acute gonococcal cystitis

Acute Gonococcal Cystitis: A Urinary Tract Infection Caused by Gonorrhea

Acute gonococcal cystitis is a type of urinary tract infection (UTI) caused by the bacterium Neisseria gonorrhoeae, also known as gonorrhea. This condition is characterized by symptoms such as:

• Suprapubic pain
• Painful urination (dysuria)
• Frequency and urgency to urinate
• Fever
• Flank pain
• Occasionally bloody urine

These symptoms can be non-specific in very young or old patients, making it challenging to diagnose. [1]

Definition

Acute gonococcal cystitis is an acute form of cystitis caused by infection with Neisseria gonorrhoeae. [3][6]

Incubation Period and Symptoms

The incubation period for gonorrhea, including cystitis, typically ranges from 2 to 6 days in men and can be longer in women. Men often experience symptoms such as a purulent urethral discharge and dysuria, while women may have symptoms like vaginal discharge and endocervicitis. [4][5]

Treatment

Uncomplicated gonococcal infection should be treated with a single 500-mg dose of intramuscular ceftriaxone in people weighing less than 331 lb (150 kg). [10]

Common signs and symptoms of acute gonococcal cystitis include:

• Painful urination (dysuria) [3]
• Suprapubic pain [15]
• Frequency and urgency to urinate [15]
• Fever [15]
• Flank pain [15]
• Occasionally, bloody urine [15]

In some cases, symptoms can be non-specific in very young or old patients.

It's essential to note that gonococcal cystitis can mimic other urinary tract infections, such as acute cystitis or vaginitis, and may not produce recognizable symptoms until complications have occurred.

• Untreated gonorrhea can lead to complications, including pelvic inflammatory disease (PID) in women [6].
• In men, untreated gonorrhea can cause disseminated gonococcal infection (DGI), which is an acute illness that causes fever, asymmetrical polyarthralgias, and skin pustules overlying small joints [5].

If you suspect you have acute gonococcal cystitis, it's crucial to consult a healthcare provider for proper diagnosis and treatment.

Diagnostic Tests for Acute Gonococcal Cystitis

Acute gonococcal cystitis, a bacterial infection caused by Neisseria gonorrhoeae, can be diagnosed using various tests. Here are some of the diagnostic tests used to detect this condition:

• Urine Nucleic Acid Amplification Tests (NAATs): These tests are highly sensitive and specific for detecting N. gonorrhoeae in urine samples [1][3]. They work by amplifying the genetic material of the bacteria, making it easier to detect.
• Gram Stain: A Gram stain can be used to evaluate urethritis and detect the presence or absence of gonococcal infection [6][9]. This test is highly sensitive and specific for documenting both urethritis and the presence or absence of gonococcal infection.
• Culture: A culture of a swab from the site of infection, such as the urethra, can be used to specifically diagnose N. gonorrhoeae [8].
• Polymerase Chain Reaction (PCR) Assays: PCR assays are available for detecting gonococcal urethritis and Chlamydia infection [5].

Other Diagnostic Tests

In addition to these tests, other diagnostic methods may also be used to detect acute gonococcal cystitis. These include:

• NAATs for Mycoplasma: NAATs are also available for detecting Mycoplasma infections [5].
• Vaginal Swabs: Vaginal swabs can be used to test for trichomoniasis, a sexually transmitted infection that may present with similar symptoms to gonococcal cystitis [4].

References

[1] MT MAYOR · 2012 · Cited by 120 — Urogenital N. gonorrhoeae infection can be diagnosed using culture or nucleic acid amplification testing.

[3] by MT MAYOR · 2012 · Cited by 120 — Urogenital N. gonorrhoeae infection can be diagnosed using culture or nucleic acid amplification testing.

[4] POC tests should include testing for trichomoniasis with vaginal swabs for wet mount microcopy or rapid testing (see Table 17.1).

[5] Sep 6, 2023 — Polymerase chain reaction (PCR) assays are available for gonococcal urethritis and Chlamydia infection.

[6] Gram stain is a POC diagnostic test for evaluating urethritis that is highly sensitive and specific for documenting both urethritis and the presence or absence of gonococcal infection.

[8] The DNA probe is an antigen detection test that uses a probe to detect gonorrhea DNA in specimens.

[9] The Gram stain is a highly sensitive and specific test for evaluating urethritis and the presence or absence of gonococcal infection.

Treatment Options for Acute Gonococcal Cystitis

Acute gonococcal cystitis, also known as gonorrhea, is a bacterial infection that can cause symptoms such as painful urination, frequent urination, and abdominal pain. Effective treatment is essential to prevent complications and transmission of the disease.

Recommended Treatment Regimens

According to recent studies [10], more than one-half of cases of gonococcal infection were estimated to be resistant to at least one drug in 2018. As a result, the CDC has changed treatment recommendations to higher doses of ceftriaxone.

• Ceftriaxone: A single intramuscular injection of ceftriaxone, 250 mg [2], is recommended as a first-line treatment for uncomplicated gonococcal infections.
• Doxycycline: For treatment of NGU (nongonococcal urethritis), the CDC currently recommends doxycycline, 100 mg orally twice a day for 7 days [3].
• Alternative Regimens: Alternative regimens include a single dose of cefixime 400mg or ofloxacin 200mg, which were successful in 89.4% and 84.2% of patients, respectively [4].

Other Treatment Options

• Azithromycin: Azithromycin 1 g orally once or doxycycline 100 mg twice a day for 7 days are recommended treatment options when gonococcal infection can be ruled out based on microscope examination [7].
• Ceftriaxone and Doxycycline: A combination of ceftriaxone, 500 mg intramuscularly, plus doxycycline, 100 mg orally twice per day for 7 days is recommended empiric treatment for urethritis [8].

Important Considerations

• Resistance Prevalence: The risk for infection with drug-resistant organisms should be considered in antibiotic selection.
• Higher Doses of Ceftriaxone: Higher doses of ceftriaxone are recommended due to the high levels of resistance observed in 2018.

It is essential to consult a healthcare provider for proper diagnosis and treatment. They may recommend additional tests, such as urine analysis or microscope examination, to confirm the diagnosis and determine the best course of treatment.

The differential diagnosis of acute gonococcal cystitis involves considering various conditions that may present with similar symptoms, such as:

• Acute cystitis or vaginitis
• Metrorrhagia (irregular uterine bleeding)
• Other sexually transmitted infections (STIs) like chlamydia or trichomonas

According to the medical literature [1][2], gonococcal infection can be diagnosed among symptomatic men by documenting the presence of a WBC-containing intracellular purple diplococci in MB or GV smears [6]. However, in women, symptoms may be mild and mimic those of acute cystitis or vaginitis [3].

It's essential to differentiate gonococcal infection from other conditions that can cause similar symptoms, such as:

• Chlamydial urethritis
• Non-gonococcal urethritis
• Other acute rectal sexually transmitted infections

A thorough medical evaluation and laboratory testing are necessary to confirm the diagnosis of gonococcal cystitis [5].

References: [1] The differential diagnosis of gonococcal infections is discussed in various medical articles, including one by MT MAYOR (2012) [3]. [2] Gonococcal infection can cause symptoms that mimic those of acute cystitis or vaginitis [4]. [3] MT MAYOR (2012) discusses the differential diagnosis of gonococcal infections. [5] Laboratory testing is necessary to confirm the diagnosis of gonococcal cystitis [6]. [6] Gonococcal infection can be diagnosed among symptomatic men by documenting the presence of a WBC-containing intracellular purple diplococci in MB or GV smears.