Gonorrhoea
Infection caused by *Neisseria gonorrhoeae*, commonly causing urethritis, cervicitis, and proctitis. Rising antimicrobial resistance makes guideline-concordant dual therapy and culture/sensitivity where available essential in the UK.
Key Facts
Key points
- NAAT diagnosis from urine/swabs (include pharyngeal/rectal sites as indicated).
- First-line (UK): ceftriaxone 1 g IM/IV plus azithromycin 1 g PO — verify current BASHH guidance.
- Test of cure: recommended 2 weeks after treatment for pharyngeal infection; follow local policy for other sites.
- Co-infection with chlamydia is common — treat both unless excluded.
- Disseminated gonococcal infection: pustular rash, tenosynovitis, septic arthritis — blood cultures; longer IV ceftriaxone course.
Overview
Resistance
Reduced fluoroquinolone susceptibility led to ceftriaxone-centred regimens; azithromycin adjunct aims to cover chlamydia and reduce resistance selection pressure (policy evolving — check updates).
Complications
PID, epididymo-orchitis, infertility, neonatal ophthalmia (rare with screening).
Clinical Presentation
Symptoms
Purulent urethral discharge, dysuria, pelvic pain, rectal discomfort, sore throat.
Examination
Urethral meatus inflammation; cervical friability; epididymal tenderness.
Differential Diagnosis
| Alternative | Notes |
|---|---|
| Chlamydia | Often milder discharge |
| NSU (M. genitalium) | May need specific testing |
| UTI | Nitrites, different risk profile |
Diagnosis / Investigation
Tests
- NAAT (urine/endocervical/rectal/pharyngeal).
- Culture where available for sensitivity (especially treatment failure).
HIV/syphilis screen
Offer routinely.
Management
Uncomplicated anogenital/urogenital
- Ceftriaxone 1 g IM/IV single dose + azithromycin 1 g PO single dose (per BASHH).
Severe PID / disseminated
- Ceftriaxone 1 g IV OD (or higher dose per protocol) with hospital admission and longer courses.
Partner management
- Treat current partners; abstain until therapy completed and symptoms resolved.
Prognosis
Excellent cure rates with effective therapy; reinfection common if partners untreated. Drug resistance threatens future treatment options.
Other Relevant Information
Public health
Mandatory reporting categories vary; maintain sexual health records confidentially.