Gonorrhea - Uncomplicated Anogenital Infection Initial Assessment

Clinical Presentation

Signs and Symptoms

Most of the infected females are asymptomatic but may present with increased or altered vaginal discharge (most common), dysuria, urethral discharge, abnormal vaginal bleeding, vulval itching or burning, dyspareunia, conjunctivitis, and proctitis.

History

Inquire regarding the patient’s sexual activities and identify possible risk factors.

 

Physical Examination

Perform a general assessment and look for signs of a sexually transmitted infection (STI). Examine mucocutaneous regions, including the conjunctivae, pharynx, and endocervix. External genitalia should be inspected for anatomical irregularities, cutaneous lesions, inflammation, and urethral discharge. For perianal inspection, a digital rectal exam and anoscopy should be considered if the patient has practiced receptive anal intercourse or has rectal symptoms. Colonization can take place even without anal intercourse. Inguinal lymph nodes should be palpated.

Illuminated Speculum Exam



Gonorrhea - Uncomplicated Anogenital Infection_Initial AssesmentGonorrhea - Uncomplicated Anogenital Infection_Initial Assesment




Visualize the cervix and vaginal walls. Evaluate vaginal and endocervical vaginal discharge. Observe for cervical mucopus, erosions, and friability, which may be associated with cervical infections. If resources are available, obtain specimens such as a cervical swab for a Chlamydia test and gonorrhea culture and a vaginal swab for a Gram stain and Trichomonas slide.

Bimanual Pelvic Exam

A bimanual pelvic examination should be done to detect uterine or adnexal masses, tenderness, or cervical motion tenderness. 

Diagnosis or Diagnostic Criteria

A syndromic management approach may be used in health care facilities where equipment and trained personnel for determining sexually transmitted infection (STI) etiology are not available. Syndromic management is based on consistent groups of symptoms and easily recognized signs. Treatment will cover the most common or serious organisms involved in causing the syndrome. Using syndromic management in cases of vaginal discharge is limited, especially if lower genital tract infections are the cause (gonococcal or chlamydial).