Gonorrhoea - the bacterium

Question 1

Causative organism

Answer 1

Neisseria gonorrhoeae

Question 2

Bacterial description/classification

Answer 2

Gram negative diplococci

Question 3

Primary cause of acquisition

Answer 3

Penetrative sex without a condom

Question 4

Sites of primary infection/bacterial colonisation (4)

Answer 4

1. Penis (urethra)
2. Vagina
3. Anus
4. Oropharynx

Question 5

Ascending GU infection in Men (3)

Answer 5

1. Prostatitis
2. Epididymitis
3. Orchiditis

Question 6

Ascending GU infection (Female)

Answer 6

PID:-

1. Endometritis
2. Salpingitis
3. Tubo-ovarian abscesses

Question 7

Symptomaticity

Answer 7

Male: >85% symptomatic (urethral infection)

Female: <20% symptomatic (vaginal infection)

<40% symptomatic (cervical infection)

Question 8

Primary prevention

Answer 8

1. [A] Abstinence/delaying sexual debut
2. [B] Monogomy/reducing no. of sexual partners
3. [C] Condoms

Question 9

Secondary prevention

Answer 9

1. Partner management
2. Contact tracing (upto last 60 days, or last contact if >60days)
3. Expedited partner therapy if partner refuses testing

Question 10

Classic male presentation

Answer 10

1. Mucopurelent urethral discharge
2. Urethritis (irritation/itchiness)
3. Dysuria

+

1. Risk factors e.g. condomless sex, high risk groups

Question 11

Strong risk factors

Answer 11

1. Age: 15-24 _{(=4 to 5x risk)}
2. MSM _{(20% all cases)}
3. Multiple sex partners
4. Poor condom use _{(THE primary risk factor)}
5. Current/prior STI _{(50-70% of chlamydia cases also have gonorrhoea)}

Question 12

Features/Risk factors

Answer 12

1. Anal itching (pruritis)
2. Pain - _{(usually with bowel movement)}
3. Tenesmus
4. Mucopurulent discharge or bleeding (from rectum) - _{(usually with bowel movement)}

+

Risk factors: Specifically MSM (penetrated partner)

Question 13

Symptoms of GU infection sequelae (Male)

Answer 13

1. Orchiditis/epidimytis
   
   • _{Unilateral swelling + pain}
2. Prostatitis
   
   • _{Pelvic pain, blood in ejaculate or features of obstruction}

Question 14

Female presentation

Answer 14

(Usually asymptomatic)

1. Mucopurulent discharge (endocervix) on examination
2. Vaginal discharge
3. Pelvic pain
4. Dyspareunia
5. Cervical friability/bleeding O/E

Question 15

Primary tests

Answer 15

NAAT

Urine, urethral, vaginal, rectal and throat
Most sensitive, slightly less specific for rectal/throat

MC&S

Chocolate agar plates (+ve)

Urinalysis

Leucocyte esterase (+ve)
Confirms urethritis, but non specific

Gram stain of discharge

Sensitive 50% of time (diplococci seen)

Chlamydia should always be tested for

HIV should be tested for in most cases

Question 16

Differential Diagnosis

Answer 16

1. Chlamydia infection
2. Other NG bacterial causes
   
   • Mycoplasma genitalium
   • Ureaplasma urealyticum
3. Trichomonas vaginalis
4. Enterobacteria
5. Candidal vaginitis
6. Bacterial vaginosis
7. UTI

Question 17

Treatment

Answer 17

1^st line: Ceftriaxone 250mg IM

2^nd line: Oral cephalosporins, eg. cefixime 400mg PO (single dose) + test of cure at 7/7

AND

anti-chlamydial Abx:-

1^st line: azithromycin 1g PO (single dose)

OR

doxycline 100mg PO BD 7/7