Gonorrhoea

Question 1

What is the causative organism of gonorrhoea?

Answer 1

Neisseria gonorrhoeae

Gram-negative diplococcus

Question 2

How does gonorrhoea present?

Answer 2

Female
- Odourless purulent discharge, green or yellow
- Dysuria
- Pelvic pain

Male
- Odourless purulent discharge, green or yellow
- Dysuria
- Testicular pain

Rectal infection- discomfort and discharge, often asymptomatic

Pharyngeal- sore throat

Conjunctivitis- erythema and purulent discharge

Question 3

How is gonorrhoea diagnosed?

Answer 3

NAAT

Endocervical
Vulvovaginal
Urethral
First-catch urine sample

Rectal and pharyngeal swab in MSM

Question 4

How is gonorrhoea managed?

Answer 4

IM cefrtiaxone
Oral ciprofloxacin

Follow-up test of cure due to high antibiotic resistance
72 hours after treatment for culture
7 days after RNA NAAT
14 days after DNA NAAT

Question 5

What further advice should a patient be given?

Answer 5

Abstain from sex for 7 days
Test and treat any other STIs
Advice about future infection
Consider safeguarding in young people

Question 6

What are the complications of gonorrhoea?

Answer 6

PID
Chronic pelvic pain
Infertility
Epididymo-orchitis
Prostatitis
Conjunctivitis- emergency in neonates
Urethral strictures
Fitz-Hugh-Curtis syndrome
Septic arthritis
Endocarditis
Disseminated Gonococcal infection

Question 7

What is disseminated gonococcal infection?

Answer 7

Bacteria spread to skin and joints
- Non-specific skin lesions
- Polyarthralgia
- Migratory polyarthritis
- Tenosynovitis
- Systemic symptoms