What is gout?

Gout is a metabolic disease (fairly common) which generally affect middle-aged to elderly men and postmenopausal women. It is due to an increased body pool of uric acid with hyperuricemia (high uric acid level in blood). It is characterized by episodic acute and chronic arthritis (joint inflammation and pain), due to deposition of monosodium urate crystals in joints and connective tissue known as tophi, and the risk for deposition in kidney interstitium to form kidney stones of uric acid (uric acid nephrolithiasis).

What are the clinical symptoms of gout?

Ocular gonorrhea or gonorrhea in eyes occurs in adults mostly due to autoinoculation (autoinfection) from infected genital site. The autoinoculation may occur through fomites, such as hands/fingers and other objects. Chlamydial infection frequently coexists with gonococcal infection.

Clinical manifestations of ocular gonorrhea:

The clinical manifestations of ocular gonorrhea may range from asymptomatic to mild to severe form as seen with genital gonorrhea. The variability of clinical manifestations of ocular gonorrhea may be due to the different strains of Neisseria gonorrhoeae causing ocular gonorrhea with different ability to elicit an inflammatory response.

Infection of pharynx by Neisseria gonorrhoeae cause pharyngeal gonorrhea. Generally there is always presence of genital gonorrhea along with pharyngeal gonorrhea.

Mode of transmission of pharyngeal gonorrhea:

The mode of transmission is oral-genital sexual exposure with genital gonorrhea infected person. Fellatio (sucking of penis by female partner) is more efficient mode of transmission of pharyngeal gonorrhea than cunnilingus (licking of vagina with tongue by male partner). Transmission of Neisseria gonorrhoeae from pharynx to sexual contact is rare.

Gonorrhea is a sexually transmitted disease (STD), caused by Neisseria gonorrhoeae, which commonly infect the epithelium cervix (cervicitis), urethra (urethritis), rectum (proctitis), and conjunctiva of eye (conjunctivitis). Gonorrhea if left untreated can lead to complications such as periurethritis and epididymitis in men, endometritis, salpingitis, abscess (in Fallopian tubes and ovaries), bartholinitis, peritonitis, and perihepatitis in women and ophthalmia neonatorum in newborns infants.

Global scenario of gonorrhea:

Gonorrhea is still a major public health problem in most parts of the world and a major cause of morbidity in developing countries. Gonorrhea may play a role in transmission of HIV infection.

Presence of Neisseria gonorrhoeae (the causative agent of gonorrhea) in rectum and anal canal can occur in females as female anatomy is such that it allows exudates from cervix to spread to rectum and sometimes N. gonorrhoeae can be recovered from rectum in women suffering from uncomplicated gonorrhea (cervicitis).

Isolation of Neisseria gonorrhoeae only in rectum is seen in approximately 5% of women with gonorrhea. Gonococcal infection only in rectum in women is generally asymptomatic, although sometimes may produce symptoms such as rectal pain, purulent discharge from rectum, bleeding from rectum, itching, spasm of rectum etc.

Anorectal gonorrhea is also seen among homosexual men, especially the receptive partner. The incidence of gonococcal infection (including anorectal gonorrhea) among homosexual men came down in 1980s (by more than 90%), but after 1990s there was a resurgence of gonorrhea including anorectal gonorrhea.