Diseases & Conditions


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Gonorrhea


The most commonly reported communicable disease in the United States, most often affecting the genitourinary tract and sometimes the pharynx, eyes, or rectum. Sexual abuse should be strongly considered when a gonorrheal infection is diagnosed in a child older than newborn and prior to puberty. A sexually transmitted disease may be the only physical evidence of sexual abuse in some cases. Reported rates of gonococcal infection range from 3 percent to 20 percent among sexually abused children. A gonococcal infection may be diagnosed in the course of an evaluation of a medical condition such as conjunctivitis, in which no suspicion of abuse existed, or it may be diagnosed during an assessment for possible sexual abuse. In preteens, gonococcal infection usually occurs in the lower genital tract, and vaginitis is the most common symptom. PELVIC INFLAMMATORY DISEASE occasionally occurs. Infections of the throat and rectum typically do not have symptoms and may go unrecognized. By law, all known cases of gonorrhea in children must be reported to the local health department and to a child protective services agency. An investigation should be conducted to determine whether other children in the same environment who may be victims of sexual abuse are also infected. In addition, a child with a positive culture for the agent that causes gonorrhea should be examined for the presence of other sexually transmitted diseases (STDs) such as SYPHILIS, CHLAMYDIA infection, HEPATITIS B, and HIV infection. Cause The disease is caused by a circular bacterium, Neisseria gonorrhoeae, that is always grouped in pairs. It is passed from one person to the next only during sex with an infected person. It is not possible to get gonorrhea from toilet seats or swimming pools. A girl who has unprotected sex with an infected man has an 80 to 90 percent chance of being infected herself—a much higher rate than with other STDs—but a boy who has unprotected sex with an infected girl has only a 20 to 25 percent chance of becoming infected. Boys have less risk because it is harder for bacteria to enter the body through the penis than through the vaginal walls. Symptoms Between three to five days after exposure, the symptoms will appear in the genital area, rectal area, or in the throat, depending on the sexual activity. Up to 80 percent of infected boys experience painful urination, frequent urge to urinate, and white or yellow thick pus from the urethra. About half of infected girls have massive swelling of the vagina, abnormal green-yellow vaginal discharge, vaginal bleeding between periods, pelvic discomfort (itching and burning), and pain when urinating. As the infection spreads—which is more common in girls than boys—there may be nausea and vomiting, fever, and rapid heartbeat or peritonitis. Inflammation of the tissues surrounding the liver also may occur, causing pain in the upper abdomen. Severe spread of the disease is also more common in girls and is characterized by signs of blood poisoning with tender lesions on the skin of the hands and feet and inflammation of the tendons of the wrists, knees, and ankles. If the disease spreads to the conjunctiva of the eyes, there may be scarring and blindness. In both girls and boys, infection in the throat causes a mild, red sore throat. Diagnosis Culture of the organism from a smear of bodily fluids. Treatment For many years, penicillin was the drug of choice, but in the late 1970s the bacteria became resistant; most resistant strains are in New York, California, and Florida, but resistance is seen in all states and most of Canada. Today treatment involves two antibiotics, a shot of ceftriaxone and doxycycline pills. The pills will also cure chlamydia, which has similar symptoms to gonorrhea. Alternatively a doctor may give a single dose of cefixime. An infant born with the symptoms of gonorrhea must be hospitalized and given ceftriaxone. Complications Pelvic inflammatory disease develops in almost 40 percent of untreated girls and causes scars in the tubes, infertility, and tubal pregnancies. Babies born to infected mothers may have gonorrhea conjunctivitis during delivery; if the baby is not treated, it will be blind. For this reason, drops are placed in all babies’ eyes at birth to prevent gonorrhea and chlamydia conjunctivitis. In boys, untreated gonorrhea can lead to infections of the testicles, or scar the urethra, which can lead to sterility.