Last edited 07/2021 and last reviewed 07/2021

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