Epidemiology of gonorrhoea : 

A. Occurrence : Gonorrhoea is the most frequent of the venereal diseases. It is endemic all over the world.

B. Ecological triad : 

1. Agent: Neisseria gonorrhoea
2. Host : 

• Age : Most infections occurs in the 15 to 30 years of age group.
• Sex : Both sexes are affeced.
• Immunity : Infection does not confer immunity

C. Natural history : 

1. Reservoir : Cases and carriers
2. Infectious period : It extends for months or years.
3. Mode of transmission  : 

• Direct sexual contact.
• From infected mother to her new born

 4. Incubation period : 2- 10 days.

Symptoms of gonorrhoea : 

1. Urinary symptoms : Dysuria (25%).
2. Excessive irritant vaginal discharge (50%).
3. Acute unilateral pain and swelling over the labia due to incolvement of Bartholin’s gland
4. There may be rectal discomfort due to associated proctitis from genital contamination.
5. Soreness in the vulva ( non – itching).
6. Others.

• Pharyngeal infection.
• Intermenstrual bleeding.

Signs of gonorrhoea :

1. Labia may be swollen and look inflamed.
2. The vaginal discharge is mucopurulent.
3. The external urethral meatus and the openings of the Bartholin’s duct look congested.
4. Speculum examination reveals congested ectocervix with increased mucopurulent cervical secretions escaping out through the external OS.

Investigation of gonorrhoea : 

1. Nucleic acid amplification testing (NAAT) of urine or endocervical discharge id done which is very sensitive and specific (95%).
2. DNA based tests are used for screening.
3. Culture of the discharge in Thayer- Martin medium.
4. CFT for gonorrhoea
5. Monoclonal antibody

Treatment  of gonorrhoea : 

A. Uncomplicated infection : 

1. Cefixime 400 mg stat, or
2. Ciprofloxacin 500 mg orally, stat, or
3. Ofloxacin 400 mg Orally stat, or
4. Ampicillin 3 grams plus probenecid 1 g orally stat.

B. Quninolone resistance : 

1. Ceftriaxone 250 mg stat or
2. Spectinomycin 2 g I/M stat.

C. Pregnancy and breast feeding : 

1. Cefixime 400 mg stat, or 
2. Ceftriaxone 250 mg I/M stat or 
3. Ampicillin 3 grams plus probenecid 1 g orally stat, or
4. Spectinomycin 2 g I/M stat.

D. Pharyngeal gonorrhoea : 

1. Cefixime 400 mg stat, or
2. Ceftriaxone 250 mg stat or
3. Ciprofloxacin 500 mg orally, stat, or
4. Ofloxacin 400 mg orally stat.

Prevention of gonorrhea : 

1. Adequate therapy for gonococcal infection and meticulous follow up are to be done till the patient is decleared cure.
2. To treat adequately the male sexual partner sumultaneously.
3. To avoid multople sex partner.\
4. To use condom till both the sexual partners are fee from disesase.

Complication of gonorrhoea : 

1. Acute prostatitis.
2. Epididymo – Orchitis.
3. Pelvic inflammatory disease (PID)
4. Stricture urethra
5. Bacteraemia
6. Bartholin gland abscess.
7. Acute gonococcal urethritis.
8. Septicaemia.
9. Acute purulent conjunctivitis