Gonorrhea Causes, Diagnosis, Symptoms and Treatment
Neisseria gonorrhoeae is a gram-negative diplococcus estimated to cause up to 600,000 infections per year in the United States.
CLINICAL PRESENTATION of Gonorrhoeae
- Infected individuals may be symptomatic or asymptomatic, have complicated or uncomplicated infections, and have infections involving several anatomic sites.
- Approximately 15% of women with gonorrhea develop pelvic inflammatory disease (PID). Left untreated, PID can be an indirect cause of infertility and ectopic pregnancies.
- In 0.5% to 3.0% of patients with gonorrhea, the gonococci invade the bloodstream and produce disseminated disease.
- The usual clinical manifestations of disseminated gonnococcal infection are tender necrotic skin lesions, tenosynovitis, and monoarticular arthritis.
DIAGNOSIS of Gonorrhoeae
- Diagnosis of gonococcal infections can be made by gram-stained smears, culture (the most reliable method), or newer methods based on the detection of cellular components of the gonococcus (e.g., enzymes, antigens, DNA, or lipopolysaccharide) in clinical specimens.
- Culture of exposed body areas is the most reliable means of diagnosing gonococcal infection.
- Alternative methods of diagnosis include enzyme immunoassay (EIA), DNA probes, and nucleic acid amplification techniques employing polymerase chain reaction and ligase chain reaction.
TREATMENT of Gonorrhoeae
- All currently recommended regimens are single-dose treatments with various oral or parenteral cephalosporins and fluoroquinolones .
- Ceftriaxone (125 mg IM) is the only parenteral agent recommended by the CDC as a first-line agent for treatment of gonorrhea.
- Coexisting chlamydial infection, which is documented in up to 50% of women and 20% of men with gonorrhea, constitutes the major cause of postgonococcal urethritis, cervicitis, and salpingitis in patients treated for gonorrhea. As a result, concomitant treatment with doxycycline or azithromycin is recommended in all patients treated for gonorrhea. A single dose of azithromycin (2g) is highly effective against chlamydia.
- Pregnant women infected with Neisseria gonorrhoeae should be treated with either a cephalosporin or spectinomycin, because fluoroquinolones are contraindicated. Erythromycin or amoxicillin is the preferred treatment for presumed Chlamydia trachomatis infection.
- Treatment of gonorrhea during pregnancy is essential to prevent ophthalmia neonatorum. The American Academy of Pediatrics recommends that either silver nitrate (1%), tetracycline (1%), or erythromycin (0.5%) be instilled in each conjunctival sac immediately postpartum to prevent ophthalmia neonatorum.
- Infants born to infected mothers should also receive an intramuscular or intravenous injection of ceftriaxone, 50 mg/kg, for 7 days.
EVALUATION OF THERAPEUTIC OUTCOMES
- Combination gonorrhea/chlamydia therapy rarely results in treatment failures, and routine follow-up of patients treated with a regimen included in the CDC guidelines is not recommended.
- Persistence of symptoms following any treatment requires culture of the site(s) of gonorrheal infection, as well as susceptibility testing if gonococci are isolated.
44-3. Presentation of Gonorrhea Infections