Gonorrhoea (Complete) Flashcards
Define gonorrhoea
Gonorrhoea is a sexually transmitted infection (STI) caused by gram-negative diplococcus Neisseria gonorrhoeae.
Name the bacteria responsible for causing gonorrhoea
Neiserria gonorrhoea
What type of bacteria is neiserria gonorrhoea?
Gram negative diplococci
Gonorrhoea is most commonly seen in what demographic of patients? (2)
Young adults (15-24)
Men who have sex with men (MSM)
What are the main clinical features of gonorrhoea in males? (3)
Urethral discharge
Dysuria
Tender inguinal lymph nodes
N.B. Often assymptomatic
What are the main clinical features of gonorrhoea in females?
Cervicitis
Micropurulant vaginal discharge typically seen from
- Cervical os
- Skene’s gland
- Bartholins gland
What are some extragenital manifestations of gonorrhoea?
Pharyngitis
Rectal pain and discharge (proctitis) [MSM]
Disseminated gnococcal infection (DGI)
What are the main features of disseminated gnococcal infection (DGI)?
Initial classic triad:
- Tenosynovitis
- Migratory polyarthritis
- Dermatitis
Followed by later complications such as:
- Septic arthritis
- Endocarditis
- Perihepatitis (Fitz-Hugh-Curtis Syndrome)
What is tenosynovitis?
Inflammation of the synovial membrane which are protective sheaths sorrounding tendons
What is migratory polyarthritis?
Migratory arthritis is a form of arthritis in which the pain or inflammation of arthritis moves from one joint to another
Which patients with gonorrhoea are at greatest risk of developing DGI? (4)
Recent menstruation
Recent assymptomatic infection
Complement deficiency
SLE
What investigations should be conducted in patients suspected of gonorrhoea?
Bedside:
Vuvovaginal swab: Females
First pass urine: Males
Bloods:
NAATs
Microscopy and culture: To check for sensitivities
STD screen: Check for other STDs and HIV
What is the gold-standard investigations for gonorrhoea?
Vaginal/Urethral/rectal swab/smears + culture
What microscopy findings are suggestive of gonorrhoea?
Gram-negative diplococci within polymorphonuclear leukocytes
What is the management for gonorrhoea?
Medicine:
Single-dose IM Ceftriaxone 1g followed by test of cure after 1 week
Conservative/preventative:
Offer STD screen and HIV test
Encourage patient led partner notification
What additonal tests should be conducted for patients with gonorrhoea after treatment?
Test of cure (using NAAT)
1 week following treatment
What complications can arise with gonorrhoea?
Pelvic inflammatory disease
Salpingitis
Epididymitis
Urethral strictures
Infertiliy due to PID in females and epididymitis in males
Disseminated infection (DGI)
Increased risk of HIV
What is the most common cause of septic arthritis in young adults?
Neiserria Gonorrhoea
What birth complication can occur in neonates of mothers with untreated gonorrhoea?
Ophthalmia neonatorum (neonatal conjunctivitis)
How can gonorrhoea be distinguished from chlamydia?
In males: Gonnorhoea tends to have yellow/green/white discharge whereas chlamydia tends to be white/clear discharge
In females:
Gonorrhoea more associated with heavier bleeds during period and pain during sex
Gonorrhoea can have itchiness/pain during bowel movements
