Gonorrhea

Gonorrhea

  • Caused by Neisseria gonorrhea
  • 350,000 new cases/year  (rates were high in the mid 70s & have been decreasing ever since–> 2010 goal is 19 cases per 100,000 ppl)
    • Rates are highest among 20-24 year olds
  • Symptoms:  vaginal/penile discharge  (may be thick, milky white, yellowish, greenish), frequent urination, burning feeling during urination, pelvic tenderness, abdominal pain, menorrhagia
    • Onset of symptoms:
      • Men: 2-8 days after exposure
      • Women:  usually within 10 days after exposure but it’s commonly asymptomatic
  • Clinical manifestations:  Gonorrhea is usually manifest as a mucosal disease, although a minority of patients develop disseminated gonococcal infection (due to bacteremia).
    • Epididimitis/prostatitis, conjuctivitis in newborns (also opthalmia neonatorum), disseminated infection (as a result of bacteremia) can result in septic arthritis, endocarditis, meningitis, PID, unilateral inflammation of joints (hands/wrists/knees mainly), rash (most often seen in extremities)
  • Mortality is extremely low, but the morbidity of and cost for treating gonococcal complications, especially pelvic inflammatory disease, are substantial.
  • Diagnosis:  gram negative diplococci on gram stain, enzyme immunoassay, DNA amplification (PCR), history/physical findings
  • Treatment for gonorrhea:
    • Adults:  ceftriaxone 125mg IM once
      • Disseminated infection:  Ceftriaxone 1 g IM once
        • Or cefotaxime 1 g q 8 h IV once
      • Alternatives:  spectinomycin 2 gm IM once (used for pregos allergic to cephalosporins)
      • Pts w/ a pharyngeal disease & cephalosporin allergy, they should receive a cephalosporin after desensitization
    • Newborns:  cefrtiaxone 50 mg/kg/day x 7 days

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