Genital Tract Infection - Gonorrhoea

Question 1

What is Neisseria gonorrhoea?

Answer 1

A gram-negative diplococcus bacterium.

Question 2

Risk Factors of Gonorrhoea.

Answer 2

1. Young and Sexually Active.
2. Multiple Sexual Partners.
3. Other STIs e.g. Chlamydia or HIV.

Question 3

Pathophysiology of Neisseria gonorrhoea.

Answer 3

Infects mucous membranes with a columnar epithelium e.g. endocervix, urethra, rectum, conjunctivitis, pharynx.

Question 4

Transmission of Gonorrhoea.

Answer 4

STI - contact with mucous secretions from infected areas.

Question 5

Incubation Period of Gonorrhoea.

Answer 5

2-5 Days.

Question 6

Why is reinfection common with Gonorrhoea?

Answer 6

Antigen variation type IV pili and Opa proteins.

Question 7

Clinical Features of Gonorrhoea (9).

Answer 7

1. More Symptomatic than Chlamydia - 90% Men and 50% Women Symptomatic.
2. Odourless Purulent Yellow-Green Discharge (Men & Women).
3. Dysuria (Men & Women).
4. Pelvic Pain.
5. Epididymo-Orchitis.
6. Proctitis.
7. Pharyngitis.
8. Prostatits - Perineal Pain, Urinary Symptoms, Tenderness.
9. Conjunctivitis - Erythema and Purulent Discharge.

Question 8

Investigations of Gonorrhoea (3).

Answer 8

1. NAAT - Endocervical, Vulvovaginal, Urethral Swabs or 1st Catch-Urine.
2. MSM or Anal/Oral Sex. - Rectal and Pharyngeal Swabs.
3. Standard Charcoal Endocervical Swab - MC&S Before Antibiotics (Resistance).

Question 9

Management of Gonorrhoea (6).

Answer 9

1. BASHH Guidelines.
2. Local and National Guidelines.
3. GUM Clinic Referral.
4. Uncomplicated - if Sensitivity Unknown : Single Dose of IM Ceftriaxone 1g.
5. Uncomplicated - if Sensitivity Known : Single Dose of Oral Ciprofloxacin 500mg.
6. Complicated/Extra-Genital/Pregnant - Single Dose of IM Ceftriaxone.
7. Refused Ceftriaxone : Single Dose of Oral Cefixime 400mg and Oral Azithromycin 2g.

Question 10

Why can Ciprofloxacin or Azithromycin not be used anymore to treat Gonorrhoea?

Answer 10

High level of antibiotic resistance.

Question 11

Test of Cure in Gonorrhoea (4).

Answer 11

1. All Patients (due to high resistance) with NAAT testing if asymptomatic or cultures if symptomatic.
2. 72 Hours After Treatment for Culture.
3. 7 Days for RNA NAAT.
4. 14 Days for DNA NAAT.

Question 12

Lifestyle Advice for Patients with Gonorrhoea (3).

Answer 12

1. Abstinence from Sex for 7 Days - Risk of Reinfection.
2. Test and Treat Other STIs.
3. Safeguarding and Sexual Abuse.

Question 13

Complications of Gonorrhoea (10).

Answer 13

1. Pelvic Inflammatory Disease.
2. Chronic Pelvic Pain.
3. Infertility.
4. Gonococcal Conjunctivitis.
5. Urethral Strictures.
6. Skin Lesions.
7. Fitz-Hugh-Curtis Syndrome.
8. Septic Arthritis.
9. Endocarditis.
10. Disseminated Gonococcal Infection (GDI).

Question 14

Male Complications of Gonorrhoea (2).

Answer 14

1. Epididymo-Orchitis.

2. Prostatitis.

Question 15

Importance of Gonococcal Conjunctivitis (2).

Answer 15

1. Contracted from Mother during Birth.

2. Neonatal - Ophthalmia Neonatorum (Medical Emergency ) : Sepsis, Perforation and Blindness.

Question 16

What is Disseminated Gonococcal Infection?

Answer 16

Complication of untreated Gonococcal Infection where bacteria spread to skin and joints.

Question 17

Clinical Features of Disseminated Gonococcal Infection (5).

Answer 17

1. Non-Specific Skin Lesions : Dermatitis.
2. Polyarthralgia.
3. Migratory Polyarthritis.
4. Tenosynovitis.
5. Systemic Symptoms.