Clinical Manifestations of Gonorrhea

Clinical Manifestations and complications of gonorrhea are very closely related to the composition of genital anatomy and physiology. Therefore, the necessary knowledge about composition of the male and female genital anatomy. Disorders arising from sexual relations other than genito-genital ways, in men and women can be orofaringitis, proctitis, and conjunctivitis.
Incubation period is very short, in men, generally varies between 2-5 days, sometimes longer, and this is because people have to self-medicate, but the symptoms are so vague so as not to be noticed by the patient. In women, the incubation period is difficult to determine because it is generally asymptomatic.

A. Early Infections and Complications in Men

1. Urethritis
The most frequent clinical symptoms occur, and acute anterior urethritis can spread proximally, resulting in their local complications, ascending, and disseminated. Subjective complaints of itching, hot in the distal part of the urethra, external urethral orifice around, followed by dysuria, polakisuria, discharge from the tip of the urethra which is sometimes accompanied by blood, and accompanied by a feeling of pain during erection.

On examination of the external urethral orifice appeared erythematous, edematous, and ectropion. There are also body mucopurulent discharge, and in some cases may occur inguinal lymph node enlargement unilateral or bilateral.
2. Tysonitis
Tyson glands are glands that produce smegma. Infection usually occurs in patients with a very long foreskin and poor hygiene. The diagnosis is made by finding points of pus or swelling in the area of ​​the frenulum tenderness. If the duct is closed there will be an abscess and is a source of latent infection.

3. Parauretritis
Often the external urethral orifice people with open or hypospadias. Duct infection characterized by pus grains in both estuaries parauretra.

4. Littritis
There are no specific symptoms, only found in the urine threads or beads. If one channel is blocked, follicular abscess can occur. Diagnosis with uretroscopy.

5. Cowperitis
When only the affected duct is usually asymptomatic. If infection occurs in Cowper's gland abscess may occur. Complaints of pain and a lump in the perineal area with full flavor and heat, pain during defecation, and dysuria. If left untreated the abscess will burst through the skin of the perineum, urethra, or rectum and cause proctitis.

6. Prostatitis
Acute prostatitis is characterized by feelings of discomfort in the perineum and suprapubic area, malaise, fever, painful urination (dysuria) until hematuria, muscle spasm of the urethra resulting in urinary retention, tenesmus ani, difficult defecation, and obstipation.

On examination palpable enlarged prostate with chewy consistency, tenderness, and if there has been a fluctuation obtained abscess. If left untreated, the abscess will burst, into the posterior urethra or rectum resulting direction proctitis.

When it becomes chronic prostatitis, symptoms are mild and intermittent, but occasionally settled. Feel uneasy on the inside and perinemum discomfort when sitting for too long. On examination of the prostate feels rubbery, shape node, and a little pain in emphasis. Examination of the prostate is usually difficult to find a sorting diplococci or gonococcal bacteria.

7. Vesiculitis

Is an acute inflammation of the seminal vesicles and ejaculatory ducts, can arise accompany acute prostatitis and acute epididymitis. Subjective symptoms resembling acute prostatitis symptoms, such as fever, polakisuria, terminal hematuria, pain during erection or ejaculation, and spasm of blood contains. \

Examination of the rectum can be palpated through the seminal vesicles were swollen and hard as sausages, extends above the prostate. Sometimes difficult to determine the limits of the enlarged prostate gland.

8. Vase deferenitis or funikulitis

Symptoms such as feeling pain in the lower abdominal area on the same side.

9. Epididymitis

Acute epididymitis is usually unilateral and every epididymitis is usually accompanied deferentinitis. Circumstances that facilitate the emergence of epididymitis is trauma to the posterior urethra caused by incorrect treatment or the patient's own negligence. Factors that affect this situation are: irrigation is too frequent, fluid irigator too hot or too thick, coarse instrumentation, sorting excessive prostate, or sexual activity and excessive physical.
Epididymitis and spermatic cords swollen and palpable heat, also a secondary hydrocele testis so resembles. At once painful emphasis. If the epididymis can lead to sterility second.

10. Trigonitis
Ascending infection of the posterior urethra to the bladder trigone. Trigonitis cause symptoms of polyuria, terminal dysuria, and hematuria.

Women and Homosexual who have sex through the anus (anal sex) can suffer from gonorrhea in the rectum. Patients will feel uncomfortable pain, pruritus, discharge, or tenesmus and discharge from the rectum. The area around the anus looks red and coarse, and the stool wrapped by mucus and pus.

B Early Infections and Complications in Women
Clinical features and course of the disease in women is different from men. This is caused by anatomical and physiological differences in male and female genitalia. In women, both acute and chronic illness, subjective symptoms are rare and almost never found an objective disorder. In general, women have come if complications occur. Most of the patients, was found at the time of antenatal care or family planning examination.

Besides, women have three future developments:
• The period of prepubertal
Vaginal epithelium in the undeveloped state (very thin), so it can happen gonorrhea vaginitis.

• reproductive period
The mucous membrane lining of the vagina becomes mature, and thick with lots of glycogen and basil Döderlein. Basil Döderlein will solve glycogen so that the atmosphere becomes acidic and the atmosphere is not favorable for the growth of germs gonococci.

• Menopause
Vaginal mucous membrane, becomes atrophy, decreased glycogen levels, and basil Döderlein also reduced, so that less acidic conditions and the atmosphere is favorable for gonococcal bacteria, so it becomes easy to happen gonorrhea vaginitis.
At first only with an infection of the cervix uteri. Duh mucopurulen and contains a lot of gonococcal flow out and invade the urethra, duct parauretra, Bartholin gland, rectum, and can also climb up to the area ovaries.

1. Urethritis
The main symptom is dysuria, polyuria sometimes. On examination, urethral orifice eksternum appear red, edematous and there is a mucopurulent secretions.

2. Parauretritis / Skenitis
Parauretra gland can be affected, but abscesses are rare.

3. Cervicitis
Can be asymptomatic, sometimes cause pain in the lower back on the examination, the cervix appears red with erosion and mucopurulent secretions. Duh body will look more in case of acute cervicitis or vaginitis caused with Trichomonas vaginalis.

4. Bartolinitis

Labium major on the affected side, swollen, red and tender. Bartholin glands are swollen, painful once when the patient walks, and people with difficult sit. When the gland duct is blocked, an abscess can arise and can rupture through the mucosa or skin. If not treated it can become recurrent or become cysts.

5. Salphyngitis
Inflammation can be acute, subacute, or chronic. Its predisposing factors, namely:
• The period of puerperal (childbed)
• Dilatation after curettage
• The use of IUDs, action IUD (intrauterine device)
How to direct infection of the cervix through the fallopian tubes to the ovaries and salphyng area which can cause pelvic inflammatory disease (PID). The PRP infections can cause sterility and ectopic pregnancy. Approximately 10% of women with gonorrhea will end up with PRP. The symptoms are pain in the lower abdomen, vaginal discharge, dysuria, and irregular menstruation or abnormal.

Diagnosis must be made ​​with some other diseases that cause symptoms similar, for example: ectopic pregnancy, acute appendicitis, septic abortion, endometriosis, regional ileitis, and diverticulitis. To establish the diagnosis can puncture the pouch Dauglas and continued culture microorganisms or by laparoscopy.

In addition to the genital organs, gonorrhea can also cause nongenital infections, such as:
1. Proctitis
Proctitis in men and women are generally asymptomatic. In women can occur due to contamination of the vagina and sometimes because the relationship genitoanal as in men. Complaints are usually milder in women than men, burning feeling in the anus and on the examination of the mucosa appeared erythematous, edematous, and covered pussy mucopurulent.

2. Orofaringitis

How to infection through contact orogenital. Gonorrhea pharyngitis and tonsillitis more often than ginggivitis, stomatitis, or laryngitis. Complaints often are asymptomatic. If no complaint is difficult to distinguish from a throat infection caused by other germs. On examination of the oropharynx area looks mucopurulent exudate were mild or moderate.

3. Conjunctivitis
This disease can occur in newborns of mothers who suffered from gonorrhea cervicitis. In adults infection occurs due to infection of the conjunctiva through the hands or tools. Complaint form photophobia, conjunctival swelling and red and out of mucopurulent exudate. When left untreated can lead to corneal ulcers, blindness panoftalmitis to arise.

4. Gonorrhea disseminated

The disease is mostly obtained in patients with previously asymptomatic gonorrhea, especially women. The symptoms may include arthritis (especially monoartritis), myocarditis, endocarditis, pericarditis, meningitis, and dermatitis

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