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Gonococcal Infections
- Neisseria gonorrhoeae – Gram negative intracellular diplococci
- Infects the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in women and men
- Can also infect the mucous membranes of the mouth, throat, eyes, and anus secondary to direct inoculation.
- Systemic gonococcal infection or disseminated gonococcal infection
- Chronic cases may lead to prostatis and pelvic inflammatory disease
Clinical Presentation
- Men:
- Abnormal discharge from the penis – yellow, creamy, and excessive, blood-tinged
- Painful or frequent urination
- Women:
- May be asymptomatic
- Abnormal purulent vaginal discharge
- Abnormal vaginal bleeding during or after sex or between periods
- Genital itching
- Painful or frequent urination
- Painful sexual intercourse
- Irregular menstrual bleeding
- Lower abdominal pain
- Fever
- Males and Females
- Eye infection – unilateral (probably) copious purulent discharge
- Septic arthritis – knee, ankle or wrist are most common
Diagnosis
- Polymerase chain reaction (PCR)
- Culture
- Gram stain
- Urinalysis
- Pelvic Ultrasound on women
Treatment
- Widespread antibiotic resistance
- IM ceftriaxone with doxycycline or azithromycin
- All partners must be treated
Methicillin-resistant Staphylococcus aureus
- Staph aureus that has acquired a resistance to beta-lactam antibiotics
- Methacilin
- Oxacilin
- Cephalosporins
- also may be reistant to
- Tetracyclines
- Macrolides
- Fluroquinolones
- Bactrim
- Staph aureus is normal human flora found on the skin and mucus membranes
- Staph infections typically cause
- Skin infections – make up 75% of infections
- Pneumonia
- Endocarditis
- Osteomyelitis
- Infectious (septic) arthritis
Labs & Studies
- Cultures
Treatment
- Vancomycin
Acute Rheumatic Fever
- Occurs after a Streptococcus pyogenes infection
- Immune response – not an infection.
- Most commonly affects children ages 5 to 15 years old
- Symptoms begin about 1 to 5 weeks after initial infection
- Common cause of cardiac issues in childhood. May cause:
- Valve stenosis
- Valve regurgitation
- Heart muscle damage
- Atrial fibrillation
- Heart failure
Clinical Presentation
- Fever
- Painful polyarthritis – multiple large joints
- Weird involuntary movements – Chorea
- Pink ringed rash – Erythema marginatum
- Subcutaneous nodules
Physical Exam
- Fever
- Chorea – unlikely to see this in the office
- Erythema marginatum (< 10% of patients)
- Subcutaneous nodules (< 10% of patients)
- New or changing murmur
- Signs of heart failure
- Pericarditis
Labs and studies
- Anti-streptococcal antibody test – there are several
- C-reactive protein
- ESR
- CXR
- ECG
- Echo
Diagnosis
- Jones Criteria
- Should have history of Strep infection and 2 Major Criteria OR 1 Major Criteria, 2 Minor Criteria
- Major Diagnostic Criteria
- Carditis
- Polyarthritis
- Chorea
- Erythema marginatum
- Subcutaneous Nodules
- Minor Diagnostic Criteria
- Fever
- Arthralgia
- Previous rheumatic fever or rheumatic heart disease
- Acute phase reactions: Elevated ESR / CRP / Leukocytosis
- Prolonged PR interval
Treatment
- Antibiotics
- Penicillin
- Anti-inflammatory
- Aspirin
- Naproxen
- NSIADs