Gonorrhoea Flashcards
Defintion
STI caused by gram-negative diplococcus = Neisseria Gonorrhoea
Transmission
- Penetrative sexual intercourse = main mode of transmission (e.g. oral, vaginal, or anal). Infected sites are the columnar epithelium-lined mucous membranes of the:
= urethra
= endocervix
= rectum
= pharynx
= conjunctiva - Vertical transmission = infected cervical exudate during vaginal delivery. This can result in meningitis, opthalmia neonatorum, or disseminated infection
Epidemiology
- Frequent unprotected sex
- Multiple sexual partners
- MSM
- Sharing unwashed sex toys
- Chlamydia infection: patients with chlamydia have an increased risk of gonorrhoea co-infection
Pathophysiology
N.gonorrhoea adheres to epithelial cells via pili causing an inflammatory response and manifests in the genitourinary tract as:
- Females = urethritis and cervical with bacterial ascension leading to pelvic inflammatory disease
- Males = urethritis with bacterial ascension leading to prostatitis and epididymo-orchitis
Subsequent haematogenous spread may result in infection at distant sites e.g septic arthritis
Re-infection
N.Gonorrhoeae type IV pili demonstrate antigenic variation.
Additionally, the surface Opa protein interacts with the CD4+ lymphocyte, inactivating proliferation. In doing so, N.Gonorrhoeae is able to prevent the host from developing immunological memory and re-infection is common
Urethritis signs and symptoms
- Dysuria often without frequency
- Mucoplurulent urethral discharge
- 90% of males are symptomatic
Prostatitis signs and symptoms
- Dysuria, frequency and urgency
- Lower back pain
Epididymo-orchitis signs and symptoms
Swollen and tender testicle and epididymis
Cervicitis signs and symptoms
Mucopurulent discharge
Dysuria
Lower abdominal pain
Up to 50% of females are asymptomatic
Pelvic inflammatory disease (PID) signs and symptoms
Fever
Lower abdominal pain
Deep dyspareunia
Adnexal and cervical motion tenderness
Proctitis signs and symptoms
Usually asymptomatic
Anal discharge and/or rectal bleeding
Peri-anal pain
Pharyngitis
Asx in 90% of patients
Sore throat
Conjunctivitis signs and symptoms
Painful, red eyes with purulent discharge
Diagnosis
An endocervical swab (women) or first-void urine (men) should be sent for one or both of the following:
- NAAT = highly sensitive (>95%)
- MC+S = culture should be taken in all patients who are NAAT positive for gonorrhoea before prescribing Abx. This is to test for Abx sensitivities and identify resistant strains.
- Sexual health screen: invesitgations for other STI e.g. chlamydia, and HIV
Treatment
FIRST LINE Abx: IM ceftriaxone 1g
- Given as a single dose if Abx sensitivity is not known
- Oral cefixime 400mg and azithromycin 2g: if Px needle phobic
- Oral ciprofloxacin 500mg: if a single dose of cultures demonstrate sensitivity.
