Term
2. **Q: Why might a patient with gonorrhoea be asymptomatic?**
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Definition
A: The bacteria can remain dormant for months without causing symptoms.
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Term
3. **Q: What is the first-line treatment for uncomplicated gonorrhoea?**
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Definition
A: **Ceftriaxone 1g IM single dose** (if susceptibility unknown).
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Term
4. **Q: When is ciprofloxacin used instead of ceftriaxone?**
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Definition
A: If gonorrhoea susceptibility to ciprofloxacin is confirmed.
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Term
5. **Q: Why is partner notification critical in gonorrhoea management?**
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Definition
A: To prevent reinfection and further transmission; partners should be tested/treated via GUM clinic or Partner Initiation Programme.
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Term
6. **Q: What advice should be given about sexual activity post-diagnosis?**
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Definition
A: Avoid sex until follow-up confirms clearance of infection. Always use condoms afterward.
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Term
7. **Q: Name two complications of untreated gonorrhoea.**
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Definition
A: Pelvic inflammatory disease (PID), infertility, ectopic pregnancy, or disseminated infection.
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Term
8. **Q: What follow-up is required after treatment?**
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Definition
A: Retest 1–2 weeks post-treatment to confirm eradication.
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Term
9. **Q: How should chlamydia co-infection be managed?**
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Definition
A: Add **doxycycline 100mg BD for 7 days** (or azithromycin if contraindicated).
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Term
10. **Q: What key safe-sex advice should be emphasized?**
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Definition
A: Condoms prevent STIs; hormonal contraceptives do not.
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Term
11. **Q: How might you address a patient’s concern about infidelity?**
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Definition
A: Explain gonorrhoea can be asymptomatic for months; infection may predate the current relationship.
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Term
12. **Q: Why is an HIV test recommended alongside gonorrhoea diagnosis?**
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Definition
A: STIs increase HIV risk; early detection improves outcomes.
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Term
13. **Q: What is the Partner Initiation Programme?**
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Definition
A: A service to anonymously notify/test partners if the patient cannot inform them directly.
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Term
14. **Q: When should the patient seek urgent care post-treatment?**
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Definition
A: If fever, pelvic pain, dysuria, or genital swelling recurs.
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Term
15. **Q: What is the route of transmission for gonorrhoea?**
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Definition
A: Unprotected vaginal, anal, or oral sex with an infected person.
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Term
| What are key differential diagnoses for gonorrhoea in an asymptomatic patient? |
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Definition
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Chlamydia (often co-occurs)
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Trichomoniasis
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Bacterial vaginosis (BV)
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Candidiasis
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Asymptomatic STIs (e.g., HIV, syphilis)
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Term
| Which history questions help differentiate gonorrhoea from chlamydia? |
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Definition
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Have you had painful urination or abnormal discharge?" (More common in gonorrhoea).
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"Have you experienced intermenstrual bleeding?" (More linked to chlamydia).
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Both may be asymptomatic; testing is required.
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Term
How would you distinguish gonorrhoea from trichomoniasis via history?
A: |
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Definition
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Ask about vaginal discharge: "Is it frothy, yellow-green, or foul-smelling?" (Trichomoniasis).
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"Do you have vaginal itching?" (More common in trichomoniasis/candidiasis).
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Term
What questions screen for bacterial vaginosis (BV) as a differential?
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Definition
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Term
| Why is it critical to ask about oral/anal sexual contact? |
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Definition
| Gonorrhoea can infect the throat/rectum, mimicking other conditions (e.g., strep throat, hemorrhoids). Other STIs (e.g., herpes, HPV) may also present similarly. |
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Term
How does a history of recurrent symptoms alter differentials?
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Definition
Suggests:
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Treatment failure (e.g., antibiotic resistance).
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Reinfection (poor partner management).
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Alternative diagnosis (e.g., candidiasis).
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Term
What systemic symptoms suggest disseminated gonococcal infection (DGI)?
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Definition
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"Have you had joint pain, rash, or eye redness?"
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DGI is a complication, not a differential, but critical to identify.
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Term
-
Why is testing for chlamydia essential even if gonorrhoea is confirmed?
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Definition
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Co-infection rates are high (15-25%). Treat with doxycycline 100mg BD for 7 days (covers chlamydia).
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Term
What history points indicate need for HIV/syphilis testing?
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Definition
Multiple sexual partners.
Unprotected sex.
Prior STI history. |
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Term
| How to address a patient’s concern about partner infidelity? |
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Definition
| "Gonorrhoea can be asymptomatic for months. This doesn’t confirm cheating—it may predate your relationship." |
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Term
| BASHH recommend a test of cure at least:.................... |
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Definition
- 72 hours after treatment for culture
- 7 days after treatment for RNA NAAT
- 14 days after treatment for DNA NAAT
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Term
| Why should patients be referred to a GUM clinic? |
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Definition
| For coordinated testing, treatment, contact tracing, and management of other STIs. |
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Term
| What is a “test of cure” and why is it needed? |
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Definition
| Repeat testing after treatment to check if the infection is gone, due to high antibiotic resistance. |
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Term
| What prevention advice should be given? |
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Definition
| Use condoms, limit partners, and get regular STI checks. |
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Term
| What safeguarding action is needed for children/young people with gonorrhoea? |
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Definition
| Consider sexual abuse and involve child protection services. |
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