[3] Gonorrhoea Flashcards
What is gonorrhoea?
A sexually transmitted infection caused the bacterium Neisseria gonorrhoea
What type of bacteria is Neisseria gonorrhoea?
A gram -ve diplococcus
What does Neisseria gonorrhoea infect?
The mucous membranes of the urethra, endocervix, rectum, pharynx and conjunctiva
What parts of the body can be affected by gonorrhoea?
- Genitals
- Mouth
- Rectum
How does gonorrhoea spread?
By direct inoculation of infected secretions from one mucous membrane to another
When can gonorrhoea be transmitted?
Usually sexually but can occur perinatally
What is the incubation period of gonorrhoea?
2-5 days but can be up to 10
How many cases of gonorrhoea were diagnosed in England in 2017?
44,000
Which group of people have a disproportionate increase in gonorrhoea cases?
MSM
What is thought to have caused the increase in cases of gonorrhoea?
- More young men coming forward for testing
- Increasing unsafe sex
Where is gonorrhoea more common?
URban areas
What are the risk factors for gonorrhoea?
- 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
What sexual activities are particularly risky for gonorrhoea transmission?
- Anal intercourse
- Frequent insertive oral sex
Which sex is gonorrhoea more commonly symptomatic in?
Men (90-95%)
What percentage of women with gonorrhoea are symptomatic?
50%
What do symptoms of gonorrhoea depend on?
The site of infection
What are the symptoms of urethral gonorrhoea infection in men?
- Discharge
- Dysuria
- Asymptomatic in <10% of cases
What are the symptoms of rectal gonorrhoea infection in men?
- Usually asymptomatic
- Anal discharge
- Perianal/anal pain
- Pruritis
- Bleeding
How does pharyngeal gonorrhoea infection usually present in men and women?
Usually asymptomatic
How does endocervical gonorrhoea infection present?
- Up to 50% asymptomatic
- Increased or altered vaginal discharge (up to 50% of cases)
- Lower abdominal pain
- Intermenstrual bleeding or menorrhagia
What are the symptoms of urethral gonorrhoea infection in women?
- Dysuria without frequency
How does rectal gonorrhoea infection present in women?
Usually asymptomatic
What are the differentials for gonorrhoea?
- Chlamydia
- Thrichomonas
- Candidiasis
- Bacterial vaginosis
- Urinary tract infection
How was gonorrhoea traditionally investigated?
Culture for diagnosis and sensitivity testing
What is overtaking culture as the main diagnostic test for gonorrhoea?
NAAT (nucleic acid amplification testing)
When is culture still necessary?
- In positive NAAT tests to ensure resistant strains are identified
- Signs and symptoms consistent with gonorrhoea
How can samples for gonorrhoea NAAT be taken?
- Urethral/endocervical swabs
- First pass urine
When should a patient be referred to a GUM clinic for gonorrhoea?
If they have symptoms or is at high risk or has tested positive
What are the management aspects in gonorrhoea?
- Give advice
- Partner notification
- Drug treatment
What advice should be given to patients with gonorrhoea?
- Explain condition, implications for patient and partner(s)
- Advice on safer sex
- Avoid sex until treatment completed in patient and partner(s)
Who should perform partner notification in gonorrhoea?
Preferably health professional
Which contacts of a man with symptomatic urethral gonorrhoea infection should be notified?
All that they have had sexual contact with in past 2 weeks or their last partner if more than 2 weeks
Which contacts of a person with asymptomatic or symptomatic non-urethral gonorrhoea infection should be notified?
All sexual partners for last 3 months
What should form part of partner notification for gonorrhoea?
- Full STI screen
- Empirical treatment for gonorrhoea and chlamydia in advance of test results
What is the recommended treatment for confirmed uncomplicated anogenital gonorrhoea?
State doses of:
- Ceftriaxone 500mg IM
- Azithromycin 1g orally
What is recommended after all treatments of gonorrhoea?
Test of cure
What can be given if there is a history of cephalosporin sensitivity (in the patient)?
Azithromycin 2g single oral dose
What are the potential complications of gonorrhoea in men?
- Gonococcal urethritis
- Local spread
What can gonococcal urethritis cause?
- Scarring
- Stricture
- Bladder-outflow obstruction
What gonorrhoea spread cause in men?
- Acute epididymitis
- Prostatitis
- Seminal vesiculitis
- Penile lymphangitis
- Peri-urethral abscess
What are the potential complications of gonorrhoea in women?
- PID
- Bartholin’s abscess
- Peri-hepatitis
What can PID lead to as a result of gonorrhoea?
- Infertility
- Chronic pelvic pain
- Ectopic pregnancy
What can gonorrhoea in pregnancy be associated with?
- Premature labour
- Miscarriage
- Corneal scarring and blindness due to neonatal ophthalmic infection
What are the potential complications of gonorrhoea that could be caused in men or women?
- Haematogenous dissemination
- Increased risk of HIV infection
What can dissemination of gonorrhoea lead to?
- Skin lesions
- Reiter’s syndrome
- Meningitis
- Endocarditis
- Myocarditis
What are the features of Reiter’s syndrome?
- Arthralgia
- Arthritis
- Tenosynovitis of ankle, wrists, hands and feet
How can gonorrhoea be prevented?
- Safer sex
- Consistent condom use
- Testing for those at risk
