Gonorrhoea Flashcards
Gonorrhoea is caused by _______
Neisseria gonorrhoeae
Body sites gonorrhoea can infect
Endocervix
Urethra
Rectum
Pharynx
Conjunctivae
Transmission of gonorrhoea is by…
Direct inoculation onto mucosal surfaces via:
Sexual contact (oral, vaginal or anal), fingering or sharing of sex toys
Mother to baby at vaginal delivery (e.g. neonatal conjunctivitis)
Symptoms of urethral gonorrhoea
~90% of penile urethral infection is symptomatic
Urethral discharge (penile urethra)
Dysuria
Symptoms of cervical gonorrhoea
Up to 80% asymptomatic
Vaginal discharge
Dyspareunia
Postcoital bleeding
Intermenstrual bleeding
Symptoms of anorectal gonorrhoea
Usually asymptomatic
Rectal discharge, irritation, painful defecation, disturbed bowel function
Symptoms of pharyngeal gonorrhoea
Usually asymptomatic
Symptoms of gonorrhoea of the eyes
Conjunctivitis – may be sight threatening
Complications of gonorrhoea
PID, subfertility, ectopic pregnancy, chronic pelvic pain
Adverse pregnancy outcomes
Disseminated disease (rare) manifested by arthritis, skin lesions, endocarditis, meningitis
Epididymitis or epididymo-orchitis
Prostatitis (very rarely)
Indications for testing
Signs or sx of gonorrhoea
Sexual contacts of people with gonorrhoea or other STIs
Before termination of pregnancy
Before IUD insertion in people at risk of STIs
Suspected epididymo-orchitis
Suspected PID
Sexually active patients aged under 30 years opportunistically when accessing health care
Men who have sex with men (MSM)
History of sexual assault or intimate partner violence
If the patient requests a sexual health check
If patient is asymptomatic and is concerned about a specific recent sexual event the recommended testing interval is ________ from time of last unprotected sexual intercourse
2 weeks
(but if unlikely to return or not prev tested - opportunistically test now + in 2 weeks)
Do you need to do an exam for a patient with suspected gonorrhoea?
Symptomatic people should be examined
Why is dual treatment recommended
Dual antibiotic treatment is recommended to create a pharmacological barrier to the development of more widespread resistance to treatment
Treatment of uncomplicated genital, pharyngeal or anorectal infection or adult gonococcal conjunctivitis
Ceftriaxone 500mg IM stat
PLUS
Azithromycin 1 g orally, as a single dose
2nd line treatment for gonorrhoea
Alternative treatments are not recommended because of high levels of resistance, EXCEPT for severe allergic reactions
Seek specialist advice
Treatment of gonorrhoea in pregnancy
Same as usual
Test of cure recommended 4 weeks after treatment completed
Rescreen in 3rd trimester
Treatment if allergy or C/I to azithromycin
Ceftriaxone alone (but increased dose - 1g instead of 500mg)
Treatment if co-infection with chlamydia
Ceftriaxone 1g IM, as a single dose
PLUS
Doxycycline 100 mg orally twice daily for 7 days
Advice re sexual intercourse while undergoing treatment for gonorrhoea
Abstain from sex or use condoms for 1 week from the start of treatment and until 1 week after sexual contact/s have been treated
If a patient has gonorrhoea there is a ________% risk of transmission per act of unprotected intercourse
20-50
Contact tracing requirements
All sexual contacts in the last 3 months should be notified
Management of sexual contacts of positive gonorrhoea
Last sexual contact within 2 weeks or symptomatic or unlikely to return - full STI screen & treat
Last sexual contact >2 weeks, asymptomatic and likely to return - wait for test results & treat if positive
F/up recommendations post treatment
Review in 1 week
Check sx have resolved
Ask if any condomless sex in the week post-treatment
Check medication was completed and tolerated
Ensure notifiable contacts have been informed
Check if any risk of re-infection. Retreatment is necessary if re-exposed to an untreated contact
What situations is a test of cure recommended
Pregnancy
Pharyngeal gonorrhoea
When should you do a test of cure
At least 4 weeks after treatment is completed
Re-testing for re-infection
Re-infection common - recommend retest at 3 months
Referral to or discussion with a sexual health specialist is recommended for…
Suspected abx resistance, e.g. persisting sx after correct management
Allergy or contraindication to standard treatment options
Patients with anorectal symptoms that may be STI related
Complicated clinical situations for further management
