Gonorrhea differential diagnosis: Difference between revisions

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Latest revision as of 21:54, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Gonorrhea must be differentiated from other sexually transmitted pathogens, nongonococcal urethritis, vaginitis, cervicitis, urinary tract infections, prostatitis, and orchitis. Additionally, disseminated gonococcal infection must be differentiated from herpes simplex virus (HSV), nongonococcal septic arthritis, syphilis, HIV infection, rheumatic fever, reactive arthritis , and Lyme disease.^[1]^[2]^[3]

Differentiating gonorrhea from other diseases

Gonorrhea must be differentiated from other sexually transmitted pathogens including Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, herpes simplex virus (HSV), and syphilis. Conditions that must be considered in the differential diagnosis of gonorrhea include:^[1]

In women
- Non gonorrheal urethritis
- Vaginitis
- Cervicitis
- Urinary tract infections
- Pregnancy
- Endometriosis
In men
- Non gonorrheal urethritis
- Prostatitis
- Orchitis
- Testicular torsion
- Urinary tract infections

Disseminated gonococcal infection

Disseminated gonococcal infection must be differentiated from:^[2]^[3]^[4]


Disease	Findings
Nongonococcal septic arthritis	Presents with an acute onset of joint swelling and pain (usually monoarticular) Culture of joint fluid reveals organisms
Acute rheumatic fever	Presents with polyarthritis and rash (rare presentation) in young adults. Microbiologic or serologic evidence of a recent streptococcal infection confirm the diagnosis. Poststreptococcal arthritis have a rapid response to salicylates or other antiinflammatory drugs.
Syphilis	Presents with acute secondary syphilis usually presents with generalized, pustular lesions at the palms and soles with generalized lymphadenopathy Rapid plasma reagin (RPR), Venereal Disease Research Laboratory (VDRL) and Fluorescent treponemal antibody absorption (FTA-ABS) tests confirm the presence of the causative agent.
Reactive arthritis (Reiter syndrome)	Musculoskeletal manifestation include arthritis, tenosynovitis, dactylitis, and low back pain. Extraarticular manifestation include conjunctivitis, urethritis, and genital and oral lesions. Reactive arthritis is a clinical diagnosis based upon the pattern of findings and there is no definitive diagnostic test
Hepatitis B virus (HBV) infection	Presents with fever, chills, polyarthritis, tenosynovitis, and urticarial rash Synovial fluid analysis usually shows noninflammatory fluid Elevated serum aminotransaminases and evidence of acute HBV infection on serologic testing confirm the presence of the HBV.
Herpes simplex virus (HSV)	Genital and extragenital lesions can mimic the skin lesions that occur in disseminated gonococcal infection Viral culture, polymerase chain reaction (PCR), and direct fluorescence antibody confirm the presence of the causative agent.
HIV infection	Present with generalized rash with mucus membrane involvement, fever, chills, and arthralgia. Joint effusions are uncommon
Gout and other crystal-induced arthritis	Presents with acute monoarthritis with fever and chills Synovial fluid analysis confirm the diagnosis.
Lyme disease	Present with erythema chronicum migrans rash and monoarthritis as a later presentation. Clinical characteristics of the rash and and serologic testing confirm the diagnosis.

References

↑ ^1.0 ^1.1 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.
↑ ^2.0 ^2.1 Rompalo AM, Hook EW, Roberts PL, Ramsey PG, Handsfield HH, Holmes KK (1987). "The acute arthritis-dermatitis syndrome. The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis". Arch Intern Med. 147 (2): 281–3. PMID 3101626.
↑ ^3.0 ^3.1 Rice PA (2005). "Gonococcal arthritis (disseminated gonococcal infection)". Infect Dis Clin North Am. 19 (4): 853–61. doi:10.1016/j.idc.2005.07.003. PMID 16297736.
↑ Bleich AT, Sheffield JS, Wendel GD, Sigman A, Cunningham FG (2012). "Disseminated gonococcal infection in women". Obstet Gynecol. 119 (3): 597–602. doi:10.1097/AOG.0b013e318244eda9. PMID 22353959.

Template:WH Template:WS

[pmid26042815-1] 1.0 ^1.1 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.

[pmid3101626-2] 2.0 ^2.1 Rompalo AM, Hook EW, Roberts PL, Ramsey PG, Handsfield HH, Holmes KK (1987). "The acute arthritis-dermatitis syndrome. The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis". Arch Intern Med. 147 (2): 281–3. PMID 3101626.

[pmid16297736-3] 3.0 ^3.1 Rice PA (2005). "Gonococcal arthritis (disseminated gonococcal infection)". Infect Dis Clin North Am. 19 (4): 853–61. doi:10.1016/j.idc.2005.07.003. PMID 16297736.

[pmid22353959-4] Bleich AT, Sheffield JS, Wendel GD, Sigman A, Cunningham FG (2012). "Disseminated gonococcal infection in women". Obstet Gynecol. 119 (3): 597–602. doi:10.1097/AOG.0b013e318244eda9. PMID 22353959.

[1]

[2]

[3]

[4]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Gonorrhea}}
-{{CMG}}
+{{CMG}}; {{AE}} {{SaraM}}
 ==Overview==
-Gonorrhea must be differentiated from nongonococcal [[urethritis]], ''[[Trichomonas vaginalis]]'' infection, [[urethral stricture]], [[acute prostatitis]], and [[Reiter's syndrome]].
+Gonorrhea must be differentiated from other sexually transmitted pathogens, nongonococcal [[urethritis]], [[vaginitis]], [[cervicitis]], [[urinary tract infections]], [[prostatitis]], and [[orchitis]].
+Additionally, disseminated gonococcal infection must be differentiated from [[herpes simplex virus|herpes simplex virus (HSV)]], nongonococcal [[septic arthritis]], [[syphilis]], [[HIV|HIV infection]],  [[rheumatic fever]], [[reactive arthritis]] , and [[Lyme disease]].<ref name="pmid26042815">{{cite journal| author=Workowski KA, Bolan GA, Centers for Disease Control and Prevention| title=Sexually transmitted diseases treatment guidelines, 2015. | journal=MMWR Recomm Rep | year= 2015 | volume= 64 | issue= RR-03 | pages= 1-137 | pmid=26042815 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26042815  }} </ref><ref name="pmid3101626">{{cite journal| author=Rompalo AM, Hook EW, Roberts PL, Ramsey PG, Handsfield HH, Holmes KK| title=The acute arthritis-dermatitis syndrome. The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis. | journal=Arch Intern Med | year= 1987 | volume= 147 | issue= 2 | pages= 281-3 | pmid=3101626 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3101626  }} </ref><ref name="pmid16297736">{{cite journal| author=Rice PA| title=Gonococcal arthritis (disseminated gonococcal infection). | journal=Infect Dis Clin North Am | year= 2005 | volume= 19 | issue= 4 | pages= 853-61 | pmid=16297736 | doi=10.1016/j.idc.2005.07.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16297736  }} </ref>
 ==Differentiating gonorrhea from other diseases==
+Gonorrhea must be differentiated from other sexually transmitted pathogens including ''[[Chlamydia trachomatis]]'', [[Trichomonas vaginalis]], [[Mycoplasma genitalium]], [[herpes simplex virus|herpes simplex virus (HSV)]], and [[syphilis]].
-Conditions that must be considered in the differential diagnosis of gonorrhea:
+Conditions that must be considered in the differential diagnosis of gonorrhea include:<ref name="pmid26042815">{{cite journal| author=Workowski KA, Bolan GA, Centers for Disease Control and Prevention| title=Sexually transmitted diseases treatment guidelines, 2015. | journal=MMWR Recomm Rep | year= 2015 | volume= 64 | issue= RR-03 | pages= 1-137 | pmid=26042815 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26042815  }} </ref>
+*In women
-* Nongonorrheal [[urethritis]]
+** Non gonorrheal [[urethritis]]
-* [[Trichomonas vaginalis]] infection
+** [[Vaginitis]]
-* [[Urethral stricture]]
+** [[Cervicitis]]
-* [[Acute prostatitis]]
+** [[Urinary tract infections]]
-* [[Reiter's syndrome]]
+** Pregnancy
+** [[Endometriosis]]
+*In men
+** Non gonorrheal [[urethritis]]
+** [[Prostatitis]]
+** [[Orchitis]]
+** [[Testicular torsion]]
+** [[Urinary tract infections]]
 ===Disseminated gonococcal infection===
-Disseminated gonococcal infection must be differentiated from:
+Disseminated gonococcal infection must be differentiated from:<ref name="pmid3101626">{{cite journal| author=Rompalo AM, Hook EW, Roberts PL, Ramsey PG, Handsfield HH, Holmes KK| title=The acute arthritis-dermatitis syndrome. The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis. | journal=Arch Intern Med | year= 1987 | volume= 147 | issue= 2 | pages= 281-3 | pmid=3101626 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3101626  }} </ref><ref name="pmid16297736">{{cite journal| author=Rice PA| title=Gonococcal arthritis (disseminated gonococcal infection). | journal=Infect Dis Clin North Am | year= 2005 | volume= 19 | issue= 4 | pages= 853-61 | pmid=16297736 | doi=10.1016/j.idc.2005.07.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16297736  }} </ref><ref name="pmid22353959">{{cite journal| author=Bleich AT, Sheffield JS, Wendel GD, Sigman A, Cunningham FG| title=Disseminated gonococcal infection in women. | journal=Obstet Gynecol | year= 2012 | volume= 119 | issue= 3 | pages= 597-602 | pmid=22353959 | doi=10.1097/AOG.0b013e318244eda9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22353959  }} </ref>
 {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
@@ Line 23: / Line 32: @@
 ! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
 |-
-| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Herpes simplex virus|Herpes simplex virus (HSV)]]'''
+| style="padding: 5px 5px; background: #DCDCDC;" |'''Nongonococcal [[septic arthritis]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Presents with an acute onset of joint swelling and pain (usually monoarticular)
+*Culture of joint fluid reveals organisms
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute rheumatic fever]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Genital and extragenital lesions can mimic the skin lesions that occur in disseminated gonococcal infection
+*Presents with polyarthritis and rash (rare presentation) in young adults. Microbiologic or serologic evidence of a recent streptococcal infection confirm the diagnosis.
-*Viral culture,  [[polymerase chain reaction|polymerase chain reaction (PCR)]], and direct fluorescence antibody confirm the presence of the causative agent.
+*Poststreptococcal arthritis have a rapid response to [[salicylate]]s or other [[antiinflammatory drugs]].
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Syphilis]]'''
@@ Line 32: / Line 46: @@
 *Presents with acute secondary syphilis usually presents with generalized, pustular lesions at the palms and soles with [[lymphadenopathy|generalized lymphadenopathy]]
 *Rapid plasma reagin (RPR), Venereal Disease Research Laboratory (VDRL) and Fluorescent treponemal antibody absorption (FTA-ABS) tests confirm the presence of the causative agent.
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Reactive arthritis]] (Reiter syndrome)'''
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Musculoskeletal manifestation include [[arthritis]], [[tenosynovitis]], [[dactylitis]], and low back pain.
+*Extraarticular manifestation include [[conjunctivitis]], [[urethritis]], and genital and oral lesions.
+*Reactive arthritis is a clinical diagnosis based upon the pattern of findings and there is no definitive diagnostic test
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Hepatitis B virus|Hepatitis B virus (HBV) infection]]'''
@@ Line 38: / Line 58: @@
 *Synovial fluid analysis usually shows noninflammatory fluid
 *Elevated [[aminotransaminases|serum aminotransaminases]] and evidence of acute HBV infection on serologic testing confirm the presence of the HBV.
+|-
+| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Herpes simplex virus|Herpes simplex virus (HSV)]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Genital and extragenital lesions can mimic the skin lesions that occur in disseminated gonococcal infection
+*Viral culture,  [[polymerase chain reaction|polymerase chain reaction (PCR)]], and direct fluorescence antibody confirm the presence of the causative agent.
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[HIV infection]] '''
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *Present with generalized rash with mucus membrane involvement, fever, chills, and [[arthralgia]]. Joint effusions are uncommon
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute rheumatic fever]]'''
-| style="padding: 5px 5px; background: #F5F5F5;" |
-*Presents with polyarthritis and rash (rare presentation) in young adults. Microbiologic or serologic evidence of a recent streptococcal infection confirm the diagnosis.
-*Poststreptococcal arthritis have a rapid response to [[salicylate]]s or other [[antiinflammatory drugs]].
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Gout|Gout and other crystal-induced arthritis]]'''
@@ Line 52: / Line 72: @@
 *Presents with acute monoarthritis with fever and chills
 *Synovial fluid analysis confirm the diagnosis.
-|-
-| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Reactive arthritis]] (Reiter syndrome)'''
-| style="padding: 5px 5px; background: #F5F5F5;" | Present with [[arthritis]], [[tenosynovitis]], [[dactylitis]], and low back pain. Extraarticular manifestation include [[conjunctivitis]], [[urethritis]], and genital and oral lesions. There is no definitive diagnostic test. Reactive arthritis is a clinical diagnosis based upon the pattern of findings.
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lyme disease]]'''
@@ Line 65: / Line 82: @@
 {{Reflist|2}}
-[[Category:Sexually transmitted infections|Gonorrhea]]
-[[Category:Infectious disease]]
-[[Category:Mature chapter]]
-[[Category:Primary care]]
 {{WH}}
 {{WS}}
+[[Category:Gynecology]]
+[[Category:FinalQCRequired]]
+[[Category:Emergency mdicine]]
+[[Category:Disease]]
+[[Category:Up-To-Date]]
+[[Category:Infectious disease]]
+[[Category:Rheumatology]]
+[[Category:Dermatology]]
+[[Category:Neurology]]
+[[Category:Cardiology]]
+[[Category:Urology]]
+[[Category:Gastroenterology]]