A22. Diagnosis and treatment of gonorrhoea

Gonorrhoea is caused by Neisseria gonorrhoeae. It mostly affects young adults. It may progress to pelvic inflammatory disease.

Clinical features

Women are often asymptomatic (30 – 60%). The incubation time can be days or weeks.

Symptoms in women can be:

• Dysuria
• Yellow, purulent, malodourous discharge
• Cervical tenderness and bleeding on physical examination

Diagnosis and evaluation

PCR of a vaginal and endocervical swab is the first choice. Should also be performed of the pharynx if oral sex occurred.

Alternatives include gram staining and culture.

Treatment

The ideal treatment for gonorrhoea:

• Treats the gonorrhoea
• Treats any coexisting syphilis and chlamydia
• Is single dose
• Covers resistant strains of gonorrhoea (many are resistant to cephalosporins)

There are two treatment options which fulfil these criteria. Either

• Single-dose ceftriaxone IM + single-dose azithromycin PO
• Single-dose cefixime PO + single-dose ciprofloxacin PO

Postgonococcal urethritis can occur due to secondary colonization with mycoplasma and chlamydia. Treatment of this is tetracycline.

Complications

Disseminated gonococcal infection (arthritis-dermatitis syndrome) is a rare complication of gonorrhoea. It occurs in 2% of cases, mostly in women.

• Intermittent fever
• Migratory arthritis
  • Pain spreads from one joint to another
• Skin lesions
  • Flea bite-like papules
  • Haemorrhagic pustules on palms, soles

Gonococcal conjunctivitis can occur in neonates who are born to mothers with gonorrhoea. It occurs due to direct contact from genitalia to hand to eye. It’s treated by silver nitrate eye drops.