Gonorrhoea

Question 1

Gonorrhoea is caused by _______

Answer 1

Neisseria gonorrhoeae

Question 2

Body sites gonorrhoea can infect

Answer 2

Endocervix
Urethra
Rectum
Pharynx
Conjunctivae

Question 3

Transmission of gonorrhoea is by…

Answer 3

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)

Question 4

Symptoms of urethral gonorrhoea

Answer 4

~90% of penile urethral infection is symptomatic
Urethral discharge (penile urethra)
Dysuria

Question 5

Symptoms of cervical gonorrhoea

Answer 5

Up to 80% asymptomatic
Vaginal discharge
Dyspareunia
Postcoital bleeding
Intermenstrual bleeding

Question 6

Symptoms of anorectal gonorrhoea

Answer 6

Usually asymptomatic

Rectal discharge, irritation, painful defecation, disturbed bowel function

Question 7

Symptoms of pharyngeal gonorrhoea

Answer 7

Usually asymptomatic

Question 8

Symptoms of gonorrhoea of the eyes

Answer 8

Conjunctivitis – may be sight threatening

Question 9

Complications of gonorrhoea

Answer 9

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)

Question 10

Indications for testing

Answer 10

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

Question 11

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

Answer 11

2 weeks
(but if unlikely to return or not prev tested - opportunistically test now + in 2 weeks)

Question 12

Do you need to do an exam for a patient with suspected gonorrhoea?

Answer 12

Symptomatic people should be examined

Question 13

Why is dual treatment recommended

Answer 13

Dual antibiotic treatment is recommended to create a pharmacological barrier to the development of more widespread resistance to treatment

Question 14

Treatment of uncomplicated genital, pharyngeal or anorectal infection or adult gonococcal conjunctivitis

Answer 14

Ceftriaxone 500mg IM stat

PLUS

Azithromycin 1 g orally, as a single dose

Question 15

2nd line treatment for gonorrhoea

Answer 15

Alternative treatments are not recommended because of high levels of resistance, EXCEPT for severe allergic reactions

Seek specialist advice

Question 16

Treatment of gonorrhoea in pregnancy

Answer 16

Same as usual

Test of cure recommended 4 weeks after treatment completed

Rescreen in 3rd trimester

Question 17

Treatment if allergy or C/I to azithromycin

Answer 17

Ceftriaxone alone (but increased dose - 1g instead of 500mg)

Question 18

Treatment if co-infection with chlamydia

Answer 18

Ceftriaxone 1g IM, as a single dose

PLUS

Doxycycline 100 mg orally twice daily for 7 days

Question 19

Advice re sexual intercourse while undergoing treatment for gonorrhoea

Answer 19

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

Question 20

If a patient has gonorrhoea there is a ________% risk of transmission per act of unprotected intercourse

Answer 20

20-50

Question 21

Contact tracing requirements

Answer 21

All sexual contacts in the last 3 months should be notified

Question 22

Management of sexual contacts of positive gonorrhoea

Answer 22

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

Question 23

F/up recommendations post treatment

Answer 23

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

Question 24

What situations is a test of cure recommended

Answer 24

Pregnancy
Pharyngeal gonorrhoea

Question 25

When should you do a test of cure

Answer 25

At least 4 weeks after treatment is completed

Question 26

Re-testing for re-infection

Answer 26

Re-infection common - recommend retest at 3 months

Question 27

Referral to or discussion with a sexual health specialist is recommended for…

Answer 27

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