Gonorrhea and Urethritis
Urethritis, with typical symptoms such as dysuria and urethral discharge, is caused by bacteria, fungi, protozoa, and viruses that are often sexually transmitted. Ascending inflammations can lead to sterility and severe clinical pictures. Pathogen charact
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Introduction
Urethritis is an inflammation of the mucous membrane of the urethra. Typical symptoms are dysuria, alguria and discharge with a positive detection of at least five polymorphonuclear leukocytes per visual field at 1000 magnification under the microscope (Fig. 1). Urethritis is caused by a broad spectrum of bacteria, fungi, protozoa, and viruses, which are often sexually transmitted. If the infection persists untreated for a longer period of time, the inflammation can progress and cause severe manifestations, as well as sterility. An overview of the practical procedure for urethritis can be found at the end of this chapter.
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Gonorrhea
(Neisser 1879) Synonyms Blennorrhea; Gonorrhoea, the clap Definition Gonorrhea is an infectious disease caused by the Gramnegative bacterium Neisseria gonorrhoeae. It occurs mainly in the mucous membranes of the urogenital tract, the anal canal, the pharynx, and the conjunctiva. Ascending infections can lead to sterility, or in the case of hematogenic spread, to disseminated gonococcal infection. S. Buder (*) German Reference Laboratory for Gonococci, Department of Dermatology and Venerology, Vivantes Hospital Berlin Neukölln, Berlin, Germany e-mail: [email protected] S. Lautenschlager Outpatient Clinic of Dermatology and Venereology, City Hospital Waid and Triemli, Zurich, Switzerland e-mail: [email protected]; [email protected] © Springer-Verlag GmbH Germany, part of Springer Nature 2020 G. Plewig et al. (eds.), Braun-Falco´s Dermatology, https://doi.org/10.1007/978-3-662-58713-3_18-1
Epidemiology The World Health Organization (WHO) estimates that gonorrhea is the fourth most common sexually transmitted disease worldwide after trichomoniasis, Chlamydia trachomatis infections, and genital warts, with 70.3 million cases per year. Humans are the only natural reservoir of N. gonorrhoeae. Transmission only occurs through direct mucosal contact, e.g., during sexual intercourse or childbirth. The incubation period is 1–14 days. The clinical course is often asymptomatic, which is decisive for the persistence and transmission of gonorrhea. In recent years, there has been a dramatic development of resistance from Neisseria gonorrhoeae to the antibiotics commonly in use. The global emergence of single- and multidrug resistance severely limits the therapeutic options. Gonorrhea is not considered a notifiable disease in all countries (WHO report global STI surveillance; ECDC, surveillance atlas STI; Newman et al. 2015; Dudareva-Vizule et al. 2014). Etiopathogenesis Neisseria gonorrhoeae or the gonococcus was discovered in 1879 by the dermatologist Albert Neisser. Gonococci prefer the cylindrical epithelium of the female and male urethra, cervical canal, rectum, and conjunctiva. Although the vagina of the adult woman, lined with squamous epithelium, is spared, the higher vaginal epithelium of prepubertal girls can become infected. Neisseria gonorrhoeae attaches to the host cell with the aid of adhesins (pilus protein, opaque prote
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