05.04 Nursing Care and Pathophysiology for Gonorrhea (STI)

Hey there, it's Meg again! During this lesson we're going to go over another commn STI: gonorrhea. This one is often detected a lot earlier than some of its STI siblings because of its trademark symptom: purulent discharge. Let's go ahead and get started.

So let's talk gonorrhea. It spreads between mucous membranes, so we often see it in our patients' genitalia, but it can also occur in the eyes. Gonorrhea and chlamydia are really best buds, so we often see them co-infecting together. Gonorrhea can spread during childbirth, so we have some preventative measures that will talk about. Untreated, it can have devastating long-term effects on both men and women.

So first let's talk about the way patients with gonorrhea are going to look. The way I keep gonorrhea straight from other STIs is by the word fragment, -rrhea. So think diarrhea or rhinorrhea, which is a runny nose. This means we know we're talking about some sort of runny discharge. Like most STIs it is more common in females. So, sorry ladies! Symptoms between males and females are pretty similar. Gonorrhea is one of the easiest STIs to detect because it does have common symptoms and that's the purulent discharge that you can see on this picture right here. Now, patients may also get these type of sores on their genitalia, but the thing that we're really going to be talking about is the discharge-- that is really the trademark symptom. Patients can also have a fever, they can have some pelvic pain, and they can even have some lower back pain-- but that's more when we're talking about pelvic inflammatory disease, which we'll get to in a moment-- or testicular pain in males. Unlike some other STIs, symptoms in just one week after infection. That also means that it's a little bit easier to nail down that patient's sexual history so that we make sure we're notifying the right people.

Okay, so we've talked about sort of the initial presentation of a patient with gonorrhea, but there are two pretty serious longterm complications if we don't treat gonorrhea. The first is a lot lesser known, and that is DGI, or disseminated gonococcal infection. It can be potentially fatal and causes skin abnormalities and joint pain. This is called a dermatitis-arthritis syndrome and what you see right here is this sort of abnormal looking lesion. And this could be confused for a lot of things-- it kind of looks like a Basal Cell Carcinoma, but that is actually DGI. All right, then the other one is much more well-known and that is pelvic inflammatory disease. This is prevalent and serious enough that it has its own lesson, so I encourage you to definitely look into pelvic inflammatory disease. It leads to potential for infertility in women and it's especially a risk with gonorrhea and chlamydia, which often cohabitate. So those are two of the major culprits of pelvic inflammatory disease. Like I said, there is a whole lesson dedicated to pelvic inflammatory disease. So once you finish your lessons on gonorrhea and chlamydia, I highly encourage that you either revisit that one or take a deep look at it.

Like other STIs gonorrhea can be transmitted during a vaginal delivery, and about a quarter of babies are going to get this infection if their mom has an infection through a vaginal delivery. This is actually so prevalent and can be so serious that the standard of care for all infants after a vaginal delivery is a one time dose of Erythromycin eye ointment. They are going to get this immediately after delivery. What happens is the nurse or the doctor will let the baby say hi to mom and then they'll take it away. They'll do the second set of apgar scores. They'll do the weight, they'll sort of clean it up a little bit, and then in that same period of time, the baby is going to get that eye ointment. So it is immediately after delivery. Like any other medication, parents have the right to refuse this, so it's important that we're educating our parents. We also have to obtain a consent for this as well.

If an infant is born to a mother with a known infection they're also going to get a one-time weight based dose of Ceftriaxone IV. So that is different-- all babies get erythromycin, only babies born to mothers with a gonorrhea infection are going to get Ceftriaxone IV.

So let's talk about treatment of gonorrhea in the adult patients. Unlike other STIs, gonorrhea is actually curable, but catching it early and giving patients antibiotics early on is going to help prevent the late stages of disease, like pelvic inflammatory disease and DGI. We assume patients have chlamydia if they have gonorrhea because they happen together just that often. When we treat a patient for gonorrhea, we go ahead and we're going to treat them for chlamydia as well. So this Azithromycin, this is actually for chlamydia. Just like the babies we give adults Ceftriaxone, and this is the one that's actually for gonorrhea.

It's also important to notify and treat sexual partners. With symptoms occurring within one week, it's a lot easier to narrow down that search and figure out who we need to tell. If you think about it, it's much better than a 90 day incubation, like some other STIs. Notifying and treating those recent sexual partners is really going to be key. The other thing about gonorrhea is we are going to treat partners regardless of symptoms. Even asymptomatic partners are going to be treated for gonorrhea and chlamydia.

When we're talking about health promotion in relation to any STI, it's going to be two-fold. We need to know our risk factors and we need to know how to prevent it. The risk factors for gonorrhea, they're going to be very similar to most other STIs-- they're going to be sex related. Gonorrhea specifically is common in sex workers. So, that is important to know about the sex worker population. In addition, unprotected sex, having new sex partners or multiple sex partners and having other STI is another risk factor. Remember chlamydia and gonorrhea, they're best buds. So how are we going to prevent it? Well, it's going to be mitigating those risk factors. We're going to be talking about using condoms, safe sex use. Condoms-- cannot stress that enough. We also are going to talk about limiting the number of sexual partners, though that is really a lifestyle change. Having those sort of conversations with your patients, you're going to be wanting to be very direct, but you're also going to be respectful of their choices. Another key preventative measure with gonorrhea is going to be no sex one week after infection. The risk of reinfection for gonorrhea is very high. So during that one week period, we need to let the antibiotics do their job, and then they can resume sexual activity with a condom one week after they're treated for their infection. And then finally, remember we're treating infants. We're going to do one of two things with infants. We're either going to be prophylactic, so we're treating it because it might happen, or therapeutic-- and that's going to be are our babies that are born to moms with gonorrhea.

So let's review our priority nursing concepts for patients with gonorrhea. First, health promotion, we need to prevent the disease and prevent the spread of infection. Remember, it can cause infertility if we don't treat it and it progresses to pelvic inflammatory disease. And then finally, sexuality. Not only is it sexually transmitted, but we also need to make sure we're notifying sexual partners and understanding the sexual dynamic and the relationship dynamics of our patients.

And finally, our key points. Let's remember, gonorrhea is sexually transmitted and it often occurs with other STIs. We can actually cure this STI if we're treating it with antibiotics. Remember, we treat all infants preventatively and we also treat infants born to mothers who test positive with a therapeutic dose of antibiotic. And finally, but most importantly, safe sex is a non-negotiable when it comes to preventing STIs-- encourage your patients to use condoms.

All right, folks, that is it for gonorrhea. Safe sex is the way to go. And don't you forget it. Now, go out and be your best selves today. And as always, happy nursing.