Gonorrhoea is the most commonly reported notifiable disease in Australia. It is contagious and mainly spread by sexual intercourse. It predominantly affects mucosal and glandular structures of the genital tract and, less commonly, the rectum, oropharynx or conjunctivae. The causative organism is Neisseria gonorrhoeae, a fastidious, gram negative, kidney -shaped diplococcus.
B-lactamase (penicillinase) producing N gonorrhoeae (PPNG) is resistant to penicillin and is common in South East Asia and endemic in Australia. Spectinomycin and cephalosporins are effective in treating these infections. Spectinomycin-resistant PPNG strains have been reported but are not yet a problem. A high incidence of PPNG indicates poor STD control. Although the total number of cases of gonorrhoea in Australia has been falling for several years, the proportion of cases with PPNG infection is increasing.
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Antibiotics effective against gram negative or anaerobic bacilli are used when PID complicates delivery, abortion or gynaecological procedure or if these organisms complicate gonococcal or chlamydial PID. Various combinations of a penicillin, tetracycline, clindamycin, an imidazole (metronidazole, tinidazole or omidazole) or other agents will be used depending upon the circumstances of each particular case.
In an acute case, the failure to respond to antibiotic treatment in 24 to 48 hours may indicate a mistaken diagnosis (appendicitis, ectopic pregnancy), pus in the pouch of Douglas or tubo-ovarian abscess and surgical intervention may be necessary. Salpingectomy or salpingo-oophorectomy is indicated for tubal or tubo-ovarian abscess. Unless the life of the patient is endangered, trial of antibiotic therapy should be considered if the diagnosis is in doubt
Women with PID should be regularly reviewed to detect reinfections or relapses in an attempt to prevent long term sequelae such as tubal damage leading to ectopic pregnancy or infertility, recurrent pelvic pain, menstrual irregularities and depression.
Male partners of women with PID should be examined and treated if indicated as they often have gonococcal or chlamydial urethral infections.
In 1988, NHMRC approved the publication of a working party report on pelvic inflammatory disease.
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