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| Gonorrhea Classification and external resources |
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| ICD-10 | A54 |
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| ICD-9 | 098 |
Gonorrhea (also gonorrhoea), caused by the bacteria Neisseria gonorrhoeae, is a common sexually transmitted disease. In the US, its incidence is second[1] only to chlamydia[2].
Non-genital sites in which it thrives are in the rectum, the throat (oropharynx), and the eyes (conjunctiva). The vulva and vagina in women are usually spared because they are lined by stratified epithelial cells—in women the cervix is the usual first site of infection. Gonorrhea typically spreads during sexual intercourse. It can also be vertically transmitted, where infected mothers can pass gonorrhea to their newborn infants during delivery. This causes conjunctivitis (eye infections) which, if left untreated, can lead to blindness. As prophylaxis against this and chlamydia, all infants are treated with eyedrops of erythromycin at birth.[3]
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Symptoms
The incubation period is 1 to 10 days with most symptoms occurring between the second and fifth days after being infected. A small number of people may be asymptomatic for up to a lifetime. Between 30–60% of people with gonorrhea are asymptomatic or have subclinical disease.[4] Women may complain of vaginal discharge, difficulty urinating (dysuria), projectile urination, off-cycle menstrual bleeding, or bleeding after sexual intercourse. The cervix may appear anywhere from normal to the extreme of marked cervical inflammation with pus. Possibility of increased production of male hormones is common in many cases. Infection of the urethra (urethritis) causes little dysuria or pus. The combination of urethritis and cervicitis on examination strongly supports a gonorrhea diagnosis, as both sites are infected in most gonorrhea patients. Gonorrhea is caused by the Neisseria gonorrhoeae bacteria. The infection is transmitted from one person to another through vaginal, oral, or anal sexual relations, though transmission occurs rarely with "safe sex" practices of condom usage with lubrication.
Men have a 20% chance of getting the infection by having sexual relations with a woman infected with gonorrhea. Women have a 50% chance of getting the infection by having sexual relations with a man infected with gonorrhea. An infected mother may transmit gonorrhea to her newborn during childbirth.
Less advanced symptoms, which may indicate development of pelvic inflammatory disease (PID), include cramps and pain, bleeding between menstrual periods, vomiting, or fever. It is not unusual for men to have asymptomatic gonorrhea. Men may complain of pain on urinating and thick, copious, urethral pus discharge (also known as gleet) is the most common presentation. Examination may show a reddened external urethral meatus. Ascending infection may involve the epididymis, testicles or prostate gland causing symptoms such as scrotal pain or swelling. Instances blurred vision in one eye may occur in adults.
Complications
In men, inflammation of the epididymis (epididymitis), prostate gland (prostatitis) and urethral structure (urethritis) can result from untreated gonorrhea.
In women, the most common result of untreated gonorrhea is pelvic inflammatory disease, a serious infection of the uterus that can lead to infertility. Further on, perihepatitis may develop. This rare complication is associated with Fitz-Hugh-Curtis syndrome. Additionally, septic arthritis in the fingers, wrists, toes, and ankles is also common. This should be evaluated promptly with a culture of the synovial fluid, blood, cervix, urethra, rectum, skin lesion fluid, or pharynx. The underlying gonorrhea should be treated; if this is done then usually a good prognosis will follow.
Treatment
Antibiotics
Antibiotics that may be used to treat gonorrhea include:
- Amoxicillin 2 g plus probenecid 1 g orally
- Ampicillin 2 to 3 g plus probenecid 1 g orally
- Azithromycin 2 g orally
- Cefixime 400 mg orally
- Cefotaxime 500 mg by intramuscular injection
- Cefoxitin 2 g by intramuscular injection, plus probenecid 1 g orally
- Cefpodoxime (Vantin) 400 mg orally
- Ceftriaxone (Rocephin) 125 to 250 mg by intramuscular injection
- Ciprofloxacin 500 mg orally
- Levofloxacin 250 mg orally
- Ofloxacin 400 mg orally
- Spectinomycin 2 g by intramuscular injection
These drugs are all given as a single dose.
The level of tetracycline resistance in Neisseria gonorrhœae is now so high as to make it completely ineffective in most parts of the world.
The fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) cannot be used in pregnancy. It is important to refer all sexual partners to be checked for gonorrhea to prevent spread of the disease and to prevent the patient from becoming re-infected with gonorrhea. Patients should also be offered screening for other sexually transmitted infections. In areas where co-infection with chlamydia is common, doctors may prescribe a combination of antibiotics, such as ceftriaxone with doxycycline or azithromycin, to treat both diseases.
Penicillin is ineffective at treating rectal gonorrhea: this is because other bacteria within the rectum produce β-lactamases that destroy penicillin. All current treatments are less effective at treating gonorrhea of the throat, so the patient must be rechecked by throat swab 72 hours or more after being given treatment, and then retreated if the throat swab is still positive.
Although gonorrhea usually does not require follow-up (with the exception of rectal or pharyngeal disease), patients are usually advised to phone for results five to seven days after diagnosis to confirm that the antibiotic they received was likely to be effective. Patients are advised to abstain from sex during this time.
Drug resistant strains are known to exist.
United States recommendations
The United States does not have a federal system of sexual health clinics, and the majority of infections are treated in family practices. A third-generation cephalosporin antibiotic such as ceftriaxone is recommended for use in most areas. Since some areas such as Hawaii and California have very high levels of resistance to fluoroquinolone antibiotics (ciprofloxacin, ofloxacin, levofloxacin) they are no longer used empirically to treat infections originating in these areas.
Since 1993, fluoroquinolones (i.e., ciprofloxacin, ofloxacin, or levofloxacin) have been used frequently in the treatment of gonorrhea because of their high efficacy, ready availability, and convenience as a single-dose, oral therapy. Beginning in 2000, fluoroquinolones were no longer recommended for gonorrhea treatment in persons who acquired their infections in Asia or the Pacific Islands (including Hawaii); in 2002, this recommendation was extended to California (2). In 2004, CDC recommended that fluoroquinolones not be used in the United States to treat gonorrhea in men who have sex with men (MSM). On the basis of the most recent evidence, CDC no longer recommends the use of fluoroquinolones for the treatment of gonococcal infections and associated conditions such as pelvic inflammatory disease (PID).[5] Consequently, only one class of drugs, the cephalosporins, is still recommended and available for the treatment of gonorrhea.[citation needed] The Center for Disease Control has recently (April 2007) updated treatment guidelines.[6]
Antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States, and successful treatment of gonorrhea is becoming more difficult. Because many people with gonorrhea also have chlamydia, another sexually transmitted disease, antibiotics for both infections are usually given together. Persons with gonorrhea should be tested for other STDs. It is important to take all of the medication prescribed to cure gonorrhea. Although medication will stop the infection, it will not repair any permanent damage done by the disease. People who have had gonorrhea and have been treated can get the disease again if they have sexual contact with persons infected with gonorrhea. If a person's symptoms continue even after receiving treatment, he or she should return to a doctor to be reevaluated.
United Kingdom recommendations
In the United Kingdom, the majority of patients with gonorrhea are treated in dedicated sexual health clinics. The current recommendation is for ceftriaxone or cefixime as first line therapy; no resistance to either drug has yet been reported in the UK. Levels of spectinomycin resistance in the UK are less than 1%, which would make it a good choice in theory, but intramuscular spectinomycin injection is very painful.
Azithromycin (given as a single dose of 2 g) has been recommended if there is concurrent infection with chlamydia. However, since 2000, the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) has gathered data on drug resistant strains of gonorrhoea in the UK. In 2005, 2.2% of cases were azithromycin resistant and in some regions of the UK this extended to 5% of cases. The mainstay of treatment now is a cephalosporin with azithromycin (to cover chlamydia). A single dose of oral ciprofloxacin 500 mg is effective if the organism is known to be sensitive, but fluoroquinolones were removed from the UK recommendations for empirical therapy in 2003 because of increasing resistance rates. In 2005, resistance rates for ciprofloxacin were 22% for the whole of the UK (42% for London, 10% for the rest of the UK).[7]
Historically
Historically it has been suggested that mercury was used as a treatment for gonorrhea. Surgeons tools on board the recovered English warship the Mary Rose included a syringe that, according to some, was used to inject the mercury via the urinary meatus into any unfortunate crewman suffering from gonorrhea. Silver nitrate was one of the widely used drugs in the 19th century, but it became replaced by Protargol. Arthur Eichengrün invented this type of colloidal silver which was marketed by Bayer from 1897 on. The silver-based treatment was used until the first antibiotics came into use in the 1940s.[8]
Prevalence
"Gonorrhea is a very common infectious disease. The CDC estimates that more than 700,000 persons in the United States get new gonorrheal infections each year. Only about half of these infections are reported to CDC. In 2004, 330,132 cases of gonorrhea were reported to the CDC. After the implementation of a national gonorrhea control program in the mid-1970s, the national gonorrhea rate declined from 1975 to 1997. After a small increase in 1998, the gonorrhea rate has decreased slightly since 1999. In 2004, the rate of reported gonorrheal infections was 113.5 per 100,000 persons."[9]
Slang terms
Gonorrhea is also commonly known by the slang term the clap.
Suggested etymology:
- Reference to a traditional treatment used to clear the blockage in the urethra from gonorrheal pus, where the penis would be "clapped" on both sides simultaneously.[citation needed]
- Reference to the painful sting in the male urethra, which feels like the sting of a clap (as in clapping hands) when infected with the disease.
- From the old French word "clapoir", meaning sexual sore. This word was derived from the old French word "clapier", meaning "brothel".
The term the clap was replaced with the similar sounding the jack in the 1975 AC/DC song The Jack, which used the metaphor of playing cards and poker as sexual innuendo in the original LP version. However, live recordings of the song make direct references to the disease.
References
- ^ "CDC - STD Surveillance - Gonorrhea". Retrieved on 2008-08-21.
- ^ "CDC Fact Sheet - Chlamydia". Retrieved on 2008-08-21.
- ^ "Erythromycin ointment for ocular prophylaxis of neonatal chlamydial infection". Retrieved on 2008-07-14.
- ^ YT van Duynhoven (1999). "The epidemiology of Neisseria gonorrheae in Europe". Microbes and Infection 1 (6): 455–464. doi:. PMID 10602678.
- ^ "CDC Update to Sexually Transmitted Treatment Guidelines". Retrieved on 2008-08-21.
- ^ "CDC STD Treatment Regimens". Retrieved on 2008-08-21.
- ^ Health Protection Agency. "The gonococcal resistance to antimicrobials surveillance programme: Annual report 2005" (PDF). Retrieved on 2006-10-28.
- ^ Max Bender (1898). "Ueber neuere Antigonorrhoica (insbes. Argonin und Protargol)". Archives of Dermatological Research 43 (1): 31–36. doi:.
- ^ "Gonorrhea - CDC Fact Sheet". Retrieved on 2008-07-31.
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From Phil Black's Dead Broke Ain't Livin is "Gun Clap Rap". Go to www.gunclaprap.com to download the album or any track off the album. Support good hip hop music by buying teh album Dead Broke Ain't Livin. For beats contact rankin.devon@gmail.com
Author: rankincd
Keywords: Phil Black Hip-Hop Illmatic Reasonable Doubt North Carolina Rap Rapper Nas
Added: August 28, 2008
Jonas Brothers - Play My Music w/lyrics (Camp Rock)
Jonas Brothers - Play My Music (Camp Rock) Lyrics: Turn on that radio As loud as it can go Wanna dance until my feet can't feel the ground (feel the ground) Say goodbye to all my fears One good song they disappear And nothing in the world can bring me down (bring me down) Hand clapping Hip shaking Heartbreaking There's no faking What you feel when your riding home Yeah, yeah Music's in my soul I can hear it everyday, everynight It's the one thing on my mind Music's got control And I'm never letting go, no no I just want to play my music Whoa (music) Got my six string on my back Don't need anything but that Everything I want is here with me (here with me) So forget that fancy car I don't need to go that far What's driving me is following my dreams, yeah Hand clapping Earth shaking Heartbreaking There's no faking What you feel when your on a roll Yeah, yeah Music's in my soul I can hear it everyday, everynight It's the one thing on my mind Music's got control And I'm never letting go, no no I just wanna play my music I just wanna play my music Can't imagine what it'd be like Without the sound of all my hero's singing all my favorite songs So I can sing along Music's in my soul I can hear it everyday, everynight It's the one thing on my mind Music's got control And I'm never letting go, no no I just wanna play my music Music's in my soul I can hear it everyday, everynight It's the one thing on my mind Music's got control And I'm never letting go, no no I just wanna play my music All night long Yeah
Author: laauraa94
Keywords: Jonas Brothers Play My Music w/lyrics Camp Rock
Added: August 28, 2008
Bill Bailey - Part Troll - Giant breaking a twig
Here is a classic bill bailey moment! taken from the Part troll dvd, i was at the Apollo when they filmed this!
Author: 1gnor4nc3
Keywords: bill bailey zen clap of acceptance lolfest
Added: August 28, 2008
pon pon, papas y papas
Welita and I have been working on teaching Miguelito how to pon pon(which is putting his pointer finger in the palm of the other hand) and clapping more doing papas y papas.
Author: sarahdtx
Keywords: pon
Added: August 28, 2008
ti hurt with lyrics
ti-hurt lyrics below Ba, ba, ba, ba, ba, ba, ba You pussy niggas finna make me kill one a y'all [Hook] Ain't a damn thang change I still keep that thang right up under my shirt Betta tell 'em I ain't playin' because it's all fun and games until somebody get hurt Ain't a damn thang change I still keep thang right up under my shirt Run up on him where he hangin', BANG! cause it's all fun and games until somebody get hurt Boy you finna get hurt, murked, put him in the dirt boy you betta catch me first Boy you finna get hurt, murked, put him in the dirt boy you betta catch me first Boy you finna get hurt, murked, put him in the dirt boy you betta catch me first Boy you finna get hurt, murked, put him in the dirt boy you betta catch me first [T.I.] Alota pussy niggas talk like broads love runnin' they mouth But then turn and run in they house Put the gun in they mouth, tell a nigga talk shit now You think you think you know the go POW I ain't scared of the law naw I'm about to go to war what it is nigga win lose or draw I'll never get caught murkin' y'all cuz it ain't what you do It's what cha near and who saw Shawty I'm way too raw Catch me any day you want you could think I'm a play if you want But the fact still remain if I got a AK and you don't Well then playa you gone Don't get me wrong there's some niggas wanna kill me too (Well where they at?) But they ain't sayin' bout shit because they very well know where I'm at They could catch me in the booth right if it really like that Naw nigga that they hoe get him in the whole shit, the 44 spit they holla oh shit Protectin' her and you both hit You betta check ya girl or you be so sick If the choppa leave you with no dick Or a plastic bag holdin' yo' shit Leave 6 in you, a couple more in ya bitch And I don't miss 'cause I'm focused nigga [Hook] [Alfa Mega] I got you tip I'm finna ride homie Fuck niggas might talk loud act real, but they don't really want this here Pussy niggas betta act right, lay low we know where ya family live Trust me you don't want me up in ya crib with a ski mask on duck tapin ya kids You can pray all you want but I don't forgive Ya shoulda been doin' that before ya did whatcha did I ain't gotta spell it out pimp you know what it is I'll rest you case to ya real man you know what it is Plus I got a hundred goons with me, dressed in black Fifty at the front door, 50 at the back Half got K's, half got Macks Bring 'em out, bring em out, show me where he at We can do him right here, we could catch him in trap Run up on his 'lac put a hole in his hat With his brain on the dash, and his thoughts in his lap and dump 50 more on him and tell him to hold that Lights out, no hasta manana, hasta la vista, senora Y tu no tomorrow, no remorse and no sorrow And the next one a y'all niggas try me like that I swear to God man I'm really gon' snap [Hook] [Busta Rhymes] Right now I'ma give you somethin' that a make a nigga beg please When a bullet in his mind I could feel a little breeze Drop to ya knees, see the big barrel of the chrome fifth triple grip handle in the squeeze I keep a couple of those for the niggaz who talk shit when I go to Jacob and cop that ring If you try to see me I'ma cock that thang And I'ma lock that thang, and the shots gon' stain (really?) The nigga ride inside the truck with me (and) for the most part the nigga stuck with me And tell you somethin' if you really were smart and you knew better people probably tell ya don't fuck with me Front if want motherfucka you can catch it Smile on my face even though I got a ratchet Pop off (police) pull me over believe I got a compartment if I gotta stash it Must I just remind y'all niggaz when I come through Know that I'ma find y'all niggaz take two Bust so many shots gun powder probably blind y'all niggaz now (Ok, ok let's go) See you don't know really wanna feel that Mossberg blow (naw) Clap up a nigga then I cap up a nigga When I finish it'll turn into an absurd show (listen) Then you better observe yo Feel the sizzle from the bullet of the glock burn slow (ssss) Shit probably twist you up just a little and have your body leanin' lookin' like a quarter past four Stay down betta (lay down) Checkin' for a nigga, come and put your body in the dirt I don't play bitch you, really need to go the other way If you ain't know I got it under my shirt
Author: moss390
Keywords: ti hurt busta rhymes alfa mega rap hip-hop
Added: August 28, 2008