Gonorrhea, an STD involving infection of columnar and transitional epithelium by N. gonorrhoeae, continues to be a significant sexually transmitted infection causing a generally asymptomatic pharyngeal infection that may later become disseminated. In some cases of N. gonorrhoeae, erythema, edema, vesicles, ulcers, and pain may be present in the oral cavity. These patients are more likely to develop systemic gonorrhea. Major virulence mechanisms include production of pili and IgAase. Gonococci are very fragile and fastidious organisms, resulting in a lack of transmission by fomites, the need for calcium alginate swabs to collect specimens, and nutrient media such as Thayer-Martin media required to culture the organism. In the head and neck, pharyngeal gonococcal infection is significant, because it is the principal origin of gonococcemia. Treatment of uncomplicated gonococcal infections currently is a single dose of cefixime, ceftriaxone, or ciprofloxacin if chlamydial infection has been ruled out. Disseminated infections (bacteremias, meningitis, endocarditis, septic arthritis) require parenteral antibiotic (ceftriaxone, cefotaxime or ceftizoxime). Previous investigations into gonococcal vaccines, most of which are composed of gonococcal pili, found that they were not protective. Control rests on better education, proper reporting, follow-up of patients and their contacts, use of condoms, and chemoprophylaxis to prevent neonatal gonoccocal conjunctivitis.
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