Gonorrhoea

Key points

• Gonorrhoea is caused by the Gram negative diplococcus Neisseria gonorrhoeae. Acute infection can occur on any mucous membrane surface, typically genitourinary but also rectum and pharynx.
• males: urethral discharge, dysuria
• females: cervicitis e.g. leading to vaginal discharge
• rectal and pharyngeal infection is usually asymptomatic Microbiology
• 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)
• TREATMENT (BASHH): first-line is CEFTRIAXONE 1 g INTRAMUSCULARLY as a SINGLE DOSE, given as MONOTHERAPY · the UK moved from dual therapy (ceftriaxone plus azithromycin) to ceftriaxone monotherapy in 2019 because of rising azithromycin resistance, and the ceftriaxone dose rose from 500 mg to 1 g at the same time.
• If ceftriaxone cannot be given: spectinomycin 2 g IM single dose, or azithromycin 2 g orally as a single dose — azithromycin only if the isolate is known to be susceptible · if injection is declined, oral cefixime 400 mg plus azithromycin 2 g may be used.
• Diagnosis is by NAAT · culture should be taken before treatment where possible for antimicrobial susceptibility testing · anyone diagnosed with gonorrhoea should also be tested for chlamydia, syphilis and HIV, with partner notification. Local complications…