Gonorrhoea

Medicine > Infection

Background knowledge 🧠

Definition

Gonorrhoea is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae.
It primarily affects the mucous membranes of the urethra, cervix, rectum, throat, and eyes.
Transmission occurs through sexual contact or perinatally from mother to child during childbirth.
Untreated gonorrhoea can lead to serious health complications.

Epidemiology

High prevalence in sexually active adolescents and young adults.
More common in urban areas with higher population density.
Rates of infection higher in men who have sex with men (MSM).
Co-infection with other STIs, particularly chlamydia, is common.
Rising incidence due to antibiotic-resistant strains.

Aetiology and pathophysiology

Caused by Neisseria gonorrhoeae, a Gram-negative diplococcus.
Bacteria adhere to and invade mucosal epithelial cells.
Elicits an inflammatory response, leading to symptoms.
Capable of antigenic variation to evade the immune system.
Can spread locally or systemically if untreated.
Antibiotic resistance is a growing concern, complicating treatment.

Clinical Features 🌡️

Symptoms

Urethral discharge and dysuria in men.
Increased vaginal discharge, dysuria, intermenstrual bleeding in women.
Rectal pain, discharge, and bleeding with rectal infections.
Pharyngeal infections often asymptomatic or mild sore throat.
Conjunctivitis with eye infections, particularly in neonates.
Many infections are asymptomatic, particularly in women.

Signs

Purulent urethral or cervical discharge.
Tenderness or swelling in the genital area.
Pelvic or lower abdominal pain on examination.
Signs of pelvic inflammatory disease (PID) in advanced cases.
Erythema and oedema in cases of conjunctivitis.
Proctitis: rectal inflammation and tenderness.

Investigations 🧪

Tests

Nucleic acid amplification tests (NAATs) from urine, urethral, or cervical swabs: gold standard for diagnosis.
Gram stain: intracellular Gram-negative diplococci in urethral smears (men).
Culture: important for antibiotic sensitivity testing.
Test for other STIs: chlamydia, HIV, syphilis.
Pregnancy test: in women of reproductive age.
Full sexual health screen in sexually active individuals.

Management 🥼

Management

Antibiotic therapy: ceftriaxone 1g IM (single dose).
Consider alternative regimens if allergic to first-line antibiotics, e.g. Ciprofloxacin, Azithromycin.
Partner notification and treatment to prevent reinfection and spread.
Abstain from sexual activity until treatment is complete and symptoms resolved.
Follow-up testing to ensure eradication of the infection.
Patient education on safe sex practices to prevent future infections.

Complications

Pelvic inflammatory disease (PID) in women.
Epididymitis and prostatitis in men.
Disseminated gonococcal infection (DGI): arthritis, tenosynovitis, dermatitis.
Infertility in both men and women.
Increased risk of acquiring and transmitting HIV.
Neonatal complications: conjunctivitis, sepsis in newborns.
Chronic pelvic pain in women.

Prognosis

Excellent with timely diagnosis and appropriate treatment.
Risk of complications increases with delayed treatment.
Antibiotic-resistant strains may complicate treatment.
Recurrence common if sexual partners are not treated.
Regular screening and safe sex practices can reduce incidence and recurrence.
Prognosis poorer in cases of disseminated infection.

Key points

Gonorrhoea is a common and treatable STI.
Prompt treatment essential to prevent complications and transmission.
Antibiotic resistance is an emerging challenge in management.
Partner notification and treatment are crucial to control spread.
Education on safe sex practices is key to prevention.
Regular screening in high-risk populations can aid early detection and treatment.

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