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Y4 Lecture Day I > Urethritis and gonorrhoea > Flashcards

Urethritis and gonorrhoea Flashcards

1
Q

What’ urethritis? (simply)

A

Inflammation of the urethra

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2
Q

Types of urethritis (2)

A
  • gonoccocal - caused by sexually transmitted gonorrhoea
  • non- gonococcal - not caused by gonorrhoea
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3
Q

symptoms of urethritis

A
  • pain
  • urinary frequency
  • a burning sensation upon urination (dysuria)
  • cloudy/white discharge (from penis, vagina)
  • itching
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4
Q

What organism causes Gonorrhoea?

A

Neisseria Gonorrhoea

*gram - negative bacteria

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5
Q

What’s non-gonococcal urethritis?

A

urethritis when gonococcal bacteria are not identified on the initial swab

*symptomatic patient (dysuria, discharge)

* swab taken-> microscopy performed which showed neutrophils but no Gram negative diplococci (i.e. no evidence of gonorrhoea).

*immediate treatment required prior to waiting for the Chlamydia test to come back

*hence an initial diagnosis of NGU is made.

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6
Q

What are two most common bacterial STIs?

A

gonorrhoea is the second most common bacterial STI (after chlamydia)

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7
Q

How gonorrhoea is transmitted?

A
  • through anal/vaginal/oral sex
  • from mother to child
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8
Q

What can be infected by Neisseria Gonorrhoea?

A

Neisseria Gonorrhoea has a strong affinity for mucous membranes

  • uterus
  • urethra
  • cervix
  • fallopian tubes
  • ovaries
  • testicles
  • rectum
  • throat
  • less commonly the eyes
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9
Q

Risk factors for gonorrhoea

A
  • Aged <25 years
  • Men who have sex with men
  • Living in high-density urban areas
  • Previous gonorrhoea infection
  • Multiple sexual partners
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10
Q

Is gonorrhoea symptomatic or asymptomatic?

A
  • often asymptomatic
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11
Q

When do the symptoms of gonorrhoea infection develop?

A

2-5 days following infection

(but often asymptomatic)

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12
Q

What’s that?

A

Vaginal discharge in a female with gonorrhoea

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13
Q

Symptoms of a female gonorrhoeal infection

A
  • altered/increased vaginal discharge (often green/yellow)
  • dysuria
  • lower abdo pain
  • rarely post-coital, inter-menstrual bleeding
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14
Q

Signs of female gonorrhoeal infection

A
  • easily induced cervical bleeding
  • endocervical discharge (mucopurulent)
  • pelvic tenderness

(but often examination can be normal!)

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15
Q

Male symptoms of gonorrhoea

A
  • uretheral discharge (purulent/mucopurulent)
  • dysuria
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16
Q

Signs of gonorrhoeal infection in men (2)

A
  • Mucopurulent/purulent urethral discharge
  • Epididymal tenderness
17
Q

Symptoms of gonorrhoeal rectal infection

A
  • Usually asymptomatic
  • Anal discharge
  • Anal pain/discomfort
18
Q

Symptoms of gonorrhoeal pharyngeal infections

A

usually asymptomatic (>90% cases)

19
Q

Investigations for gonorrhoea

A
  • if suspected → refer to GUM or specialist sexual service

Microscopy

Culture

Nucleic Acid Amplification Test (NAAT)/PCR

20
Q

What’s NAAT test?

A

NAAT - ucleic acid test or nucleic acid amplification test

  • technique utilized to detect a particular nucleic acid, virus, or bacteria which acts as a pathogen in blood, tissue, urine, etc.
  • NAT system differs from other tests in that it detects genetic materials rather than antigens or antibodies
21
Q

Ix for female gonorrhoea (2)

A

Females:

  • Endocervical/vaginal swab – NAAT
  • Endocervical/urethral swab – microscopy and culture
22
Q

Tests for male gonorrhoea (2)

A
  • First pass urine – NAAT
  • Urethral/meatal swab – microscopy and culture
23
Q

Where else, apart from genitals, can we obtain swabs if gonorrhoea is suspected?

A

Swabs for NAAT + microscopy & culture can be obtained from the throat, rectum or eye if indicated

24
Q

What else NAATs are used for?

A

NAATs are the standard investigation for chlamydia and these tests often provide dual testing for both chlamydia and gonorrhea.

25
Q

First-line drug management of gonorrhoea

A

First-line treatment is a single dose of

IM ceftriaxone 1g

26
Q

Non-drug management/advice in gonorrhoeal infections

A
  • should test for other STIs (especially chlamydia due to common co-infection)
  • advise a patient to contact previous sexual partners so they can be screened and treated for gonorrhoea
  • future safe sex advice
  • encourage to wait with sex until both partners have completed Rx
27
Q

Complications of untreated gonorrhoea in female

A
  • PID → infertility, ectopic pregnancy, chronic pain
  • disseminated gonococcal infection (DGI) → joint pain, skil lesions
28
Q

Complications of untreated gonococcal infection in male

A
  • epididymo-orchitis → painful, rarely infertility
  • prostatitis
29
Q

When a patient with gonorrhoea should be admitted to hospital (2)

A
  • Systemic symptoms (e.g. malaise, joint pain, fever, rash) → disseminated gonorrhoea which can potentially develop into a life-threatening infection such as gonococcal meningitis
  • Females show signs of complicated or severe pelvic inflammatory disease
30
Q

Complications of gonorrhoea in pregnancy

A
  • perinatal mortality
  • spontaneous abortion
  • premature labour
  • early membrane rupture
31
Q

Can gonorrhoea be transmitted from mum to baby during birth? What’s the outcome?

A
  • Can transmitted during delivery from an untreated mother
  • can cause the neonate to have gonococcal conjunctivitis
32
Q

What’s gonococcal conjunctivitis?

  • management
  • complications
A
  • neonate will experience eye pain, redness and discharge
  • Prophylactic antibiotics can prevent this and treatment during pregnancy is the same as for uncomplicated gonorrhoea.
  • For the infected neonate, urgent referal and appropriate treatment is necessary to prevent long term damage and blindness
33
Q

What’s that?

A

Gonorrhoea

Y4 Lecture Day I (13 decks)

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