Gonorrhea still remains an important health problem. The causative organism is Neisseria gonorrheae — a Gram-negative diplococcus. The incubation period is 3–7 days.
The principal site of invasion is the columnar and transitional epithelium of the genitourinary tract. As such, the primary sites of infection are endocervix, urethra, Skene’s gland, and Bartholin’s gland. The organism may be localized in the lower genital tract to produce urethritis, bartholinitis, or cervicitis. Other sites of infection are oropharynx anorectal region, and conjunctiva. As squamous epithelium is resistant to gonococcal invasion, vaginitis in adult is not possible, but vulvovaginitis is possible in childhood. In about 15 percent of untreated cervicitis, gonococcal infection may ascend up to produce acute pelvic inflammatory disease (PID). Rarely, it may produce septicemia with distant involvement to cause tenosynovitis and septic arthritis. Upper genital organs are involved as the infection spreads along the spermatozoa. Gonococci attach to the spermatozoa and are being carried up.
Endometritis and salpingitis are common.It should be remembered that N. gonorrhoeae is often present with other sexually transmitted diseases and women with gonorrhea are considered to be at risk for incubating syphilis. One-third of such cases are associated with chlamydial infection.
CLINICAL FEATURES IN ADULT: - About 50 percent of patients with gonorrhea are asymptomatic and even when the symptoms are present, they are non-specific. The clinical features of acute gonococcal infection are described as follows:
- Labia may be swollen and look inflamed
- The vaginal discharge is mucopurulent
- The external urethral meatus and the openings of the Bartholin’s ducts look congested. On squeezing the urethra and giving pressure on the Bartholin’s glands, purulent exudate escapes out through the openings. Bartholin’s gland may be palpably enlarged, tender with fluctuation, suggestive of formation of abscess.
- Speculum examination reveals congested ectocervix with increased mucopurulent cervical secretions escaping out through the external os.
Nucleic acid amplication testing (NAAT) of urine or endocervical discharge is done. First void morning urine sample (preferred) or at least one hour since the last void sample should be tested. NAAT is very sensitive and specific (95%).
In the acute phase, secretions from the urethra, Bartholin’s gland, and endocervix are collected for Gram stain and culture.
A presumptive diagnosis is made following detection of Gram-negative intracellular diplococci on staining. Culture of the discharge in Thayer Martin medium further confirms the diagnosis. Drug sensitivity test is also to be performed.
Hydrastis Canadensis: -Whitish or yellowish discharge from the vagina. Heavy or Prolonged Vaginal Bleeding. Pain in the rectum. Pus containing discharge in the urine.
Sulphur: - Burning sensation in the vagina. Excessive white or yellow colored vaginal discharge. Delayed, short and scanty menstruation. Itching of genitals.
Pulsatilla:- Intermittent menstrual flow with clots. Painful urination. Pain from Abdomen to the vulva.
Sepia: - Thick yellowish or greenish discharge through the vagina.
Merc Sol: - The person needing merc Sol has to hurry to pass urine. There is greenish Vaginal discharge with burning and itching with increased frequency of urination.