1. Gonorrhoea & PID
PHCP 402
By K S Labaran

2. Risk factors Multiple or new sex partners Or inconsistent condom use
Urban resistance in areas with disease prevalence
Adolescent, females particularly
Lower socio-economic status
Exchange of sex for drugs or money

3. Unmarried marital status

4. Transmission Efficiently transmitted by Male to female via semen
Vagina to male urethra
Perinatal transmission
Gonorrhoea is associated with increased transmission of and susceptibility to HIV infection

5. What causes it Neisseria gonorrhoeae
Gram–negative intracellular diplococcus

6. Clinical manifestations
Genital infection in men
Becomes clinically apparent 1 to 7 days after contact with an infected source
First sign
Purulent discharge
Often accompanied by dysuria
Discharge may be clear or cloudy

7. Also
Unilateral testicular pain and swelling
Infrequent, but most common local complications in males

8. Genital infection: women
Often asymptomatic
At least 50%
Non-specific symptoms
Symptoms may occur within 10 days of infection
Abnormal vaginal discharge

9. Inter-menstrual bleeding
Dysuria
Lower abdominal pain
Patients with asymptomatic disease serve as reservoirs for the infection
Men may be asymptomatic carriers as well

10. Complications in women
Pelvic inflammatory disease (PID)
May be asymptomatic
May present with
Lower abdominal pain
Discharge
Irregular menstrual bleeding
Fever

11. Treatment for uncomplicated gonococcal infections
Ceftriaxone + Azithromycin or Doxycycline
Alternative if allergic to cephalosporins
Cipro Or
Ofloxacin
Azithromycin
Pregnancy?

12. Follow-up
A test of cure is recommended if an alternative regimen is administered
Repeat testing in 3 months

13. Screening
1st prenatal visit for women at risk/living in an area in which prevalence is high
Repeat test in the 3rd trimester for those at continued risk

14. Partner management
Evaluate and treat all sex partners for N. gonorrhoeae and C. trachomatis infections if contact was within 60 days of symptoms or diagnosis
If last sexual intercourse was >60 days treat most recent sex partner
Avoid sex until therapy is completed and both partners have no symptoms

15. Counselling/education
Nature of the disease
Asymptomatic in females and usually symptomatic in males
Untreated infections can lead to PID, infertility, and ectopic pregnancy
Epididymitis in men
Transmission
Efficiently transmitted
Risk reduction
Use prevention strategies

16. Pelvic inflammatory disease (PID)

17. It is a clinical syndrome associated with ascending spread of microorganisms from the vagina or cervix to the endometrium, fallopian tubes, ovaries
Comprises of spectrum of inflammatory disorders including any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis

18. Peritonitis
Salpingitis/ooophoritis/ tubo-ovarian abscess
Endometritis
Cervicitis

19. Risk factors
Gonorrhoea or chlamydia, or a history of gonorrhea or chlamydia
Male partners with gonorrhea or chlamydia
Insertion of IUD
Oral contraceptive use

20. Etiology Most cases are polymicrobial Most common pathogens:
N. gonorrhea (upto 80% of cases)
C. trachomatis (upto 40%)
Combination of both organisms ( upto 75% of cases)

21. Classification Subclinical/silent (60%)
Mild to moderate symptoms (36%)
Severe symptoms (4%)

22. sequelae
Ectopic pregnancy
Infertility
Chronic pelvic pain

23. Management
Ceftriaxone + Doxycycline with or without Metronidazole

24. Partner management
Male sex partners should be examined and treated if they had sexual contact with the patient during the 60 days preceding the patient’s onset of symptoms
Male partners are often asymptomatic