Gonorrhoea Flashcards
What type of organism is Neisseria gonorrhoeae?
- gram-negative diplococcus bacteria
- it infects mucous membranes** with a **columnar epithelium
- e.g. endocervix, urethra, rectum, conjunctiva + pharynx
- it spreads via contact with mucous secretions from infected areas
What increases the risk of gonorrhoea infection?
- young age (<25)
- sexually active
- multiple sexual partners
- having other STIs (e.g. chlamydia / HIV)
What is significant about treating gonorrhoea infections?
there is a high level of antibiotic resistance to gonorrhoea
- ciprofloxacin or azithromycin used to be used for treatment, but there are now high levels of resistance
What % of infections are symptomatic?
- 90% in men
- 50% in women
What are the symptoms of gonorrhoea infection in women?
- odourless purulent discharge (may be green / yellow)
- dysuria
- pelvic pain
What are the symptoms of gonorrhoea infection in men?
- odourless purulent discharge (may be green / yellow)
- dysuria
- testicular pain / swelling (epididymo-orchitis)
How may a rectal or pharyngeal gonorrhoea infection present?
rectal infection:
- often asymptomatic
- may present with rectal discomfort / discharge
pharyngeal infection:
- often asymptomatic
- may present with sore throat
How may prostatitis / conjunctivitis due to gonorrhoea present?
prostatitis:
- perineal pain, urinary symptoms + prostate tenderness on examination
conjunctivitis:
- erythema + purulent discharge
What 2 swabs are needed to diagnose gonorrhoea infection?
NAAT swab:
- this is used to diagnose the presence of gonorrhoea
- it CANNOT provide information about antibiotic resistance
- endocervical/vulvovaginal swab in women
- first-catch urine sample in men
charcoal swab:
- this is required for MC&S and to guide the choice of antibiotic treatment
- endocervical swab in women
When are rectal / pharyngeal swabs for gonorrhoea recommended?
- all men who have sex with men (MSM)
- symptoms of infection in those areas
- risk factors (e.g. anal / oral sex)
What is the treatment for gonorrhoea infections if antibiotic sensitivities are known / not known?
if sensitivities not known:
- single dose of IM ceftriaxone 1g
if sensitivities are known:
- single dose of oral ciprofloxacin 500mg
Is a test of cure required following gonorrhoea treatment?
- all patients should have a follow up “test of cure”
- this is with NAAT testing if they are asymptomatic
OR
- with cultures if they are symptomatic
When should a test of cure be performed?
at least:
- 72 hours after treatment for culture
- 7 days after treatment for RNA NAAT
- 14 days after treatment for DNA NAAT
What is the most significant complication of gonorrhoea infection?
gonococcal conjunctivitis in a neonate
- gonococcal infection is contracted during birth
- this results in ophthalmia neonatorum
- this is a medical emergency associated with sepsis, perforation of the eye + blindness
What are the other potential complications of gonorrhoea infection?
- PID
- chronic pelvic pain
- infertility
- epidiymo-orchitis
- prostatitis
- conjunctivitis
- urethral strictures
- disseminated gonococcal infection
- skin lesions
- Fitz-Hugh-Curtis syndrome
- septic arthritis
- endocarditis
