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Gonorrhoea

Gonorrhoea in women

What is gonorrhoea?

  • Gonorrhoea is a bacterial sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoea.
  • It infects the genital tract including the cervix (neck of the womb), uterus (womb), fallopian tubes, urethra (urine canal), rectum or anus and sometimes the throat and eyes.
  • In women symptoms may be mild or absent but if left untreated may lead to serious complications such as infertility.
  • Testing needs to be done in a specialised sexual health clinic such as the Wolverton Centre as specific testing is required to ensure the correct antibiotics are given.
  • Early treatment will prevent long term problems.
  • If you have gonorrhoea we recommend that you should have a full STI screen including an HIV test.

How common is gonorrhoea?

  • Gonorrhoea is the second most common bacterial STI in the UK.
  • It is found most frequently in young women 16-19 years, young men 20- 24 years and in Black Africans or Afro-carribeans.

How do you catch gonorrhoea?

  • Gonorrhoea is passed on through:
    • unprotected vaginal, anal or oral sex (or sharing sex toys) with someone that has gonorrhoea
    • from an infected mother to her baby at birth
    • sometimes from genitals to fingers to eyes where it may cause conjunctivitis
    • Gonorrhoea cannot be caught by kissing, or from swimming pools, saunas or toilet seats.

What would I notice if I had gonorrhoea?

  • Most women will have very mild or no symptoms at all – hence the term ‘silent disease’ – but they can still pass the infection on.
  • Symptoms if they do occur may include the following:
    • bleeding between periods or after sex
    • pelvic pain particularly during sex
    • ‘cystitis’ or burning pain when passing urine
    • increased vaginal discharge

How do I get tested for gonorrhoea?

  • In women testing involves an internal examination by a doctor or nurse with swabs taken from the cervix (neck of the womb) and sometimes from other sites such as the urethra (urine canal) depending on your symptoms or personal history.
  • For women that do not have any symptoms a self-taken low vaginal swab may be done instead.
  • Urine samples are not reliable enough to use for gonorrhoea testing in women
  • The swabs are sent to Kingston Hospital laboratory where a specific NAATS test and cultures for gonorrhoea are done. Together these tests provide an accurate diagnosis
  • Some results for gonorrhoea may be available during your first visit (by direct microscopy) – but the final results will be ready in 3 days. These will be sent to you via a text message or the nurse may call you.

How is gonorrhoea treated?

  • Gonorrhoea can be easily treated with antibiotics. The most commonly used antibiotics are as follows but different ones may be prescribed depending on the sensitivity profile of your strain of gonorrhoea – some strains are resistant to certain antibiotics.

Either:

  • CEFTRIAXONE 250mg a single injection IM

OR

  • CEFIXIME 400mg  a single dose (2 tablets)

AND

  • AZITHROMYCIN 1g (4 tablets) to cover chlamydia at the same time
  • All treatments from the Wolverton Centre are free and are given to you in the clinic.
  • Allow 7 days for the treatment to work before having sex again.
  • The antibiotics may interfere with the contraceptive pill and make it less effective – use condoms for 7 days after finishing the antibiotics and when you finish your current pack of pills immediately start the next pack i.e. omit the 7 day break
  • The nurse will phone you one week later to discuss your results and make sure you don’t need any more treatment or a follow up test.

What about my partner?

  • Gonorrhoea is a sexually transmitted infection so it is important that all partners are tested and treated before resuming sex again.
  • Some of your previous partners may also need treatment – the nurse will advise about this.

What problems can untreated gonorrhoea lead to?

  • Gonorrhoea infects the cervix (neck of the womb) where it is usually ‘silent’.
  • It may then spread up into the uterus (womb), fallopian tubes and ovaries and lead to pelvic infection.
  • Pelvic infection (called pelvic inflammatory disease or PID Click here for further information on PID) may cause pelvic pain (but sometimes there is no pain) and damage / scarring of the fallopian tubes.
  • PID can result in an ectopic pregnancy (baby in the tube) and infertility.
  • Gonorrhoea can spread to the blood or joints and lead to very serious infection.
  • These problems can be prevented by early treatment of gonorrhoea.

Gonorrhoea in pregnancy

  • Pregnant women with gonorrhoea may pass the infection onto their baby during vaginal delivery.
  • Babies may develop a sticky eye (conjunctivitis) or more seriously septicaemia.
  • Pregnant women can be easily tested and treated during pregnancy and this will prevent infection in the baby.
  • All pregnant women are advised to have a repeat test after treatment to ensure the gonorrhoea has gone.

Will gonorrhoea come back again after treatment?

  • Treatment for gonorrhoea always works – as long as you have taken the right antibiotics correctly (your doctor will advise about this) and checked that your partner has been tested and treated too.
  • But you could catch gonorrhoea again so it is important to use condoms with new partners and both get tested for STIs before having sex without a condom.

For more information

http://www.bashh.org/

http://www.nhs.uk/Livewell/STIs/Pages/STIs-hub.aspx