Sexually Transmitted Diseases - Gonorrhoea

Question 1

Pathology : Neisseria gonorrhoea (3).

Answer 1

1. Gram-Negative Diplococcus.
2. Infects mucous membranes with a columnar epithelium e.g. endocervix, urethra, rectum, conjunctiva and pharynx.
3. Transmission : contact with mucous secretions from infected areas.

Question 2

Clinical Presentation of Gonorrhoea (4).

Answer 2

1. More Symptomatic than Chlamydia.
2. Women : Odourless Purulent Discharge (Yellow/Green); Dysuria; Pelvic Pain.
3. Men : Odourless Purulent Discharge (Yellow/Green); Dysuria; Epididymo-orchitis.
4. Other Manifestations : Rectal/Pharyngeal Infection; Prostatitis; Conjunctivitis.

Question 3

Medical Management of Gonorrhoea (2).

Answer 3

1. 1st Line - Uncomplicated : Single Dose of IM Ceftriaxone 1g (Empirical); Single Dose of Oral Ciprofloxacin 500mg (if Unknown Sensitivities).
2. Test of Cure (due to high Antibiotic Resistance) - NAAT Testing (asymptomatic) or Cultures (symptomatic) : 72 hours post-treatment for culture; 7 days post-treatment for RNA NAAT; 14 days post-treatment for DNA NAAT.

Question 4

Additional Management of Gonorrhoea (5).

Answer 4

1. Sexual Abstinence for 7 Days of Treatment.
2. Refer to GUM Clinic : Contact Tracing an Notification of Partners.
3. Advice.
4. Testing and Treating Other STIs.
5. Safeguarding Issues and Sexual Abuse.

Question 5

What is Disseminated Gonococcal Infection (GDI)? (4)

Answer 5

1. Complication of untreated Gonocococcal infection - Bacteria spreads to Skin and Joints.
2. Migratory Polyarthritis, Polyarthralgia, Tenosynovitis.
3. Non-Specific Skin Lesions.
4. Systemic Symptoms.

Question 6

What is Gonococcal Conjunctivitis?

Answer 6

1. Ophthalmia Neonatorum.
2. Contracted from mother during birth.
3. Risk of Sepsis, Perforation of Eye and Blindness : Medical Emergency.