Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Gonorrhea


Related Terms

  • Arthritis-dermatitis Syndrome
  • Clap
  • Disseminated Gonococcal Disease
  • Gonococcal Arthritis
  • Gonococcal Cervicitis
  • Gonococcal Proctitis
  • Gonococcal Urethritis

Differential Diagnosis

Specialists

  • Cardiovascular Internist
  • Dermatologist
  • Gynecologist
  • Infectious Disease Internist
  • Neurologist
  • Rheumatologist
  • Urologist

Comorbid Conditions

  • Impaired immune system

Factors Influencing Duration

The length of disability will be influenced by the response to treatment or if there are any complications. Antibiotic-resistant infections may be more severe and require prolonged treatment. Pregnancy complications, including infection of the developing fetus, may extend disability. Untreated heart or brain involvement can lead to long-term disabilities.

Medical Codes

ICD-9-CM:
098.0 - Gonococcal Infection, Acute, Lower Genitourinary Tract; Gonococcal: Bartholinitis, Acute; Urethritis, Acute; Vulvovaginitis, Acute: Gonorrhea (Acute), NOS, Genitourinary NOS
098.10 - Gonococcal Infection; Acute, Upper Genitourinary Tract; Site Unspecified
098.11 - Gonococcal Infection; Acute, Upper Genitourinary Tract; Gonorrhea (Acute) of Bladder
098.12 - Gonococcal Infection; Acute, Upper Genitourinary Tract; Gonococcal Prostatitis (Acute)
098.14 - Gonococcal Infection; Acute, Upper Genitourinary Tract; Gonococcal Seminal Vesiculitis (Acute); Gonorrhea (Acute) of Seminal Vesicle
098.15 - Gonococcal Infection; Acute, Upper Genitourinary Tract; Gonococcal Cervicitis (Acute); Gonorrhea (Acute) of Cervix
098.16 - Gonococcal Infection; Acute, Upper Genitourinary Tract; Gonococcal Endometritis (Acute); Gonorrhea (Acute) of Uterus
098.17 - Gonococcal Infection; Acute, Upper Genitourinary Tract; Gonococcal Salpingitis, Specified as Acute
098.19 - Gonococcal Infection, Acute, Upper Genitourinary Tract, Other
098.2 - Gonococcal Infection; Chronic, Lower Genitourinary Tract
098.30 - Chronic Gonococcal Infection of Upper Genitourinary Tract, Site Unspecified
098.31 - Gonococcal Cystitis, Chronic; Gonorrhea of Bladder, Chronic
098.32 - Gonococcal prostatitis, chronic
098.34 - Gonococcal Seminal Vesiculitis, Chronic; Gonorrhea of Seminal Vesicle, Chronic
098.35 - Gonococcal Cervicitis, Chronic; Gonorrhea of Cervix, Chronic
098.36 - Gonococcal Endometritis, Chronic
098.37 - Gonococcal Salpingitis (Chronic)
098.39 - Gonococcal Infection, Chronic, Upper Genitourinary Tract, Other
098.40 - Gonococcal Conjunctivitis, Neonatorum; Gonococcal Ophthalmia, Neonatorum
098.41 - Gonococcal Iridocyclitis
098.42 - Gonococcal Endophthalmia
098.43 - Gonococcal Keratitis
098.49 - Gonococcal Infection of Eye, Other
098.50 - Gonococcal Arthritis; Gonococcal Infection of Joint NOS
098.51 - Gonococcal Synovitis and Tenosynovitis
098.52 - Gonococcal Bursitis
098.53 - Gonococcal Spondylitis
098.59 - Gonococcal Infection of Joint, Other; Gonococcal rheumatism
098.6 - Gonococcal Infection of Pharynx
098.81 - Gonococcal Keratosis, Blennorrhagica
098.82 - Gonococcal Meningitis
098.83 - Gonococcal Pericarditis
098.84 - Gonococcal Endocarditis
098.85 - Gonococcal Infection of Other Specified Sites, Other Gonococcal Heart Disease
098.86 - Gonococcal Peritonitis
098.89 - Gonococcal Infection of Other Specified Sites, Other; Gonococcemia

Overview

Gonorrhea is a highly contagious sexually transmitted disease (STD) caused by the bacterium Neisseria gonorrhoeae. The disease is spread through sexual contact and initially causes an infection in the lower reproductive tract (the cervix, vagina, and urethra in women or the urethra in men). With anal sex, the infection occurs in the rectum. With oral sex, the infection can begin in the throat (pharynx).

If the disease is not treated, the infection can move up the reproductive tract to the pelvic organs in women and the prostate, epididymis, and testis in men. It can then enter the blood, affecting the joints and major organs of the body (disseminated gonorrhea). Because symptoms can be delayed, it is often spread before individuals realize they are infected. It can also be transmitted from an infected mother to her newborn infant during childbirth, causing an eye infection in the newborn (ophthalmia neonatorum). Nongonococcal urethritis and Chlamydia infections often coexist with gonorrhea (35% to 50% of infected women and 15% to 25% of infected heterosexual men). Gonorrhea is not spread, as some believe, by touching doorknobs and toilet seats.

The use of condoms, both male and female types, substantially reduces the risk of spread. Fortunately, the disease is not difficult to cure, but resistant strains of N. gonorrhoeae may complicate the treatment and require combined antibiotic therapy using more potent antibiotics. All states require that cases of gonorrhea be reported to the State Department of Health to allow for testing of sexual contacts.

Incidence and Prevalence: Gonorrhea is one of the oldest STDs known and is the second most commonly reported notifiable disease in the US today. In 2012, 334,826 cases were reported in the US (107.5 cases per 100,000 population) ("Gonorrhea"), but this may be a fraction of the real figure (an estimated 700,000 new cases). The number of estimated yearly cases of gonorrhea in the US is between 1.5 and 3 million. Worldwide there are about 62 million cases annually. The disease is prevalent in both industrialized and nonindustrialized nations.

Source: Medical Disability Advisor



Causation and Known Risk Factors

While all social strata in the US can be affected, gonorrhea is especially common in low socioeconomic settings. Gonorrhea affects women more than men and blacks more than whites (Hispanic and non-Hispanic). It is most common in sexually active individuals between the ages of 15 and 29. Women younger than age 20 and those whose partners do not use condoms are particularly at risk; the risk is also increased in individuals with other STDs, and increases with the number of sexual partners. Once a male is infected, the risk of transmission to a female partner is about 50% to 70% per contact, while the risk after vaginal intercourse with an infected female is 20% per episode (Wong).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report history of sexual contact with a new or multiple partners. Symptoms usually appear 3 days to 2 weeks after infection. However, some men, and up to half of all women, may not experience any symptoms (asymptomatic). Common symptoms include urinary frequency with pain or burning (dysuria). A purulent discharge from the vagina or penis may be present, and the penile opening may become red and swollen; occasional vaginal bleeding may also be present. As the disease progresses, there may be fever, deep abdominal pain, discomfort during intercourse, or bleeding between menstrual periods in women. Depending on specific sexual practices, the infection may occur in the throat, causing pain and inflammation (gonococcal pharyngitis); or in the rectum (rectal gonorrhea), causing itching, discharge, and painful bowel movements. If infected fluid enters the eye, redness and inflammation may occur (gonorrheal conjunctivitis). Although less expected, a wide range of symptoms may correspond to other structures (such as the heart and joints) being compromised should the organism travel through the bloodstream.

Physical exam: Men will usually exhibit a thick purulent discharge from the penis. A similar discharge from the cervix may be found in women, with possible tenderness of the fallopian tubes. Abscesses of the tubes can sometimes be detected by a pelvic examination. A sore throat, difficulty swallowing, and swelling of nodes in the neck may suggest gonococcal pharyngitis.

Because an infected woman may have no symptoms for weeks or even months, the disease may only be discovered after her partner is diagnosed and she is identified as his contact.

Tests: Microscopic examination of pus may reveal characteristic-appearing bacteria. Culture of pus positive for growth of N. gonorrhoeae confirms the diagnosis. Once bacteria are grown in culture, specific antibiotics that kill these bacteria can also be identified (sensitivity testing), ensuring effective treatment.

Tests that look for specific proteins or DNA of the gonorrheal bacteria are faster and simpler. Unfortunately these tests, including enzyme-linked immunosorbent assay (ELISA or EIA) and direct immunofluorescence test (DFA), are less sensitive in detecting the infection and do not provide any information on antibiotic sensitivity.

A newer DNA probe test can be used to detect specific bacterial genes. Combining a pus sample from an affected area with a chemical that agitates the bacteria causes it to release DNA. Analyses of these DNA samples allow for a specific diagnosis.

Source: Medical Disability Advisor



Treatment

Gonorrhea is treated with antibiotics either orally or by injection. Although penicillin was once the drug of choice, over the past 2 decades many cases of gonorrhea have been found that are resistant to penicillin, ampicillin, and tetracycline; hence, currently alternative antibiotics are used such as ceftriaxone in combination with azithromycin or doxycycline. Either azithromycin or doxycycline is added both to slow development of resistance to ceftriaxone and to provide concomitant treatment for nongonococcal urethritis and Chlamydia. More than 97% of uncomplicated gonorrheal urethral and cervical infections are eradicated by a large single dose of the appropriate antibiotics. Anal and throat infections are more likely to need multiple doses.

All sexual partners of the infected individual should be treated. Because asymptomatic infection is common, routine screening is recommended for women who are sexually active with new or multiple partners, or with a partner diagnosed with a STD. All women with positive screening cultures should be treated with appropriate antibiotics.

Source: Medical Disability Advisor



Prognosis

With early antibiotic treatment, the prognosis for gonorrhea is good. The infection usually clears in 2 to 4 weeks provided the bacteria are susceptible to the recommended antibiotics. For those with an impaired immune system, infections may last for months and become more severe.

Untreated or improperly treated infection can cause complications. In men, urethral gonorrhea infections can result in acute or chronic prostate gland inflammation or testicular infection. In women, infection can spread to the uterus and fallopian tubes, causing sterility, ectopic (tubal) pregnancy, or pelvic inflammatory disease. In pregnant women, infection can lead to spontaneous abortion, premature rupture of the membranes, premature delivery, and stillbirth.

Source: Medical Disability Advisor



Rehabilitation

Individuals treated for gonorrhea may require counseling for a variety of reasons. Psychologists or social workers may counsel individuals about risky sexual behaviors such as having multiple partners and/or engaging in unprotected sex, which places them at risk for contracting other potentially fatal STDs like hepatitis B and HIV/AIDS. Because women with gonorrhea are often asymptomatic, they are at increased risk of infertility due to late diagnosis. Women in this situation may receive counseling about their potentially decreased fertility as well as available fertility treatments. For an individual infected by a long-term partner who has had relations outside of the partnership, individual or couples counseling may be necessary to help resolve feelings of betrayal.

Gonorrhea requires no specific physical rehabilitation, although individuals who develop acute arthritis may require two to four sessions of physical therapy to address pain control and muscle strengthening of the specific joints involved.

Source: Medical Disability Advisor



Complications

Gonorrhea bacteria spreading through the bloodstream (disseminated gonococcal disease) can cause fever, rash, and joint pain. Although fever and rash resolve, one or more joints may become swollen with infected fluid (migratory polyarthritis, and tenosynovitis), and red pus-filled lesions may appear on the skin (arthritis-dermatitis syndrome). This complication is more common in women, especially during menstruation or in the second and third trimesters of pregnancy. Arthritis-dermatitis syndrome is the most common cause of infectious arthritis in young adults.

Involvement of the heart or brain can cause endocarditis or meningitis. Liver involvement in women can cause perihepatitis or Fitz-Hugh-Curtis syndrome. Infection of the eyes causes gonococcal conjunctivitis.

In pregnant women, infection can lead to spontaneous abortion, premature delivery, and low birth weight babies. Gonorrhea leads to pelvic inflammatory disease in 10% to 20% of infected women. Scarring of the fallopian tubes and other pelvic organs can cause chronic pain, ectopic pregnancy, and infertility. Infection of the Bartholin's gland near the vagina may lead to painful abscess formation.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

There are no anticipated work restrictions or accommodations for uncomplicated gonorrhea. Although some accommodations may be required if complications are present, the nature and extent of the accommodations will depend on the severity of the symptoms. Long-term disability is not expected.

Risk: There is no risk to coworkers with gonorrhea infection. Education on lifestyle factors including safe sex practices will need to be initiated to prevent recurrence.

Capacity: Capacity is dependent on the extent and anatomic locations affected by the infection. Virtually all individuals will be able to work normally except in those with widespread infection into the internal organs.

Tolerance: Tolerance is not expected to be a factor with gonorrheal infection.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has diagnosis of gonorrhea been confirmed?
  • Was ELISA, EIA, or DFA test needed to confirm the diagnosis? DNA probe test?
  • Did the infection include more than one STD?
  • Did individual experience any secondary infections or complications?
  • Does individual also have nongonococcal urethritis or a Chlamydia infection?
  • Does individual have an impaired immune system?

Regarding treatment:

  • Was infection treated with antibiotics? Were multiple doses required?
  • Was effectiveness verified by follow-up culture?
  • Was a culture and sensitivity test done to indicate the most effective antibiotic?
  • Where was infection located?
  • Does the bacterium appear resistant to the antibiotic used?
  • If complications occurred, should individual be hospitalized for intravenous antibiotics?
  • Would individual benefit from consultation with an appropriate specialist for further treatment recommendations?
  • Were sexual contacts located and treated?

Regarding prognosis:

  • Was follow-up culture done to confirm that the infection was completely eradicated?
  • Was individual educated about future prevention and the risks of reinfection?

Source: Medical Disability Advisor



References

Cited

"Gonorrhea." MedlinePlus. 13 Aug. 2014. National Library of Medicine. 16 Aug. 2014 <http://www.nlm.nih.gov/medlineplus/gonorrhea.html>.

"Gonorrhea: 2012 Sexually Transmitted Diseases Surveillance." Centers for Disease Control and Prevention. 7 Jan. 2014. U.S. Department of Health and Human Services. 16 Aug. 2014 <http://www.cdc.gov/std/stats12/gonorrhea.htm>.

Wong, Brian. "Gonorrhea." eMedicine. Ed. Burke A. Cunha. 16 Apr. 2014. Medscape. 16 Aug. 2014 <http://emedicine.medscape.com/article/218059-overview>.

Source: Medical Disability Advisor






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