Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

DipGUM > Gonorrhoea > Flashcards

Gonorrhoea Flashcards

1
Q

first line empirical treatment - gonorrhoea

A

Ceftriaxone 1gram IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

treatment if antimicrobial sensitivity available for gonorrhoea

A

ciprofloxacin 500mg oral STAT (if isolate sensitive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

within how many days of exposure should a person be offered epidemiological treatment

A

14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which organism causes gonorrhoea

A

Neisseria gonorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

During microscopy what would you expect to see on direct visualisation of N. gonorrhoea?

A

Monomorphic Gram negative diplococci (light pink colour) within polymorphonuclear leukocytes (PMNLs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which CELLS in the body are implicated in gonorrhoea infection/transmission?

A

columnar epithelium-lined mucous membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which sites in the body does gonorrhoea infection occur?

A

primary sites of infection are the columnar epithelium-lined mucous membranes of the URETHRA, ENDOCERVIX, RECTUM, PHARYNX and CONJUNCTIVA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Male infection - how many display symptoms?

A

90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Incubation period of gonorrhoea - time of exposure to infection to onset of symptoms?

A

2-5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Female infection - most common symptom?

A

Increased or altered vaginal discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Female infection - what proportion will have lower abdominal pain?

A

25% (however, pelvic and lower abdominal ten- derness is an uncommon examination finding in the absence of coinfection with Chlamydia trachomatis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What proportion of cisgender women with urogenital infection will also have rectal infection?

A

1/3 (a third)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Secondary infection to other anatomical sites occurs through which 2 routes?

A

Transluminal spread from urethra or endocervix OR haematogenous dissemination from infected mucous membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What complications can occur if there is transluminal spread? (3)

A

Epididymo-orchitis, prostatitis, PID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which complications occur from disseminated gonorrhoea?

A

skin lesions, arthralgia, arthritis, tenosynovitis. Rare - meningitis, endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What 2 methods are used to detect N. gonorrhoea?

A

Nucleic acid amplification test (NAAT) or culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

At what level of prevalence is routine testing recommended for gonorrhoea

A

Prevalence greater than or equal 1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

At what level of prevalence would the majority of positive screening tests for gonorrhoea be false positive?

A

Prevalence <1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the sensitivity of microscopy for diagnosing gonorrhoea on urethral or meatal swabs with PENILE discharge? without penile discharge?

A

Penile discharge 90 - 95%; without symptoms 50-75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the sensitivity of microscopy for diagnosing gonorrhoea from ENDOCERVICAL samples?

A

37-50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the sensitivity of microscopy for diagnosing gonorrhoea from FEMALE urethral samples?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the sensitivity of cervical microscopy compared to nucleic acid amplification tests?

A

16%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When should ano-rectal smears and microscopy be performed?

A

ONLY if rectal SYMPTOMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Nucleic acid amplification tests (NAATs) are recommended for extra-genital sites - what is their sensitivity?

A

> 95% in BOTH symptomatic and asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How does the sensitivity of NAAT on urine and urethral swab in cisgender men compare?

A

Equivalent sensitivity - first void urine preferred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the recommended test for female samples for diagnosis of gonorrhoea?

A

NAAT of vulvovaginal swabs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

If a woman has had a hysterectomy, how might this alter your sampling site for gonorrhoea?

A

There is no evidence on optimal sampling site. Guidelines suggest urine and VVS for NAAT

28
Q

If a person has confirmed genital gonorrhoea, when should pharyngeal sampling be performed? Why?

A

Oropharygeal infection is more difficult to treat. Therefore, regardless of gender or reported sexual behaviour, test if:
susceptibility results are not available and the infection may have been acquired in the Asia-Pacific region. This is because of high levels of antimicrobial resistance in that
treat which may lead to treatment failure
OR Genital infection with a confirmed ceftriax- one-resistant strain

29
Q

Following genital reconstruction surgery, what needs to be considered when assessing the susceptibility of a site to gonococcal infection?

A

The tissue used for reconstruction - sites constructed with MUCOSAL tissue are MORE SUSCEPTIBLE that sites constructed from skin

30
Q

How likely is gonococcal infection of the neopenis?

A

Rare

31
Q

What is the optimal genital testing site in transgender women?

A

Swab of neovagina and first void urine

32
Q

What is the optimal genital testing site in transgender men?

A

First void urine. If the vagina is still present, consider vulvovaginal swab also

33
Q

What proportion of patients with gonorrhoea also have concurrent infection with C. trachomatis?

A

19%

34
Q

List the 4 indications for gonorrhoea treatment?

A
  1. Identification of intracellular Gram-negative diplo- cocci on microscopy
  2. A positive culture for N. gonorrhoeae
  3. A confirmed positive NAAT for N. gonorrhoeae
  4. Sexual partner of confirmed case of gonococcal
    infection
35
Q

What percentage of gonorrhoea in the UK is resistant to ciprofloxacin?

A

36.4% (in 2017)

36
Q

Molecular testing on NAAT-positive gonorrhoea samples can be performed to identify susceptibility to ciprofloxacin - what does it test for?

A

gyrA gene mutations

37
Q

A lower dose of ceftriaxone would be adequate to treat the majority of gonococcal strains - why treat with a higher dose?

A

Ceftriaxone 1g is more effective against most isolates with increased MICs

38
Q

UK cases of gonorrhoea with resistance to both azithromycin and ceftriaxone were linked to which part of the World?

A

Asia-Pacific region

39
Q

What MIC level confers ceftriaxone resistance for gonorrhoea positive samples?

A

MIC >0.125mg/L

40
Q

What alternative treatment for gonorrhoea has Grade 1A evidence to support its use?

A

gentamicin 240mg IM WITH azithromycin 2gram oral

41
Q

What are the limitations of giving azithromycin alone for gonorrhoea treatment?

A

azithromycin 2g would not be effective against high level azithromycin-resistant isolates AND the GI side effects are poorly tolerated

42
Q

How long can low levels of azithromycin remain in the mucosal surfaces?

A

4 weeks

43
Q

What is the potential clinical implication if a person is re-infected within 4 weeks of treatment with azithromycin for gonorrhoea?

A

If re-infected and sub-MIC levels of azithromycin could result in azithromycin resistance.

44
Q

What other organisms may develop resistance if concurrent infection when treated by azithromycin for gonorrhoea?

A

Mycoplasma genitalium AND treponema pallidum

45
Q

Which anatomical sites may experience potential serious side effects with quinolone or fluoroquinolone use?

A

muscles
tendons
joints
nervous system

46
Q

Which groups of people should you practice additional caution when prescribing quinolone or fluoroquinolone?

A

> 60 yrs old
corticosteroids (people on)
Chronic kidney disease
Organ transplantation

47
Q

What 3 alternative regimens for gonorrhoea treatment can be given with Grade 1B evidence?

A

CEFIXIME 400mg oral stat WITH azithromycin 2g oral
SPECTINOMYCIN 2g im stat WITH azithromycin 2g oral
Azithromycin 2g oral alone

48
Q

Why are alternative regimen for treatment of gonorrhoea not advised as monotherapy?

A

All alternative agents have been associated with TREATMENT FAILURE particularly PHARYNGEAL INFECTION and therefore should be given as DUAL therapy with azithromycin

49
Q

What is the treatment for gonococcal PID?

A

Ceftriaxone 1g IM stat AND standard PID treatment course

50
Q

What is the treatment for gonococcal epididymis-orchitis?

A

Ceftriaxone 1g IM stat AND standard EO treatment course

51
Q

What is the treatment for gonococcal conjunctivitis?

A

Ceftriaxone 1g IM stat AND saline irrigation of eye

52
Q

What is the treatment for gonococcal conjunctivitis, if there is history of penicillin anaphylaxis or cephalosporin allergy?

A

Lack of evidence. Treatment should be guided by antimicrobial susceptibility if available

53
Q

What is the treatment for disseminated gonococcal infection?

A

Treat for 7 days
Ceftriaxone 1 g intramuscularly or intravenous every 24 hours or
Cefotaxime 1 g intravenous every eight hours or
Ciprofloxacin 500 mg intravenous every 12 hours (if
the infection is known to be susceptible) or
Spectinomycin 2 g intramuscularly every 12 hours

54
Q

When can you switch treatment for disseminated gonococcal infection from IV/IM to oral therapy?

A

24-48 hours after symptoms improve. Therapy should continue for total 7 days.

55
Q

following initial IV/IM therapy, What are the oral regimens for disseminated gonococcal infection?

A

Guided by sensitivities:
CEFIXIME 400mg twice daily or
CIPROFLOXACIN 500mg twice daily or
OFLOXACIN 400mg twice daily

56
Q

quinolone or tetracycline antimicrobials should no be used in Pregnant and breastfeeding individuals. What treatment can they have?

A

Ceftriaxone 1g intramuscularly as a single dose or
Spectinomycin 2 g intramuscularly as a single dose
Azithromycin 2 g as a single oral dose (only if adequate alternatives are not available)

57
Q

When is epidemiological treatment recommend for contacts of gonorrhoea?

A

If presenting within 14 days of exposure, consider treatment

58
Q

A test of cure for all patients treated for gonorrhoea is recommended. Which patients in particular?

A

Persistent symptoms or signs
Pharyngeal infection
Treated with anything other than first line recom-
mended regimen
Infection acquired in the Asia-Pacific region

59
Q

What are the typical time-to-negative TOC for RNA NAATs and DNA NAATs respectively?

A

RNA NAAT = 7 days; DNA NAAT = 14 days

60
Q

What percentage is the performance standard expected for all BASHH auditable outcomes for gonorrhoea?

A

97%

61
Q

What must laboratories do before issuing a positive gonorrhoea result?

A

Ensure the result as been confirmed by supplementary testing

62
Q

When can an initial/first positive gonorrhoea result be accepted?

A

When the PPV is greater than or equal to 90%

63
Q

What antibiotic should be used in neonates for gonorrhoea treatment?

A

IV cefotaxime

64
Q

What age of neonate is ceftriaxone contraindicated for treatment of gonorrhoea?

A

<41 weeks postmenstrual age

65
Q

Why is ceftriaxone contraindicated in neonates <41 weeks postmenstrual age?

A

risk of precipitation in urine and lungs

66
Q

For children 2-12 yrs what is the treatment for gonococcal PID?

A

ceftriaxone 125mg IM then erythromycin 250mg BD and metronidazole weight adjusted for 2 weeks

67
Q

For children >12 yrs what is the treatment for gonococcal PID?

A

ceftriaxone 500mg IM + usual adult regimen

DipGUM (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions