Gonorrhoea
Neisseria gonorrhoeae is a gram-negative diplococcus that directly invades columnar and transitional epithelium, producing a florid local inflammatory response set against a backdrop of rapidly evolving antimicrobial resistance that dictates how it must be tested and treated.
In a nutshell
Neisseria gonorrhoeae directly invades columnar and transitional epithelium, provoking a brisk neutrophilic response that makes infection florid and symptomatic in men but often silent in women. Rising antimicrobial resistance means culture and susceptibility testing, not NAAT alone, underpins safe treatment.
Classic presentation
A man with a short-incubation, profuse purulent urethral discharge and dysuria, or a woman identified on screening with mild or no symptoms.
Key points
- Direct epithelial invasion causes a florid neutrophilic response, unlike the low-grade inflammation of chlamydia, hence the purulent discharge in men.
- Women are frequently asymptomatic despite identical underlying infection, mirroring chlamydia's epidemiology.
- Culture (not just NAAT) is essential because of evolving antimicrobial resistance, guiding safe antibiotic choice.
- Untreated infection can ascend to pelvic inflammatory disease or disseminate as bacteraemic infection with rash and septic arthritis.
- A test of cure is routinely arranged after treatment, unlike for chlamydia, reflecting the resistance risk.
- Partner notification and epidemiological treatment are essential to prevent reinfection and onward transmission.
First-line investigation
NAAT to detect infection, with a culture swab taken wherever possible for antimicrobial susceptibility testing before treatment is started.
First-line management
A single-dose antibiotic regimen per current BASHH guidance (commonly an injectable cephalosporin), followed by a test of cure and partner notification.
Exam traps
- NAAT alone cannot confirm that treatment will work: culture and sensitivities are needed because of resistance.
- Do not assume gonorrhoea is asymptomatic like chlamydia in men: the short incubation and purulent discharge are classic and often prompt earlier presentation.
- A test of cure is routine for gonorrhoea but not for uncomplicated chlamydia: do not conflate the two follow-up pathways.
Educational content pending clinical review. Not medical advice.