Gonorrhoea

Gonorrhoea is a sexually transmitted disease caused by a gram negative diplococcus Neisseria gonorrhoeae (1)

• it is an uncomplicated infection of the lower genital tract
  • undetected or inadequately treated disease may result in complicated infection of the upper genital tract (uncommon in UK) e.g. - prostatitis or epididymitis in men and salpingitis or pelvic inflammatory disease in women (2)
• primary sites of infection include - urethra, endocervix, rectum, pharynx and conjunctiva (1)
• the disease is transmitted by direct inoculation of infected secretions from one mucous membrane to another - genital-genital, genital-anorectal, oro-genital or oro-anal contact (3)
  • most common form of transmission is from sexual contact
  • non-sexual transmission can occur when an infected mother passes the infection to a newborn child, usually resulting in gonococcal conjunctivitis

Clinical features of the disease vary between genders.

• about 50% of females are asymptomatic whereas asymptomatic infection rarely occurs in males
• due to this asymptomatic nature, complicated gonococcal infection is more common in women than in men (2)
• common symptoms in women may include increased or altered vaginal discharge and lower abdominal pain. It can also be a rare cause of heavy menstrual, postcoital or intermenstrual bleeding due to cervicitis or endometritis (4)

Gonorrhoea is known to facilitate the acquisition and transmission of HIV (2).

Key points (5):

• antibiotic resistance is now very high
• use IM ceftriaxone if susceptibility not known prior to treatment
• use Ciprofloxacin only If susceptibility is known prior to treatment and the isolate is sensitive to ciprofloxacin at all sites of infection
• refer to GUM
• Test of cure is essential

Reference:

• (1) Bignell C, Fitzgerald M; Guideline Development Group.UK national guideline for the management of gonorrhoea in adults, 2011. Int J STD AIDS. 2011;22(10):541-7.
• (2) Health Protection Agency (HPA) 2010. Guidance for gonorrhoea testing in England and Wales.
• (3) Bignell C; IUSTI/WHO. 2009 European (IUSTI/WHO) guideline on the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS. 2009;20(7):453-7.
• (4) FSRH and BASHH Guidance (February 2012) Management of Vaginal Discharge in Non-Genitourinary Medicine Settings.
• (5) Public Health England (June 2021). Managing common infections: guidance for primary care