Neisseria gonorrhoeae gonococcal infection

Acute cervicitis is inflammation of the uterine cervix diagnosed by visualized mucopurulent endocervical discharge or a friable os that bleeds with a swab, most often caused by Neisseria gonorrhoeae or Chlamydia trachomatis, treated empirically at the same visit while nucleic acid amplification testing is pending.

Chlamydia trachomatis is the most commonly reported bacterial sexually transmitted infection in the United States, frequently asymptomatic, and diagnosed by nucleic acid amplification testing of urine or genital/rectal/oropharyngeal swabs. Uncomplicated genital infection is treated with a single dose of azithromycin or a course of doxycycline, complications include pelvic inflammatory disease and epididymitis, and LGV serovars require a 21-day course and are an increasing cause of proctitis.

Pelvic inflammatory disease is an ascending polymicrobial infection of the upper female genital tract, most often caused by Neisseria gonorrhoeae, Chlamydia trachomatis, or Mycoplasma genitalium, diagnosed clinically on uterine, adnexal, or cervical motion tenderness. Most women are treated as outpatients with a single dose of ceftriaxone plus 14 days of doxycycline, while parenteral cefotetan or cefoxitin plus doxycycline, or clindamycin plus gentamicin, is reserved for hospitalized patients, with tubo-ovarian abscess and infertility among the major complications of delayed treatment.

Infectious urethritis is inflammation of the urethra from a sexually transmitted pathogen, most often Neisseria gonorrhoeae, Chlamydia trachomatis, or Mycoplasma genitalium, presenting with dysuria and urethral discharge. Diagnosis rests on urethral or urine leukocytes plus nucleic acid amplification testing, and empiric treatment covers gonorrhea with ceftriaxone and chlamydia with doxycycline while results are pending.

Epididymitis is inflammation of the epididymis, most often infectious, causing unilateral scrotal pain and swelling of gradual onset that must be distinguished urgently from testicular torsion. Diagnosis is clinical, supported by a positive Prehn sign and preserved cremasteric reflex, and treatment is empiric ceftriaxone plus doxycycline for age under 35 or STI risk, or levofloxacin alone for age over 35 with enteric-organism risk.

Septic arthritis is bacterial infection of a joint, most often Staphylococcus aureus seeding the knee hematogenously, and is a medical and surgical emergency diagnosed by expeditious arthrocentesis showing a synovial leukocyte count generally above 50,000/microliter. Treatment combines empiric intravenous antibiotics such as vancomycin plus ceftriaxone with urgent joint drainage, since delayed source control destroys cartilage within days.

Reactive arthritis is a sterile, human leukocyte antigen B27 (HLA-B27)-associated spondyloarthritis that follows a genitourinary or enteric infection by 1 to 4 weeks, producing asymmetric lower-limb oligoarthritis, enthesitis, and the urethritis-conjunctivitis-arthritis triad. It is a clinical diagnosis of a culture-negative joint. First-line treatment is an NSAID such as piroxicam for at least 2 weeks, escalating to glucocorticoids and then sulfasalazine or a tumor necrosis factor (TNF) inhibitor for disease persisting beyond 3 to 6 months.

Ophthalmia neonatorum is conjunctivitis presenting in the first month of life, caused by chemical irritation, Neisseria gonorrhoeae, Chlamydia trachomatis, or herpes simplex virus acquired at delivery. Age of onset and discharge character point to the organism, and treatment is organism-specific because gonococcal and herpetic disease can destroy the eye within days.

Conjunctivitis is inflammation of the conjunctiva from viral, bacterial, or allergic causes presenting with red eye, discharge, and preserved vision, diagnosed clinically by discharge character and managed with supportive care, targeted topical antibiotics, or topical antihistamine/mast-cell-stabilizer therapy.

Trichomonas vaginalis is a flagellated protozoan sexually transmitted infection that presents with malodorous frothy yellow-green discharge and a strawberry cervix but is frequently asymptomatic, especially in men. Diagnosis rests on nucleic acid amplification testing of vaginal secretions, and treatment is a single 2 g oral dose of metronidazole or tinidazole with partner treatment and retesting in 3 months for high reinfection rates.

Bacterial vaginosis is a polymicrobial dysbiosis of the vagina caused by loss of lactobacilli and anaerobic overgrowth, diagnosed clinically by the Amsel criteria and treated with oral or intravaginal metronidazole or clindamycin.

Syphilis is a sexually transmitted infection with the spirochete Treponema pallidum that progresses through painless chancre (primary), disseminated rash and condyloma lata (secondary), latent, and tertiary stages including neurosyphilis, diagnosed by paired nontreponemal and treponemal serology and treated with a single dose of intramuscular benzathine penicillin G for early disease.

Acute HIV infection, also called the acute retroviral syndrome, is the symptomatic viremic phase in the days to weeks after HIV acquisition, presenting with fever, fatigue, myalgia, rash, and pharyngitis at a time when antibody testing may still be negative. Diagnosis requires an HIV RNA viral load, and antiretroviral therapy should begin as soon as the patient is ready, regardless of CD4 count.

A fertilized ovum implants outside the endometrial cavity, almost always in the fallopian tube, and is the leading cause of maternal death in the first trimester. Diagnosis rests on quantitative beta-hCG paired with transvaginal ultrasound, and management branches immediately on hemodynamic stability.