Author: Vanessa Ngan, Staff Writer, 2005. Updated by Dr Daniela Vanousova, Dermatologist, Czech Republic, July 2015.
Gonorrhoea is an infection of the mucous membranes caused by the bacteria Neisseria gonorrhoeae. It is a common sexually transmitted infection that is primarily passed from person to person during sexual contact. It may also be passed to newborns delivered vaginally if the mother is infected, causing conjunctivitis (eye infection).
Sexually active people that do not practice safe sex, including the proper use of barrier contraceptives (condoms), are most at risk of getting gonorrhoea. The bacteria are transmitted from one person to another through vaginal, oral or anal sexual contact. Sexual penetration is not necessary as the bacteria are found in mucosal discharge and mucosal surfaces. Groups who are particularly at risk of getting gonorrhoea include:
The signs and symptoms of localised gonorrhoea are different between males and females.
Discharge in men can be mild to severe and does recede over time if left untreated. The only symptom can be a so-called "morning drop" with no further discharge. Despite the lack of symptoms, the patient is infectious and can pass the infection on to other partners. Rectal infection may occur from anal intercourse, and, in women, by the local spread of the organism as well. Rectal symptoms include rectal pain, pruritus (itching), constipation and rectal discharge sometimes with the presence of blood, or more often, there may be no symptoms at all. Pharyngitis (inflammation of the throat) that may cause mild to severe difficulty in swallowing may also occur in men and women with gonorrhoea. Gonococcal infection can be transmitted by infected fingers to the eyes causing unilateral conjunctivitis with severe inflammation and a yellowish discharge.
Not all patients with gonorrhoea will experience symptoms of the disease. There are no symptoms at all in 10–15% of men and in up to 80% of women. However, once infected the disease will spread until properly treated. Hence, in many women, gonorrhoea may have spread to other organs (disseminated gonococcal infection) and caused significant damage due to pelvic inflammatory disease before any signs or symptoms become apparent.
Occasionally, a widespread or disseminated gonococcal infection may occur. Signs and symptoms of disseminated gonococcal infection (gonococcaemia) include:
It is important to remember that patients presenting with disseminated gonococcal infection may not show any localised signs and or symptoms at the primary site of mucosal infection.
Gram-staining and culture are the most common laboratory tests used to diagnose gonorrhoea.
Gonorrhoea may also be detected on chlamydia swabs, urine specimens and thin prep cytological samples by nucleic acid amplification tests (NAATs).
A skin biopsy of cutaneous gonorrhoea reveals a suppurative abscess.
An ultrasound scan may be performed if pelvic inflammatory disease is suspected.
Gonorrhoea is treated with antibiotics effective against Neisseria gonorrhoeae and should be started as soon as possible to prevent further complications.
Chlamydial infection is often found in patients with gonorrhoea, so it is important to ensure both infections are treated.
The choice of antibiotic depends on local sensitivities. For up to date and detailed recommendations, see WHO 2016 guidelines for the treatment of Neisseria gonorrhoeae.
The current recommendation in New Zealand is for a single dose of ceftriaxone 500mg by intramuscular injection plus azithromycin 1g to cover chlamydia. If the organism is susceptible to these antibiotics on culture, a single dose with oral ciprofloxacin 500mg or amoxicillin 3g with 1g probenecid may be used.
A follow-up visit after treatment completion to recheck cultures and confirm eradication of infection is important. Sexual activity should not take place until treatment is completed and all partners have been tested and treated appropriately.
If gonorrhoea is left untreated the following complications may occur:
In patients with gonorrhoea, tests for syphilis, human immunodeficiency virus (HIV) and chlamydia infection should be undertaken to exclude co-infections, whether or not there are other symptoms to suggest these diseases.
If you think you are infected, stop all sexual contact and see your doctor or sexual health clinic. Notify all sexual contacts immediately so they can be checked for infection and treated appropriately. Safe-sex practices to prevent the spread of gonorrhoea include:
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