Gonorrhoea

Question 1

Define gonorrhoea.

Answer 1

Gonorrhoea is any manifestation of infection by N gonorrhoeae. Aside from causing infection in the lower genital tract, it can also cause conjunctivitis and severe disseminated infections, especially if acquired congenitally.

Question 2

How common is gonorrhoea?

Answer 2

Gonorrhoea is the second most common bacterial STI worldwide
M>F
Usually 15-49yrs

Question 3

What is the incubation period of gonorrhoea?

Answer 3

2-5 days

Question 4

Can you get reinfected with gonorrhoea?

Answer 4

Immunisation is not possible and reinfection is common due to:

• Antigen variation of type IV pili (proteins which adhere to surfaces) AND
• Opa proteins (surface proteins which bind to receptors on immune cells)

Question 5

What are the clinical features of gonorrhoea in males and females?

Answer 5

• males: urethral discharge, dysuria, prostate/testis tenderness
• females: cervicitis/cervical friability e.g. leading to vaginal discharge, pelvic pain,
• rectal and pharyngeal infection is usually asymptomatic

Question 6

What are the complications of gonorrhoea?

Answer 6

• Urethral strictures
• Epididymitis
• Salpingitis - hence infertility
• Ectopic pregnancy
• Disseminated infection
• Septic arthritis - gonorrhoea is the most common cause of this in young people
• Endocarditis
• Fitz-Hugh-Curtis syndrome - perihepatitis; mimics acute cholecystitis in its presentation
• Blindness - complication of ophthalmia neonatorum

Question 7

What is the management of gonorrhoea?

Answer 7

Ceftriaxone 1g IM once (no longer adding azithromycin according to BASHH guidelines) - same for pregnant women
OR PO ciprofloxacin 500mg once if sensitivities are known

NB: Cephalosporins are more widely used than ciprofloxacin now as there is 36% resistance to ciprofloxacin in the UK

Question 8

What are the main features of disseminated gonococcal infection?

Answer 8

• Tenosynovitis
• Migratory polyarthritis
• Dermatitis (maculopapular or vesicular)

Question 9

Where does arthritis usually occur in gonococcal polyarthritis?

Answer 9

wrists, ankles, and small joints of hands and feet

Question 10

What are the risk factors for gonorrhoea?

Answer 10

• Age 20-29yrs
• MSM
• Current or prior history of STI
• Multiple recent sexual partners
• Inconsistent condom use

Question 11

What is the management of ophthalmia neonatorum?

Answer 11

Ceftriaxone 25-50mg/kg IV/IM single dose

OR cefotaxime 100mg/kg IV/IM single dose