Gonorrhoea

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This is a bacterial infection that may involve the genitals, conjunctivae, mouth, and/or rectum.

Causes

  • Neisseria gonorrhoeae

Signs and symptoms in men

- Burning sensation during urination

- Foul-smelling urethral discharge of pus with/without burning sensation

-Oropharyngeal gonorrhoea from orogenital sex (fellatio) may present as mouth sores

Signs and symptoms in women

Mostly asymptomatic

-Vaginal discharge, burning sensation during urination, lower abdominal pain or pain with sexual intercourse

-Cervicitis

-Oropharyngeal gonorrhoea from orogenital sex (fellatio) may present as mouth sores

Complications in men

  • Littre abscess involving peri-urethral glands
  • Para-urethral abscesses
  • Proximal urethral involvement with frequency and terminal haematuria
  • Cowper's gland abscess involving the bulbo-urethral glands, producing a swelling behind the base of the scrotum that can produce a proximal or Cowper's stricture
  • Prostatitis
  • Proctitis
  • Urethral stricture leading to hydroureters and hydronephrosis
  • Chronic epididymo-orchitis leading to sterility

Complication in women

  • Pelvic inflammatory disease (PID)
  • Ectopic pregnancy
  • Infertility
  • Premature rupture of membranes
  • Premature labour
  • Chorioamnionitis
  • Septic abortion

Risk to the new-born infant:

  • Ophthalmia neonatorum
  • Oropharyngeal gonorrhoea

Differential diagnosis

  • Trichomoniasis, vulvovaginal candidiasis, bacterial vaginosis, chlamydiasis, genital warts, cervical warts, syphilitic chancre
  • Balanitis, trauma, tumour, testicular torsion

Investigations

  • Urethral and vaginal swab for microscopy, culture and sensitivity
  • Urine test
  • Blood cultures- if disseminated
  • VDRL
  • HIV screening

Treatment objectives

  • Eliminate the organism in the patient and treat partners(s)
  • Prevent re-infection
  • Prevent complications

Pharmacological treatment

Uncomplicated genital and anorectal gonococcal infections

Ceftriaxone IM

Adult:

250 mg as a single dose

OR

Ciprofloxacin oral

500 mg orally as a single dose

Note: Contraindicated during pregnancy

Complicated genital and anorectal gonococcal infections

Ceftriaxone IM

Adult:

1 g IM, every 24 hours for 7 days     

 

Uncomplicated oropharyngeal gonococcal infections

Adult and adolescent:

Ceftriaxone IM

250 mg IM as a single dose

 

Uncomplicated gonorrhoea

Cefixime oral

200 mg oral single dose

 

Complicated genital and anorectal gonococcal infections

Ceftriaxone IM

Adult:

1g IM, every 24 hours for 7 days

 

Re-treatment of gonococcal infections after treatment failure

Ceftriaxone IM

500 mg IM as a single dose

OR

Gentamicin IM

240 mg IM as a single dose

 

Gonococcal conjunctivitis in neonates

Ceftriaxone IM or IV

50 mg/kg (maximum 125 mg) IM or IV as a single dose

 

For ocular prophylaxis immediately after birth

Tetracycline hydrochloride 1% eye ointment

Apply to both eyes immediately after birth for 7 days

OR

Chloramphenicol 1% eye ointment

Apply to both eyes immediately after birth for 7 days

         

Gonococcal meningitis and endocarditis

Ceftriaxone IV

1-2 g IV every 12-24 hours for 2-4 weeks, respectively

Prevention

  • Advise patient to use condom during sex
  • Clean the eyes of newborn immediately after birth
  • All infants should receive topical anti-gonococcal therapy immediately after birth e.g. tetracycline, 1% ointment

Referral

  • If infection persists after the above treatment refer for specialist care