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A - MSRA Gynaecology [8] > [3] Gonorrhoea > Flashcards

[3] Gonorrhoea Flashcards

1
Q

What is gonorrhoea?

A

A sexually transmitted infection caused the bacterium Neisseria gonorrhoea

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2
Q

What type of bacteria is Neisseria gonorrhoea?

A

A gram -ve diplococcus

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3
Q

What does Neisseria gonorrhoea infect?

A

The mucous membranes of the urethra, endocervix, rectum, pharynx and conjunctiva

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4
Q

What parts of the body can be affected by gonorrhoea?

A
  • Genitals
  • Mouth
  • Rectum
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5
Q

How does gonorrhoea spread?

A

By direct inoculation of infected secretions from one mucous membrane to another

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6
Q

When can gonorrhoea be transmitted?

A

Usually sexually but can occur perinatally

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7
Q

What is the incubation period of gonorrhoea?

A

2-5 days but can be up to 10

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8
Q

How many cases of gonorrhoea were diagnosed in England in 2017?

A

44,000

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9
Q

Which group of people have a disproportionate increase in gonorrhoea cases?

A

MSM

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10
Q

What is thought to have caused the increase in cases of gonorrhoea?

A
  • More young men coming forward for testing

- Increasing unsafe sex

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11
Q

Where is gonorrhoea more common?

A

URban areas

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12
Q

What are the risk factors for gonorrhoea?

A
  • Young age
  • History of previous STI
  • Co-existent STI
  • New or multiple sexual partners
  • Recent sexual activity abroad
  • Certain sexual activities
  • Inconsistent condom use
  • History of drug use or commercial sex work
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13
Q

What sexual activities are particularly risky for gonorrhoea transmission?

A
  • Anal intercourse

- Frequent insertive oral sex

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14
Q

Which sex is gonorrhoea more commonly symptomatic in?

A

Men (90-95%)

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15
Q

What percentage of women with gonorrhoea are symptomatic?

A

50%

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16
Q

What do symptoms of gonorrhoea depend on?

A

The site of infection

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17
Q

What are the symptoms of urethral gonorrhoea infection in men?

A
  • Discharge
  • Dysuria
  • Asymptomatic in <10% of cases
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18
Q

What are the symptoms of rectal gonorrhoea infection in men?

A
  • Usually asymptomatic
  • Anal discharge
  • Perianal/anal pain
  • Pruritis
  • Bleeding
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19
Q

How does pharyngeal gonorrhoea infection usually present in men and women?

A

Usually asymptomatic

20
Q

How does endocervical gonorrhoea infection present?

A
  • Up to 50% asymptomatic
  • Increased or altered vaginal discharge (up to 50% of cases)
  • Lower abdominal pain
  • Intermenstrual bleeding or menorrhagia
21
Q

What are the symptoms of urethral gonorrhoea infection in women?

A
  • Dysuria without frequency
22
Q

How does rectal gonorrhoea infection present in women?

A

Usually asymptomatic

23
Q

What are the differentials for gonorrhoea?

A
  • Chlamydia
  • Thrichomonas
  • Candidiasis
  • Bacterial vaginosis
  • Urinary tract infection
24
Q

How was gonorrhoea traditionally investigated?

A

Culture for diagnosis and sensitivity testing

25
Q

What is overtaking culture as the main diagnostic test for gonorrhoea?

A

NAAT (nucleic acid amplification testing)

26
Q

When is culture still necessary?

A
  • In positive NAAT tests to ensure resistant strains are identified
  • Signs and symptoms consistent with gonorrhoea
27
Q

How can samples for gonorrhoea NAAT be taken?

A
  • Urethral/endocervical swabs

- First pass urine

28
Q

When should a patient be referred to a GUM clinic for gonorrhoea?

A

If they have symptoms or is at high risk or has tested positive

29
Q

What are the management aspects in gonorrhoea?

A
  • Give advice
  • Partner notification
  • Drug treatment
30
Q

What advice should be given to patients with gonorrhoea?

A
  • Explain condition, implications for patient and partner(s)
  • Advice on safer sex
  • Avoid sex until treatment completed in patient and partner(s)
31
Q

Who should perform partner notification in gonorrhoea?

A

Preferably health professional

32
Q

Which contacts of a man with symptomatic urethral gonorrhoea infection should be notified?

A

All that they have had sexual contact with in past 2 weeks or their last partner if more than 2 weeks

33
Q

Which contacts of a person with asymptomatic or symptomatic non-urethral gonorrhoea infection should be notified?

A

All sexual partners for last 3 months

34
Q

What should form part of partner notification for gonorrhoea?

A
  • Full STI screen

- Empirical treatment for gonorrhoea and chlamydia in advance of test results

35
Q

What is the recommended treatment for confirmed uncomplicated anogenital gonorrhoea?

A

State doses of:

  • Ceftriaxone 500mg IM
  • Azithromycin 1g orally
36
Q

What is recommended after all treatments of gonorrhoea?

A

Test of cure

37
Q

What can be given if there is a history of cephalosporin sensitivity (in the patient)?

A

Azithromycin 2g single oral dose

38
Q

What are the potential complications of gonorrhoea in men?

A
  • Gonococcal urethritis

- Local spread

39
Q

What can gonococcal urethritis cause?

A
  • Scarring
  • Stricture
  • Bladder-outflow obstruction
40
Q

What gonorrhoea spread cause in men?

A
  • Acute epididymitis
  • Prostatitis
  • Seminal vesiculitis
  • Penile lymphangitis
  • Peri-urethral abscess
41
Q

What are the potential complications of gonorrhoea in women?

A
  • PID
  • Bartholin’s abscess
  • Peri-hepatitis
42
Q

What can PID lead to as a result of gonorrhoea?

A
  • Infertility
  • Chronic pelvic pain
  • Ectopic pregnancy
43
Q

What can gonorrhoea in pregnancy be associated with?

A
  • Premature labour
  • Miscarriage
  • Corneal scarring and blindness due to neonatal ophthalmic infection
44
Q

What are the potential complications of gonorrhoea that could be caused in men or women?

A
  • Haematogenous dissemination

- Increased risk of HIV infection

45
Q

What can dissemination of gonorrhoea lead to?

A
  • Skin lesions
  • Reiter’s syndrome
  • Meningitis
  • Endocarditis
  • Myocarditis
46
Q

What are the features of Reiter’s syndrome?

A
  • Arthralgia
  • Arthritis
  • Tenosynovitis of ankle, wrists, hands and feet
47
Q

How can gonorrhoea be prevented?

A
  • Safer sex
  • Consistent condom use
  • Testing for those at risk

A - MSRA Gynaecology [8] (52 decks)

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