Gonorrhoea Flashcards
What bacteria causes gonorrhoea?
Neisseria gonorrhoeae
What type of bacteria is neisseria gonorrhoeae?
gram-negative diplococcus bacteria
What membranes are infected
infects mucous membranes with a columnar epithelium, such as the endocervix in women, urethra, rectum, conjunctiva and pharynx.
It spreads via contact with mucous secretions from infected areas.
Is gonorrhoea an STI?
Yes
What increases risk of gonorrhoea?
Being young, sexually active and having multiple partners increases the risk of infection with gonorrhoea.
Having other sexually transmitted infections, such as chlamydia or HIV, also increases the risk.
ciprofloxacin or azithromycin were commonly used to treat gonorrhoea, however they are not used as much anymore. Why is this?
Antibiotic resistance
Infection with gonorrhoea is more likely to be symptomatic than infection with chlamydia. 90% of men and 50% of women are symptomatic. true/false?
True
What can female genital infections present with?
Odourless purulent discharge, possibly green or yellow
Dysuria
Pelvic pain
What can male genital infections present with?
Odourless purulent discharge, possibly green or yellow
Dysuria
Testicular pain or swelling (epididymo-orchitis)
Presentation of infections at other sides?
Rectal infection may cause anal or rectal discomfort and discharge, but is often asymptomatic.
Pharyngeal infection may cause a sore throat, but is often asymptomatic.
Prostatitis causes perineal pain, urinary symptoms and prostate tenderness on examination.
Conjunctivitis causes erythema and a purulent discharge.
What testing can be used for diagnosis?
Nucleic acid amplification testing (NAAT) is used to detect the RNA or DNA of gonorrhoea.
What swab methods can be used with NAAT?
Genital infection can be diagnosed with endocervical, vulvovaginal or urethral swabs, or in a first-catch urine sample.
Rectal and pharyngeal swab are recommended in all men who have sex with men (MSM), and in those with risk factors (e.g. anal and oral sex) or symptoms of infection in these areas.
Are NAAT swab tests specific for the certain bacteria?
NAAT tests are used to check if a gonococcal infection is present or not by looking for gonococcal RNA or DNA.
They do not provide any information about the specific bacteria and their antibiotic sensitivities and resistance.
What is an endocervical charcoal swab used for?
taken for microscopy, culture and antibiotic sensitivities before initiating antibiotics.
This is particularly important given the high rates of antibiotic resistance.
Management of gonorrhoea?
Patient should be referred to sexual health clinic to coordinate testing, treatment and contact tracing.
For uncomplicated gonococcal infections:
A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known
A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known
What is a follow-up “test for cure”?
Screening 6 months after treatment to identify if infection has been successfully treated.
Factors and advice to consider for treatment of genital infection?
Abstain from sex for seven days of treatment of all partners to reduce the risk of re-infection
Test for and treat any other sexually transmitted infections
Provide advice about ways to prevent future infection
Consider safeguarding issues and sexual abuse in children and young people
Complications of gonorrhoea?
Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Epididymo-orchitis (men)
Prostatitis (men)
Conjunctivitis
Urethral strictures
Disseminated gonococcal infection
Skin lesions
Septic arthritis
Endocarditis
What is disseminated gonococcal infection?
Disseminated gonococcal infection (GDI) is a complication of untreated gonococcal infection, where the bacteria spreads to the skin and joints.
What can disseminated gonococcal infection cause?
Various non-specific skin lesions
Polyarthralgia (joint aches and pains)
Migratory polyarthritis (arthritis that moves between joints)
Tenosynovitis
Systemic symptoms such as fever and fatigue
Discharge appearance for gonorrhoea?
Odourless purulent discharge, possibly green or yellow.
