Journal for Gonorrhea

Summary

Gonorrhea is a global medical problem. The World Health Organization reports indicate that more than 2.6million cases are reported annually in the USA alone. Out of these cases, 1.3million are men; hence the remainder is women. Gonorrhea has a dissimilar epidemiologic specific feature, which is thought to be developmental in nature, implying that the observable traits of the illness must be first comprehended before designing or modeling the disease for the sake of predicting its mutation. The symptoms, spread symptoms, complexities, and management of gonorrhea have advanced with time. Neisseria gonorrhea is a common bacterial infection due to the generation of resistance to antibiotic treatment. N. gonorrhoeae can rapidly acquire resistance to numerous antibiotic medication. The infection has gradually become resistant to sulfonamides and other classes of medications; as the years pass, the rates of infection rise. For instance, in the USA, in 2011, 100 cases were reported in 100,000 people. In Canada and the USA, Gonorrhea is prevalent among young people.

Introduction

Neisseria gonorrhoeae is obligate and has a cell cover made up of internal cytoplasmic skin, a central section, and an external layer (Taylor et al., 2018). The external layer consists of lipids, endotoxins, and other proteins that help the illness invade tissues and resist the host's defense mechanisms.  Due to the severe and social medical impacts of gonorrhea, medics usually advise medics to use three diagnostic levels to identify the illness without any misdiagnosis. A concentrate gonorrhea diagnosis should be acquired for medical and legal reasons. A suggestive diagnosis is distinct through the occurrences of mucopurulent endocervical during the physical evaluations (Alirol et al., 2017). Additionally, a presumptive gonorrhea diagnosis should consist of- gram-negative evaluations, growth of gram-negative from the infected person, and finally, the detection of gonorrhea bacteria. The observation of gram-negative, intracellular cells under the microscope is an indication of gonorrhea infection.

Pathobiology of Gonorrhea

Gonorrhea, a sexually transmitted illness, is known for causing inflaming the mucus membrane within the genital tract and urethra. The inflammation stems from the gonococcus- a bacterium responsible for destroying the mucous covering along the genital tracts and other nearby areas. All gonococcal diseases are passed on through sexual contact with an infected person. Gonorrhea is common due to its extensive spread across the world. The rise in gonorrhea cases takes place occasionally (Fairley et al., 2017). The rising cases are partly responsible for the drug-resistant N.gonorrhoeae and inconsistent sex norms. Mortality rates of gonorrhea are insignificant, but the indirect impact gonorrhea has had on the population over the years is innumerable. For example, gonorrhea can cause sterilization in both men and women.

The gonorrhea incubation phase is normally3-5 days. Burning sensations characterize the initial stage in men. While urinating, men experience urethral discharge, which might go unnoticed or be noticed (Taylor et al., 2018). Without medication, the illness normally spreads further and deeper into the upper sections of the urethra, the sections of urinary bladder prostate glands. Insistence and regularity of urination and rarely, blood mixed with urine are some of the most visible signs of the illness. Impulsive recovery might occur in the next number of days or years after a person acquires the disease. Specifically, among homosexuals, rectal gonorrhea infests the perianal regions of the body and affects stool flow during excretion.

 The initial indications in women are mild and can go unobserved most of the time—insignificant vaginal discharge accompanied by inflammations. The illness normally goes unnoticed by patients or even medics until some difficulties emerge. Sores around the Bartholin gland occur during the initial stages of the disease. Most women recuperate suddenly from gonorrhea illnesses, which cannot spread further than the uterine cervix. In most cases, the illness spreads via the uterus into the fallopian tubes, leading to a condition known as pelvic inflammatory illness (Choudhri et al., 2018). Fever, normally coupled with abdominal pain, is a primary sign of this particular sexually transmitted disease. Some of the symptoms are similar to appendicitis. Remedial takes place without resorting to surgical medication. Nevertheless, gonorrhea might lead to sterilization and even physical disability. Among young women, the infection affects the functionalities of the vagina. Gonorrhoeae can occasionally go into the bloodstream leading to gonococcal infection in all the organs found in the patient's system. In both women and men, arthritis might manifest as a result of gonococcal infection. The mechanism of settling more than one joint infection leads whenever there is no medication.

Aetiological Agent

 The disease's evolving nature dictates how medics handle the dynamics of the infection and how they contain its spread from one person to another. As confirmed in the past, Neisseria gonorrhoeae is an etiological agent for gonorrhea (Hook III, & Kirkcaldy, 2018). After one acquires the disease, the immunity declines; hence a person can be infected more than once. Generally, the illness is a multifaceted mucus infection tied to pustular discharges. Supplementary severe inflammatory infections lead to sterility and even ectopic pregnancy. Sometimes, the disease can flow into the blood leading to infection of the blood. Annually, gonorrhea infections are 60million. In terms of medication and curability, gonorrhea is prone to a group of antibiotics. Antibiotic resistance is growing into a primary source of concern; presently, third-generation cephalosporin is recommended for the medication of gonorrhea. For most of it, the molecular procedures are meant to mitigate the spread of gonorrhea—Gonococci intricate frequent plans to frustrate the immune system. The illness takes part in extensive stages, and the antigenic disparities resulting from its interference with the body produces surface antigens. The illness is expressed as IgA, which is then attached to the mucus antibodies (Reekie et al., 2018). The infection can mutate into a resistant serum that is an expressed protein subversive agent that hinders the activation of important proteins.

The Evolution of Gonorrhea Pathogen

Gonorrhea has increasingly established resistance to antibiotic medication approved for its treatment. After the dissemination of gonococcal fluoroquinolone resistance, cephalosporin remains to be the most effective drug against gonorrhea (Hill, Masters, & Wachter, 2016). The development of cephalosporin, which effectively fights gonorrhea, would meaningfully obscure the capability of medical experts to medicate gonorrhea successfully since there are limited options for medicating the drug; hence the medics need to come up with an effective manner of ensuring that the mechanism of the issues is termed into medical terms and lead to the important medical process meant to give terms to the medical condition. Also, the successful implication of the changing times for the rapid method of ensuring everything runs smoothly while taking the medication.

Genome Plasticity

 The bacteria Neisseria has perfected horizontal DNA transmission mechanisms and genetic recombination as the main processes of production of broad protein disparity and inflection of genetic countenance (Cornelisse et al., 2019). Localized recombination has been well researched in families with family multi genetic makeup whose alterations support repetitive patterns. Gonococci are fundamentally transformable, and this feature has tremendously enabled the examination of gonorrhea. Gonococci easily combines with DNA filled up with Neisseria sequences. The combination of these genetic material leads to an inverted repetition. Plasmids applied for the transformation of N.gonorrhoeae already is infected with gonorrhea infection hence aiding in replicating the disease all over the body (Jenness et al., 2017). Gonococci are demanding in nature.  They can be grown in areas with multiple nutrients, such as chocolate agar. For the sake of explaining the underlying mechanisms which make gonorrhea resistant to antibiotics. The gonorrhea infection can be transformed into effective bacteria in concentrated agar. This way, one can witness how the infection integrates plasmid into the chromosomal systems, which in turn facilitates mutations (Jones et al., 2019). One single gonococcal DNA can be turned into a circular plasmid, subsequently leading to antibiotic resistance selection and isolation during the crossover. In the end, the study of gonorrhea has led to the identification of more than one medication and DNA format that inhibits the presence of antibiotic medication.

Diagnosis of Gonorrhea

 The diagnosis of basic evaluations of gonorrhea infections led to the emergence of important ways of hindering the disease from spreading further. Besides, an insight into the factual interpretation of how gonorrhea resists antibiotics is an effective way of ensuring that both males and females are treated properly (Kularatne et al., 2018). Urogenital gonorrhea can be detected through urine examination in men or the medical examination of the vagina in women suspected of having a sexually transmitted illness through the application of nucleic acid and other testing mechanisms (Yang et al., 2018). Also, a gonorrhea culture can be used to diagnose gonorrhea through the swab specimens. If two or more people engage in oral or anal sex without protection, a swab can be collected from both parties. With appropriate medication, gonorrhea can be easily cured due to the extensive aspects used to make the disease reduce with time. The patients need to finish the entire medication as instructed to avoid any further apprehension that might arise due to the disease. In the long run, gonorrhea medication differs from one person to another. It is vital to note that even though the gonorrhea medication stops the medication's spread, it cannot reverse the damage done. The resistance the disease exposes the medicine to makes the treatment of the disease harder and more severe. In order to expose the patient to more than one medical option, the medical specialist has to come to terms with the continual expression of the symptoms as they build up with the advancement of or the progression of the infection (Weston et al., 2018). In case the infection persists after completing the infection, a patient is advised to seek medical advice from the medics so that the medication can be reevaluated wholesomely and give way forward to the patient. If symptoms persist further, the patient should return to the medic and seek extensive medication due to the bacteria's replication, causing infection. In case a sexual partner is diagnosed with gonorrhea, they should inform their sexual partners.

 A common technique used in the diagnosis of gonorrhea is the Gram stain technique. The gram technique is specifically used to test males who have symptomatic infections (Shover et al., 2018). The technique uses endocervical specimens to ensure that people can meet all their needs during the medication. In the Gram stain technique, cells with gram-negative gonorrhea bacteria are termed as infected. Some of the places where people take the specification are synovial fluid and within the cervix in females (Tsoumanis, Hens, & Kenyon, 2018). For most of it, the people who are to undertake these tests do not need to wait for long periods of time before getting accurate results from the subjected samples, making these techniques effective for examining symptoms and prescribing medication based on the specified results outcomes. The Gram stain technique can also be used as a substitute mechanism due to the changing patterns associated with gonorrhea infection—the chance of acquiring more than one subjected means of taking care of sampled issues and accurate results.

Gonorrhea Treatment

Gonorrhea can be medicated through appropriate treatment. Most medical research institutes insisted on taking a single dosage of 250mg of intramuscular ceftriaxone (Shover et al., 2018). It is vital to consume all the recommended medication while treating gonorrhea. The medication and some of the most common forms of issuing the disease's personal subjection to more than one causal agent. The medication's exclusive nature depends on how the people are to be presented with the manifestation of the symptoms (Tuite et al., 2017). Therefore, the manifestation of the symptoms dictates the type of treatment one will receive after a long workday. Medical experts can detect gonorrhea in numerous mechanisms. Medics can take samples from symptomatic regions such as the anal and throat areas. The samples are taken with swabs and then take to medical laboratories for further analysis. If a medic suspects that the patient has a blood or joint infection, giving people good and effective results leads to conclusive results.

Discussion

 Gonorrhea is transferred sexually when two people engage in unprotected oral or vaginal sex. Gonorrhea affects body parts such as the urethra, anal region, and throat. In females, gonorrhea affects the cervical and vaginal areas of the body. As stated earlier, the infection spreads through oral, vaginal, or oral intercourse. Whenever infants are infected during birth, the eyes are hindered from effectively working (Oliver et al., 2017). Abstaining from sexual activities or even using latex condoms during sex are among the most common ways of preventing sexually transmitted infections. Also, having one preferred sexual partner effectively prevents gonorrhea from spreading from one sexual partner to another. Moreover, some reports indicated that gonorrhea could fail to indicate symptoms. In these rare cases where patients do not present any symptoms, the medics are forced to rely on pain experienced during urination, pus discharge from the vagina or penis (Arando et al., 2019). In most symptomatic women, gonorrhea is manifested as vaginal discharge, excruciating urination, bleeding during menses, and pelvic pain. Immediately the symptoms start getting out of hand, the handful mechanisms used to hinder the disease from further extending into deeper sections of the body, medics are to subscribe medication based on the needs of the patients (Davis et al., 2018). Neisseria gonorrhoeae is the underlying cause of gonorrhea. Some of the risk factors are associated with the being sexually active because it is an infection that is common among people who are sexually active and below 25 years old. Other factors which might increase susceptibility to the disease. Moreover, untreated gonorrhea can lead infertility among women and sterilization among men due to the inflammatory infection among in the fallopian tubes and even the uterus parts of the reproductive parts. As a result of the complications arising from affected area women find it hard to give birth.

 

 

References

Alirol, E., Wi, T. E., Bala, M., Bazzo, M. L., Chen, X. S., Deal, C., ... & Hook, E. W. (2017). Multidrug-resistant gonorrhea: A research and development roadmap to discover new medicines. PLoS medicine, 14(7), e1002366.

Arando, M., Caballero, E., Curran, A., Armengol, P., Barberá, M. J., & Vall-Mayans, M. (2019). The epidemiological and clinical characteristics of the epidemic of syphilis in Barcelona. Actas Dermo-Sifiliográficas (English Edition), 110(10), 841-849.

Choudhri, Y., Miller, J., Sandhu, J., Leon, A., & Aho, J. (2018). Sexually transmitted infections: Gonorrhea in Canada, 2010–2015. Canada Communicable Disease Report, 44(2), 37.

Cornelisse, V. J., Bradshaw, C. S., Chow, E. P., Williamson, D. A., & Fairley, C. K. (2019). Oropharyngeal gonorrhea in absence of urogenital gonorrhea in sexual network of male and female participants, Australia, 2018. Emerging infectious diseases, 25(7), 1373.

Davis, A. P., Stern, J., Tantalo, L., Sahi, S., Holte, S., Dunaway, S., & Marra, C. M. (2018). How well do neurologic symptoms identify individuals with neurosyphilis?. Clinical Infectious Diseases, 66(3), 363-367.

Fairley, C. K., Hocking, J. S., Zhang, L., & Chow, E. P. (2017). Frequent transmission of gonorrhea in men who have sex with men. Emerging infectious diseases, 23(1), 102.

Hill, S. A., Masters, T. L., & Wachter, J. (2016). Gonorrhea-an evolving disease of the new millennium. Microbial cell, 3(9), 371.

Hook III, E. W., & Kirkcaldy, R. D. (2018). A brief history of evolving diagnostics and therapy for gonorrhea: lessons learned. Clinical Infectious Diseases, 67(8), 1294-1299.

Jenness, S. M., Weiss, K. M., Goodreau, S. M., Gift, T., Chesson, H., Hoover, K. W., ... & Rosenberg, E. S. (2017). Incidence of gonorrhea and chlamydia following human immunodeficiency virus preexposure prophylaxis among men who have sex with men: a modeling study. Clinical Infectious Diseases, 65(5), 712-718.

Jones, M. L. J., Chapin-Bardales, J., Bizune, D., Papp, J. R., Phillips, C., Kirkcaldy, R. D., ... & Padgett, P. (2019). Extragenital chlamydia and gonorrhea among community venue–attending men who have sex with men—five cities, United States, 2017. Morbidity and Mortality Weekly Report, 68(14), 321.

Kularatne, R. S., Niit, R., Rowley, J., Kufa-Chakezha, T., Peters, R. P., Taylor, M. M., ... & Korenromp, E. L. (2018). Adult gonorrhea, chlamydia and syphilis prevalence, incidence, treatment and syndromic case reporting in South Africa: Estimates using the Spectrum-STI model, 1990-2017. PLoS One, 13(10), e0205863.

Oliver, S. E., Cope, A. B., Rinsky, J. L., Williams, C., Liu, G., Hawks, S., ... & Ocular Syphilis Disease Investigation Specialists Workgroup Hall Jason Hough Victor Ivey Andre Hawks Stephanie Greene Samantha Taylor Dishonda Mercurio Mike Gipson Miraida. (2017). Increases in ocular syphilis—North Carolina, 2014–2015. Clinical Infectious Diseases, 65(10), 1676-1682.

Reekie, J., Donovan, B., Guy, R., Hocking, J. S., Kaldor, J. M., Mak, D. B., ... & Liu, B. (2018). Risk of pelvic inflammatory disease in relation to chlamydia and gonorrhea testing, repeat testing, and positivity: a population-based cohort study. Clinical Infectious Diseases, 66(3), 437-443.

Shover, C. L., Beymer, M. R., Unger, E. M., Javanbakht, M., & Bolan, R. K. (2018). Accuracy of presumptive gonorrhea treatment for gay, bisexual, and other men who have sex with men: results from a Large Sexual Health Clinic in Los Angeles, California. LGBT health, 5(2), 139-144.

Taylor, S. N., Marrazzo, J., Batteiger, B. E., Hook III, E. W., Seña, A. C., Long, J., ... & Mueller, J. (2018). Single-dose zoliflodacin (ETX0914) for treatment of urogenital gonorrhea. New England Journal of Medicine, 379(19), 1835-1845.

Taylor, S. N., Morris, D. H., Avery, A. K., Workowski, K. A., Batteiger, B. E., Tiffany, C. A., ... & Dumont, E. F. (2018). Gepotidacin for the treatment of uncomplicated urogenital gonorrhea: a phase 2, randomized, dose-ranging, single-oral dose evaluation. Clinical Infectious Diseases, 67(4), 504-512.

Tsoumanis, A., Hens, N., & Kenyon, C. R. (2018). Is screening for chlamydia and gonorrhea in men who have sex with men associated with reduction of the prevalence of these infections? A systematic review of observational studies. Sexually transmitted diseases, 45(9), 615-622.

Tuite, A. R., Gift, T. L., Chesson, H. W., Hsu, K., Salomon, J. A., & Grad, Y. H. (2017). Impact of rapid susceptibility testing and antibiotic selection strategy on the emergence and spread of antibiotic resistance in gonorrhea. The Journal of infectious diseases, 216(9), 1141-1149.

Weston, E. J., Workowski, K., Torrone, E., Weinstock, H., & Stenger, M. R. (2018). Adherence to CDC recommendations for the treatment of uncomplicated gonorrhea—STD Surveillance Network, United States, 2016. Morbidity and Mortality Weekly Report, 67(16), 473.

Yang, L. G., Zhang, X. H., Zhao, P. Z., Chen, Z. Y., Ke, W. J., Ren, X. Q., ... & Tucker, J. D. (2018). Gonorrhea and chlamydia prevalence in different anatomical sites among men who have sex with men: a cross-sectional study in Guangzhou, China. BMC infectious diseases, 18(1), 675.