Gonorrhoea is a sexually transmitted disease caused by Neisseria gonorrhoea, occurring worldwide .
The most common form of transmission is from sexual contact. Non-sexual transmission can occur - for example an infected mother passing the infection to a newborn child, usually resulting in symptoms are present in the majority of affected men but only 40% of women
males usually present within 3-5 days with urethritis characterised by a purulent urethral discharge, meatal oedema, dysuria and frequency of micturition
symptomatic females present with purulent vaginal discharge, frequency of micturition and anorectal discomfort. There may be bartholinitis.
disseminated gonococcal infection causes fever, malaise, myalgia and a diffuse pustular and erythematous rash
in females there may be endometritis and salpingitis
gonococcus contracted via anal sex may cause proctitisgonococcal conjunctivitis.
History and examination are suggestive but definitive diagnosis can only be made by identifying the organisms in smears or by culturing them in special media - Thayer Martin. Smears may be obtained from genital discharge, blood, tissue, synovial fluid, the genitourinary tract or skin.
Men who have sex with men and commercial sex workers should have additional rectal and pharyngeal swabs taken for culture (1).
Transport of the organism should be in a suitable transport medium to the micobiology laboratory.
The organisms are Gram negative diplococci.
Co-infection with Chlamydia is reported in 20-40 per cent of cases (1).
paraurethral duct infection
Cowperitis and abscess
acute or chronic prostatitis
pelvic abcess, peritonitis
Bartholins glands resulting in an abscess
conjunctivae - gonococcal ophthalmia neonatorum
Referral to GUM clinic for management of this condition.
Consider local antibiotic resistance patterns and follow local guidelines if these exist:
Previous first-choice therapeutic option was ciprofloxacin 500mg as a single oral dose.
however, there is evidence of an increased incidence of ciprofloxacin-resistant gonorrhoea
the Gonococcal Resistance to Antimicrobial Surveillance Programme (GRASP) (2) reported ciprofloxacin resistance in 9.8 per cent of UK isolates in 2002 - this compared with 2.1% in 2000
a treatment option should eliminate infection in over 95 per cent of patients - however as ciprofloxacin treatment no longer satisfies this criterion, it is now recommended that patients receive cephalosporins
Recommended treatment options for gonococcal infection are therefore (1):
cefixime as a 400mg single oral dose OR ceftriaxone 250mg single im dose OR cefotaxime (Claforan) 500mg single im dose - these treatment options are already in use in secondary care
in cases of pharyngeal gonorrhoea - ceftriaxone has a much better penetration
in gonococcal infection in pregnancy - see linked item
Patient should refrain from sexual intercourse and alcohol consumption until the condition is cured.
Follow-up: confirm cure, STD screen, contact tracing via genitourinary medicine clinic.
in all cases contacts must be traced and patients rescreened around three days after treatment to confirm cure (1)
Referral to secondary care for treatment is recommended for neonates with suspected gonococcal ophthalmia neonatorum (1).
Consider Chlamydia infection