Gonorrhea physical examination: Difference between revisions

Sexually transmitted diseases Main Page
	Gonorrhea Microchapters
Home
Patient Info
Overview
Historical perspective
Classification
Pathophysiology
Causes
Differentiating Gonorrhea from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Antibiotic Resistance
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Gonorrhea physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Gonorrhea physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Gonorrhea physical examination
CDC on Gonorrhea physical examination
Gonorrhea physical examination in the news
Blogs on Gonorrhea physical examination
Directions to Hospitals Treating Gonorrhea
Risk calculators and risk factors for Gonorrhea physical examination

VisualWikitext

Revision as of 14:24, 28 September 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Gonococcal infections are typically asymptomatic in women until complications such as PID develop. Women with gonococcal infection may present with mucopurulent urethral, cervical or vaginal discharge; friable appearance of the cervix; and cervical motion tenderness. Common physical examination findings of gonococcal infection among men include mucopurulent urethral discharge. Less commonly penile edema, and epididymal tenderness and edema (epididymitis) may also be seen as a part of complicated gonococcal infection.

Pharygial gonococcal infection may be present as mild pharingitis and rectal gononcoccal infection may be present with mucopurulent Anal discharge.

Physical examination

Common urogenital and extragenital Infection

The most common site of gonococcal infection is the urethra, endocervix, rectum, and pharynx. Physical examination of patients with gonococcal infection is usually remarkable for:


Type of Gonococcal Infection	Physical Examination
Urogenital infection in men^[1]	Mucopurulent urethral discharge Bull-headed clap (penile edema) Unilateral epididymal tenderness and edema (epididymitis) Sign of urethral stricture Periurethral abscesses
Urogenital infection in women:^[2]^[3]^[4]^[5]^[6]^[7]	Mucopurulent urethral, cervical or vaginal discharge Positive cervical motion tenderness Friable cervical mucosa Abdominal pain with negative rebound tenderness Lower abdominal pain (consistent with PID) Right upper quadrant pain (Fitz-Hugh-Curtis syndrome) Labial edema and Bartholin’s gland enlargement and tenderness (Bartholinitis)
Proctitis^[8]	Anal mucopurulent discharge Anorectal tenderness Anorectal bleeding
Pharyngitis^[9]^[10]	Pharyngeal exudates Cervical lymphadenitis
Conjunctivitis	Adult conjunctivitis Conjunctival injection Purulent eye discharge Periorbital edema Corneal involvement Neonatal Conjunctivitis Chemosis Severe lid edema Mucopurulent discharge Corneal involvement

Disseminated Gonococcal Infection

Dissemination gonococcal infection can result two clinical syndromes:

Septic arthritis (purulent arthritis)
Arthritis-dermatitis syndromes (with a triad of tenosynovitis, dermatitis, and polyarthralgias)

Other less common manifestations of disseminated gonococcal infection include:

Physical examination of patients with disseminated gonococcal infection is usually remarkable for:


Disseminated Gonococcal Infection	Organ systems
General Appearance	Fever (usually less than 39°C) Chills Generalized malaise Note: Occurs in the acute phase of infection
Skin	Painless skin lesions (on the torso, limbs, palms, and soles) which varis based on clinical stages Maculopapular, pustular, necrotic, or vesicular rash Hemorrhagic lesions Erythema nodosum Urticaria Erythema multiform
Eye	Conjunctivitis Conjunctival injection Purulent eye discharge Periorbital edema
Musculoskeletal	Arthritis Polyarthralgia with joint tenderness Decreased range of motion Erythema Note: purulent arthritis may be abrupt onset of monoarthritis or oligoarthritis without skin lesions and fever Tenosynovitis Erythema along a tendon sheath Local tenderness along a tendon sheath Painful active or passive range of motion Note: most commonly occurs in hands and less commonly lower extremities Muscle abscess Localized tenderness Localaized edema Pain with motion
Central Nervous System	Meningitis Decreased mental status
Cardiac	Endocarditis New murmur Tachycardia

Male

Purulent or mucopurulent discharge from urethera. The discharge can be demonstrated by milking the shaft of penis.
Epididymal tenderness and edema usually unilateral

Female Pelvic examination

Inspection

Purulent or mucopurulent discharge
Vaginal bleeding

Palpation

Cervical mucosa may become fragile and bleed even with some manipulation.
Cervical motion tenderness during bimanual pelvic examination

Gallery

The following are images associated with gonorrhea physical examination.^[11]^[12]

Gonococcal ophthalmia is due the pathogenic bacteria Neisseria gonorrhea
Gonococcal urethritis, which result in DGI and lead to gonococcal conjunctivitis
Gonococcal infection involving the cervix
Penile discharge in a patient with gonorrhea
Gonococcal pharyngitis
Ophthalmia neonatorum

References

↑ Sherrard J, Barlow D (1996). "Gonorrhoea in men: clinical and diagnostic aspects". Genitourin Med. 72 (6): 422–6. PMC 1195730. PMID 9038638.
↑ Workowski KA, Bolan GA, Centers for Disease Control and Prevention (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR Recomm Rep. 64 (RR-03): 1–137. PMID 26042815.
↑ Barlow D, Phillips I (1978). "Gonorrhoea in women. Diagnostic, clinical, and laboratory aspects". Lancet. 1 (8067): 761–4. PMID 76760.
↑ Huppert JS, Biro F, Lan D, Mortensen JE, Reed J, Slap GB (2007). "Urinary symptoms in adolescent females: STI or UTI?". J Adolesc Health. 40 (5): 418–24. doi:10.1016/j.jadohealth.2006.12.010. PMC 1976261. PMID 17448399.
↑ Eschenbach DA, Buchanan TM, Pollock HM, Forsyth PS, Alexander ER, Lin JS; et al. (1975). "Polymicrobial etiology of acute pelvic inflammatory disease". N Engl J Med. 293 (4): 166–71. doi:10.1056/NEJM197507242930403. PMID 806017.
↑ Risser WL, Risser JM, Benjamins LJ, Feldmann JM (2007). "Incidence of Fitz-Hugh-Curtis syndrome in adolescents who have pelvic inflammatory disease". J Pediatr Adolesc Gynecol. 20 (3): 179–80. doi:10.1016/j.jpag.2006.08.004. PMID 17561186.
↑ Rees E (1967). "Gonococcal bartholinitis". Br J Vener Dis. 43 (3): 150–6. PMC 1047872. PMID 4963696.
↑ Stansfield VA (1980). "Diagnosis and management of anorectal gonorrhoea in women". Br J Vener Dis. 56 (5): 319–21. PMC 1045815. PMID 7427703.
↑ Kraus SJ (1Link title979). "Incidence and therapy of gonococcal pharyngitis". Sex Transm Dis. 6 (2 Suppl): 143–7. PMID 386537. Check date values in: |year= (help)
↑ Osborne NG, Grubin L (1979). "Colonization of the pharynx with Neisseria gonorrhoeae: experience in a clinic for sexually transmitted diseases". Sex Transm Dis. 6 (4): 253–6. PMID 119330.
↑ STD Gonorrhea Infection Gallery http://www.std-gov.org/std_picture/gonorrhea_w.htm Accessed on September 22, 2016
↑ Centers for Disease Control and Prevention. Public Health Image Library (PHIL) http://phil.cdc.gov/phil/home.asp Accessed on September 22, 2016

Template:WH Template:WS

[pmid9038638-1] Sherrard J, Barlow D (1996). "Gonorrhoea in men: clinical and diagnostic aspects". Genitourin Med. 72 (6): 422–6. PMC 1195730. PMID 9038638.

[pmid26042815-2] Workowski KA, Bolan GA, Centers for Disease Control and Prevention (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR Recomm Rep. 64 (RR-03): 1–137. PMID 26042815.

[pmid76760-3] Barlow D, Phillips I (1978). "Gonorrhoea in women. Diagnostic, clinical, and laboratory aspects". Lancet. 1 (8067): 761–4. PMID 76760.

[pmid17448399-4] Huppert JS, Biro F, Lan D, Mortensen JE, Reed J, Slap GB (2007). "Urinary symptoms in adolescent females: STI or UTI?". J Adolesc Health. 40 (5): 418–24. doi:10.1016/j.jadohealth.2006.12.010. PMC 1976261. PMID 17448399.

[pmid806017-5] Eschenbach DA, Buchanan TM, Pollock HM, Forsyth PS, Alexander ER, Lin JS; et al. (1975). "Polymicrobial etiology of acute pelvic inflammatory disease". N Engl J Med. 293 (4): 166–71. doi:10.1056/NEJM197507242930403. PMID 806017.

[pmid17561186-6] Risser WL, Risser JM, Benjamins LJ, Feldmann JM (2007). "Incidence of Fitz-Hugh-Curtis syndrome in adolescents who have pelvic inflammatory disease". J Pediatr Adolesc Gynecol. 20 (3): 179–80. doi:10.1016/j.jpag.2006.08.004. PMID 17561186.

[pmid4963696-7] Rees E (1967). "Gonococcal bartholinitis". Br J Vener Dis. 43 (3): 150–6. PMC 1047872. PMID 4963696.

[pmid7427703-8] Stansfield VA (1980). "Diagnosis and management of anorectal gonorrhoea in women". Br J Vener Dis. 56 (5): 319–21. PMC 1045815. PMID 7427703.

[pmid386537-9] Kraus SJ (1Link title979). "Incidence and therapy of gonococcal pharyngitis". Sex Transm Dis. 6 (2 Suppl): 143–7. PMID 386537. Check date values in: |year= (help)

[pmid119330-10] Osborne NG, Grubin L (1979). "Colonization of the pharynx with Neisseria gonorrhoeae: experience in a clinic for sexually transmitted diseases". Sex Transm Dis. 6 (4): 253–6. PMID 119330.

[11] STD Gonorrhea Infection Gallery http://www.std-gov.org/std_picture/gonorrhea_w.htm Accessed on September 22, 2016

[CDCGonorrheapic-12] Centers for Disease Control and Prevention. Public Health Image Library (PHIL) http://phil.cdc.gov/phil/home.asp Accessed on September 22, 2016

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

@@ Line 4: / Line 4: @@
 ==Overview==
-Gonococcal infections are typically asymptomatic in women until complications such as [[Pelvic inflammatory disease|PID]] develop. Women with gonococcal infection may present with [[Mucopurulent discharge|mucopurulent]] [[urethral]], [[cervical]] or [[vaginal]] discharge; friable appearance of the cervix; and cervical motion tenderness. Common physical examination findings of gonococcal infection among men include [[Mucopurulent dishareg|mucopurulent]] urethral discharge. Less commonly penile edema, and epididymal tenderness and edema ([[epididymitis]]).Bull-headed clap (penile edema) may also be seen as a part of complicated gonococcal infection.
+Gonococcal infections are typically asymptomatic in women until complications such as [[Pelvic inflammatory disease|PID]] develop. Women with gonococcal infection may present with [[Mucopurulent discharge|mucopurulent]] [[urethral]], [[cervical]] or [[vaginal]] discharge; friable appearance of the cervix; and cervical motion tenderness. Common physical examination findings of gonococcal infection among men include [[Mucopurulent discharge|mucopurulent]] urethral discharge. Less commonly penile edema, and epididymal tenderness and edema ([[epididymitis]]) may also be seen as a part of complicated gonococcal infection.
+Pharygial gonococcal infection may be present as mild [[pharingitis]] and rectal gononcoccal infection may be present with [[Mucopurulent discharge|mucopurulent]] Anal discharge.
 ==Physical examination==
 ===Common urogenital and extragenital Infection===