Gonorrhea differential diagnosis: Difference between revisions

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Revision as of 15:10, 29 September 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Gonorrhea must be differentiated from nongonococcal urethritis, bacterial vaginosis, vaginitis, cervicitis, urinary tract infections, endometriosis, prostatitis, and orchitis. Disseminated gonococcal infection must be differentiated from herpes simplex virus (HSV),nongonococcal septic arthritis, syphilis, HIV infection, rheumatic fever, [Reactive arthritis]] , and Lyme disease.

Differentiating gonorrhea from other diseases

Conditions that must be considered in the differential diagnosis of gonorrhea:

In women
- Nongonorrheal urethritis
- Bacterial vaginosis
- Vaginitis
- Cervicitis
- Urinary tract infections
- Pregnancy
- Endometriosis
In men
- Nongonorrheal urethritis
- Prostatitis
- Orchitis
- Testicular torsion
- Urinary tract infections

Disseminated gonococcal infection

Nongonococcal septic arthritis Disseminated gonococcal infection must be differentiated from:


Disease	Findings
Nongonococcal septic arthritis	Presents with an acute onset of joint swelling and pain (usually monoarticular) Culture of joint fluid reveals organisms
Acute rheumatic fever	Presents with polyarthritis and rash (rare presentation) in young adults. Microbiologic or serologic evidence of a recent streptococcal infection confirm the diagnosis. Poststreptococcal arthritis have a rapid response to salicylates or other antiinflammatory drugs.
Syphilis	Presents with acute secondary syphilis usually presents with generalized, pustular lesions at the palms and soles with generalized lymphadenopathy Rapid plasma reagin (RPR), Venereal Disease Research Laboratory (VDRL) and Fluorescent treponemal antibody absorption (FTA-ABS) tests confirm the presence of the causative agent.
Reactive arthritis (Reiter syndrome)	Present with arthritis, tenosynovitis, dactylitis, and low back pain. Extraarticular manifestation include conjunctivitis, urethritis, and genital and oral lesions. There is no definitive diagnostic test. Reactive arthritis is a clinical diagnosis based upon the pattern of findings.
Hepatitis B virus (HBV) infection	Presents with fever, chills, polyarthritis, tenosynovitis, and urticarial rash Synovial fluid analysis usually shows noninflammatory fluid Elevated serum aminotransaminases and evidence of acute HBV infection on serologic testing confirm the presence of the HBV.
Herpes simplex virus (HSV)	Genital and extragenital lesions can mimic the skin lesions that occur in disseminated gonococcal infection Viral culture, polymerase chain reaction (PCR), and direct fluorescence antibody confirm the presence of the causative agent.
HIV infection	Present with generalized rash with mucus membrane involvement, fever, chills, and arthralgia. Joint effusions are uncommon
Gout and other crystal-induced arthritis	Presents with acute monoarthritis with fever and chills Synovial fluid analysis confirm the diagnosis.
Lyme disease	Present with erythema chronicum migrans rash and monoarthritis as a later presentation. Clinical characteristics of the rash and and serologic testing confirm the diagnosis.

References

Template:WH Template:WS

@@ Line 4: / Line 4: @@
 ==Overview==
-Gonorrhea must be differentiated from nongonococcal [[urethritis]], ''[[Trichomonas vaginalis]]'' infection, [[urethral stricture]], [[acute prostatitis]], and [[Reiter's syndrome]].
+Gonorrhea must be differentiated from nongonococcal [[urethritis]], [[bacterial vaginosis]], [[vaginitis]], [[cervicitis]], [[urinary tract infections]], [[endometriosis]], [[prostatitis]], and [[orchitis]].
+Disseminated gonococcal infection must be differentiated from [[herpes simplex virus|herpes simplex virus (HSV)]],nongonococcal [[septic arthritis]], [[syphilis]], HIV infection,  [[rheumatic fever]], [Reactive arthritis]] , and [[Lyme disease]].
 ==Differentiating gonorrhea from other diseases==
@@ Line 10: / Line 12: @@
 *In women
 ** Nongonorrheal [[urethritis]]
-** Bacterial vaginosis
+** [[Bacterial vaginosis]]
 ** [[Vaginitis]]
 ** [[Cervicitis]]
+** [[Urinary tract infections]]
 ** Pregnancy
 ** [[Endometriosis]]
@@ Line 20: / Line 23: @@
 ** [[Orchitis]]
 ** [[Testicular torsion]]
+** [[Urinary tract infections]]
-* Urinary tract infections
-vaginitis, ectopic pregnancy, pregnancy, tubo-ovarian abscess, endometriosis, and mucopurulent cervicitis. In men, consider epididymitis, orchitis, and testicular torsion
 ===Disseminated gonococcal infection===
+Nongonococcal septic arthritis
 Disseminated gonococcal infection must be differentiated from:
@@ Line 33: / Line 34: @@
 ! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Herpes simplex virus|Herpes simplex virus (HSV)]]'''
+| style="padding: 5px 5px; background: #DCDCDC;" |'''Nongonococcal [[septic arthritis]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Presents with an acute onset of joint swelling and pain (usually monoarticular)
+*Culture of joint fluid reveals organisms
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute rheumatic fever]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Genital and extragenital lesions can mimic the skin lesions that occur in disseminated gonococcal infection
+*Presents with polyarthritis and rash (rare presentation) in young adults. Microbiologic or serologic evidence of a recent streptococcal infection confirm the diagnosis.
-*Viral culture,  [[polymerase chain reaction|polymerase chain reaction (PCR)]], and direct fluorescence antibody confirm the presence of the causative agent.
+*Poststreptococcal arthritis have a rapid response to [[salicylate]]s or other [[antiinflammatory drugs]].
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Syphilis]]'''
@@ Line 42: / Line 48: @@
 *Presents with acute secondary syphilis usually presents with generalized, pustular lesions at the palms and soles with [[lymphadenopathy|generalized lymphadenopathy]]
 *Rapid plasma reagin (RPR), Venereal Disease Research Laboratory (VDRL) and Fluorescent treponemal antibody absorption (FTA-ABS) tests confirm the presence of the causative agent.
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Reactive arthritis]] (Reiter syndrome)'''
+| style="padding: 5px 5px; background: #F5F5F5;" | Present with [[arthritis]], [[tenosynovitis]], [[dactylitis]], and low back pain. Extraarticular manifestation include [[conjunctivitis]], [[urethritis]], and genital and oral lesions. There is no definitive diagnostic test. Reactive arthritis is a clinical diagnosis based upon the pattern of findings.
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Hepatitis B virus|Hepatitis B virus (HBV) infection]]'''
@@ Line 48: / Line 57: @@
 *Synovial fluid analysis usually shows noninflammatory fluid
 *Elevated [[aminotransaminases|serum aminotransaminases]] and evidence of acute HBV infection on serologic testing confirm the presence of the HBV.
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Herpes simplex virus|Herpes simplex virus (HSV)]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Genital and extragenital lesions can mimic the skin lesions that occur in disseminated gonococcal infection
+*Viral culture,  [[polymerase chain reaction|polymerase chain reaction (PCR)]], and direct fluorescence antibody confirm the presence of the causative agent.
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[HIV infection]] '''
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *Present with generalized rash with mucus membrane involvement, fever, chills, and [[arthralgia]]. Joint effusions are uncommon
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute rheumatic fever]]'''
-| style="padding: 5px 5px; background: #F5F5F5;" |
-*Presents with polyarthritis and rash (rare presentation) in young adults. Microbiologic or serologic evidence of a recent streptococcal infection confirm the diagnosis.
-*Poststreptococcal arthritis have a rapid response to [[salicylate]]s or other [[antiinflammatory drugs]].
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Gout|Gout and other crystal-induced arthritis]]'''
@@ Line 62: / Line 71: @@
 *Presents with acute monoarthritis with fever and chills
 *Synovial fluid analysis confirm the diagnosis.
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Reactive arthritis]] (Reiter syndrome)'''
-| style="padding: 5px 5px; background: #F5F5F5;" | Present with [[arthritis]], [[tenosynovitis]], [[dactylitis]], and low back pain. Extraarticular manifestation include [[conjunctivitis]], [[urethritis]], and genital and oral lesions. There is no definitive diagnostic test. Reactive arthritis is a clinical diagnosis based upon the pattern of findings.
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lyme disease]]'''