STI's: Gonorrhoea

Question 1

Definition

Answer 1

Gram negative diplococcus bacteria
Infects mucus membranes with a columnar epithelium such as endocervix in women, urethra, conjunctiva and pharynx

Question 2

How does it spread

Answer 2

Via contact with mucous secretions from infected areas

Question 3

Epidemiology + Risk factors

Answer 3

Young
Sexually active
Multiple partners
Having other sexually transmitted infections such as chlamydia, or HIV

Question 4

Signs and symptoms

Answer 4

Infection with gonorrhoea is more likely to be symptomatic than infection with chlamydia. 90% of men and 50% of women are symptomatic. The presentation will vary depending on the site. Female genital infections can present with:
- Odourless purulent discharge, possibly green or yellow
- Dysuria
- Pelvic pain
Male genital infections can present with:
- Odourless purulent discharge, possibly green or yellow
- Dysuria
- Testicular pain or swelling (epididymo-orchitis)
Rectal infection may cause anal or rectal discomfort and discharge, but is often asymptomatic.
Pharyngeal infection may cause a sore throat, but is often asymptomatic.
Prostatitis causes perineal pain, urinary symptoms and prostate tenderness on examination. Conjunctivitis causes erythema and a purulent discharge.

Question 5

Diagnosis

Answer 5

FIRST LINE = standard charcoal endocervical swab should be taken for microscopy, culture and antibiotic sensitivities before initiating antibiotics.
GOLD STANDARD: Nucleic acid amplification testing (NAAT) is used to detect the RNA or DNA of gonorrhoea.
- Endocervical, vulvovaginal or urethral swabs, or in a first-catch urine sample
- Rectal and pharyngeal swab are recommended in all men who have sex with men (MSM)

Question 6

Management

Answer 6

For uncomplicated gonococcal infections:
- A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known
- A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known
All patients should have a follow-up “test of cure” given the high antibiotic resistance. This is with NAAT testing if they are asymptomatic, or cultures where they are symptomatic

Question 7

Complications

Answer 7

Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Epididymo-orchitis (men)
Prostatitis (men)
Conjunctivitis
Urethral strictures
Disseminated gonococcal infection
Skin lesions
Fitz-Hugh-Curtis syndrome
Septic arthritis
Endocarditis