Gonorrhea: Signs, Symptoms & Diagnosis

00:01 Now as far as the clinical features of gonorrhea go, this organism is notorious for producing very, very severe dysuria.

00:14 Urination is extremely painful.

00:18 It would be very unusual if gonorrhea were totally asymptomatic.

00:23 It's possible but very unusual.

00:28 The urethral discharge may start out as scant and mucoid.

00:33 But within 1 to 2 days, it is frank pus.

00:37 Interestingly enough, in contrast to urinary tract infections, there's not the urgency to urinate, and urinary frequency is not common, like it is in a urinary tract infection.

00:55 If patients don't seek treatment, this syndrome will resolve in several weeks.

01:05 And this cartoon shows what these organisms look like under the microscope.

01:12 You notice that they are inside of neutrophils.

01:16 And they are diplococci, pairs of cocci.

01:21 And the other thing to notice is that the flat sides of these cocci are apposed.

01:27 They are not end to end like in Streptococcus pneumoniae.

01:32 So biscuit-shaped diplococci, notably inside of neutrophils.

01:42 Now to prove that a patient has gonorrhea versus non-gonococcal urethritis, you would want to culture the discharge and Gram-stain the discharge.

01:57 The typical culture media is a media known as Thayer-Martin medium.

02:06 Thayer-Martin is nothing more than chocolate agar, which will grow many, many organisms, and supplies hemin and nicotinamide adenine dinucleotide to fastidious organisms.

02:19 So many things will grow on Thayer-Martin media, but we're only interested in isolating Neisseria gonorrhoeae.

02:30 So how do we get rid of the other organisms that might grow? Well, what we would do is we put antibiotics into the medium.

02:39 For example, we put vancomycin and you may know that vancomycin is broad spectrum for Gram-positive organisms.

02:49 So therefore, no Gram-positives should grow on Thayer-Martin.

02:54 The other thing in Thayer-Martin is colistin.

02:58 Colistin is a broad spectrum, Gram-negative antibiotic.

03:03 In other words, for Gram-negative rods like E. coli, like pseudomonas, and other things that may tend to grow.

03:13 But those won't grow with colistin added to thayer-martin media.

03:18 And finally, nystatin which is an antifungal agent will keep the growth of yeast and other fungi away.

03:29 And so therefore, Thayer-Martin media is a highly selective media.

03:36 In general, you use Thayer-Martin only for Neisseria gonorrhoeae.

03:42 There are other things you would use chocolate agar for but for Thayer-Martin, it's gonorrhea.

03:50 Now as far as the Gram-stained smears, we've already discussed that they're Gram-negative intracellular diplococci.

04:00 In contrast, this particular view with the cartoon shown.

04:05 But I think you can still see the these are flat sides apposed Gram-negative diplococci.

04:13 And the Gram stain is very, very sensitive in symptomatic men.

04:21 In other words, Gram-stain that discharge and you should be able to find these organisms.

04:28 However, if the unusual scenario obtains that the man is asymptomatic, then the Gram stain is only 50% sensitive.

04:43 What is now being used in many laboratories, instead of culture is something called the nucleic acid amplification test.

04:56 This has largely replaced cultures for screening, especially in asymptomatic genital infections.

05:05 And the test is able to detect not only Neisseria gonorrhoeae, but it's often combined to detect Chlamydia trachomatis.

05:19 However, it is not more sensitive than a regular culture.

05:26 It just depends upon the facilities that the laboratory has.

05:31 However, it is very, very sensitive for Chlamydia trachomatis and culturing Chlamydia trachomatis is cumbersome and not used widely.

05:45 But the bottomline is that all patients with urethritis should be tested for both Neisseria gonorrhoeae and Chlamydia trachomatis.