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The gonococcus has become an extremely important organism in obstetrics and gynecology. It is associated with a wide array of clinical syndromes that frequently confront the practitioner. The diagnostic modalities available are many and are rapidly increasing. Therapy likewise is becoming complex as we learn more about the infections associated with this microbe. The basic principles of care still include a high index of suspicion of infection; clinical evaluation of the potentially infected patients; laboratory support of the clinical diagnosis; specifically directed antimicrobial therapy of adequate dosage and duration; treatment of sexual partners; and follow-up test-of-cure evaluation in all patients.This report provides an overview of the Neisseria gonorrhoeae microbe and the syndromes associated with it that are currently of significance in obstetric and gynecologic patients. The prevalence of gonorrhea varies significantly between populations. Accurate incidence figures are difficult to obtain but about 1 million infections/year are reported in the US, 2/3 in patients aged 16-24. The disease is more common in urban areas and in the US the largest number of new cases occur in the summer. Age, sex, contraceptive method, multiple sex partners, and habitation patterns appear to be risk factors. In the male, urethritis is considered to represent uncomplicated disease. Male complications may include infection of the epididymus, urethral stricture, and disseminated disease. Approximately 80% of infected women appear to be asymptomatic. In the female, cervicitis and urethritis are considered uncomplicated disease, while complications may include disseminated gonococcal infections and pelvic inflammatory disease, which may have longterm sequelae. Arthritis, amniotic infection syndrome, and ophthalmia neonatorum are possible complications in pregnant patients. Penicillinase-producing N. gonorrhoeae were 1st described in 1976 in the US and the number of cases is increasing. Both sexes may have pharyngitis, proctitis, and the arthritis-dermatitis syndrome. The most reliable test for diagnosis is a positive culture; instructions for the culture are included. Serologic tests are under investigation but thus far no cost-effective technique has been developed. Antigen detection techniques, which permit diagnosis within 24 hours, appear to be on the verge of widespread utilization. N. gonorrhoeae is sensitive to a large number of antibiotics, including penicillin, tetracycline, and erythromycin. Therapy usually depends on the severity of the disease, the resistance patterns of organisms in specific geographic locales, the exposure and toxicity of the drugs, and the potential site of infection. Care should include treatment of sexual partners and follow-up test-of-cure evaluation in all patients. |
