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Gonorrhea
1.
2. Most common bacterial STD.
Incidence highest among adolescents and young
adults.
Causes a range of clinical syndromes
3. Adolescents > age 20-25 years > older
Black/Hispanic > White/API
Multiple sex partners
Inconsistent use of barrier methods
4. Can be acquired from asymptomatic partner
It is greater from male to female
Male to female: 50 - 90%
Female to male: 20 - 80%
Vaginal & anal intercourse more efficient than oral
Increases transmission and susceptibility to HIV 2-5
fold
Efficiently transmitted by sexual contact
7. GC are ingested,
evade host defenses,
and spread through
subepithelial tissues
Attachment mediated
by pili and divides
every 20-30 min.
Leads to formation of submucosal
abscesses
and accumulation of exudate in lumen
GC toxins damage
cells
20. Gonococcal bacteremia
Patients with congenital deficiency of C7, C8, C9 are
at high risk
More common in females
Occurs in < 5% of GC-infected patients
Sources of infection include symptomatic and
asymptomatic infections of pharynx, urethra, cervix
21. “Dermatitis-arthritis syndrome”
Arthritis: 90%
Characterized by fever, chills, skin lesions,
arthralgias, tenosynovitis
Less commonly, hepatitis, myocarditis,
endocarditis, meningitis
Rash characterized as macular or papular, pustular,
hemorrhagic or necrotic, mostly on distal extremities
33. Gram stain
(male urethra exudate)
DNA probe
Culture
NAATs *
Sensitivity
90-95%
85-90%
80-95%
90-95%
Specificity
> 95%
> 95%
> 99%
> 98%
* Able to use URINE specimens
34. Accessory gland infection: similar to male urethritis
Not useful in pharyngeal infections
In cervicitis & Proctitis :
50-70%sensitivity, 95% specificity
In symptomatic male urethritis:
>95% sensitivity and specificity: reliable to diagnose and exclude GC
36. PMN with Gram
negative
intracellular
diplococci
37. In cases of suspected sexual abuse, culture is the only
test accepted for legal purposes
Requires prompt placement in high-CO2environment
(candle jar, CO2 incubator)
Sensitive to oxygen and cold temperature
Requires selective media with antibiotics to inhibit
competing bacteria (Modified Thayer Martin Media, NYC
Medium)
38.
39.
40.
41. Recommended regimens:
Cefixime 400 mg PO x 1 or
Ceftriaxone 125 mg IM x 1 or
Ciprofloxicin 500 mg PO x 1 or
Ofloxacin 400 mg PO x 1 or
Levofloxacin 500 mg PO x 1
All sex partners within past 60 days need evaluation and
treatment
PLUS if chlamydia is not ruled out:
Azithromycin 1 g PO x 1 or
Doxycycline 100 mg PO BID x 7 d
42. Alternative regimens:
Ceftizoxime 500 mg IM x 1
Cefotaxime 500 mg IM x 1
Cefoxitin 2 g IM x 1 + probenecid 1 g PO x 1
Gatifloxacin 400 mg PO x 1
Lomefloxacin 400 mg PO x 1
Norfloxacin 800 mg PO x 1
Spectinomycin 2 g IM x 1
43. Pharyngeal infection:
Ceftriaxone 125 mg IM x 1 or
Ciprofloxicin 500 mg PO x 1 or
Conjunctivitis:
Ceftriaxone 1 g IM x 1 dose
PLUS if chlamydia is not ruled out:
Azithromycin 1 g PO x 1 or
Doxycycline 100 mg PO BID x 7 d
44. Must avoid quinolones & tetracycline
Recommended regimens:
Cefixime 400 mg PO x 1
Ceftriaxone 125 mg IM x 1
PLUS if chlamydia is not ruled out:
Azithromycin 1 g PO x 1
Other appropriate chlamydial regimen
Test of cure in 3-4 weeks
45. Ophthalmia neonatorum prophylaxis:
Silver nitrate 1% aqueous solution topical x 1
Erythromycin 0.5% ointment topical x 1
Tetracycline 1% ointment topical x 1
Ophthalmia neonatorum treatment:
Ceftriaxone 25-50 mg/kg IV or IM x 1 NTE 125
mg
46. Prophylaxis for maternal GC infection:
Ceftriaxone 25-50 mg/kg IV or IM x 1 NTE 125 mg
Disseminated Gonococcal Infection:
Ceftriaxone 25-50 mg/kg/d IV or IM QD x 7 d
(use 50 mg/kg/d for older children,
treat for 10-14 d if child weighs ≥ 45 kg)
Cefotaxime 25 mg/kg IV or IM q12h x 7 d
47. Uncomplicated genital infection:
◦ ≥ 45 kg: same as adults
◦ < 45 kg: ceftriaxone 125 mg IM x 1 (alternative
spectinomycin 40 mg/kg IM x 1)
Disseminated Gonococcal Infection:
Ceftriaxone 25-50 mg/kg/d x 7 d
Use 50 mg/kg/d for older children
Treat for 10-14d if child weighs ≥ 45 kg
48. Recommended regimen:
◦ Ceftriaxone 1g IV or IM q 24 h
Alternative Regimens:
Cefotaxime 1 g IV q 8 h
Ceftizoxime 1 g IV q 8 h
Ciprofloxacin 400 mg IV q 12 h
Ofloxacin 400 mg IV q 12 h
Levofloxacin 250 mg IV q 24 h
Spectinomycin 2 g IM q 12 h
Begin IV therapy for 24-48 hrs, switch to oral therapy for a
total of 1 week
49. Recommended Regimes:
◦ Cefixime 400 mg PO BID
◦ Ciprofloxacin 500 mg PO BID
◦ Ofloxacin 400 mg PO BID
Oral therapy for total treatment of 1 week
50. Resistance in 20%-30% of gonococcal isolates
Plasmid mediated
◦ B - Lactamase production
◦ High-level tetracycline resistance
Chromosomal mediated
◦ Confers resistance to PCN, tetracycline, spectinomycin,
erythromycin, fluoroquinolones, and/or cephalosphorins
