Gonorrhoea  

Exam Cram

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

• Presentations: urethral discharge, septic arthritis, proctitis, disseminated sepsis

• Diagnosis: NAAT +ve or joint aspirate

• Management: Ceftriaxone +/- Azithromycin

STI Outline

Background 

• Gonorrhea is caused by Neisseria gonorrhoeae: gram negative diplococci

Assessment

History:

• Acute history in young individual

• Dysuria, urethral discharge

• Risk factors: unprotected sexual intercourse, new partner

Examination:

• Urethral purulent discharge

Investigations:

• NAAT swab urethral swab: positive gonorrohoea

• Microscopy: gram -ve diplococci

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

Gonorrhea SeptiC Arthritis

• Presentation

  1. • 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

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.