Gonorrhoea

Question 1

Definition / Risk factors

Answer 1

Neisseria gonorrhoeae [Gram -ve intracellular diplococci]

2nd most common STI (behind Chlamydia)

Risk Factors: unprotected sex, multiple partners, presence of other STI, HIV, age<25, MSM

Question 2

Symptoms and Signs

Answer 2

Asymptomatic in up to 50% patients

• Symptomatic = PV discharge (thin, any colour), IMB, PCB, dysuria, dyspareunia, lower abdominal pain

Sings

Speculum:

• Bimanual Exam (assess for PID)
• Mucopurulent endocervical discharge
• Cervical motion / adnexal tenderness
• Easily induced endocervical bleeding
• Uterine tenderness

Question 3

Investigations

Answer 3

n.b. empirical treatment ONLY if recent sexual contact with confirmed gonococcal infection:

Direct microscopy (neutrophils, gram -ve diplococci) -> prescribe antibiotics

• 1st (NAAT): Men: first catch urine sample ; Women: vulvovaginal swab
  NAAT -> prescribe antibiotics
• 2nd: Culture and sensitivities -> prescribe antibiotic

Question 4

Management

Answer 4

after confirmation by NAAT, confirmation by culture (& sensitivities), or direct microscopy +ve):

• 1st line – ceftriaxone 1g (IM) [NEW, 2019]

 

• Screening for other STIs/HIV
• Contact tracing
• Avoid sex for 1-week
• Follow-up appointment 1-week later
• Cure rate = 95% with treatment

Question 5

Complications

Answer 5

• PID, infertility, ectopic, conjunctivitis
• Fitz-Hugh-Curtiz syndrome (perihepatitis) – a PID characterised by adhesions from liver to abdominal wall
• Increased HIV susceptibility
• Disseminated disease in 1% (fever, rash, arthralgia, septic arthritis, meningitis, endocarditis)
• Vertical transmission – ophthalmia neonatorum – bilateral conjunctivitis