Sexually Transmitted Infections (STIs): Gonorrhea and Syphilis
1. Senthilvel Murugan Maharajan
2. Kangashanmuga Balaji
3. Aidarbek Kyzy Aidanek
(1. Student, International Medical Faculty, Osh State University, Kyrgyz Republic)
(2. Student, International Medical Faculty, Osh State University, Kyrgyz Republic)
(3. Faculty, Department of Obstetrics and Gynecology, International Medical Faculty, Kyrgyz Republic)
INTRODUCTION
Sexually transmitted infections (STIs) are infections that are primarily transmitted through sexual contact, including vaginal, anal, and oral intercourse. They remain a major global public health concern due to their high prevalence, potential complications, and social stigma. Among the numerous STIs, gonorrhea and syphilis are two classical and clinically significant bacterial infections. Both conditions have been known for centuries and continue to pose challenges due to antibiotic resistance, diagnostic difficulties, and inadequate awareness.
GONORRHEA
Definition
Gonorrhea is a sexually transmitted bacterial infection caused by Neisseria gonorrhoeae, a Gram-negative, intracellular diplococcus. It primarily affects mucous membranes of the urogenital tract but can also involve the rectum, pharynx, conjunctiva, and joints.
Etiology and Microbiology
The causative organism, Neisseria gonorrhoeae, is a kidney-shaped diplococcus that appears intracellularly within polymorphonuclear leukocytes. It is non-motile, non-spore-forming, and oxidase-positive. The organism has pili that help in attachment to epithelial cells and plays a role in virulence and immune evasion.
Epidemiology
Gonorrhea is one of the most common STIs worldwide, particularly affecting sexually active adolescents and young adults. Risk factors include multiple sexual partners, unprotected intercourse, co-existing STIs, and low socioeconomic status.
Mode of Transmission
Transmission occurs primarily through sexual contact. Vertical transmission from mother to neonate can occur during childbirth, leading to ophthalmia neonatorum.
Pathogenesis
Neisseria gonorrhoeae attaches to mucosal epithelial cells using pili and outer membrane proteins. The bacteria invade the cells, multiply, and trigger an inflammatory response. This results in purulent discharge and tissue damage. The organism can spread to the bloodstream, causing disseminated gonococcal infection.
Clinical Features
In males:
- Urethritis with purulent urethral discharge
- Dysuria
- Testicular pain due to epididymitis
In females:
- Often asymptomatic
- Cervicitis with vaginal discharge
- Dysuria
- Lower abdominal pain
- Pelvic inflammatory disease (PID)
Extragenital gonorrhea:
- Rectal infection: pain, discharge
- Pharyngeal infection: sore throat
- Conjunctivitis
Complications
- Pelvic inflammatory disease
- Infertility
- Ectopic pregnancy
- Disseminated gonococcal infection (arthritis, dermatitis)
- Neonatal conjunctivitis
Diagnosis
- Gram stain showing intracellular Gram-negative diplococci
- Nucleic acid amplification tests (NAATs)
- Culture on Thayer-Martin medium
Treatment
Due to increasing antibiotic resistance, current treatment includes:
- Ceftriaxone (single intramuscular dose)
- Plus doxycycline if Chlamydia co-infection is not excluded
Prevention
- Safe sexual practices
- Condom use
- Regular screening in high-risk groups
- Treatment of sexual partners
SYPHILIS
Definition
Syphilis is a chronic systemic sexually transmitted infection caused by Treponema pallidum, a slender, spiral-shaped spirochete.
Etiology and Microbiology
Treponema pallidum is a motile spirochete visible under dark-field microscopy. It cannot be cultured in artificial media and has limited antigenic properties, allowing it to evade the immune system.
Epidemiology
Syphilis remains prevalent worldwide, particularly in developing countries and among high-risk populations. Congenital syphilis remains a serious public health problem.
Mode of Transmission
- Sexual contact
- Transplacental transmission (congenital syphilis)
- Rarely through blood transfusion
Pathogenesis
The organism enters through microabrasions in the skin or mucous membranes. It disseminates rapidly via lymphatics and bloodstream, leading to multisystem involvement. The disease progresses through distinct clinical stages.
Clinical Stages
Primary Syphilis:
- Painless chancre at the site of inoculation
- Firm, indurated ulcer
- Regional lymphadenopathy
Secondary Syphilis:
- Generalized rash involving palms and soles
- Mucous patches
- Condyloma lata
- Fever, malaise, lymphadenopathy
Latent Syphilis:
- Asymptomatic phase
- Early latent and late latent stages
Tertiary Syphilis:
- Gummatous lesions
- Cardiovascular syphilis (aortitis, aneurysm)
- Neurosyphilis (tabes dorsalis, general paresis)
Congenital Syphilis:
- Stillbirth
- Bone deformities
- Hutchinson teeth
- Deafness
Diagnosis
- Non-treponemal tests: VDRL, RPR
- Treponemal tests: FTA-ABS, TPHA
- Dark-field microscopy
Treatment
- Penicillin G is the treatment of choice for all stages
- Doxycycline for penicillin-allergic patients (non-pregnant)
Prevention
- Early diagnosis and treatment
- Screening during pregnancy
- Safe sexual practices
- Public health surveillance
COMPARISON BETWEEN GONORRHEA AND SYPHILIS
Gonorrhea is an acute infection primarily affecting mucosal surfaces, while syphilis is a chronic systemic disease with multiple stages. Gonorrhea commonly presents with purulent discharge, whereas syphilis initially presents with a painless ulcer. Antibiotic resistance is a major concern in gonorrhea, while penicillin remains highly effective for syphilis.
CONCLUSION
Gonorrhea and syphilis are significant sexually transmitted infections with serious health consequences if left untreated. Early diagnosis, effective treatment, partner notification, and preventive strategies are essential to control their spread. Increased awareness, education, and access to healthcare services play a crucial role in reducing the global burden of these infections.
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