Gonorrhea

Microbiology

Neisseria gonorrheae is a gram-negative, intracellular diplococcus that grows best in a CO2 rich environment.  Many subtypes are resistant to traditional antibiotic regimens.  see also gonococcal conjunctivitis

Symptoms/Signs

  • Female
    • Vaginal discharge
    • PID and infertility
    • May be asymptomatic
  • Males
    • Purulent discharge
    • Dysuria
    • Rarely asymptomatic

Management

  • Investigate as chlamydia
    • Females
      • Endocervical swab/self taken vulvovaginal swab for GC/CT PCR
    • Males
      • First pass urine for GC/CT PCR
      • NB a urethral swab can be taken (only at an SRH clinic)
    • Rectal/anal swabs if appropriate.
  • Treatment
    • Single dose oral Azithromycin and IM ceftriaxone
    • Test for cure recommended at two weeks if asymptomatic
      • IMPORTANT: Test of cure in this case (I presume) would be a culture test- PCR requires 5-6 weeks clearance to avoid false positive detection of dead bacteria.
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