Gonorrhoea  

Exam Cram

• Gonorrhea is a core sexually transmitted infection, caused by Neisseria gonorrhoeae: gram negative diplococci

• Presentations: urethritis, septic arthritis, proctitis, disseminated sepsis

• Diagnosis: NAAT +ve or joint aspirate

• Management: Ceftriaxone +/- Azithromycin

URethral Gonorrhoea

Background 

• Gonorrhea is caused by Neisseria gonorrhoeae: gram negative diplococci

• Gonorrhea can live in the urethra, uterous, cervix, rectum and throat

• Gonorrhea is typically transmitted via semen, vaginal discharge, throat or rectum fluids, hence is transmitted via unprotected vaginal or anal intercourse, oral sex or sharing sex toys

• Latent period: 1-14 days

Assessment

History:

• Asymptomatic: 50% F, 10% M; throat is asymptomatic

• Urethritis: dysuria, urethral discharge, lower abdo pain

• Risk factors: unprotected sexual intercourse, new partner

Examination:

• Urethral purulent discharge

Investigations:

• NAAT swab urethral swab: positive gonorrohoea

• Microscopy: gram -ve diplococci

• Rule out STIs: syphilis, chlamydia +- blood bourne viruses (HIV, HBV, HCV)

Diagnosis

Diagnostic criteria: symptoms & positive NAAT

Differentials: Chlamydia, Syphilis 

Management

Acute

1. Ceftriaxone

2. Azithromycin

Comments

• Both ceftriaxone and azithromycin safe in pregnancy

• If concerns around resistance, combination therapies can be used: 

  • Ceftriaxone + Azithromycin

  • Azithromycin + Gentamicin

Prognosis

• Should notice improvement within 2 days

• Sex abstinence until finished treatment for 1 week 

• Test of cure 2 weeks after finishing treatment

• Complications: Pelvic Inflammatory Disease (PID), epididymo-orchitis, disseminated gonorrheoa, infertility

Gonorrheal SeptiC Arthritis

Presentation

• Starts with polyarthropathy, progresses to monoarthropathy,

• Vesicular rash on extremities, dysuria (urethritis), tenosynovitis

Only 20% of fluid aspirates will grow gonorrhoea

Management: 

1. Aspiration

2. Ceftriaxone

3. Surgical incision and drainage

GonorrheaL Proctitis

Background: Gonnorrhoea can infect the rectum, particularly in unprotected anal intercourse. 

Presentation: 

• Diarrhoea

• Mucopurulent anal discharge with bleeding

• Background: unprotected anal intercourse in MSM (Men who have sex with Men)

Diagnosis: NAAT anal swab

Management: ceftriaxone

Deeper Dive

Confidentiality

A common ethical scenario. 

1. Encouraged to inform current and recent sexual contacts themselves

2. Clinic can send 'confidential text message' informing partner to get tested, with patient's consent & passing on contact details

This text message will state they're at risk of an STI and advised to be tested, hence confidentiality is respected, however the individual may be able to work out who sent the text. 

Confidentiality cannot be broken and the partner cannot be told without patient's consent. 

References and Resources

Links

• Body Systems: male & female reproductive systems, haematopoetic & immune systems

• Disease type: infection

• Specialties: genitourinary medicine (GUM), infective diseases (ID)

Page written in 2024.