Gonorrhoea - transmission, Clinical Features, Diagnosis, Treatment and prevention

Genital infections, in particular cervical infection, are the most common infections associated with N. gonorrhoea, it is STD and can ascend to involve the reproductive organs, causing pelvic inflammatory disease and/or complications of pregnancy.

Frequency of Gonorrhoea 0.8% (female ), 0.6% (men). Approximately 88 million cases of gonorrhea occur each year. It can infect both men and women.

Mode of transmission

Gonorrhea is spread through sexual contact with an infected person. That consists of oral, anal, and vaginal sex. It can also spread transplacentally that is from mother to child during giving birth.

It tends to infect warm, moist areas of the body, such as urethra, eyes, throat, vagina, anus, female reproductive tract  I.e fallopian tubes, cervix, as well as urethra.

The risk for Developing gonorrhea

people who have unprotected sex and people  with multiple sex partners.

Male and women  who are under the age of 25. men and women who engage in sex work as well .

Clinical Features of Gonorrhoea

• Cervicitis
• Urethritis
• Pelvic inflammatory disease(PID)
• Perihepatitis (Fitz-Hugh-Curtis syndrome)
• Bartholinitis
• Pharyngitis
• Disseminated gonococcal infection.

Complications of pregnancy 

The risk of these complications in the setting of gonococcal infection is approximately two to five times greater than uninfected controls.

• Chorioamnionitis
• Premature rupture of membranes
• Preterm birth
• Low birth weight or small for gestational age infants
• Spontaneous abortions 

Complications in neonate 

Transmission of N. gonorrhea from an untreated infected mother to her baby may occur in 30 to 50 percent of cases.

• Neonatal conjunctivitis (“ophthalmia neonatorum”)
• Pharyngitis
• Arthritis
• Sepsis
• Meningitis
• Less severe manifestations include:-
rhinitis, vaginitis, urethritis, and infection at sites of fetal monitoring.

Screening

All pregnant women aged <25 years and older women at increased risk for gonorrhea (e.g., those with a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has a sexually transmitted infection) should be screened for N. gonorrhea at the first prenatal visit.

Women found to have gonococcal infection should be treated immediately and retested within 3 months. 

Pregnant women who remain at high risk for gonococcal infection also should be retested during the third trimester.

Diagnosis of Gonorrhoea

Specimen—self or clinician-collected vaginal swab, endocervical swab, urine and liquid Pap smear medium, rectal(proctitis) or pharyngeal swab(pharyngitis) .

Gram stain -microscopy demonstrates polymorphonuclear leukocytes with intracellular gram-negative diplococcic.

Methylene blue/gentian violet stain -WBC and gonococcal forms on urethral swab.

Culture- Thayer-Martin agar

Nucleic acid amplification testing (NAAT)- gold standard

Leukocyte esterase urine test

Immunochromatographic tests

Nucleic acid hybridization (nucleic acid probe) tests.

Treatment of Gonorrhoea

Dual therapy consisting of ceftriaxone 250 mg in a single IM dose and azithromycin 1 g orally as a single dose.

Doxycycline should be avoided during pregnancy.

Gentamicin plus azithromycin can be used as an alternate regimen during pregnancy if desensitization cannot be performed. A test of cure is recommended if a pregnant patient is treated with an alternative regimen.

All pregnant women with pelvic(PID) inflammatory disease should be hospitalized and given parenteral antibiotics, due to the potential complications of infection resulting in adverse pregnancy outcomes.

Monitoring of Gonorrhoea

Patients who finish a recommended regimen for treatment of uncomplicated gonorrheal infections and have no further symptoms do not need to return for a test of cure.

However, the CDC recommends that a test of cure be performed if an alternate regimen (eg, a cefixime-based regimen) is used for oropharyngeal gonococcal infection.

should be retested following treatment within three months

pregnant women who are at continued high risk for gonorrhea should be tested again during the third trimester.

Ophthalmia neonatorum

Prevention

Erythromycin (0.5%) ophthalmic ointment in each eye in a single application at birth.

Treatment

Ceftriaxone 25–50 mg/kg IV or IM in a single dose, not to exceed 125 mg.

Disseminated Gonococcal Infection and Gonococcal Scalp Abscesses .

Treatment

Ceftriaxone 25–50 mg/kg/day IV or IM in a single daily dose for 7 days, with a duration of 10–14 days if meningitis is documented
OR
Cefotaxime 25 mg/kg IV or IM every 12 hours for 7 days, with a duration of 10–14 days if meningitis is documented.

About gonorrhea vaccine 

One study published in 2017 showed that MeNZB group B meningococcal vaccine provided partial protection against it. The vaccine efficiency was estimated to be 31%.

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