Gonorrhoea
Last Updated: 2023-07-07
Author(s): Anzengruber F., Navarini A.
ICD11: 1A7Z
Last Updated: 2023-07-07
Author(s): Anzengruber F., Navarini A.
ICD11: 1A7Z
Neisser, 1879
Gonorrhoea, Neisser's disease.
Worldwide sexually transmitted infection (STI or STD) caused by Neisseria gonorrhoeae. Seen as an indicator for the prevention of HIV and other STDs, as it is often a co-infection (ulcers serve as a port of entry).
Extragenital manifestation
Table 1. Diagnostic steps in all urethritis patients | Sample collection | Processing | To detect |
---|---|---|---|
Step 1) |
Men: Swab from the urethra with the eSwab using a thin swab (Figure 1):
Women: If culture desired, arrange for smear of endocervix in gynaecology department. |
Step 1a: Smear on slide dab/smear for Gram stain |
Gram-negative diplococci (Neisseria gonorrhoeae), Other bacteria, Leukocytes |
Step 1b): Then immediately add the smear to the medium |
Neisseria gonorrhoeae culture (incl. resistance) |
||
Step 2) |
Men: first stream urine (min. 2 hrs. after last micturition) Alternatively, if micturition is not possible: In case of urethral swab of step 1, additionally require PCR Women: Vaginal swab |
Care |
Neisseria gonorrhoeae - PCR, Chlamydia trachomatis - PCR |
Step 3) | Blood collection |
Care |
Luesserology, HIV test |
|
Sample collection | Processing | For detection | |
1) | Urethral swab |
Put the swab into the medium |
Mycoplasma genitalium - PCR, Trichomonas vaginalis - PCR |
Genito-anal, pharyngeal, less frequently other localisations.
Barrier measures (attention oral sex).
The therapy recommendation is basically based on the pathogen detection.
Therapy at the initial visit to the polyclinic is based on the result of the direct preparation (Table 1.)
Table 1. Therapy recommendation according to the result of the direct preparation test result | Interpretation | Procedure / Therapy |
Direct preparation unremarkable | Unclear urethritis |
No therapy, Only protected intercourse, Control in 1 week |
In direct preparation gram-negative diplococci (mainly intracellular) and leucocytes (> 5/facial field) | Gonorrhoea |
Ceftriaxone i.m. 1.0g single dose |
In direct preparation leukocytes (> 5/facial field) and possibly bacteria | Non-gonorrhoeal urethritis |
Doxycycline p.o. 100 mg 2x/d for 7 days Alternatively: Second line: Azithromycin 500mg "single dose", then 250mg 1xtgl. for 4 days (IUSTI 2016) |
Further recommendations