TAILIEUCHUNG - Chapter 137. Gonococcal Infections (Part 7)

Gonococcal Infections in HIV-Infected Persons The association between gonorrhea and the acquisition of HIV has been demonstrated in several well-controlled studies, mainly in Kenya and Zaire. The nonulcerative STIs enhance the transmission of HIV by three- to fivefold, possibly because of increased viral shedding by persons with urethritis or cervicitis (Chap. 182). HIV has been detected by polymerase chain reaction (PCR) more commonly in ejaculates from HIV-positive men with gonococcal urethritis than in those from HIV-positive men with nongonococcal urethritis. PCR positivity diminishes twofold after appropriate therapy for urethritis. Not only does gonorrhea enhance the transmission of HIV; it may. | Chapter 137. Gonococcal Infections Part 7 Gonococcal Infections in HIV-Infected Persons The association between gonorrhea and the acquisition of HIV has been demonstrated in several well-controlled studies mainly in Kenya and Zaire. The nonulcerative STIs enhance the transmission of HIV by three- to fivefold possibly because of increased viral shedding by persons with urethritis or cervicitis Chap. 182 . HIV has been detected by polymerase chain reaction PCR more commonly in ejaculates from HIV-positive men with gonococcal urethritis than in those from HIV-positive men with nongonococcal urethritis. PCR positivity diminishes twofold after appropriate therapy for urethritis. Not only does gonorrhea enhance the transmission of HIV it may also increase the individual s risk for acquisition of HIV. A proposed mechanism is the significantly greater number of CD4 T lymphocytes and dendritic cells that can be infected by HIV in endocervical secretions of women with nonulcerative STIs than in those of women with ulcerative STIs. Laboratory Diagnosis A rapid diagnosis of gonococcal infection in men may be obtained by Gram s staining of urethral exudates Fig. 137-1 . The detection of gram-negative intracellular monococci and diplococci is usually highly specific and sensitive in diagnosing gonococcal urethritis in symptomatic males but is only 50 sensitive in diagnosing gonococcal cervicitis. Samples should be collected with Dacron or rayon swabs. Part of the sample should be inoculated onto a plate of modified Thayer-Martin or other gonococcal selective medium for culture. It is important to process all samples immediately because gonococci do not tolerate drying. If plates cannot be incubated immediately they can be held safely for several hours at room temperature in candle extinction jars prior to incubation. If processing is to occur within 6 h transport of specimens may be facilitated by the use of nonnutritive swab transport systems such as Stuart or Amies medium. For

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