Hive Medical Trivia: Weekend Wrap-up

It is the weekend again. We had the trivia focus on gonorrhoea this week.
Sexually transmitted infections (STIs) like gonorrhoea can have serious consequences if left untreated, especially in women of reproductive age.

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Monday: Diagnosing Gonorrhea Based on Symptoms

Case:
A 24-year-old woman presents with increased vaginal discharge and mild lower abdominal pain. She is sexually active and has had multiple partners in the last 6 months. She denies fever but reports occasional burning during urination.

Options:
A) Gonorrhea
B) Bacterial vaginosis
C) Candidiasis
D) Urinary tract infection

Answer:
A) Gonorrhea

Explanation:
This patient’s sexual history and symptoms—especially abnormal vaginal discharge, dysuria, and mild pelvic discomfort—strongly suggest gonorrhea. Gonorrhea often presents with minimal or non-specific symptoms in women, which is why a high index of suspicion is necessary in sexually active individuals with new or multiple partners. Bacterial vaginosis and candidiasis are more likely to present with itching or a distinct discharge without pelvic discomfort, and UTIs typically don’t cause increased vaginal discharge.

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Tuesday: Complication of Untreated Gonorrhea

Case:
A 30-year-old woman with a history of untreated gonorrhea presents with fever, severe lower abdominal pain, and pain during intercourse. On examination, she has tenderness in the lower abdomen and cervical motion tenderness.

Options:
A) Pelvic inflammatory disease (PID)
B) Ectopic pregnancy
C) Ovarian cyst rupture
D) Endometriosis

Answer:
A) Pelvic inflammatory disease (PID)

Explanation:
The combination of fever, lower abdominal pain, cervical motion tenderness, and a history of untreated gonorrhea is classic for pelvic inflammatory disease (PID). PID is a serious complication resulting from ascending infection of the female reproductive tract. If left untreated, PID can lead to infertility, chronic pelvic pain, and increase the risk of ectopic pregnancy—though these are consequences of PID rather than immediate complications.

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Thursday: Best Test for Gonorrhea in Women

Case:
A 26-year-old woman is asymptomatic but had a partner recently diagnosed with gonorrhea. She wants to get tested but is unsure how the test is done.

Options:
A) Blood test for gonorrhea antibodies
B) Pelvic ultrasound
C) Skin swab
D) Nucleic Acid Amplification Test (NAAT) on a vaginal or cervical swab

Answer:
D) Nucleic Acid Amplification Test (NAAT) on a vaginal or cervical swab

Explanation:
The NAAT is the gold standard for diagnosing gonorrhea and chlamydia. It's highly sensitive and specific and can be performed using urine samples or swabs from the cervix, vagina, urethra, or rectum depending on exposure. Blood tests are not useful for detecting current gonorrheal infections, and pelvic ultrasound or skin swabs are not diagnostic tools for STIs.

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Friday: Risk to Baby if Gonorrhea is Untreated in Pregnancy

Case:
A 28-year-old pregnant woman (12 weeks) tests positive for gonorrhea during a routine antenatal check-up. She is worried about the baby.

Options:
A) Neonatal conjunctivitis (ophthalmia neonatorum)
B) Preterm labor
C) Fetal malformations
D) Stillbirth

Answer:
A) Neonatal conjunctivitis (ophthalmia neonatorum)

Explanation:
Neonatal conjunctivitis, also known as ophthalmia neonatorum, is the most serious risk to the baby if maternal gonorrhea goes untreated. The baby can acquire the infection during delivery, leading to a severe eye infection that can cause blindness. This is why routine screening and treatment of STIs during pregnancy is crucial. Preterm labor is also a possible risk, but not the most serious or direct complication. Gonorrhea does not cause fetal malformations.

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Final Thoughts:

Gonorrhea remains a significant public health concern, especially among sexually active women. Early detection through screening, proper antibiotic treatment, and partner notification are key to preventing complications such as PID, infertility, and neonatal infections. If you're sexually active or pregnant, regular STI screening is an essential part of maintaining both your health and your baby’s well-being.

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If you found this helpful, share it with someone who might benefit from understanding more about STIs and women’s health. Stay informed and stay safe!

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