Gonorrhoea

Gonorrhoea is a sexually transmitted disease (STD) caused by Neisseria gonorrhoeae, a Gram negative diplococcus. (Prof. ABM Abdulllah) or

Gonorrhoea is an infection of the mucous membrane of genitourinary tract caused by Neisseria gonorrhoeae. (Prof.P.C Das)

Incubation period: 2-10 days(Sir Stainly Davidson) or 2-8 days (P.C. Das) or 2-5 days (Chauhan & Mitagupta)

Miasmatic cleavage: Acute phase of sycotic miasmatic disorder.

Clinical feature:

In males:

The infection first starts in the anterior urethra and gradually and spreads to prostaste, urinary bladder and epididymis. Due to involvement of these organs different feature will develop 2- days after sexual contact. The feature are billow-

ü  Dysuria(painful or difficult urination)due to prostritis, frequency and burning micturation (burning sensation in the urethra)

ü  Urethral discharge-copious, mucopurulent or purulent (white or greenish yellow or yelow discharge from urethra), which willl be less and less gradually and will be observed only on waking up from sleep which is called gleet.

ü  Lower abdominal pain

ü  May cause Epididymitis, there may be severe pain and tenderness.

ü  Orchitis (Inflammation of testis)

In female:

ü  Dysuria, frequency and burning micturition

ü  Urthral discharge-copious, mucopurulent or purulent

ü  Lower abdominal pain

ü  Vulvovaginitis, cervicitis, salpingitis(inflammation of the fallopian tubes), salpingo-oophorotis(inflammation of a fallopian tube and an ovary)

ü  Bartholin abscess

Children:

Opthalmia neonatorum: Conjunctivitis, swollen eyelids, severe hyperaemia, chemosis, profuse purulent discharge. Rarely, corneal ulcer and perforation.

Other Feature: According to site of involvement-

ü  Anorectum(both-male and female)- proctitis with pain and purulent discharge

ü  Pharynx- Pharyngitis with erytheme secondary to oro-genital sexual exposure.

ü  Disseminated infection-if untreated, disseminated gonococcal infection may occur. Typically affects women with asymptomatic genital infection. There may be arthritis of one or more joints, pustular skin lesions, fever

ü  Conjunctivities,  panopthalmitis

Management:

Investigation:

ü  Gram stain-Gram negative diplococci seen on microscopy of smear from infected site.

ü  Culture (Chocolate agar media, Thayer-Martin media)
- Men: swab from urethra, rectum, oropharynx
- Women: Swab from cervix, rectum, oropharynx

Treatment:

Treatment of uncomplicated anogenital gonorrhoea

Homoeopathic Treatment:

Repertory: Kent: Chapter Urethra-Symptom discharge; prurulent: Arg-n, Arn, Bar-c, Calc, Calc-s, Cann-s, Canth, Caps, Carb-v, Chel, Clem, Con, Cop, Cub, Kali-I, Kali-s, Led, Lyc, Med, Merc, Merc-c, Nit-ac, Ph-ac, Phos, Psor, Puls, Sabin, Sars, Sil, Sulph, Thuj.

Short Indications for male patients:
Agn: Repeated attacks of gonorrheal urethritis with purulent discharge (gleet)
Ferr: Chronic urethral discharge (gleet), with copious painless milky discharge.
Hydr: Debility, with urethral discharge (gleet); copious, painless, thick, yellow discharge.
Klai-bi: Urethral discharge (gleet); stringly, gelly like.
Sulph: Urethral discharge (gleet); yellow, light, scanty
Puls: Urethritis, with offensive, purulent discharge as in gonorrhoea. (Gentry, Male sexual)
Cop: Chronic gleet with muco-purulent discharge. (Repertory; Gentry, Chapter-Male sexual organs)
Merc: Gonorrhea; frequent painful erection; burning pain in urethra, green, purulent discharge; hot swollen prepurce (Rerertory; Gentry. Chapter-Male Sexual Organs)
Cann-s: Gonorrhoea: Inflammatory stage; penis swollen, thick purulent discharge, dysuria (micturation difficult), with intermittent flow (Repertory Gentry. Chapter-Male sexual organs)
Caps:Discharge; purulent from urethra like cream (repertory-gentry. Chapter-Male-Sexual organs)
Thuja-occ: In chronic cases; burning urine, pain & itching in urethra, watery dischare from urethr (yellow discharge may be seen sometime burn & pain after urine and last few minutes, white color seen into tips of penis, itching in the anus area,feel better at rest but pain increases when walking or riding in vehicles, pain is hevier than burning= Three doses of Thuja 200C at 6 hourly interval for one day. No other medicines . Wait for a day and use Natrum Sulph 200C one dose a day for three days. Report on 3rd day and 6th day. Use Mercurious Corr. 30C three times a day from 7th day onwards
Merc-cor:  Merc Cor,.30C But buy 200C for later use. Use Copaiva officianalis 3X three times a day for three days and report on painful burning urine and polyuria or dysuria and on the condition of Swollen testicles. Raise potency if needed. with best wishes

Short indication for female patients:
Repertory-Kent; Chapter Genitalia female symptom; Leucorrhoea-Purulent: Alum, Arg-m, Bufo, Calc, Cal-s, Chin, Cocc, Hydr, Ign, Kali-s, Kreos, Merc, Merc-i-f, Nit-ac, Sabin, Sep, Sil.
Repertory Boericke-Chapter female sexual-Symptom-Leucorrhoea; Purulent type; staining yellow; Aesc, Agn, Alumn, Arg-n, Ars, Aur-m, Bov, Calc, Cann-s, Carb-an, Cean, Cham, Cinch, Eupi, Fago, Helin, Hydr, Ign, Iod, Kali-bi, Kali-s, Kreos, Lach, Lil-t, Lyc, Merc, Nat-s, Puls, Sep, Stann, Sulph, Tril, Ust.

Short indication:
Sep: Discharge; purulent from vagina.
Merc: Ulcerated cervix, with copious muco-purulent discharge from vagina, (Repertory-Gentry.Chapter-Uterus and Appendages)
Calc: Inflammation and swelling of genitals, with purulent discharge, moisture between labia and thighs, with biting pain, inflammation, redness and swelling of vulva with purulent discharge from friction, in leuco-phlegmatic women. (Repertory-Gentry. Chapter-Uterus and Appendages)
Rob: Feenong, nymphomania; with whitish or yellowish-green, thick, acrid, purulent leucorrhoea, with tumefaction and bruised feeling in cervix, general prostration.

Alopathic treatment:

Uncomplicated infection

1.       Ceftriaxone 500 mg IM or

2.       Cefixime 400 mg stat or

3.       Ciprofloxacin 500 mg orally stat(Contraindicated in pregnancy and breastfeeding) ,( If prevalence of quinolone resistance for N. gonorrhoeae < 5%) or

4.       Ofloxacin 400 mg orally stat (Contraindicated in pregnancy and breastfeeding) , ,(If prevalence of quinolone resistance for N. gonorrhoeae < 5%) or

5.       Amoxicillin 3 g plus probenecid 1 g orally stat(If prevalence of penicillin resistance for N. gonorrhoeae < 5%)

Quinolone resistance

1.       Ceftriaxone 500 mg IM stat or

2.       Spectinomycin 2 g IM stat(May only be available in specialist clinics)

Pregnancy and breastfeeding

1.       Ceftriaxone 500 mg IM stat or

2.       Cefixime 400 mg stat or

3.       Amoxicillin 3 g plus probenecid 1 g orally stat³ or

4.       Spectinomycin 2 g IM stat(May only be available in specialist clinics)

Pharyngeal gonorrhoea

1.       Ceftriaxone 500 mg IM stat or

2.       Cefixime 400 mg stat or

3.       Ciprofloxacin 500 mg (Contraindicated in pregnancy and breastfeeding),(If prevalence of quinolone resistance for N. gonorrhoeae < 5%)orally stat or

4.       Ofloxacin 400 mg(Contraindicated in pregnancy and breastfeeding), (If prevalence of quinolone resistance for N. gonorrhoeae < 5%) orally stat

Complications of delayed therapy in gonorrhoea

1.       Acute prostatitis

2.       Epididymo-orchitis

3.       Bartholin’s gland abscess

4.       PID (may lead to infertility or ectopic pregnancy)

5.       Disseminated gonococcal infection