Gonorrhoea

What organism causes gonorrhoea?

• Gram‑negative diplococcus (Neisseria gonorrhoeae)

What type of tissue does gonorrhoea infect?

• Mucous membranes with columnar epithelium

  • endocervix

  • urethra

  • rectum

  • conjunctiva

  • pharynx

How is gonorrhoea transmitted?

• Contact with infected mucous secretions

Key risk factors for gonorrhoea?

• Young age,

• increased sexual activity,

• multiple partners

• having other STIs (chalmydia and HIV) increases risk

Can gonorrhoea spread beyond local infection?

• Yes — can enter bloodstream → joints, heart, meninges

How can gonorrhoea affect newborns?

• Transmitted during childbirth → corneal infection

Symptoms of gonorrhoea in men?

• insufferably symptomatic

• swollen testicales

• thick yellow/milk/green fluid

• testicular pain

• acute inflammation

• painful urination

• purulent discharge

• can invade prostate and epididymis to cause infertility

Symptoms in women?

• often asymptomatic

• Green/yellow vaginal discharge

• Burning sensation during urination

• Low abdominal pain

• Bleeding between periods or after sex

Diagnosis for gonorrhoea?

• swab from cervix more accurate in women

• swab of discharge or urine sample in men

• nucleic acid amplification test = detect RNA or DNA of gonorrhoea

Management of gonorrhoea?

• single intra-muscular antibiotic injection of ceftriaxone 1g if sensitivities are not known

• A single dose of oral ciprofloxacin 500mg if sensitivities are known

Follow up management?

• All patients should have a follow up of test of cure given the antibiotic resistance

• 72hrs after treatment for culture

• 7 days after treatment for RNA NAAT

• 14 days after treatment for DNA NAAT

Complications of gonorrhoea?

• pelvic inflammatory disease

• chronic pelvic pain

• infertility

• prostatitis - men

• Conjunctivitis

• urethral strictures

• skin lesions

• septic arthritis

• endocarditis