This document provides an overview of gonorrhea, including that it is a common bacterial STI caused by Neisseria gonorrhoeae. It affects the urogenital tract most commonly. Screening is recommended annually for sexually active individuals and more frequently for those at higher risk. Most women are asymptomatic while men typically experience dysuria and discharge. Treatment involves antibiotics and retesting partners and patients themselves within a few months to check for reinfection.

1. Gonorrhea
Dr.Ahmed Al-Shukaili
Family medicine resident

2. Outline
• Introduction
• Risk factors
• Screening
• Symptoms & signs
• Diagnosis
• Treatment
• Follow up

3. Introduction
• It is bacterial infection caused by Neisseria gonorrhoeae causes
urogenital, anorectal, conjunctival, and pharyngeal infections.
• Urogenital tract infections are most common.
• It is second most frequently reported bacterial sexually transmitted
infection (STI) after Chlamydia trachomatis.
• Coinfection with C. trachomatis is common.

5. Screening
• The USPSTF recommends routine screening for gonorrhea in all
sexually active women at increased risk of infection, including
during pregnancy, but recommends against screening low-risk men
and women.
• Routine screening for gonorrhea and other curable STIs should be
performed at least annually in sexually active patients with HIV
infection.
• Screening for urethral infections should be performed with urine
nucleic acid amplification testing, whereas rectal or pharyngeal
screening should be performed with nucleic acid amplification
swab.

6. Screening
• Screening every three to six months also is recommended for men
who have sex with men if they have multiple because they are at
highest risk of contracting STIs.
• Uninfected pregnant women who remain at high risk should be
tested during the third trimester.

8. Infection in women
• More than 95% of women with gonorrhea have no symptoms.
• If symptoms occur, they are usually mild, and may mimic acute cystitis or
vaginitis.
• The most common manifestation is cervicitis, which usually occurs 5-10
day after exposure.
• 10-20% of women with cervical gonorrhea also have a pharyngeal
infection.

9. Infection in women
• Untreated gonorrhea causes 10 – 20% of PID cases, and 15 percent of
women with PID develop infertility from tubal scarring.
• CDC recommends that symptomatic women be examined for PID by
palpating for cervical or adnexal tenderness, and tested for gonorrhea,
chlamydia, bacterial vaginosis, and trichomoniasis with
oendocervical swabs for light microscopy
oand nucleic acid amplification testing.

10. Infection in men
• Men with gonorrhea usually are symptomatic, but asymptomatic urethral
infections may occur in at least 10 % of cases.
• Symptoms typically appear 2-5 days after infection, but may take as long
as 30 days to appear.
• Common signs and symptoms include dysuria and purulent penile
discharge.
• Unilateral epididymitis without discharge also may be present.

11. Infection in men
• Chlamydia causes 15-40 % of non-gonococcal urethritis cases in
men.
• 1-2 % of men who have non-gonococcal urethritis develop sexually
acquired reactive arthritis.

12. Infections in Infants
• It can occur in neonates from exposure to infected cervical secretions during
delivery.
• neonatal conjunctivitis (Treatment is important to prevent globe perforation
and blindness)
• Arthritis
• pharyngitis, rhinitis rarely pneumonia
• vaginitis, urethritis
• localized scalp infections or abscesses
• Sepsis and Meningitis

13. Disseminated Infection
• Disseminated gonococcal infection is rare, affecting 0.4 to 3 % of patients with
gonorrhea, examples :
• Skin infection
• Tenosynovitis and septic arthritis
• Rare disease progression may result in
• perihepatitis
• Meningitis
• endocarditis

14. Laboratory diagnoses
• Gram stain of a urethral smear or cervical swab showing gram-
negative intracellular diplococci.
• Urine nucleic acid amplification testing in women and men (and
urine polymerase chain reaction testing in men) has comparable
sensitivity and specificity to cervical and urethral samples.

15. Treatment
• Patients’ sex partners within 60 days before symptom onset should
also be treated.
• Fluoroquinolones are not recommended in the United States for
treatment of gonorrhea or associated conditions because of the
emergence of quinolone-resistant N. gonorrhoeae

17. Follow up
• Retesting men and women is recommended three to six months
after treatment, regardless of partner treatment, because of high
rates of reinfection within six months of therapy
• Pregnant women with first-trimester gonococcal infection should be
retested within three to six months, in addition to routine test of
cure, preferably in the third trimester.
• Uninfected pregnant women who remain at high risk should be
retested during the third trimester.

18. should we test pt with positive gonorrheal infection for HIV ?

19. • All patients who test positive for gonorrhea should be tested for
other STIs, including chlamydia, syphilis, and HIV.

20. References
• AFPP
• CDC