• Diagnostic method includes NAAT from vaginal or urethral swabs.
• Treat with antibiotics such as azithromycin or doxycycline; ensure treatment of sexual partners.
• Follow-up includes retesting in 3 months.

Trichomonas

• Caused by the parasite Trichomonas vaginalis.
• Risk factors mainly involve unprotected sex.
• Symptoms include frothy, greenish-yellow vaginal discharge, pruritus, and dysuria; may show "strawberry cervix."
• Objective examination may find motile protozoa.
• Management involves a single dose of metronidazole; partners should also be treated.

Syphilis

• Caused by Treponema pallidum; high-risk groups include those with multiple partners, MSM, HIV-positive individuals, and substance users.
• Primary Stage: Painless chancre; may resolve spontaneously in 3-6 weeks if untreated.
• Secondary Stage: Fever, malaise, sore throat, skin rash (especially on palms/soles), mucous membrane lesions, patchy alopecia.
• Tertiary Stage: Neurological symptoms, cardiovascular issues, or gummatous lesions.
• Diagnostic testing includes non-treponemal tests (screening) and treponemal tests (confirmatory and specific).
• Treat primary/secondary syphilis with Benzathine penicillin G; alternatives for allergy include doxycycline or tetracycline.
• For early latent syphilis, benzathine penicillin G is administered weekly for 3 weeks.
• Neurosyphilis is treated with intravenous penicillin G.
• Caution about Jarisch-Herxheimer reaction after treatment, usually in early stages.

Genital Warts

• The most common STI globally; caused by specific low-risk types of HPV (6 and 11).
• Hyperplasia of epithelial cells leads to characteristic warty growths.
• Spread through skin-to-skin contact, notably via sexual activities.
• Risk factors include multiple partners, unprotected sex, early sexual debut, smoking, immunosuppression, and previous STIs.
• Often presents as painless, soft growths on the genitals or anus, usually asymptomatic.
• Diagnosis is primarily clinical; further testing is only required for biopsy or concerns about syphilis.

This quiz covers the essential details about gonorrhea, including its pathophysiology caused by Neisseria gonorrhoeae, risk factors, subjective presentation, and diagnostic workup. Test your knowledge on the symptoms, physical exams, and differentiation from other STIs.