Gonorrhoea infection: diagnosis and treatment
pharmaceutical-journal.com/article/ld/gonorrhoea-infection-diagnosis-and-treatment
Diagnoses of gonorrhoea in England rose by 26% between 2017 and 2018. Pharmacy
teams can help prevent transmission and promote good sexual health practices through
identifying patients at risk.
An artist’s rendering of the gram-negative diplococci bacteria Neisseria gonorrhoeae
Science Photo Library
Gonorrhoea is a sexually transmitted infection (STI) caused by the Gram-negative
bacterium Neisseria gonorrhoeae (N. gonorrhoeae) that primarily affects the urogenital
tract and rectum, as well as extragenital sites, such as the pharynx, endocervix and
conjunctiva[1],[2] .
In 2018, the World Health Organization estimated there were 87 million new cases of
gonorrhoea worldwide, with 54,798 new diagnoses made in England and 3,233 in
Scotland during the same year[3] ,[4],[5] . With a 14% decrease (equal to £96m) in total
local authority spending on sexual health between 2013 and 2018, coupled with
increasing infection and antimicrobial resistance rates, gonorrhoea presents a significant
public health challenge for healthcare professionals and policymakers[6] .
Guidance published by Public Health England (PHE) in 2019 suggested that pharmacists
could help alleviate some of the current burdens on the system, because of their
accessibility to deprived communities and the trusted relationship they enjoy with the local
1/13
, communities they interact with daily[7] .
Pharmacies are a source of healthcare advice for patients in the community. Pharmacists
can refer patients to sexual health services and are opportunistically able to promote
good sexual health practices. Pharmacists are also well trained in identifying a wide
range of symptoms and making treatment recommendations, which are covered in this
article on gonorrhoea infection.
Epidemiology and transmission
With transmission of gonorrhoea occurring through direct inoculation of infected
secretions from one mucous membrane to another, anyone who is sexually active can
become infected, but particular risk factors include multiple sexual partners, a current or
prior history of STIs and inconsistent condom usage[8] .
The highest incidence of infection is seen in those aged between 20–24 years, in men
who have sex with men (MSM), black ethnic minorities and individuals with increased
rates of partner change[9] . Localised geographical outbreaks can occur, often in urban
areas as transmission tends to concentrate within sexual networks[10] . Relative
socioeconomic deprivation has been linked with increased infection rates, the reason for
which is likely a mix of factors including education, job security and access to services
within these communities[11] .
Signs and symptoms
Gonorrhoea presents as an uncomplicated infection of the lower genital urethral tract with
symptoms following a two to five day incubation period[12],[13] . Male urethral infection is
symptomatic in more than 90% of cases; however, one in ten infected men and almost
half of infected women do not experience any symptoms[1],[14] .
White, yellow or green mucopurulent urethral discharge and pain upon urination (dysuria)
are among the more common symptoms in men; however, testicular or rectal pain and
epididymitis may also occur[13] .
Women may present with odourless white, yellow or green vaginal discharge or dysuria.
In cervical infection, abnormal uterine bleeding and mucopurulent discharge may be
found on examination, as well as pain during sexual intercourse (dyspareunia)[12] . Lower
abdominal pain and fever may indicate ascending infection, such as pelvic inflammatory
disease (PID)[15] .
The majority of men and women with rectal infections are asymptomatic; however, some
may present with anal discharge, pain, discomfort and pruritis[13] . Pharyngeal infection is
predominantly asymptomatic, occasionally presenting with a sore throat[13] .
Complications
2/13
pharmaceutical-journal.com/article/ld/gonorrhoea-infection-diagnosis-and-treatment
Diagnoses of gonorrhoea in England rose by 26% between 2017 and 2018. Pharmacy
teams can help prevent transmission and promote good sexual health practices through
identifying patients at risk.
An artist’s rendering of the gram-negative diplococci bacteria Neisseria gonorrhoeae
Science Photo Library
Gonorrhoea is a sexually transmitted infection (STI) caused by the Gram-negative
bacterium Neisseria gonorrhoeae (N. gonorrhoeae) that primarily affects the urogenital
tract and rectum, as well as extragenital sites, such as the pharynx, endocervix and
conjunctiva[1],[2] .
In 2018, the World Health Organization estimated there were 87 million new cases of
gonorrhoea worldwide, with 54,798 new diagnoses made in England and 3,233 in
Scotland during the same year[3] ,[4],[5] . With a 14% decrease (equal to £96m) in total
local authority spending on sexual health between 2013 and 2018, coupled with
increasing infection and antimicrobial resistance rates, gonorrhoea presents a significant
public health challenge for healthcare professionals and policymakers[6] .
Guidance published by Public Health England (PHE) in 2019 suggested that pharmacists
could help alleviate some of the current burdens on the system, because of their
accessibility to deprived communities and the trusted relationship they enjoy with the local
1/13
, communities they interact with daily[7] .
Pharmacies are a source of healthcare advice for patients in the community. Pharmacists
can refer patients to sexual health services and are opportunistically able to promote
good sexual health practices. Pharmacists are also well trained in identifying a wide
range of symptoms and making treatment recommendations, which are covered in this
article on gonorrhoea infection.
Epidemiology and transmission
With transmission of gonorrhoea occurring through direct inoculation of infected
secretions from one mucous membrane to another, anyone who is sexually active can
become infected, but particular risk factors include multiple sexual partners, a current or
prior history of STIs and inconsistent condom usage[8] .
The highest incidence of infection is seen in those aged between 20–24 years, in men
who have sex with men (MSM), black ethnic minorities and individuals with increased
rates of partner change[9] . Localised geographical outbreaks can occur, often in urban
areas as transmission tends to concentrate within sexual networks[10] . Relative
socioeconomic deprivation has been linked with increased infection rates, the reason for
which is likely a mix of factors including education, job security and access to services
within these communities[11] .
Signs and symptoms
Gonorrhoea presents as an uncomplicated infection of the lower genital urethral tract with
symptoms following a two to five day incubation period[12],[13] . Male urethral infection is
symptomatic in more than 90% of cases; however, one in ten infected men and almost
half of infected women do not experience any symptoms[1],[14] .
White, yellow or green mucopurulent urethral discharge and pain upon urination (dysuria)
are among the more common symptoms in men; however, testicular or rectal pain and
epididymitis may also occur[13] .
Women may present with odourless white, yellow or green vaginal discharge or dysuria.
In cervical infection, abnormal uterine bleeding and mucopurulent discharge may be
found on examination, as well as pain during sexual intercourse (dyspareunia)[12] . Lower
abdominal pain and fever may indicate ascending infection, such as pelvic inflammatory
disease (PID)[15] .
The majority of men and women with rectal infections are asymptomatic; however, some
may present with anal discharge, pain, discomfort and pruritis[13] . Pharyngeal infection is
predominantly asymptomatic, occasionally presenting with a sore throat[13] .
Complications
2/13
