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Flashcards in Gonorrhoea Deck (6):

What causes gonorrhoea?

- Gonorrhoea is caused by the Gram negative diplococcus Neisseria gonorrhoea.
- Acute infection can occur on any mucous membrane surface, typically genitourinary but also rectum and pharynx.
- The incubation period of gonorrhoea is 2-5 days


What are the features of gonorrhoea?

- males: urethral discharge, dysuria
- females: cervicitis e.g. leading to vaginal discharge
- rectal and pharyngeal infection is usually asymptomatic


What is the vaccine?

Immunisation is not possible and reinfection is common due to antigen variation of type IV pili (proteins which adhere to surfaces) and Opa proteins (surface proteins which bind to receptors on immune cells)


What local complications may arise?

Local complications that may develop include urethral strictures, epididymitis and salpingitis (hence may lead to infertility). Disseminated infection may occur...


What happens in disseminated gonorrhoea?

Disseminated gonococcal infection (DGI) and gonococcal arthritis may also occur, with gonococcal infection being the most common cause of septic arthritis in young adults.

The pathophysiology of DGI is not fully understood but is thought to be due to haematogenous spread from mucosal infection (e.g. Asymptomatic genital infection).

Initially there may be a classic triad of symptoms:
1) tenosynovitis,
2) migratory polyarthritis
3) dermatitis (lesions can be maculopapular or vesicular)
Later complications include septic arthritis, endocarditis and perihepatitis (Fitz-Hugh-Curtis syndrome)


How is gonorrhoea managed?

- Ciprofloxacin used to be the treatment of choice. However, there is increased resistance to ciprofloxacin and therefore cephalosporins are now used
- The 2011 British Association for Sexual Health and HIV (BASHH) guidelines recommend ceftriaxone 500mg I.M. as a single dose with azithromycin 1 g PO as a single dose. The azithromycin is thought to act synergistically with ceftriaxone and is also useful for eradicating any co-existent Chlamydia infections
- If ceftriaxone is refused or contraindicated other options include cefixime 400mg PO (single dose)