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Giardiasis 

Giardiasis
Chapter:
Giardiasis
DOI:
10.1093/med/9780198729228.003.0066
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date: 26 June 2019

Neisseria gonorrhoeae is an intracellular Gram-negative diplococcal bacterium. Infection in the paediatric age range occurs as two distinct clinical entities—newborn infants and older children/adolescents. Transmission is due to direct inoculation of infected secretions from one mucous membrane to another. Infection of the newborn results from passage through the birth canal of an infected mother, although infection after Caesarean delivery has been documented. Infection in children and adolescents occurs through sexual contact. Newborn infants develop ophthalmia neonatorum which can be unilateral or bilateral and progress from eyelid oedema, through chemosis, to mucopurulent discharge. Infection in children or adolescents involves mucous membranes exposed to sexual contact and can vary from asymptomatic infection, through vaginitis, urethritis, or cervicitis with discharge, to pelvic inflammatory disease, epididymitis, and perihepatitis. Microscopic examination, Gram stain, and culture of exudate from a swab is the gold standard for diagnosis; however, nucleic acid amplification tests are now recognized as a useful investigation for a wide range of specimens. Positive nucleic acid amplification tests from extragenital sites and low-prevalence populations must be confirmed with supplementary testing, using a different nucleic acid target. Management involves treatment with third-generation cephalosporins. It is important to consider the possibility of coexistent Chlamydia infection. It is important to involve genitourinary medicine specialists to instigate contact tracing, if appropriate. Consider child sexual abuse at any age, but in particular for prepubertal children.

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