Gonorrhoeae Flashcards
Caused by
infection with the bacterium Neisseria gonorrhoeae
Features
Highly infectious
Can infect the endocervix, urethra, rectum, pharynx, and conjunctivae.
Pharyngeal and rectal infection are usually asymptomatic
Occasionally there may be pharyngeal symptoms, anal discharge, anal bleeding, or anal discomfort.
It is transmitted through
Direct inoculation onto:
- mucosal surfaces via oral
- vaginal, or anal sex
- fingering
- rimming or sharing of sex toys
- via perinatal transmission at delivery.
Complications can include:
- pelvic inflammatory disease (PID)
- sub-fertility
- chronic pelvic pain and ectopic pregnancy.
- epididymo-orchitis
- disseminated infection –> arthritis, skin lesions, meningitis
- Fitz-Hugh Curtis syndrome (peri-hepatitis)
- conjunctivitis and reactive arthritis
- neonatal conjunctivitis or disseminated infection if mother infected at delivery.
Assessment
1). Ask about symptoms:
- Males with urethral infection often have dysuria, urethral discharge, or both.
- Females are usually asymptomatic.
2). Complete testing:
- if sexual contacts of gonorrhoea or another STI.
- before referral for termination of pregnancy (TOP).
- during IUD insertion. If patient aged
- for pregnant women with risk factors who are having antenatal screening.
- if the patient requests an STI check.
3) . If the pt is asymptomatic, offer the sexual health check with the appropriate routine testing and assessment.
4) . If they are concerned about a specific recent sexual event, check:
- Chlamydia and gonorrhoea
- HIV
- Syphilis
5) . Test all people at risk for gonorrhoea for other STI.
6) . Carry out specific assessment: Females v Males
7) . For contacts of syphilis and HIV, seek sexual health advice.
Specific assessment for females
1) . Check for history of vaginal discharge, dysuria, abnormal or inter-menstrual bleeding, lower abdominal pain.
2) . Consider pregnancy test.
3) . If the pt is asymptomatic:
- Perform a clinician-collected or self-collected vulvovaginal nucleic acid amplification test (NAAT) swab for chlamydia and gonorrhoea.
- Vulvovaginal swabs are more sensitive than endocervical swabs.
- Consider trichomoniasis testing.
- If the pt has anal sex, arrange an anorectal NAAT swab for chlamydia and gonorrhoea.
4) . If the pt is symptomatic, perform a full clinical examination.
5) . Consider first catch urine test – less sensitive than clinician-collected or self-collected vaginal swabs, however can be done if this is the only acceptable option for the patient.
6) . If anorectal symptoms and a history of receptive anal sex, collect an anorectal swab for chlamydia and gonorrhoea.
Specific assessment for Males
1) . Check for history of urethral discharge, dysuria, urethral irritation, testicular pain or swelling.
2) . Ask men who have sex with men (MSM) about anorectal symptoms e.g., anal discharge or bleeding.
3) . If the pt is asymptomatic, collect first catch urine sample for chlamydia and gonorrhoea NAAT testing.
4) . If the pt is a man who has sex with men (MSM), obtain pharyngeal and anorectal NAAT swabs for chlamydia and gonorrhoea, and first catch urine, regardless of reported sexual practices.
5) . If patient is symptomatic, check for:
- urethral discharge; clear, milky, or mucopurulent.
- signs of epididymo-orchitis.
6). If urethral discharge:
Take a urethral culture swab for gonorrhoea, followed by a first catch urine for chlamydia and gonorrhoea testing.
Consider trichomoniasis testing only if recent sexual contact of trichomoniasis or if persistent or recurrent symptoms of urethritis.
- Routine screening is not recommended due to low sensitivity of the test in men.
- If testing is required, this can be requested on the same first void urine sample used for chlamydia and gonorrhoea testing.
7). If clinically suspected UTI or epididymo-orchitis, also collect mid-stream urine.
Management
Give dual therapy
- with ceftriaxone and azithromycin
- recommended due to increasing anti-microbial resistance to gonorrhoea
Uncomplicated gonorrhea infections
Give intramuscular ceftriaxone 500mg (available MPSO-endorsed “gonorrhoea”) and azithromycin 1 g orally immediately.
Both drugs are compatible in pregnancy and breast feeding.
If allergy to penicillin, the risk of allergic cross‑reaction to third generation cephalosporins e.g., ceftriaxone is extremely low
For infants born to mothers with untreated gonorrhoea infection, seek paediatric advice.
Complicated gonorrhoea infections
For females, follow PID pathway.
For males, follow Epididymo-orchitis pathway.
If suspected gonococcal conjunctivitis, complete full sexual health check and urgently seek ophthalmology advice.
Management
1). If suspected, e.g., in a male patient with frank milky urethral discharge, or if pt is a contact of gonorrhoea, do not wait for test results. Treat immediately:
- Uncomplicated gonorrhoea infections, including in pregnant and breastfeeding patients
- Complicated gonorrhoea infections
2) . Adviseto abstain from sex or use condoms for 7 days, and until 7 days after all current sexual partner(s) have been treated.
3) Manage sexual contacts. Advise patient to:
- contact all sexual contacts in the last 3 m, and tell them to attend a health service for testing and treatment.
- give pt information to contacts.
- Evidence shows that the provision of patient information improves outcomes.
- Advise contacts to attend a health service for testing and treatment.
4). Notify The Institute of Environmental Science and Research of gonorrhoea.
Follow-up
Arrange phone call or face-to-face appointment in 7 days to:
- ensure symptom resolution.
- check treatment compliance.
- provide results.
- check partner notification.
Ask all pts with positive gonorrhoea results to return for a sexual health check-up in 3 months because of risk of re-infection.
When to re-test?
Tests of cure are not routinely needed for patients who are asymptomatic after completing treatment, unless:
- persistent symptoms > 1 week.
- non‑first‑line treatment (2 weeks after treatment).
- pharyngeal infections (2 weeks after treatment).
- pregnancy (repeat test in third trimester).
If symptoms persist after treatment, re-test by culture 3 days after treatment and re-treat if index case at risk of reinfection.
When to re-treat?
Re-treat if any unprotected sex with untreated sexual contacts during the follow-up interval.
If antibiotic resistance is suspected e.g. persisting symptoms after correct management, request acute sexual health assessment.
Requestacute sexual health assessment if:
- antibiotic resistance is suspected e.g., persisting symptoms after correct management.
- recurrent gonorrhoea infections.
