N. gonorrhoeae is a gram-negative bacterium that is transmittedprimarily through sexual contact. Infection can also occur in neonates as a result of contact during birth. N. gonorrhoeae can cause mucosal, local, or disseminated infection. Asymptomatic infection is somewhat common.
Gonorrhea most frequently manifests with local manifestations. In men, urethritis and epididymitis are the most common symp-toms. Gonorrhea is more likely to be asymptomatic in women than in men. The uterine cervix is the primary site of local infec-tion, and symptoms often include urinary tract infection, increased vaginal discharge, and itching. The most common complication of localized gonococcal infection in women is pelvic inflamma-tory disease (PID), in which the organism infects the uterus, fal-lopian tubes, or peritoneal fluid. A complication of gonococcal PID is increased risk for ectopic pregnancy and bilateral tubal occlusion, which results in infertility.
In rare circumstances, the organism may disseminate in un-treated, infected people. Other systemic signs, such as arthritis or dermatitis, can accompany bacteremia. In rare instances, valves of the heart can be infected with N. gonorrhoeae, or gonococcal meningitis can develop.
The patient is assessed for fever; for urethral, vaginal, and rectal discharge; and for signs of arthritis. Culture and sensitivity stud-ies are the usual and preferred methods of diagnosing and verify-ing effectiveness of therapy. In the male patient, specimens are obtained from the urethra, anal canal, and pharynx. In the female patient, cultures are obtained from the endocervix, pharynx, and anal canal.
When obtaining these cultures, the nurse should wear disposable gloves and wash hands thoroughly after glove re-moval. Lubricating jelly is not used for the vaginal examination because it may contain substances that inhibit growth or kill some pathogens, decreasing the microbiologic test accuracy. In-stead, water is used as the lubricant. Because N. gonorrhoeae or-ganisms are susceptible to environmental changes, specimens must be delivered to the laboratory immediately after they are obtained.
The CDC-recommended treatment for gonorrheal infections is administration of ceftriaxone (Rocephin) (or cefixime [Suprax], ciprofloxacin [Cipro], or ofloxacin [Floxin]) along with doxy-cycline. Doxycycline is added to first-line therapy to treat presumptive Chlamydia trachomatis, which commonly causes co-infection in patients with gonorrhea. Patients with uncomplicated gonorrhea who are treated with CDC-recommended therapy do not routinely need to return for a proof-of-cure visit. If the pa-tient reports a new episode of symptoms or tests reveal gonorrhea again, the most likely explanation is reinfection rather than treat-ment failure. Serologic testing for syphilis and HIV should be offered to patients with gonorrhea, because any STD increases the risk for other STD infections.
Gonorrhea is a reportable communicable disease. In any health care facility, a mechanism should be in place to ensure that all pa-tients diagnosed with gonorrhea are reported to the local public health department to ensure follow-up of the patient. The pub-lic health department also is responsible for interviewing the pa-tient to identify sexual contacts, so that contact notification and screening can be initiated.
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