Gonorrhea physical examination: Difference between revisions

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Revision as of 20:06, 4 October 2016

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

Overview

Women with gonococcal infection usually appear to be well until complications such as PID develop. Physical examination of women with gonococcal infection is usually remarkable for mucopurulent urethral, cervical or vaginal discharge, friable appearance of the cervix, and cervical motion tenderness. Common physical examination finding of gonococcal infection among men includes mucopurulent urethral discharge. Less commonly penile edema, and epididymal tenderness and edema (epididymitis) may also be seen as a part of complicated gonococcal infection.^[1]^[2]^[3]

Physical examination of patients with pharyngeal gonococcal infection is usually remarkable for mild pharyngeal exudates and rectal gonococcal infection is usually remarkable for mucopurulent anal discharge. Physical examination of patients with disseminated gonococcal infection (DGI) is usually remarkable for fever, pustular or vesicular rash, and musculoskeletal findings.^[1]^[4]

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^[2]	Mucopurulent urethral discharge Bull-headed clap (penile edema) Unilateral epididymal tenderness and edema (epididymitis)
Urogenital infection in women:^[1]^[3]^[5]^[6]^[7]^[8]	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^[9]	Anal mucopurulent discharge Anorectal tenderness Anorectal bleeding
Pharyngitis^[10]^[11]	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 usually can result two clinical syndromes:^[4]^[12]^[13]

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:^[1]^[4]


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

Images

The following are images associated with gonorrhea physical examination.^[14]^[15]

Gonococcal ophthalmia is due the pathogenic bacteria Neisseria gonorrhea
Gonococcal urethritis, which result in DGI and lead to gonococcal conjunctivitis
Purulent discharge emanating from the cervical os, and pooling in the vagina
Penile discharge in a patient with gonorrhea
Gonococcal pharyngitis
Ophthalmia neonatorum
Swollen testes consistent with epididymitis in a patient with gonorrhea
Gonococcal infection of the conjunctiva in a neonate
Cutaneous gonococcal lesion due to a disseminated Neisseria gonorrhea
The lesion on the left hand due to the systemic dissemination of the Neisseria gonorrhea.
Gonococcal arthritis, inflammation of the skin due to a disseminated gonococcal infection
Close-up of a gonococcal lesion on the skin of a patient’s arm
Lesions of skin and arthritic knee joints due to Neisseria gonorrhea
Gonococcal arthritis of the hand

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 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.
↑ ^2.0 ^2.1 Sherrard J, Barlow D (1996). "Gonorrhoea in men: clinical and diagnostic aspects". Genitourin Med. 72 (6): 422–6. PMC 1195730. PMID 9038638.
↑ ^3.0 ^3.1 Barlow D, Phillips I (1978). "Gonorrhoea in women. Diagnostic, clinical, and laboratory aspects". Lancet. 1 (8067): 761–4. PMID 76760.
↑ ^4.0 ^4.1 ^4.2 Rice PA (2005). "Gonococcal arthritis (disseminated gonococcal infection)". Infect Dis Clin North Am. 19 (4): 853–61. doi:10.1016/j.idc.2005.07.003. PMID 16297736.
↑ 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.
↑ Bleich AT, Sheffield JS, Wendel GD, Sigman A, Cunningham FG (2012). "Disseminated gonococcal infection in women". Obstet Gynecol. 119 (3): 597–602. doi:10.1097/AOG.0b013e318244eda9. PMID 22353959.
↑ O'Brien JP, Goldenberg DL, Rice PA (1983). "Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms". Medicine (Baltimore). 62 (6): 395–406. PMID 6415361.
↑ 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

[pmid26042815-1] 1.0 ^1.1 ^1.2 ^1.3 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.

[pmid9038638-2] 2.0 ^2.1 Sherrard J, Barlow D (1996). "Gonorrhoea in men: clinical and diagnostic aspects". Genitourin Med. 72 (6): 422–6. PMC 1195730. PMID 9038638.

[pmid76760-3] 3.0 ^3.1 Barlow D, Phillips I (1978). "Gonorrhoea in women. Diagnostic, clinical, and laboratory aspects". Lancet. 1 (8067): 761–4. PMID 76760.

[pmid16297736-4] 4.0 ^4.1 ^4.2 Rice PA (2005). "Gonococcal arthritis (disseminated gonococcal infection)". Infect Dis Clin North Am. 19 (4): 853–61. doi:10.1016/j.idc.2005.07.003. PMID 16297736.

[pmid17448399-5] 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.

[pmid806017-6] 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.

[pmid17561186-7] 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.

[pmid4963696-8] Rees E (1967). "Gonococcal bartholinitis". Br J Vener Dis. 43 (3): 150–6. PMC 1047872. PMID 4963696.

[pmid7427703-9] Stansfield VA (1980). "Diagnosis and management of anorectal gonorrhoea in women". Br J Vener Dis. 56 (5): 319–21. PMC 1045815. PMID 7427703.

[pmid386537-10] 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)

[pmid119330-11] 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.

[pmid22353959-12] Bleich AT, Sheffield JS, Wendel GD, Sigman A, Cunningham FG (2012). "Disseminated gonococcal infection in women". Obstet Gynecol. 119 (3): 597–602. doi:10.1097/AOG.0b013e318244eda9. PMID 22353959.

[pmid6415361-13] O'Brien JP, Goldenberg DL, Rice PA (1983). "Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms". Medicine (Baltimore). 62 (6): 395–406. PMID 6415361.

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

[CDCGonorrheapic-15] Centers for Disease Control and Prevention. Public Health Image Library (PHIL) http://phil.cdc.gov/phil/home.asp Accessed on September 22, 2016

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@@ Line 53: / Line 53: @@
 **Periorbital edema
 **Corneal involvement
-*Neonatal Conjunctivitis
+*[[Neonatal Conjunctivitis]]
 **[[Chemosis]]
 **Severe lid edema