Gonorrhoea:
Diagnosis and management
Diagnosis
Management
Epidemiologic treatment
Patient
education
Follow-up
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 Typical
thick yellow urethral discharge associated with gonococcal
infection. Heavy discharge and dysuria usually develops within
one week of infection. However, some infected men remain
asymptomatic.
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Presumptive – requires confirmation for diagnosis
- Gram
stain smear – typical intracellular Gram negative diplococci (GNID)
- PCR
first catch urine – positive result
Confirmed
-
Culture
of urethral swab
- Typical colonial morphology on
selective culture medium, typical Gram stain morphology, positive
oxidase reaction confirmed with sugar utilisation, coagglutination
or antigonococcal fluorescent antibody testing
Antibiotic treatment
Standard therapy all sites
ceftriaxone
250 mg im as one dose diluted in 2ml of 1% lignocaine
Observe
patient in clinic for 15 minutes after administration
Note – there is no
readily available oral therapy recommended for routine treatment of
gonorrhoea in South Australia
Patients with penicillin
hypersensitivity
spectinomycin 2 g im as one dose
Patients
should be referred to Clinic 275.
Children weighing less than 45 kg
ceftriaxone 125 mg im as one dose
children with penicillin hypersensitivity
spectinomycin
40 mg/kg im as one dose
Patients
should be referred to Clinic 275
Children
weighing more than 45 kg should receive adult regimens
Disseminated gonococcal infection
ceftriaxone 1g im or iv daily for 7 days
Patients with penicillin hypersensitivity
spectinomycin
2 g im 12 hourly for 7 days
Epidemiologic
treatment refers to treatment with standard regimens, after laboratory
tests have been taken, but before confirmatory results are available, on
the basis that the benefits of treating outweigh the benefits of not
treating.
The
following patients should receive epidemiologic treatment:
- Those who are contacts
of a person with proven gonorrhoea
- Those from whom an
endocervical, urethral or rectal smear show intracellular Gram
negative diplococci.
The
following points must be discussed:
- the importance of
immediate testing and treating of all sex partners
- abstinence from sex
until a test of cure is performed
- patient
education/provision of literature
on gonorrhoea
- gonorrhoea is a
notifiable disease.
Contact
tracing
Patients
need to be contact traced/referred for contact tracing
All
patients should return 5-10 days after completion of treatment for
-
evaluation of symptoms
and signs
-
check reaction to
medication
-
enquiry about sexual
activity since treatment
-
culture from infected
sites (test of cure) to include rectal culture from all women with
endocervical gonorrhoea
-
ensure contact tracing
has occurred
-
screen for other STDs
and arrange follow up at 3 months for blood borne virus serology and
syphilis testing
Gonorrhoea
is
a notifiable
infection in South Australia.
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