Gonorrhea physical examination: Difference between revisions

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Revision as of 18:18, 22 September 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Physical examination

Physical examination of patients with gonococcal infection is usually remarkable for:


Type of Gonorrheal Infection	Physical Examination
Male genitourinary^[1]	Mucopurulent urethral discharge Bull-headed clap (penile edema) Unilateral epididymal tenderness and edema (epididymitis) Sign of urethral stricture Periurethral abscesses
Female genitourinary:^[2]^[3]^[4]^[5]^[6]^[7]	Mucopurulent uretral, cervical or vaginal discharge Positive cervical motion tenderness Friable cervical mucosa Abdominal pain with negative rebound tenderness Lower abdominal pain (consistent with PID) Right upper quadrant pain (Fitz-Hugh-Curtis syndrome) Labial edema and Bartholin’s gland enlargement and tenderness (Bartholinitis)
Proctitis^[8]	Anal mucopurulent discharge Anorectal tenderness Anorectal bleeding
Pharyngitis^[9]^[10]	Pharyngeal exudates Cervical lymphadenitis

Physical examination of patients with disseminated gonococcal infection is usually remarkable for:


Disseminated Gonorrheal Infection	Organ systems
General Appearance	Fever (usually less than 39°C) Chills Generalized malaise Note: Occurs in the acute phase of infection
Dermatitis	Painless skin lesions (on the torso, limbs, palms, and soles) which varis based on clinical stages Maculopapular, pustular, necrotic, or vesicular rash Hemorrhagic lesions Erythema nodosum Urticaria Erythema multiforme
Arthritis	Polyarthralgia with joint tenderness Decreased range of motion Erythema Note: purulent arthritis may be abrupt onset of monoarthritis or oligoarthritis without skin lesions and fever
Tenosynovitis	Erythema along a tendon sheath Local tenderness along a tendon sheath Painful active or passive range of motion Note: most commonly occurs in hands and less commonly lower extremities
Meningitis	Decreased mental status Fever Cold chills Dysnea Dark purple rash
Endocarditis	New murmur Tachycardia Fever Embolic lesions
Muscle abscess	Localized tenderness Edema Pain with motion

Male

Purulent or mucopurulent discharge from urethera. The discharge can be demonstrated by milking the shaft of penis.
Epididymal tenderness and edema usually unilateral

Female Pelvic examination

Inspection

Purulent or mucopurulent discharge
Vaginal bleeding

Palpation

Cervical mucosa may become fragile and bleed even with some manipulation.
Cervical motion tenderness during bimanual pelvic examination

Gallery

A highly contagious infection, gonococcal ophthalmia is due the pathogenic bacteria Neisseria gonorrhoeae. From Public Health Image Library (PHIL). ^[11]
This patient presented with gonococcal urethritis, which became systemically disseminated leading to gonococcal conjunctivitis of the right eye. From Public Health Image Library (PHIL). ^[11]
Photograph of a gonococcal infection involving the cervix of a patient who presented with a case of gonorrhea. From Public Health Image Library (PHIL). ^[11]

References

↑ Sherrard J, Barlow D (1996). "Gonorrhoea in men: clinical and diagnostic aspects". Genitourin Med. 72 (6): 422–6. PMC 1195730. PMID 9038638.
↑ Workowski KA, Bolan GA, Centers for Disease Control and Prevention (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR Recomm Rep. 64 (RR-03): 1–137. PMID 26042815.
↑ Barlow D, Phillips I (1978). "Gonorrhoea in women. Diagnostic, clinical, and laboratory aspects". Lancet. 1 (8067): 761–4. PMID 76760.
↑ Huppert JS, Biro F, Lan D, Mortensen JE, Reed J, Slap GB (2007). "Urinary symptoms in adolescent females: STI or UTI?". J Adolesc Health. 40 (5): 418–24. doi:10.1016/j.jadohealth.2006.12.010. PMC 1976261. PMID 17448399.
↑ Eschenbach DA, Buchanan TM, Pollock HM, Forsyth PS, Alexander ER, Lin JS; et al. (1975). "Polymicrobial etiology of acute pelvic inflammatory disease". N Engl J Med. 293 (4): 166–71. doi:10.1056/NEJM197507242930403. PMID 806017.
↑ Risser WL, Risser JM, Benjamins LJ, Feldmann JM (2007). "Incidence of Fitz-Hugh-Curtis syndrome in adolescents who have pelvic inflammatory disease". J Pediatr Adolesc Gynecol. 20 (3): 179–80. doi:10.1016/j.jpag.2006.08.004. PMID 17561186.
↑ Rees E (1967). "Gonococcal bartholinitis". Br J Vener Dis. 43 (3): 150–6. PMC 1047872. PMID 4963696.
↑ Stansfield VA (1980). "Diagnosis and management of anorectal gonorrhoea in women". Br J Vener Dis. 56 (5): 319–21. PMC 1045815. PMID 7427703.
↑ Kraus SJ (1979). "Incidence and therapy of gonococcal pharyngitis". Sex Transm Dis. 6 (2 Suppl): 143–7. PMID 386537.
↑ Osborne NG, Grubin L (1979). "Colonization of the pharynx with Neisseria gonorrhoeae: experience in a clinic for sexually transmitted diseases". Sex Transm Dis. 6 (4): 253–6. PMID 119330.
↑ ^11.0 ^11.1 ^11.2 "Public Health Image Library (PHIL)".

Template:WH Template:WS

[pmid9038638-1] Sherrard J, Barlow D (1996). "Gonorrhoea in men: clinical and diagnostic aspects". Genitourin Med. 72 (6): 422–6. PMC 1195730. PMID 9038638.

[pmid26042815-2] Workowski KA, Bolan GA, Centers for Disease Control and Prevention (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR Recomm Rep. 64 (RR-03): 1–137. PMID 26042815.

[pmid76760-3] Barlow D, Phillips I (1978). "Gonorrhoea in women. Diagnostic, clinical, and laboratory aspects". Lancet. 1 (8067): 761–4. PMID 76760.

[pmid17448399-4] Huppert JS, Biro F, Lan D, Mortensen JE, Reed J, Slap GB (2007). "Urinary symptoms in adolescent females: STI or UTI?". J Adolesc Health. 40 (5): 418–24. doi:10.1016/j.jadohealth.2006.12.010. PMC 1976261. PMID 17448399.

[pmid806017-5] Eschenbach DA, Buchanan TM, Pollock HM, Forsyth PS, Alexander ER, Lin JS; et al. (1975). "Polymicrobial etiology of acute pelvic inflammatory disease". N Engl J Med. 293 (4): 166–71. doi:10.1056/NEJM197507242930403. PMID 806017.

[pmid17561186-6] Risser WL, Risser JM, Benjamins LJ, Feldmann JM (2007). "Incidence of Fitz-Hugh-Curtis syndrome in adolescents who have pelvic inflammatory disease". J Pediatr Adolesc Gynecol. 20 (3): 179–80. doi:10.1016/j.jpag.2006.08.004. PMID 17561186.

[pmid4963696-7] Rees E (1967). "Gonococcal bartholinitis". Br J Vener Dis. 43 (3): 150–6. PMC 1047872. PMID 4963696.

[pmid7427703-8] Stansfield VA (1980). "Diagnosis and management of anorectal gonorrhoea in women". Br J Vener Dis. 56 (5): 319–21. PMC 1045815. PMID 7427703.

[pmid386537-9] Kraus SJ (1979). "Incidence and therapy of gonococcal pharyngitis". Sex Transm Dis. 6 (2 Suppl): 143–7. PMID 386537.

[pmid119330-10] Osborne NG, Grubin L (1979). "Colonization of the pharynx with Neisseria gonorrhoeae: experience in a clinic for sexually transmitted diseases". Sex Transm Dis. 6 (4): 253–6. PMID 119330.

[PHIL-11] 11.0 ^11.1 ^11.2 "Public Health Image Library (PHIL)".

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@@ Line 31: / Line 31: @@
 *Labial edema and Bartholin’s gland enlargement and tenderness ([[Bartholinitis]])
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" | '''Proctitis'''<ref name="pmid7427703">{{cite journal| author=Stansfield VA| title=Diagnosis and management of anorectal gonorrhoea in women. | journal=Br J Vener Dis | year= 1980 | volume= 56 | issue= 5 | pages= 319-21 | pmid=7427703 | doi= | pmc=1045815 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7427703  }} </ref><ref name="pmid7427703">{{cite journal| author=Stansfield VA| title=Diagnosis and management of anorectal gonorrhoea in women. | journal=Br J Vener Dis | year= 1980 | volume= 56 | issue= 5 | pages= 319-21 | pmid=7427703 | doi= | pmc=1045815 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7427703  }} </ref>
+| style="padding: 5px 5px; background: #DCDCDC;" | '''Proctitis'''<ref name="pmid7427703">{{cite journal| author=Stansfield VA| title=Diagnosis and management of anorectal gonorrhoea in women. | journal=Br J Vener Dis | year= 1980 | volume= 56 | issue= 5 | pages= 319-21 | pmid=7427703 | doi= | pmc=1045815 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7427703  }} </ref>
 | style="padding: 5px 5px; background: #F5F5F5;" |
 * Anal [[mucopurulent discharge]]
@@ Line 42: / Line 42: @@
 * [[lymphadenitis|Cervical lymphadenitis]]
 |}
+Physical examination of patients with disseminated gonococcal infection is usually remarkable for:
 {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
 |+
-! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Type of Disseminated Gonorrheal Infection}}
+! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Disseminated Gonorrheal Infection}}
-! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Physical Examination}}
+! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Organ systems}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''General Appearance'''
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Fever (usually less than 39°C)
+* Chills
+* Generalized malaise
+Note: Occurs in the acute phase of infection
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''Dermatitis'''
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Painless skin lesions (on the torso, limbs, palms, and soles) which varis based on clinical stages
+** [[Maculopapular]], [[pustular]], [[necrotic]], or [[vesicular]] rash
+**Hemorrhagic lesions
+**Erythema nodosum
+**Urticaria
+**Erythema multiforme
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''Arthritis'''
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* [[Polyarthralgia]] with joint tenderness
+* Decreased range of motion
+* [[Erythema]]
+Note: purulent arthritis may be abrupt onset of monoarthritis or oligoarthritis without skin lesions and fever
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" | '''Female genitourinary'''
+| style="padding: 5px 5px; background: #DCDCDC;" | '''Tenosynovitis'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* [[Mucopurulent discharge|Mucopurulent]] uretral,  cervical or [[vaginal discharge]]
+* Erythema along a tendon sheath
-* Positive cervical motion tenderness
+* Local tenderness along a tendon sheath
-* Friable cervical mucosa
+* Painful active or passive range of motion
-* Abdominal pain with negative [[rebound tenderness]]
+Note: most commonly occurs in hands and less commonly lower extremities
-** Lower abdominal pain (consistent with [[PID]])
-** Right upper quadrant pain ([[Fitz-Hugh-Curtis syndrome]])
-*Labial edema and Bartholin’s gland enlargement and tenderness ([[Bartholinitis]])
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" | '''Male genitourinary'''
+| style="padding: 5px 5px; background: #DCDCDC;" | '''Meningitis'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* [[Mucopurulent dishareg|Mucopurulent]] urethral discharge
+* Decreased mental status
-* Bull-headed clap (penile edema)
+*Fever
-* Unilateral epididymal tenderness and edema ([[epididymitis]])
+*Cold chills
-* Sign of urethral stricture
+*Dysnea
-* Periurethral abscesses
+*Dark purple rash
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" | '''Proctitis'''
+| style="padding: 5px 5px; background: #DCDCDC;" | '''Endocarditis'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* Anal [[mucopurulent discharge]]
+* New murmur
-* Anorectal tenderness
+* Tachycardia
-* Anorectal bleeding
+* Fever
+* Embolic lesions
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" | '''Pharyngitis'''
+| style="padding: 5px 5px; background: #DCDCDC;" | '''Muscle abscess'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-* [[exudates|Pharyngeal exudates]]
+* Localized tenderness
-* [[lymphadenitis|Cervical lymphadenitis]]
+* Edema
+* Pain with motion
 |}
 ===Male===

Gonorrhea physical examination: Difference between revisions

Revision as of 18:18, 22 September 2016

Overview

Physical examination

Male

Female Pelvic examination

Inspection

Palpation

Gallery

References

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