gonorrhoea

what organism causes gonorrhoea?

neisseria gonorrhoea

what is the incubation period fo gonorrhoea?

1-10 days

what are the risk factors for gonorrhoea?

- young age

- multiple partners

- concurrent STI

what percentage of males and females are symptomatic with gonorrhoea?

males - 90%

females - 50%

what are the main clinical features for gonorrhoea in men?

- mucopurulent green urethral discharge

- dysuria

- testicular pain or swelling

what are the main clinical features for gonorrhoea in women?

- GREEN vaginal discharge

- dysuria

- lower abdominal/pelvic pain

- abnormal bleeding

- cervicitis on examination

what are the clinical features of rectal infection with gonorrhoea?

- anal pain

- anal discharge

- pruritis

what are the complications in men?

- prostatitis

- epididymo-orchitis

- urethral strictures

- infertility

what are the complications in women?

- PID

- tubal infertility

- pregnancy complications

what happens if gonorrhoea is left untreated?

disseminated gonorrhoea

what are the features of disseminated gonorrhoea?

- tendonitis

- tenosynovitis

- septic arthritis

- meningitis

- endocarditis

how would you test for gonorrhoea in men?

NAAT from first catch urine

how would you test for gonorrhoea in women?

NAAT from vulvovaginal swab

what do NICE recommend after initial treatment for gonorrhoea?

follow-up after 1 week to check adherence and symptoms

who does the infected patient need to inform?

male symptomatic - past 2 weeks

male asymptomatic - past 3 months

female asymptomatic - past 6 months

what is the management of gonorrhoea?

single dose ceftriaxone 1g IM

OR

cefixime and azithromycin 500mg PO

which treatment can you give in pregnancy?

ceftriaxone

when would you give ciprofloxacin?

when the antibiotic susceptibility is known

what is recommended after treatment?

test of cure

why is a test of cure recommended?

neisseria gonorrhoea very resistant

how should the test of cure be different in symptomatic vs asymptomatic?

symptomatic - cultures

asymptomatic - NAAT

when should cultures be done?

72 hours after treatment

when should NAAT for RNA be done?

7 days after treatment

when should NAAT for DNA be done?

14 days after treatment

what other general management should be done for pts with gonorrhoea?

- test for other STIs

- abstain from sex for 7 days

what is seen on microcopy in gonorrhoea?

gram negative diplococci intracellular

what colour is gram negative?

pink