Gonorrhoea Flashcards
Defintion
STI caused by gram-negative diplococcus = Neisseria Gonorrhoea
Transmission
- Penetrative sexual intercourse = main mode of transmission (e.g. oral, vaginal, or anal). Infected sites are the columnar epithelium-lined mucous membranes of the:
= urethra
= endocervix
= rectum
= pharynx
= conjunctiva - Vertical transmission = infected cervical exudate during vaginal delivery. This can result in meningitis, opthalmia neonatorum, or disseminated infection
Epidemiology
- Frequent unprotected sex
- Multiple sexual partners
- MSM
- Sharing unwashed sex toys
- Chlamydia infection: patients with chlamydia have an increased risk of gonorrhoea co-infection
Pathophysiology
N.gonorrhoea adheres to epithelial cells via pili causing an inflammatory response and manifests in the genitourinary tract as:
- Females = urethritis and cervical with bacterial ascension leading to pelvic inflammatory disease
- Males = urethritis with bacterial ascension leading to prostatitis and epididymo-orchitis
Subsequent haematogenous spread may result in infection at distant sites e.g septic arthritis
Re-infection
N.Gonorrhoeae type IV pili demonstrate antigenic variation.
Additionally, the surface Opa protein interacts with the CD4+ lymphocyte, inactivating proliferation. In doing so, N.Gonorrhoeae is able to prevent the host from developing immunological memory and re-infection is common
Urethritis signs and symptoms
- Dysuria often without frequency
- Mucoplurulent urethral discharge
- 90% of males are asymptomatic
Prostatitis signs and symptoms
- Dysuria, frequency and urgency
- Lower back pain
Epididymo-orchitis signs and symptoms
Swollen and tender testicle and epididymis
MC Unilateral
Cervicitis signs and symptoms
Mucopurulent discharge
Dysuria
Lower abdominal pain
Up to 50% of females are asymptomatic
Pelvic inflammatory disease (PID) signs and symptoms
Fever
Lower abdominal pain RLQ
Deep dyspareunia
Adnexal and cervical motion tenderness
Proctitis signs and symptoms
Usually asymptomatic
Anal discharge and/or rectal bleeding
Peri-anal pain
Pharyngitis
Asx in 90% of patients
Sore throat
Conjunctivitis signs and symptoms
Painful, red eyes with purulent discharge
Diagnosis
An endocervical swab (women) or first-void urine (men) should be sent for one or both of the following:
- NAAT = highly sensitive (>95%)
- MC+S = culture should be taken in all patients who are NAAT positive for gonorrhoea before prescribing Abx. This is to test for Abx sensitivities and identify resistant strains.
- Sexual health screen: invesitgations for other STI e.g. chlamydia, and HIV
Treatment
FIRST LINE Abx: IM ceftriaxone 1g
- Given as a single dose if Abx sensitivity is not known
- Oral cefixime 400mg and azithromycin 2g: if Px needle phobic
- Oral ciprofloxacin 500mg: if a single dose of cultures demonstrate sensitivity.
