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.