Treatment for Gonorrhea

Important points regarding treatment

 

  1. Suspected or diagnosed infection should be followed up for confirmation
  2. Once treated, symptoms will recede.
  3. You or patient should refrain from sexual activity until the end of treatment
  4. It is important that you or patient complete treatment
  5. Safe sex should be practiced in the future to avoid recurrence
  6. More testing will need to be followed up on in case of pregnancy
  7. It is important to let your partner(s) know what your going through
  8. It is imperative that partner be identified and treated as well.
  9. Treatment is for all adults and adolescents, regardless of travel history or sexual behaviors.
  10. High compliance from you or patient is absolutely necessary for 100% treatment efficacy and for the prevention of recurrence, future reinfection and resistance of gonoccoi to antibiotics.

 

The treatment for Gonorrhea depends

 

Treatment can be for uncomplicated infection of the cervix, urethra and rectum, uncomplicated treatment of the pharynx and disseminated gonococcal infection, gonococcal conjunctivities and for special populations: neonates and infants, pediatric patients, those pregnant and those with HIV. The most likely infection is an uncomplicated gonococcal infection of the cervix, urethra and rectum.

 

Treatment of uncomplicated gonorrhea of the cervix, urethra and rectum

 

Treatment should be the antibiotic ceftriaxone 250 mg intramuscular in a single dose OR, if NOT AN OPTION cefixime 400mg orally in a single dose OR single-dose injectable cephalosporin regimes PLUS azithromycin 1g orally in a single dose OR doxycycline 100mg orally twice a day for seven days.

 

Treatment for uncomplicated pharynx infection

 

Recommended: Ceftriazone 250 mg intramuscular in a single dose PLUS azithromycin 1g orally in a single dose OR doxycycline 100mg orally twice a day for seven days.

 

Disseminated gonococcal infection

 

Hospitalization is recommended. Patient should be examined for evidence of meningitis or endocarditis. Recommended first-line antibiotic is ceftriaxone which should be continued for 24 to 48 hours after clinical improvement. Alternatively, cefotaxime, ceftizoxime or spectinomycin (if available) may be used. Patients should be switched to an oral therapy (cefixime) to complete at least 7 days of antibiotic therapy. Gonococcal meningitis and endocarditis should be treated with intravenous ceftriazone for 10 to 14 days (meningitis) or up to four weeks (enndocarditis). Quinolones may be an alternative treatment option, but only if antimicrobial sensitivity testing can be documented by culture. Expert infectious disease consultation is required for patients who have severe cephalosporin allergies and for whom spectinomycin is not appropriate; cephalosporin treatment following desenitization or azithromycin may be considered. All patients should be treated for chlamydial infection if it has not been ruled out. Closed drainage of suppurative joints should be performed.

 

Gonococcal conjunctivities

 

Treat with a single dose of ceftriaxone. Consider lavage of the infected eye with saline solution once.

 

Management of gonococcal infection in special patient groups

Neonates and infants

 

Gonococcal infection in infants usually results from exposure to infected cervical exudate at birth. The most severe manifestation of N. gonorrhoea infection in this patient group is ophthalmia neonatorum and sepsis. Ceftriaxone is the treatment of choice in newborns with ophthalmia neonatorum. Instillation of a prophylactic agent into the eyes of all newborns is recommended to prevent ophthalmia neonatorum. This procedure is required by law in most states of the U.S. Disseminated gonococcal infections and gonococcal scalp abscesses should be treated with either ceftriaxone or cefotaxime. Expert infectious disease consulation is required for patients who have severe cephalosporin allergies.

 

Pediatric patients

 

Children uncomplicated gonococcal infection should be t

reated with a single dose of ceftriaxone. Alternatively, a single dose of spectinomycin may be used; however, this treatment is unreliable for pharyngeal infections and is not available in the U.S. Children weighting more than 45r kg with bacteremia or arthritis should be treated with ceftriaxone for 7 days. Expect infectious disease consultation is required for patients who have severe cephalosporin allergies.

 

In pregnancy

 

Pregnant women should be treated with recommended cephalosporin. Alternatively, spectinomycin may be used in patients who cannot tolerate cephalosporins. All patients should also be treated for chlamydial infection if it has been ruled out; azithromycin should be used in pregnancy rather than doxycycline. Expert infectious disease consultation is required for patients who have severe cephalosporin allergies.

 

Patients with HIV infection

 

Treatment is the same as that for HIV-negative patients.

 

Info for sex partners

 

All recent sex partners should be treated to prevent reinfection and to stop spreading of infection. All partners within 60 days before onset of symptoms in individual should be evaluated and treated for both gonorrhea and chlamydia. If last sexual intercourse wasmore than 60 days ago before signs and symptoms then most recent sex partner shouldbe seen and treated. All patients involved should avoid sexual intercourse until completely asymptomatic. If mother has infant with gonoccoal infection, mother and her sex partners should be seen and treated.

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