Gonorrhea vs Chlamydia

[fly1346]

I keep getting questions on either one, and always get confused, between the 2. Can someone please explain, the key differences between the 2 along with the treatment. Mainly, how do they present clinically..

Much appreciated

Thanks

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[CherryRedDracul]

Both can cause urethritis and the feared complication, pelvic inflammatory disease. Urethritis, but not cystitis, will give you discharge.

N. gonorrhea: Gram - diplococci.
C. trachomatis: you might see a bunch of neutrophils, but no organisms. That's because Chlamydia are obligate intracellular organisms.

For treatment, a 3rd generation cephalosporin like ceftriaxone does the trick for Neisseria species. You can treat Chlamydia with either a macrolide like azithromycin or a tetracycline like doxycycline. But you don't want to give doxy to a pregnant patient. Often, you'll treat patients with both antibiotics because co-infection is so common.

 

[J ROD]

Good description. Not much I can add.

 

[Venko]

Gonorrhea also can cause a monoarthritis without any urinary symptoms.

 

[dyspareunia]

CT is more common than GC.

GC = thick, purulent discharge.
CT = watery, cloudy discharge.

Prophylactic erythromycin ointment prevents GC neonatal conjunctivitis, but doesn't work for CT.

Both can cause urethritis and the feared complication, pelvic inflammatory disease. Urethritis, but not cystitis, will give you discharge.

N. gonorrhea: Gram - diplococci.
C. trachomatis: you might see a bunch of neutrophils, but no organisms. That's because Chlamydia are obligate intracellular organisms.

For treatment, a 3rd generation cephalosporin like ceftriaxone does the trick for Neisseria species. You can treat Chlamydia with either a macrolide like azithromycin or a tetracycline like doxycycline. But you don't want to give doxy to a pregnant patient. Often, you'll treat patients with both antibiotics because co-infection is so common.

I think CT doesn't show on gram stain because it lacks muramic acid, not because it is obligate intracellular. You will see gram neg diplococci inside PMNs in the case of GC.. hence you can see intracellulars on gram stain.

 

[CherryRedDracul]

I think CT doesn't show on gram stain because it lacks muramic acid, not because it is obligate intracellular. You will see gram neg diplococci inside PMNs in the case of GC.. hence you can see intracellulars on gram stain.

Makes sense. Thanks for pointing that out.

 

[Enzymes]

CT is more common than GC.

GC = thick, purulent discharge.
CT = watery, cloudy discharge.

Prophylactic erythromycin ointment prevents GC neonatal conjunctivitis, but doesn't work for CT.



I think CT doesn't show on gram stain because it lacks muramic acid, not because it is obligate intracellular. You will see gram neg diplococci inside PMNs in the case of GC.. hence you can see intracellulars on gram stain.

Yes, good discussion guys. I also really like the point about the difference in discharges. Sometimes that is your only clue. It is much thicker with Neisseria.