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Flashcards in Dz Deck (266):
1

In which zone does BPH occur?

transition zone

2

In which zone does prostate cancer occur?

peripheral zone

3

What is the purpose of DRE?

to check for nodules/cancer

4

Is DRE helpful for detecting BPH?

NO

5

What are the type of BPH?

obstructive and irritative

6

What is obstructive BPH? ie?

mechanical obstruction
ie) Bladder outlet obstruction
dynamic component
ie) adrenergic tone - muscle tone is causing obstruction

7

What is irritative BPH?

detrusor muscle hypertrophy/hyperplasia
the BLADDER is irritated

8

How may a pt with BPH come in looking like?

swollen abdomen/bladder

9

When should peds get imaging done on their kidneys/bladders?

male <2yo
GU anaomolies
recurrent (3+/yr)

10

What labs should be done for BPH?

Serum creatinine
UA

11

Serum creatinine would be elevated or decreased in BPH? What next?

elevated
US

12

UA in BPH? What next?

hematuria
CT urogram
refer to urology

13

What imaging if considering cancer?

cystoscopy

14

BPH mild - tx?

mild: nothing

15

BPH mod- severe - tx?

selective alpha 1a-receptor blocker (not lungs)
-tamsulosin (flomax)
-alfuzosin (uroxatrol)
nonselective alpha blockers (lungs)
-terazoin (hytrin)
-doxazosin (cardura)

16

BPH w/ large prostate + hematuria?

5 alpha-reductase inhibitors
6mo until benefit
ADD W/ ALPHA BLOCKER

17

BPH when to refer?

failed tx
cannot urinate
recurrent UTI
recurrent hematuria
renal insufficiency

18

BPH surgery gold standard?

Transurethral resection of the prostate (TURP)

19

What does PSA measure?

NOT cancer
protein that is measured in the blood --> if elevated may indicate: infxn, cancer, enlarged prostate
--further eval would be needed

20

Hypospadias?

failure of the urethral folds to close at the tip of the penis
benign

21

Hypospadias -refer?

if infant has a strong pee

22

Hypospadias - tx?

nothing - unless bothersome

23

Urethral stricture/meatal stenosis?

narrowing of the urethra

24

Complication from uncircumcised penis?

phimosis
pearly penile papules
balanitis
smegma
HPV

25

Decrease urine stream, spraying/double stream, postvoiding dribbling?

urethral stricture/meatal steonsis

26

Phimosis?

chronic infxn from poor hygiene
SQUAMOUS CELL CARCINOMA UNDER FORESKIN

27

Phimosis - tx?

abx

28

Paraphimosis?

foreskin gets stuck when retracted behind the glans

29

Paraphismosis - sx/pe?

edema d/t venous congestion
arterial occlusion and necrosis may occur

30

Paraphismsis - tx?

firmly squeezing glans for 5min to decrease tissue edema
skin can be drawn forward over glans
abx

31

Curvature of the penis of the painful erection but NO pain when not erected?

peyronie's dz

32

Penis is rigid but NOT painful?

nonischemic priaprism

33

Nonischemic priapism -tx?

observe/self limiting

34

What should sickle cell pts be aware of?

ischemic priapism

35

What is happening in ischemic priapism?

venous drainage circulation gets cut off --> build up of viscous and poorly oxygenated blood in copora cavernosa

36

What drug can cause ischemic priapism?

trazodone

37

Ischemic priapism - tx?

analgesia + alpha agonist
corporal aspiration
surgical shunt

38

If pt has sickle cell and ischemic priapism?

treat the underlying sickle cell dz - O2, hydration, transfusion

39

Where does LH and FSH come from?

anterior pituitary

40

LH?

leydig --> synthesize testosterone --> secondary characterisitcs

41

FSH?

sertoli cell --> spermatogensis

42

Fails at testes?

primary hypergonadotrophic hypogonadism

43

Primary hypergonadotrophic hypogonadism- LH and FSH?

HIGH
NO negative feedback because testes are broken --> continuos LH and FSH is made but NO testosterone

44

Secondary hypogonadotrophic hypogonadism?

fails at the gonads

45

Secondary hypogonadtrophic hypogonadism - LH and FSH?

low LH and FSH --> LOW testosterone

46

Secondary hypogonadtrophic hypogonadism PE-before puberty?

before puberty- nothing

47

Secondary hypogonadtrophic hypogonadism PE-after puberty?

after puberty - NO secondary characteristics (hair, narrow shoulders, gynocomastia)

48

Secondary hypogonadtrophic hypogonadism PE-later in life?

later in life - erectile dysfxn, poor libido, mood changes (depression), low energy

49

Normal range for testosterone?

300-1,000

50

What do to if lower than 300 testosterone level?

suspect androgen deficiency

51

What do you a LH and FSH lab test for those w/have small testes?

to distinguish between primary hypergonadtrophic and secondary hypogondatrophic hypogoandism

52

When do you tx for hypogonadism?

testosterone is <300
AND 3 sx (erectile dysfxn, poor libido, mood changes, fatigue)

53

How long do you monitor hypogonadisim tx? What else do you monitor?

after 3 mo + q 3 mo
consider prostate screening, hct, lipids

54

What are contraindications for testosterone replacement?

incr Hct
sleep apnea
CHF, MI, unstable angina
hx of prostate cancer, breast cancer
severe lower urinary tract sx

55

What form does testosterone replacement come in?

oral
buccal
patch
gel
IM

56

What are DIs for testosterone replacement?

anticoag
antidiabetic
corticosteroids
ACTH

57

What are the benefits of testosterone replacement?

better mood --> depression
better libido --> libido
decrease erectile dysfunction --> erectile dysfunction
more muscle strength and endurance --> fatigue

58

What are the treatments for hypogonadism?

testosterone replacement
gonadotropins

59

Premature gonadal failure vs "andropause"?

premature gonadal failure: ABNORMAL decrease of testosterone in YOUNG males
andropause: NATURAL decrease of testosterone w/age

60

What are the diff types of testicular dysfxn?

Klinefleter
cryptorchidism
trauma/torsion
mumps/infxn orchitis
radiation

61

What is Klinefleter?

XXY

62

What is cryptorchidism?

incomplete dropping of the testes

63

Cryptorchidism -tx?

correct before 2yo - surgery

64

Cryptorchidism - complication?

Bilateral > unilateral
increase risk for testicular neoplasm
increase risk for inguinal hernias

65

What is testicular torsion?

twisting of the testes

66

Testicular torsion - cx?

trauma
growth spurt
tumor
HX OF CRYPTOCHIDISM (complication)

67

Testicular torsion - population?

<25yo

68

Testicular torsion - sx/pe?

"bellclapper"
testes move freely in the tunica vaginls
ACUTE pain
swelling
asymmetric scrotum

69

What is the timeframe for testicular torsion saving?

sx w/ 6+hrs = risk of losing testes

70

What haps if you lose one testes?

other will kick into gear - not a prob

71

Testicular torsion - test?

cremastric reflex

72

Testicular torsion - tx?

surgery
manual detorsion

73

Erection?

parasympathetic
S2-S4
blood flow increases --> presses down on the veins --> blood accumulates --> erection

74

Ejaculation?

sympathetic
T10-L2
needs both pudendal nerve and skeletal muscle
1) seminal emission
2) projectile ejaculation
--needs both pudendal nerve and skeletal muscle

75

How to tx premature ejaculation?

-behavioral therapy: stop stimulation just prior to climax and hold base of penis anterior to posterior to prevent emission (kind of like desensitizing)
-SSRI: d/t increase in serotonin
-reduce penile sensitivity: condomn, topical anesthetizing cream

76

What can cx delayed oragsm?

SSRI
opiates

77

What is retrograde ejaculation?

backflow of semen into the bladder

78

Cx of retrograde ejaculation?

after TURP (d/t BPH)
alphablockers for BPH

79

Tx for retrograde ejaculation?

alphasympathomimetics (benadryl)
remove alphablockers

80

Erectile dsyfunction-types?

organic
psychogenic

81

What is organic erectile dysfunction?

having the desire but not able to physically get the penis erected

82

What is pychogenic erectile dysfunction?

not having the desire to get an erection

83

What must be ruled out before erectile dysfunction?

neurological disorder
-brain lesions
-peripheral neuropathy (diabetes)

84

Pt comes in erectile dysfunction - what is important to take note of/review?

-meds: SSRI, opiates, non selective beta blockers, antishitamines, H2 blockers
-ETOH drinker

85

If pt is taking meds for the heart and is having trouble with erections, what drug can be used? avoided?

-change the beta blocker to alpha agonist
-do NOT use sildenfil in case pt needs to take nitro

86

What pts should have labs done for erectile dysfunction?

ONLY if they are:
-depressed
-fatigue
-libido

87

Tx erectile dysfunction?

lifestyle changes
adjust meds (Beta blockers, SSRI)
drugs: PDE 5Is
transurethral therapy: alprostadil
vacuum pump device
intracavernous injection
penile implant

88

What adjustment to meds for erectile dysfunction?

Beta blockers --> alpha agonist
SSRI --> bupropion/wellbutrin, drug holiday, reduce SSRI

89

What drugs can be used for erectile dsyfunction?

-sildenafil
-verdenafil
-tadalafil

90

When are the drugs for erectile dysfunction effective?

IF he is aroused

91

MOA of sildenafil?

increase cGMP levels --> vasodilation

92

Who may NOT respond to sildenafil?

DM

93

Sildenfil ADR?

HA
flushing
GI
vision (blue)
hypotensive

94

Sildenfil DI?

NO nitrites
alpha blockers
CYP450

95

Which tx of erectile dysfunction does NOT need sexual arousal?

intracavernous injection

96

What are the types of hernias?

groin --> inguinal and femoral
incisional
hiatal
ventral
umbilical
rectus diastasis

97

RF for hernias?

CHRONIC COUGH/CONSTIPATION
abdominal wall injury
HX OF CRYPTORCHIDISM
older age
male
caucasian
smoker

98

Hx of cryptorchidism can cx?

inguinal hernias
testicular torsion
cancer
sterility

99

Population for hernias?

50yo

100

Hernia hx/sx?

dull pain when NOT moving
worse w/ moving, heavy lifting, coughing

101

Hernia PE?

bulge in groin but NON TENDER

102

Inguinal hernia: direct vs indirect PE?

direct: rounder
indirect: 'narrow'

103

Complication of hernia?

if painful:
incarceration --> strangulation --> bowel obstruction

104

What is incarceration (hernia)?

the bowel gets stuck outside - pain

105

What is strangulation (hernia)?

bowel AND ischemia starts - blood flow compromised

106

What is bowel obstruction (hernia)?

BLOCKING of gas/stool - DIFFUSE abdomen pain

107

How to diff indirect and direct hernia?

US

108

When to use CT for hernia?

COMPLICATED

109

When to use MRI for hernia?

to check if strangulated

110

How to tx hernia uncomplicated w/ little sx?

watchful waiting

111

How to tx hernia uncomplicated w/ sx?

elective repair

112

How to tx ACUTE incarcerated hernia w/ no sx of strangulation?

manual reduction - trandelenburg w/ slow pressure

113

How to tx unreducible incarerated hernia +/-strangulation?

emergent repair

114

Congenital hernia vs acquired hernia?

congenital: processus vaginalus did NOT oblierate and internal ring did NOT close
acquired: trauma/damage to fibromuscular tissue of abdominal wall (cyclists, straining of the abdomen that increases pressure, etc)

115

What hernia is ABOVE the inguinal ligament?

indirect and direct inguinal hernia

116

What hernia is BELOW the inguinal ligament?

femoral hernia

117

What hernia is congenital?

indirect hernia

118

What hernia is acquired?

femoral hernia

119

What hernia can be both congenital and acquired?

direct hernia

120

Which hernia can be seen in children?

indirect hernia

121

Which hernia can be seen in adults?

direct hernia
femoral hernia

122

Which hernia is the most common? least?

most: indirect
least: femoral but MORE complications

123

What is hap in indirect hernia?

goes THROUGH the inguinal ring
LATERAL to the inferior epigastric artery

124

What is hap in direct hernia?

goes THROUGH the Hesselbach's triangle
LATERAL to inferior epigastric vessels
MEDIAL to rectus muscle

125

What is hap in femoral hernia?

goes THROUGH the empty space MEDIAL to femoral canal
THROUGH the femoral ring

126

What is follicular/sebaceous cyst?

BLOCKED sebaceous gland/hair follicle

127

Is follicular/sebaceous cyst - benign/malignant?

benign

128

"small dome-shaped skin-colored 'pearly' papules on the CORONAL margin"?

pearly penile papules

129

"benign dome shaped subcutaneous papules on SCROTUM"?

follicular/sebaceous cysts

130

"black/blue/dark red dome shaped papules on scrotum"?

angiokeratomas of fordyce

131

Which derm are reassurance and tx for cosmetics?

follicular/sebaceous cysts
pearly penile papules
angiokeratomas of fordyce
lichen planus unless lesions

132

Pearly penile papules vs herpes/warts?

pearly penile papules: ON THE CORONAL

133

What is psoriasis?

non infectious and of the GLANS

134

"Well demarcated scaly erythematous plaques"?

psoriasis

135

Psoriasis tx?

symptomatic: hydrocortisone
prevention: calcipoterine

136

Pt comes in with dilated thin walled venules and black/blue papules on scrotum - pt most likely has...?

passed puberty

137

"violet flat topped lesions" on...?

glans and shaft

138

Pruitic/painful lesions on glans and shaft?

lichen planus

139

Lichen planus tx?

papular lesions - topical corticosteroids
erosive lesions - intralesional steroid injection

140

Pt is <5yo, uncircumcised, poor hygiene + early stages of red erosions on glans?

balanitis

141

Balanitis - later stages?

erythema
swelling
discharge
pain

142

Balanitis -tx?

abx
antifungal
steroid

143

Uncircumcised + old skin cells, oils, but NO skin irritation?

smegma

144

Smegma - tx?

retract foreskin

145

What is lichen sclorsis also called?

balanitis xerotica obliterans

146

What are the stages of lichen sclorsis?

early: atophic puritic white plaques/papules
progressing: dysuria, painful erection
later: phimosis, meatal stenosis

147

Tx for lichen sclorsis?

early: HD topical steroids
later: intralesional corticosteroids

148

What are the gonadal deficiency?

HIV, COPD, cancer, liver/kidney dz
obesity
age
drugs

149

What drugs can affect gonadal deficiency?

spirnolactone
ketecoonazole
steroids
ETOH
marijuana
opoids
pit. tumor

150

What is androgen insensitivity?

do not have secondary characteristics

151

How does an androgen insensitivity person look like?

genitally male (XX) but appearance is female

152

What is precocious puberty?

puberty comes on TOO fast
<9yo

153

What is delayed puberty?

NO secondary characteristics by 14yo

154

Delayed puberty vs constitutional delay?

GnRH stimulation

155

What is officially gynecomastia?

bigger than 4cm
GLANDULAR tissue NOT adipose

156

What is hydrocele?

fluid accumlating

157

Cx of hydrocele?

trauma
infxn

158

What can hydrocele be associated with?

testicular:
-neoplasm
-torsion

159

Why do a US in hydrocele?

distinguish between simple (watch) vs complex (refer)

160

If young child has hydrocele?

normal d/t testes dropping

161

Spermatocele/epididymal cyst?

PAINLESS cyst that is MOVEABLE
located AWAY from testes

162

Spermatocele/epididymal cyst -tx?

observe

163

"dilation of venous plexus and internal spermatic vein" - what would you expect?

bag full of worms

164

Which side is varoicele commonly found?

Left
Right --> refer
right is DIRECTLY connected to the IVC

165

Tx of varicocele?

surgery

166

What can cause infertility?

varicocele
hx of cryptochiasm

167

Pt notices ONE blue dot that is hard and tender?

torsion of appendix testes

168

What is high and low risk in HPV?

high: 16, 18
low: 6, 11

169

How can HPV be transmitted?

skin to skin
sexual contact

170

HPV incubation period?

2wks-8mo

171

HPV sx/pe?

asymptomatic
genital warts: condylomata acuminata, flat genital, smooth papule

172

Do you bx HPV?

ONLY if pt is immunosuppressed, bleeding, ulceration

173

What STD has a vaccine?

HPV

174

What are the vaccines available for HPV?

Quadrivalent and bivalent

175

Age for vaccine HPV?

between 9-10yo; before 11yo
men who have sex w/men: cut off is 26yo

176

HPV vaccine dosage?

1st --> 2) 2mo later --> 3) 6mo later

177

First line tx for HPV? dosage?

podofilox 0.5% GEL NOT solution
3x/daily x 4days for 4 cycles --> no change? suspect cancer

178

How does HSV1 present?

oral
papules --> vesicles -->pustules --> ulcers --> crust

179

HSV1 on the nose?

be careful for ocular herpes/herpes keratits--> may cause blindness
test w/ Floursecein --> medical emergency

180

HSV1 and HSV2 present?

F/C/HA/Fatigue/dysuria

181

What can trigger HSV2?

sunlight
stress
burning and tingling

182

HSV dx? what is no longer used?

viral culture - gold standard
Tzanck is no longer used

183

HSV tx for fist episdoe?

1) acyclovir 800mg TID
2) valacyclovir 1000mg BID
3) Famciclovir 250mg TID
x7-10days

184

HSV tx chronic suppressive if..?

1x/mo

185

HSV tx chornic suppressive?

acyclovir TID x3-5days
valacyclovir 1gx5days
famiciclovir 1g BID x1day

186

Complication for HSV2?

somatitis and pharyngitis
neonatal herpes

187

if HSV is on the face?

aseptic meningitis

188

What is chlamydia assocaiated with?

gonorrhea

189

RF for chlamydia?

15-24yo
AA

190

Chlamydia sx/pe?

WATERY discharge
oropharynx infxn - NO discharge
conjunctivitis
proctitis
dysuria

191

Chlamydia dx?

NAAT

192

When to culture for chlamydia?

if suspicion for child abuse

193

Chlamydia tx?

azithromycin 1g PO x 1 dose

194

IF pt is allergic to azithormycin-chlamydia?

doxycycline 100mg PO BID x7days
levofloxacin 500mg PO daily x 7days

195

Pt education for chlamydia?

NO sex for 7 days after tx OR after 7days w/ abx

196

Trichomoniasis pe?

scant grayish green penile discharge

197

Trichomoniasis tx?

metronidazole 2g PO x 1dose

198

What to advise during tx for trichomoniasis?

do NOT drink ETOH

199

Pubic lice sx/pe?

pruitic reddish/bluish papules/wheals

200

Pubic lice tx?

permethrin RINSE 1% x10min
OR
permethrin CREAM 5% for 8hrs

201

Granuloma inguinale cx?

klebsiella

202

Where is granuloma inguinale found?

tropical

203

Granuloma inguinale sx/pe?

1) painless
2) painful - foul smelling purulent discharge
lesions WAIST down

204

Granuloma inguinale dx?

bx--> DONOVAN BODIES

205

Granuloma inguinale tx?

doxycylcline 100mg PO BID x3-4wks
OR
TMP-SMX DS Q12hrs x3wks
UNTIL ALL LESIONS HEAL

206

Which STI have bubos?

lymphogranuloma venereum
Chancoid

207

Lymphgogranuloma venereum cx?

subset CHLYMADIA

208

Where is lymphogranuloma found?

tropical

209

Lymphogranuloma venereum sx/pe?

1) painless ulcer/papule
2) painful inguinal LYMPHADENOPATHY
3) BUBOS -purple
check partners w/in 60 days

210

Lymphogranuloma venereum tx?

doxycycline 100mg PO BID 3-4wks
tx partners like chlyamdia b/c it is subset

211

What STI are txd with doxycylcine?

granuloma inguinale
lymphogranuloma venereum
chlyamdia if allergic to azithromycin

212

Chancroid found where?

caribbean

213

What is important to keep in mind for chancroid?

CO FACTOR FOR HIV

214

Chancroid sx/pe?

1) PAINFUL vesticulopustural lesion - red at the base and bleeds easily (friable)
2) bubos
INGUINAL CANAL

215

Chancroid tx?

ceftriaxone 250mg IM x1dose
OR
azithromycin 1g PO x1dose
MUST RTC 3-7DAYS
check parter w/in 60 days

216

Chlamydia associated?

gonorrhea

217

What are AA RF?

chlamydia
gonorrhea
syphilis

218

Chlamydia vs gonorrhea sx/pe?

chlamydia: water discharge, NO discharge from oropharynx
gonorrhea: PURULENT discharge and in oropharynx

219

What do BOTH chlamydia and gonorrhea have?

dysuria
conjunctivitis

220

How dx chlamydia and gonorrhea?

NAAT

221

How to tx gonorrhea?

Ceftriaxone 250mg IM x1dose
AND cover for chlyamdia - azythromycin 1g PO x1dose

222

What is the diff between dipstick, microscopy, and culture?

UA is a screening tool
microscopy can be used for dx

223

When to use culture?

when microscopy is positive for bacteria/WBC

224

When to suspect false positive for dipstick?

if the sticks have been exposed to air for a proglonged period of time

225

Sx/PE for acute bacterial cystitis?

foul smelling urine

226

Tx for acute bacteria cystitis?

bactrim or cipro (fluroquinolone) x 7days

227

What sx/PE acute bacterial cystitis, acute prostitis, and chronic prostitis have in common?

dysuria
hematuria
frequency
suprapubic pain
urgency

228

What is the difference between acute prostitis and chronic prostitis?

acute: fast, FEVER, PAINFUL DRE/prostate, can lead to septic
chronic: slow, afebrile, normal DRE

229

How to tell difference between acute bacterial cystitis vs prostitis?

prostitis has PERINEAL PAIN

230

Tx of acute prostitis?

bactrim or cipro x 4-6wks

231

Tx for chronic prostitis?

bactrim or cipro x 6wks-3mo

232

What are younger men likely to have-acute or chronic prostits? bug?

acute - e.coli

233

pt has scrotal pain?

epididmytis/orchitis

234

What other PE can epididmytis/orchitis have?

positive phren sign
reactive hydrocele

235

How to tx epididmytis/orchitis?

50yo
o Fluroquinolone PO x14days

236

RF for syphilis?

AA
25-29yo

237

How can syphilis be spread?

skin to skin
sexual

238

Syphilis sx/pe?

ANYTIME! ANY rash!

239

What are the sub types of syphilis?

primary and secondary syphilis
latent syphilis: early latent and late latent
tertiary syphilis

240

Primary syphilis sx/pe?

chancre
PAINLESS w/ CLEAN bse

241

Secondary syphilis sx/pe?

rash
warts

242

When does chancre heal?

1-6wks

243

When does secondary syphilis sx/pe occur?

3-6wks

244

How can primary and secondary syphilis present?

THEY CAN OVERLAP

245

How does latent syphilis present?

NO lesions

246

When does latent syphilis occur?

between primary and secondary
secondary relapses
AFTER secondary stage

247

What is the criteria for early latent syphilis?

pos w/in 12mo
4 fold incr from previous titer test
sx w/in 12 mo
contact w/ someone who has syphilis (documented)
possible exposure w/in 12 mo

248

What is late latent syphilis?

same sx as early but more than 1 yr

249

PE for tertiary syphilis?

gummatous lesions - destruction of nasal bone/septum
cardiovascular syphilis - aneurysms, aortic regurgitation, CAD

250

What is early neurosyphilis?

mo-yrs
cranial nerve dsyfxn
meningitis
altered mental status

251

What is late neurosyphilis?

tabes dorsalis
18-25yo
poor judgement skills

252

What labs should you run for syphilis? to be aware of?

partners should get VDRL
note: if sx are early in primary syphilis - may be false negative

253

What is dx if pt has chancre?

darkfield microscopy + VDRL/RPR

254

What is dx if pt doe snot have chancre?

FTA-ABS + VDRL/RPR

255

How to tx primary, secondary, and early latent? F/u?

Benzathine penicillin G: 2.4million units IM x1dose
f/u: 6-12mo

256

How to tx late latent and tertiary?

Benzathine penicillin G: 2.4million x3 doses (total 7.2)
f/u: 6, 12, 18, 24mo

257

How to tx neurosyphilis?

aqueous crystalline penicillin G + admit

258

Complication from tx'ing syphilis?

Jarisch-Herxheimer Rxn

259

What is Jarisch-Herxcheimer rxn?

NOT an allergic rxn from the penicillin --> the bug dying int he body
usually occurs w/in 24hrs after therapy

260

"pearly, skin colored, umbilicated papules"?

molluscum contagiosum

261

Molluscum contagiosum - bug?

pox virus

262

How can molluscum contagiosum spread?

skin-skin
fomites
bathes/swimming pool

263

When is molluscum contagiosum the most contagious?

thick white paste

264

How to tx molluscum contagiosum?

imiquimod 5% 3x/wk for 1-3mo

265

Incubation period for chlaymdia?

7-10days

266

Incubation period for gonorrhea?

1-14days