Gonorrhea (sexually transmitted infections)

Question 1

what are STI’s manifestations like?

Answer 1

These infections generally have acute manifestations and often progress to a chronic clinical picture

Question 2

The acute manifestations of the most frequent STIs fall into 3 groups which are?

Answer 2

i) mucopurulent cervicitis and urethritis
- gonorrhea and chlamydial infection
ii) genital ulcer diseases
- syphilis, chancroid, genital herpes
iii) genital warts

Question 3

The most serious consequences of STIs, related to the progression from acute to chronic infection, includes?

Answer 3

i) pelvic inflammatory disease
- caused by gonococci and chlamydia
ii) anogenital cancer
- caused by some HPV
iii) secondary and tertiary syphilis
iv) recurrent herpes infection

Question 4

why are oral manifestations important for STIs?

Answer 4

• Oral manifestations of STIs have important therapeutic and diagnostic implications for dentistry, since oral lesions are common extragenital features.
• The dentist may be the first to see initial lesions

         the presence of viable and highly infectious organisms in these lesions poses major problems to infection control.

Question 5

what is gonorrhea?

Answer 5

Gonorrhea is a bacterial infection cause by the G(-) coccus Neisseria gonorrhoeae (Gonococcus), transmitted through sexual contact from person to person.

Question 6

what is the usual site of entry of the gonococcus for gonorrhea?

what is the main resevoir for this infection?

Answer 6

The usual site of entry of the gonococcus into the body is via the vagina or urethral mucosa of the penis.

 - Other sexual practices may deposit the gonococci in the oropharynx or the rectum.

The main reservoir is asymptomatic infected individuals, usually women.

Question 7

what is the virulence of neisseria gonorrhoeae?

Answer 7

Spread is facilitated by various virulence factors:
Capsule
Pili
Protein I, II, III
IgA1 protease
Lipopolysaccharide (endotoxin)
Beta-lactamase

The gonococcus protects itself from the host’s secretory antibodies by means of an IgA protease.

Question 8

what are the symptoms in women?

Answer 8

- Women
50% are asymptomatic
Endocervix is the primary site of symptoms
Purulent exudate
Erythematous and edematous cervix

Question 9

what are the symptoms in men?

Answer 9

• Men
  5% are asymptomatic
  Painful urination
  Purulent discharge

Question 10

what are the virulence factors and pathogenicity?

Answer 10

Anorectal gonorrhea is increasing in prevalence.  
Common symptoms are:
anorectal pain
bleeding
discharge

Question 11

what are disseminated gonococcal infections/

Answer 11

The infection usually remains localized, however, the gonoccous can invade the bloodstream and cause disseminated infections with septicemia and infection of skin & joints.

 - Infected women (1-3%)
 - Infected men (much lower percentage)

Question 12

what are clinical manifestations of disseminated infection?

Answer 12

Clinical manifestations of disseminated infection includes:

 - Fever
 - Migratory arthralgias
 - Suppurative arthritis in the wrists, knees, & ankles
 - Pustular rash on an erythematous base over the extremities

Gonococcus is a leading cause of purulent arthritis in adults.

Question 13

what are oral manifestations and symptoms of gonorrhea?

Answer 13

Most cases of gonorrhea are reported in younger patients who are sexually active.

The most common site of oral involvement is the pharyngeal area along with the tonsils and uvula.

Usually, oral lesions are primary infections resulting from oro-genital contact.

Although kissing and cunnilingus have been implicated as possible modes of transmission, most cases of oral lesions arise as a result of fellatio.

Oral symptoms include:
sore throat
gingivitis
foul breath
cervical lymphadenopathy

Question 14

Oral gonorrhea poses problems for dental personnel, because?

Answer 14

(i) the incidence of oral infections has increased with changing sexual practices
(ii) the asymptomatic state can mask a potential infectious hazard
(iii) the chances for gonococcal dissemination increase in the absence of appropriate treatment
(iv) transfer of gonococcal infection to adjacent tissues can occur via dental procedures

Question 15

how do you diagnose gonorrhea?

Answer 15

Gram (-) diplococci in purulent discharge (in males) and cervical smears (in females) is presumptive for gonorrhea.

Diagnosis of oropharyngeal gonorrhea is complicated by the presence of oxidase-positive oral Neisseria that are part of the normal oral flora.

Question 16

What is the treatment, prevention and control for gonorrhea?

Answer 16

Aqueous procaine penicillin, ampicillin or amoxicillin with probenicid.

For patients allergic to penicillin, spectinomycin or tetracycline is used.

Patient education, accurate reporting, and follow up of patients and their contacts constitute the best means of prevention.

Question 17

what is a serious consequence of gonococcal infection?

Answer 17

loss of eyesight.