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Gonorrhea Nursing Guide

The content for this course was created by Tameka N. Warren, MSN, RN, CLC.

Gonorrhea Overview

This course is intended as a Quick Reference for gonorrhea and will cover an overview as well as nursing considerations utilizing the nursing process. 

Gonorrhea Etiology and Epidemiology 

In the U.S., gonorrhea is the second most common sexually transmitted infection. The bacteria responsible for causing gonorrhea is the Neisseria gonorrhoeae bacterium or N. gonorrhoeae (Centers for Disease Control and Prevention [CDC], 2021b). In 2018, more than 1.6 million new gonorrhea infections were diagnosed, and half of those new infections where among those aged 15 to 24 (CDC, 2021b). 

These staggering numbers can be due to the fact that many infected are asymptomatic. Women in particular are mostly asymptomatic or experience very mild symptoms. Men, however, do experience symptoms more frequently (CDC, 2021b). 

Gonorrhea is transmitted through unprotected vaginal, anal, and oral sex. Gonorrhea usually affects the urethra and rectum of both males and females but can infect other areas of the body including the throat, eyes, and joints. However, in females, the cervix can also be affected. 

During childbirth, gonorrhea can also be transmitted to the infant. 

 Complications can vary and may include (CDC, 2021b): 

  • Infertility in men (epididymitis) and women (pelvic inflammatory disease or PID) 
  • Gonococcal arthritis 
  • Disseminated gonococcal infection (DGI) 
  • Increased risk of HIV transmission 
  • Pregnancy and neonatal complications 
  • Blindness 
  • Blood infections 
  • Joint infections 

Gonorrhea Diagnosis 

Diagnostic tests include (CDC, 2021c): 

  • Culture: Endocervical, urethral, oropharyngeal, conjunctival, and rectal specimens can be collected 
  • Nucleic acid amplification testing (NAAT) and point of care (POC) NAAT: Urine and endocervical, vaginal, urethral, rectal, and pharyngeal swab specimens 

Gonorrhea Management 

Gonorrhea may be managed with antibiotic therapy, if appropriate. Uncomplicated cases of gonorrhea can be treated with a recommended one-dose injection of ceftriaxone (CDC, 2020c): 

  • 500 milligrams (mg) if the individual weights less than 150 kilograms (kg) or 330.693 pounds (lbs) 
  • 1 gram (g) if the individual’s weight is equal or greater than 150kg or 330.693 pounds 

In cases when ceftriaxone is not available, the following antibiotic treatments are recommended (CDC, 2020c): 

  • Gentamicin 240 mg injection in a single dose plus one of the following: 
    • Azithromycin 2 g orally in a single dose 
    • Cefixime 800 mg orally in a single dose 

It is important to note that some gonorrhea infections are resistant to antibiotic treatments. It is recommended to retest for cure of the gonorrhea infection 7 days after treatment to confirm efficacy. If symptoms persist and a retest is still positive for gonorrhea, the individual should be tested for antimicrobial-resistant N. gonorrhoeae. This will help guide treatment to find a suitable medication for treatment of that particular type of gonorrhea. 

 Antibiotic resistant gonorrhea is, and continues to be, a growing concern and problem when trying to control infections and manage cases. Cephalosporins are the last type of antibiotic that is effective against gonorrhea (CDC, 2020a). 

Gonorrhea Nursing Care Plan

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for gonorrhea are listed below. 

Gonorrhea Assessment 

A thorough history should be taken and include: 

  • Past and present health condition 
  • Current symptoms 
  • Sexual history and practices 
  • Menses history 

Upon physical assessment for gonorrhea, redness, swelling of affected areas, and a tender abdominal region may be noted. 

The individual may report the following symptoms (CDC, 2020b): 

  • Pain 
  • Testicular or scrotal 
  • Lower abdominal 
  • Throat 
  • Upon urination 
  • With intercourse 
  • Bleeding with intercourse and bleeding between periods 
  • Vaginal/penile discharge (purulent and/or bloody) 

During assessment, it is also important to assess the individual’s emotional and mental state. Depression, anxiety, and even self-harm behaviors may be discovered due to gonorrhea. 

Nursing Diagnosis/Risk For 

During the primary and recurrent episodes/outbreaks the individual is at risk of the following nursing diagnoses: 

  • Risk for acute pain 
  • Risk of infection 
  • Risk of deficient knowledge of disease and disease processes 
  • Risk for infection transmission 
  • Risk for disruption of the symbiotic maternal-fetal dyad 

There is a societal stigma surrounding gonorrhea, which can lead to psychological distress and can have a negative impact on quality of life, interpersonal, and sexual relationships (WHO, 2021). Nursing diagnosis related to these factors must also be explored: 

  • Risk for ineffective coping 
  • Risk for anxiety 
  • Risk for depression 

Interventions 

Interventions should include measures to increase comfort during active infections including: 

  • Following the prescribed antibiotic treatment 
  • Pain control through over-the-counter analgesics 
  • Sitz baths to ease pain 
  • Warm compresses for abdominal or joint discomfort 

Expected Outcomes 

Report a decrease in: 

  • Symptoms 
  • Unsafe sex practices 
  • Anxiety due to illness 

Patient/Caregiver Education 

  • Disease process: Educate on various disease topics needed for adequate management. 
  • Transfer of infection: Ensure the individual is aware of methods to help reduce the transfer of infection to other parts of their bodies, especially the eyes. 
  • Transmission prevention: Ensure the individual understands that condom use is important; however, gonorrhea can be spread with the use of a condom (CDC, 2021a). 
  • Reinfection possibilities: Ensure the individual is aware they can be reinfected by an untreated partner. 
  • Communication: The individual must communicate with partners about their gonorrhea status and methods for them all to stay protected. 
  • Self-care measures and support groups. 

Pharmacology of Drugs for Sexually Transmitted Infections: Syphilis and Gonorrhea

The goal of this course is to provide an overview of pharmacological recommendations for those members of the healthcare team that may treat syphilis and gonorrhea.


 

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Additional Information

Content Release Date

4/1/2022

Content Expiration

12/31/2025

Course Contributor 

The content for this course was created by Tameka N. Warren, MSN, RN, CLC. 

Tameka N. Warren, MSN, RN, CLC, earned her Bachelor and Master of Science in Nursing degrees from Indiana University School of Nursing at IUPUI, and her Associate of Science in Nursing from Ivy Tech College. She has over 16 years of nursing experience in public health, regulation, home health, education, maternal child community health, and long-term care environments. Tameka served as a Public Health Nurse Surveyor (Home Health & Hospice) certified by the Centers for Medicare & Medicaid Services, or CMS, a maternal and infant mortality advocate, an ALPP Certified Lactation Counselor, and an Adjunct Clinical Professor. Tameka’s passion is to serve the most vulnerable populations affected by health disparities and to inspire a new generation of nurses to do the same successfully. 

Resource 

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