It is equally important that the clinician request to interview the adolescent alone to fully assess lifestyle factors that may be contributing to the disease process. On the other hand, N. gonorrhoeae infection in women often is asymptomatic and can lead to sterility or ectopic gestation. Key GC structures that are subject to variability but are associated with pathogenesis because they enhance the organism’s ability to evade host defenses include: porin proteins (aid with host cell insertion), Opa (adherence), pili, (adherence), lipooligosaccharide (tissue toxin), and peptidoglycan (tissue toxin). Urinalysis may be positive if tested for leucocyte esterase. Disseminated gonococcal infection causes. In particular, the MICs were >32 μg/ml for penicillin, 24 μg/ml for tetracycline, and 4 μg/ml for Cip. Gonococcal arthritis is a bacterial arthritis that develops in approximately 42-85% of patients with disseminated gonococcal infection of Gram-negative diplococcus Neisseria gonorrhoeae from primary sexually acquired mucosal gonococcal infection 1).Gonococcal arthritis has become rare in … 606-13. 1462-1465. 1980. pp. vol. Vaginal specimens (female) and urine samples may also be tested for GC using nucleic acid amplification testing. 35. Among those who acquire a GC infection, approximately 0.5-3% of patients will acquire disseminated disease. 2008. pp. Alternative names: Disseminated gonococcal infection (DGI); Disseminated gonococcemia; Septic arthritis — gonococcal arthritis. Viral Infections (acute HIV infection, parvovirus B19, measles, and rubella). Copyright © 2017, 2013 Decision Support in Medicine, LLC. Spectrum of the gonococcal arthritis-dermatitis syndrome. e196-7. Submission, Review, & Publication Processes, Disseminated Gonococcal Infection in an Immunocompetent Patient Caused by an Imported Neisseria gonorrhoeae Multidrug-Resistant Strain, Copyright © 2006 American Society for Microbiology. What causes this disease and how frequent is it? Gram stain of urethral discharge (99% specific, 95% sensitive) may expedite the clinical decision-making process. The New England Journal of Medicine. 2006. pp. Gonococcal antibody was detected in 47% of patients when they presented with the syndrome. The N. gonorrhoeae isolate was completely characterized for its microbiological features. To date, this is the first case of DGI due to a multidrug-resistant strain reported in Italy. Clinical symptoms related to gonococcal infection have been reported since ancient times. Our mission is to provide practice-focused clinical and drug information that is reflective of current and emerging principles of care that will help to inform oncology decisions. 369-371. Partner diagnosis and treatment is important to prevent reinfection and complications. The erythrocyte sedimentation rate was 78 mm/h, and the C-reactive protein level was 5.9 mg/dl. Thank you for sharing this Journal of Clinical Microbiology article. Journal of Clinical Microbiology. Sex Transm Dis. CSF, however, should be obtained for cell count, protein, glucose, culture, and susceptibility testing if the patient has meningeal signs or in febrile infants with suspected DGI. Annals of Internal Medicine. Clinicians should always conduct a detailed assessment regarding medication allergies that will influence antibiotic choices. vol. Treatment for gonococcal infection in Delhi, find doctors near you. Please login or register first to view this content. In patients with a true septic joint synovial fluid will have a white blood-cell count = 50,000 or greater and positive cultures. The organism’s survival has been primarily due to its ability evade host defenses through antigenic variation and the associated structural changes involved in pathogenesis. “Gonorrhea in the newborn”. (5). 637-42. Treatment with 2 g oxacillin four times daily intravenously and 80 mg gentamicin twice daily was commenced. Wiggers, M.N.L., Oudesluys-Murphy, A.M.. “A child presenting with fever and arthritis due to disseminated gonorrhoea”. This work was supported by Ministero della Salute grant Quinto Programma Nazionale di Ricerca sull'AIDS (20F/F-Art529). Sexually Transmitted Diseases. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. We want you to take advantage of everything Cancer Therapy Advisor has to offer. American Society for Microbiology vol. 45. Microbes Infect. In women with disseminated infections, prompt recognition and antimicrobial treatment will usually result in a … Culture is also useful for antimicrobial sensitivity testing, treatment failure, and epidemiological purposes (outbreaks, surveillance). “Sexually Transmitted Diseases”. 6,7 The probability of the organism spreading to the joints and other tissues depends upon … The tetracycline resistance mobile elements were detected by PCR using three primers, UF (5′-CTCGAACAAGAGGAAAGC), AR (5′-GCATTCCACTTCCCAAC), and DR (5′-TGCAGCAGAGGGAGG), as previously described (10, 11, 16). Most patients respond rapidly to treatment within 24 to 48 hrs. 693-701. 2007. pp. The isolate showed a reactivity against both porin proteins, thus resulting in a hybrid serovar (IA/IB). In fact, multidrug-resistant DGI can be fatal if not recognized and treated correctly. Individuals who engage in high risk sexual behaviors (multiple partners, commercial sex work) or are a part of a sexual network in a high GC prevalence community are at risk for infection. 798-801. vol. Gorgos, L, Newman, L, Satterwhite, C, Berman, S, Weinstock, H. “Gonorrhea positivity among women aged 15-24 years in the USA, 2005-2007”. In addition to a thorough general clinical examination with vital signs, particular attention should be paid to: DGI skin lesion of the hand, Courtesy: Dr.Jonathan Zenilman, Department of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore Maryland, Less than 30 painful, necrotic pustules on a base of erythema. vol. Rosenthal, L, Olhagen, B, Ek, S. “Aseptic arthritis after gonorrhea”. Lyss, SB, Kamb, ML, Peterman, TA, Moran, JS, Newman, DR, Bolan, G. “Project RESPECT Study Group. vol. N. gonorrhoeae can spread through the bloodstream and infect other parts of the body, including the joints, resulting in disseminated gonococcal infection (DGI), which occurs in 0.5% to 3% of patients infected with N. gonorrhoeae. MICs for ceftriaxone and spectinomycin were 0.002 and 6 μg/ml, respectively. A small subset of patients may require additional radiological procedures if other issues such as DGI related osteomyelitis are suspected or if the patient does not have substantial improvement while being treated with appropriate antibiotic coverage for DGI. Use of arthroscopy and open drainage of GC arthritis is rarely necessary and of limited value given the effectiveness of antibiotic regimens available for treatment. First, despite a widespread increase in the rates of reproductive tract infections, this case is evidence of a low attention to sexually transmitted infections, since a sexually transmitted pathogen was not initially suspected despite the history of travel and sexual exposure in a country with a high prevalence of sexually transmitted infections. The most common presentation of disseminated gonococcal infection (DGI) is acute arthritis, tenosyovitis, and dermatitis (Arthritis-Dermatitis Syndrome). pp. 15. His past medical history revealed hypertension and a recent trip to Thailand where he had engaged several times in sexual intercourse with local sex workers. Disseminated Gonococcal Infection (DGI) Predisposing factors. The most common site of Neisseria gonorrhoeae infection is the urogenital tract. What laboratory studies should you request to help confirm the diagnosis? Upon admission, biochemistry was normal, and the white blood cell count was 14,100 (83.9% polymorphonuclear leukocytes, 7.3% lymphocytes, and 8.5% monocytes). Disseminated gonococcal infection (DGI) results from bacteremic spread of the sexually transmitted pathogen, Neisseria gonorrhoeae, which can lead to a variety of clinical symptoms and signs, such as arthritis or arthralgias, tenosynovitis, and multiple skin lesions. Raychaudhuri, M, Peall, A, Page, C, Browing, M. “A case of duplicitous diplococci”. Treatment for Gonococcal Arthritis or Disseminated Gonococcal Infection The first step towards treatment is to cure gonorrhea of the infected patient using appropriate antibiotics. vol. Disseminated gonococcal infection”. Few cases have been reported in the literature since the first case was described in 1922. 1583-1584. The gonococcal strain was sent to the laboratory of the Istituto Superiore di Sanità for complete phenotypic and genotypic characterization. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. Disseminated gonococcal infection is most common in young women but may develop in sexually active persons of any age. vol. Pain relief may be needed for patients with epididymitis, pelvic inflammatory disease, and disseminated gonococcal infection (DGI). 1989. pp. Chernesky, M, Freund, GG, Hook, E. “Detection of and infections in North American women by testing SurePath liquid-based Pap specimens in APTIMA assays”. 66. Want to view more content from Cancer Therapy Advisor? 2008. pp. vol. 11. Annals of Rheumatic Disease,. 2010. Two main comments arise from the case described. vol. After growth on GC agar plates supplemented with 2% Isovitalex (Oxoid) and incubated at 37°C in 5% CO2 for 18 to 20 h, a serological assay by coagglutination reaction was performed using two monoclonal antibodies (Phadebact GC serovar test; Boule Diagnostic AB, Sweden) directed against epitopes of the IA and IB porin proteins. A possible selective antibiotic pressure, for instance, penicillin and tetracycline, could also contribute to the appearance and survival of such hybrid gonococcal strains (5). GC strains that are able to resist destruction by antibodies and complement, thus limiting the cellular immune response, may allow for a longer period of asymptomatic infection leading to DGI. Disproportionate rates of disease exist among under-represented minority groups. Already have an account? Gonococcal arthritis. The risk for invasive gonococcal infection likely persists throughout the duration of eculizumab therapy. What other disease/condition shares some of these symptoms? “Emerging antimicrobial resistance in Neisseria gonorrhoeae: urgent need to strengthen prevention strategies”. Gonorrhea is a sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae that leads to genitourinary tract infections such as urethritis, cervicitis, pelvic inflammatory disease and epididymitis.The disease primarily affects individuals between 15–24 years of age and has an incubation period of 2–7 … 1981 Feb; 10 (3):173–197. Holmes, KK, Sparling, PF. 94. There were no signs of meningeal involvement. Washington, DC 20036 Hybrid N. gonorrhoeae strains expressing both IA and IB porin proteins are quite uncommon among clinical isolates (4, 5). Complications may occur and patients may also rarely present with meningitis or endocarditis resulting from DGI. 2008. pp. The differential diagnosis for DGI includes a number of other clinical disorders as outlined below.Other forms of The primary clinical syndrome associated with DGI is diagnosed based on the clinical examination and detection of the organisms using culture and/or PCR. 2003. pp. Obrien, SF, Bell, TA, Farrow, JA. “Neisseria meningitis and Neisseria gonorrhoeae bacteremia associated with C6, C7, or C8 deficiency”. When the bacteria spread, disseminated gonorrhea can cause symptoms like fevers, chills, and a general feeling of being unwell. Dal Conte, I., Starnino, S., Di Perri, G., Stefanelli, P. “Disseminated gonococcal infection in an immunocompetent patient caused by an imported Neisseria gonorrhoeae multidrug-resistant strain”. The routine use of radiologic studies for diagnosis of septic arthritis remains unsupported in systematic reviews in the literature. All rights reserved. It occurs in 0.5–3% of infected individuals. The pathogenesis of DGI has been associated with both microbial and host factors. The Licensed Content is the property of and copyrighted by DSM. J Clin Microbiol. INTRODUCTION. Akkinepally, S, Douglass, E, Moreno, A. 550-1. 1984 Apr-Jun. If you are able to confirm that the patient has Disseminated Gonococcal Infection, what treatment should be initiated? Home » Decision Support in Medicine » Pediatrics. Annals of Rheumatic disease. 87. 2004. pp. Since that time, access to highly effective antibiotics in the context of asymptomatic screening have further reduced the incidence. Russ, S, Wrenn, K. “Images in clinical medicine. If so, which ones? “Pathogenic consequences of Neisseria gonorrhoeae pilin glycan variation”. Those authors hypothesized two possible reasons for the rare occurrence of a hybrid form of porin: first, there might be a reduced fitness of such strains since they could be more easily recognized and killed by bactericidal antibodies in patients with a previous gonococcal infection; second, a hybrid form of this porin could be responsible for its altered function on the surface of the gonococcus. vol. 2005. pp. Are additional laboratory studies available; even some that are not widely available? Acute rheumatic fever (post-streptococcal arthritis can usually be distinguished by the rash and evidence of recent streptococcal infection). Black, JR, Cohen, MS. “Gonococcal osteomyelitis: a case report and review of the literature”. Women have a slightly higher risk than men (female patients often have asymptomatic infections), and the rate of DGI is disproportionately high among underrepresented minorities and those living in poverty. 150. Infection with GC is common worldwide. Patient should also be aware that some strains of GC may be resistant to various treatment regimens. 139. 108. In 2009, there were 301,174 cases of GC reported in the United States for a rate of 99.1 cases per 100,000. in the population. International Journal of Infectious Disease. Individuals with a defect in the terminal complement deficiency (C5-C9) are more likely to develop severe disease. We herein report the microbiological features of a Neisseria gonorrhoeae strain isolated from an immunocompetent patient with disseminated gonococcal infection (DGI). Synovial fluid cultures are positive in 20-30% of patients with DGI. Individuals who develop DGI are thought to have infection with gonococcal strains that express the PI.A porin and Opa proteins and /or short lipooligosaccharides. The strain was resistant to three of the five antibiotics tested. 441-2. -history of present illness including clinical manifestations timing, course, and review of systems (e.g., fever, rash, arthralgias, joint swelling, vaginal or urethral discharge, dysuria, abdominal pain, sore throat, headache, vomiting, confusion, neck stiffness, fatigue, shortness of breath, chest pain), -sexual history with most recent sexual intercourse, types of sexual contact (vaginal, anal, oral), number of partners, partner symptoms, -past medical history including chronic medical problems and sexually transmitted infections, -last menstrual period (female patients) to assess menstrual timing (50% of patients with DGI are diagnosed within 7 days of last period) and pregnancy risk assessment (female patients), -family history to determine risk for other diseases, -social history including query for sexual abuse, Key Components of the Physical Examination. Enter multiple addresses on separate lines or separate them with commas. Serology for human immunodeficiency virus and syphilis was negative, and the patient was not immunocompromised. Other forms of infectious and non-infectious arthritis (synovial fluid analysis and cultures for Neisseria gonorrhoeae (GC) should distinguish DGI from other arthritis syndromes). Copyright © 2020 Haymarket Media, Inc. All Rights Reserved Treatment Options. DGI occurs in 1–3% of all cases of N. gonorrhea infection. Endocarditis caused by another organism if cardiac symptoms present. S3. How can Disseminated Gonococcal Infection be prevented? Pharyngeal culture is indicated for patients with history of oral sexual contact. We also thank Tonino Sofia and Marta Boffito for editing the manuscript and Paola Mastrantonio for helpful comments. vol. You’ve read {{metering-count}} of {{metering-total}} articles this month. Complement testing should be reserved for individuals with recurrent DGI. Treatment Of Disseminated Gonococcal Infection. Conjunctival gonococcal infection can result in scarring, permanent visual impairment and blindness. Centers for Disease Control and Prevention, Public Health Image Library, http://phil.cdc.gov/phil/details.asp, Last accessed: 4/12/11, General status (alert versus sleepy; oriented versus confused), Light sensitivity (particularly with headache), Lower abdominal pain (to assess for pelvic inflammatory disease (PID) in female patients), Vaginal discharge/cervical motion tenderness on bimanual examination to assess for concurrent PID (female), Urethral discharge/scrotal enlargement or pain to assess for concurrent epidymitis (male). Alternate presentations seen as lesions progress: Joint examination: (See Figure 2 and Figure 3. What are the possible outcomes of Disseminated Gonococcal Infection? A nitrocefin chromogenic test (Oxoid) was used to detect the presence of β-lactamase production. To investigate the presence of amino acid substitutions on the two target genes (gyrA and parC) known to be involved in resistance to ciprofloxacin (2), sequence analyses of the quinolone resistance determinant regions were performed after amplification with primers gyrA1 (5′-CGGCGCGTACTGTACGCGATGCA), gyrA2 (5′-ATGTCTGCCAGCATTTCATGTGAGA), parC1 (5′-ATGGCGATATGGGTTTGAC), and parC2 (5′-GGACAACAGCAATTCCGCAA) (15). 1-110. 2006. pp. Kimmitt, P.T., Kirby, A., Perera, N., Nicholson, K.G., Schober, P.C., Rajakumar, K., Chapman, C.A. 2434-8. Chest X rays and transthoracic echocardiography were normal. 29. 2009. pp. US Department of Health and Human Services. Your use of this website constitutes acceptance of Haymarket Media’s Privacy Policy and Terms & Conditions. Disseminated gonococcal infection results from the spread of the bacteria to the joints and other tissues. The characterization of molecular changes associated with gonococcal resistance in DGI is essential to provide rapid advice for clinical management of cases. 85. Masi AT, Eisenstein BI. To date, this is the first case reported in our country of DGI due to an imported multidrug-resistant strain. How should you interpret the results? (Reference: Centers for Disease Control & Prevention, 2010 STD Treatment Guidelines http://www.cdc.gov/std/treatment/2010/gonococcal-infections.htm). Gram-negative diplococci were identified by API-NH (bioMerièux, France) as Neisseria gonorrhoeae in blood culture. Affected patients are usually young (most under 40 years), healthy, sexually active, and/or with asymptomatic genitourinary, pharyngeal, and/or rectal infection. cervical, urethral, or skin infection), but have negative synovial fluid cultures. Disseminated gonorrhea—which occurs in an estimated 0.5–3% of infected individuals—can happen within two weeks of a gonorrhea infection. These changes have already been described in the literature as being correlated to the Cip-resistant phenotype (1). The frequency of disseminated gonococcal infection decreased remarkably over the 34-year study period, paralleling the decreasing prevalence of mucosal Neisseriagonorrhoeae infections reported nationwide. CancerTherapyAdvisor.com is a free online resource that offers oncology healthcare professionals a comprehensive knowledge base of practical oncology information and clinical tools to assist in making the right decisions for their patients. Gonococcemia (also known as "Arthritis–dermatosis syndrome" [1] and "Disseminated gonococcal infection" [1] ) is a condition characterized by a hemorrhagic vesiculopustular eruption, bouts of fever, and arthralgia or actual arthritis of one or several [en.wikipedia.org]Laboratory studies were consistent with an acute septic arthritis and the diagnosis of the gonococcal … Disseminated gonococcal infection complicated 0.4%–3% of gonococcal infections during the 1970–80s.1, 2 Although rates declined thereafter,1, 2 a recent resurgence has been attributed to oral–genital sexual practices among men who have sex with men (MSM).2 The classic presentation is a triad of … 607-626. Would imaging studies be helpful? Ann Int Med,. Sex Transm Infect. In recent years, despite the worldwide increase in genital gonococcal infections, complicated cases such as DGI have rarely been reported (6, 9, 14). For males, treatment is always outpatient for genital infection; however, admission may be necessary for complications such as disseminated gonococcal infection (DGI) or gonococcal arthritis. These results do not support the hypothesis that circulating immune complexes are involved in the pathogenesis of disseminated gonococcal arthritis‐dermatitis … vol. The diagnosis of gonococcal arthritis or DGI is also secure if a mucosal gonococcal infection is documented in the presence of a typical clinical syndrome that responds promptly to appropriate antimicrobial therapy. 440-5. “Disseminated gonococcal infection in pregnancy”. 74. 90. 178-85. NOTE: We request your email address only to inform the recipient that it was you who recommended this article, and that it is not junk mail. Following this period, the patient can be … vol. Obstetrics and Gynecology. Since GC is a sexually transmitted infection, DGI can be prevented by: Routine asymptomatic screening for sexually transmitted infections every 6-12 months (depending on age and disease prevalence). 224-227. Book Appointment Online, View Fees, Reviews Doctors for Gonococcal Infection Treatment in Kolkata | Practo Schachter, J, Moncada, J, Liska, S. “Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men”. Matthews, CJ, Kingsley, G, Field, M, Jones, A, Weston, VC, Phillips, M, Walker, D, Coakley, G. “Management of septic arthritis: a systemic review”. 2006. pp. Performance standards for antimicrobial susceptibility testing. Gonococcal bacteremia is more likely to be associated with polyarthralgias and skin lesions. Testing for other sexually transmitted infections is important to identify coexistent STIs and also eliminate STIs which may present with similar clinical findings (noted above) from the differential diagnoses. The patient's complement deficiency is considered one of the most important causes favoring the course of disease (12). Recent trends show slightly lower rates of infection among men compared with women. Definition: Gonococcal arthritis is inflammation of a joint due to a gonorrhea infection.. Gonococcal arthritis is a type of septic arthritis.This is inflammation of a joint due to a bacterial or fungal infection… The only way that DGI can be prevented is by preventing acquisition of GC infection. Annals of Internal Medicine. Ongoing controversies regarding etiology, diagnosis, treatment, Recommended: Ceftriaxone 1 g intravenously (IV) or intramuscularly (IM) every 24 hoursAlternative regimens include: Cefotaxime 1g IV every 8 hours or Ceftizoxime 1g IV every 8 hours), 24-48 hours of IV therapy (or until 24 hours after clinical improvement) followed by oral cefixime 400 mg (oral) daily to complete 7 days of therapy, 7-14 days of IV therapyPatient may require drainage by orthopedic surgery, Children > 45kg: Ceftriaxone 50 mg/kg IM or IV in a single dose daily f (max dose: 1 g)Children:≤ 45kg:Ceftriaxone 50 mg/kg IM or IV in a single dose daily, 7 days DGI10-14 days if meningitis documented. Individuals with low CD50, but normal CD 3 and 4 will need additional testing of terminal components (C5-9). In the United States, an estimated 820,000 new N. gonorrhoeae infections occur each year ().Gonorrhea is the second most commonly reported communicable disease ().Urethral infections caused by N. gonorrhoeae among men can produce symptoms that cause them to seek curative treatment … Petersen, BH, Lee, TJ, Snyderman, R, Brooks, GF. Phone: (202) 737-3600, Copyright © 2020 American Society for Microbiology | Privacy Policy | Website feedback, Print ISSN: 0095-1137; Online ISSN: 1098-660X, Disseminated Gonococcal Infection in an Immunocompetent Patient Caused by an Imported, Sign In to Email Alerts with your Email Address. 1752 N St. NW Sign in Close more info about Disseminated gonococcal infection, OVERVIEW: What every practitioner needs to know. Khoo, CL, Davies, AJ, Dobson, CM, Cheesbrough, J, Edwards, J, Sweeney, J. 6. Urethral (male) or cervical (female) culture, nucleic acid hybidization testing, or nucleic acid amplification testing should be performed. Read, P, Abbott, R., Pantelidis, P., Peters, B.S., White, J.A. Patients who are suspected of having gonococcal meningitis should have a lumbar puncture and evaluation of the cerebrospinal fluid with culture. Treatment for gonorrhea is effective and available, but many cases go untreated. Sexually Transmitted infections. The clinical manifestations of DGI include skin disorders, arthritis, endocarditis (rarely occurring in 1 or 2% of cases), or other localized infections (1, 7-9, 13, 14). Book Appointment Online, View Fees, Reviews Doctors for Gonococcal Infection Treatment in Delhi | Practo Notification and treatment of all sexual partners/exposed individuals. In addition, eculizumab exposure persists for approximately 3 months after therapy discontinuation due to the prolonged eculizumab half-life ; therefore, the risk for disseminated infection likely … Secondary syphilis (note that the rash of secondary syphilis usually involves palms and soles). Blood cultures are positive in 30-40% of patients with DGI. 59. Patients may present with infectious arthritis wthout associated skin findings. What are the typical findings for this disease? Culture of pustular material within skin lesions is typically negative, but should be obtained for gram stain and culture. 180-6. The high level of tetracycline resistance (MIC of 24 μg/ml) was due to a plasmid defined as an “American type plasmid,” the most frequently detected plasmid in tetracycline-resistant N. gonorrhoeae isolates (16). vol. 979-93. Evaluation for genitourinary gonococcal infection should be performed. N. gonorrhoeae, the causative agent of the homonymous sexually transmitted disease, has the human genital tract as its reservoir. “Triscuspid valve gonococcal endocarditis: fourth case report”. In this report, we investigated a case of DGI in an immunocompetent patient with suspected bacterial endocarditis. 1979. pp. In particular, after total bacterial DNA extraction with a QIAGEN DNA extraction kit, a multiplex PCR assay was used to differentiate β-lactamase plasmids using the following primers: BL1 (5′-TACTCAATCGGTAATTGGCT), BL2 (5′-CACCTATAAATCTCGCAAGC), BL3 (5′-CCATAGTGTTGAGTATTGCGAA), and BL4 (5′-TCATTCGTGCGTTCTAGGA) (10, 11, 16). In females, the decision is much more difficult, because the risk of complications is much higher. Treatment of gonococcal infections is outlined in Table 3.4,14 Patients' sex partners within 60 days before symptom onset should also be treated. However, besides sharing common features with the majority of gonococci responsible for DGI, identified as penicillinase-producing N. gonorrhoeae (10, 11), and the presence of the most commonly identified plasmid in tetracycline-resistant N. gonorrhoeae strains (16), the imported strain is characterized by the presence of an IA/IB serotype. Now, molecular epidemiology can efficiently clarify transmission dynamics and geographic patterns; it may also be helpful in exploring bacterial virulence factors and drug resistance.

disseminated gonococcal infection treatment

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disseminated gonococcal infection treatment 2020