Neisseria gonorrhoeae

(Redirected from Gonococcal disease)

Background

Clinical Features

Differential Diagnosis

Sexually transmitted diseases

Vesiculobullous rashes

Febrile

Afebrile

Evaluation

Workup

  • Dependent upon the infected organ
  • PCR or culture on Thayer-Martin agar (most common)

Management

Presumed GC/chlamydia of cervix, urethra, or rectum (uncomplicated)[1]

Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.

Standard

  • Gonorrhea
    • Ceftriaxone IM x 1
      • 500 mg, if weight <150 kg
      • 1 g, if weight ≥150 kg
  • Chlamydia


Ceftriaxone contraindicated

^Additional chlamydia coverage only needed if treated with cefixime only

Partner Treatment

Presumed GC/chlamydia of the pharynx (uncomplicated)[2]

Standard
Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.

  • Gonorrhea
    • Ceftriaxone IM x 1
      • 500 mg, if weight <150 kg
      • 1 g, if weight ≥150 kg
  • Chlamydia


Ceftriaxone contraindicated

  • No reliable alternative treatments are available for pharyngeal gonorrhea
    • For persons with a history of a beta-lactam allergy, a thorough assessment of the reaction is recommended.[3]
    • For persons with an anaphylactic or other severe reaction (e.g. Stevens Johnson syndrome) to ceftriaxone, consult an infectious disease specialist for an alternative treatment recommendation.


Test of Cure
CDC recommends a repeat culture be obtained 7-14 days after initial treatment only in persons with pharyngeal gonorrhea.

Specific Disease Processes

Antibiotic Sensitivities[4]

Category Antibiotic N. gonorrhoeae
Penicillins Penicillin G 0
Penicillin V 0
Anti-Staphylocccal Penicillins Methicillin 0
Nafcillin/Oxacillin 0
Dicloxacillin 0
Amino-Penicillins AMP/Amox 0
Amox-Clav +
AMP-Sulb +
Anti-Pseudomonal Penicillins Ticar-Clav +
Pip-Tazo +
Carbapenems Doripenem +
Ertapenem +
Imipenem +
Meropenem +
Aztreonam +
Fluroquinolones Ciprofloxacin +*
Ofloxacin +*
Levofloxacin +*
Moxifloxacin +*
Gemifloxacin
Gatifloxacin +*
1st G Cephalo Cefazolin +
2nd G Cephalo Cefotetan +/-
Cefoxitin +/-
Cefuroxime +/-
3rd/4th G Cephalo Cefotaxime +/-
Cefizoxime +/-
CefTRIAXone +
Ceftaroline +
CefTAZidime +/-
Cefepime +
Oral 1st G Cephalo Cefadroxil 0
Cephalexin 0
Oral 2nd G Cephalo Cefaclor +/-
Cefproxil +/-
Cefuroxime +/-
Oral 3rd G Cephalo Cefixime +
Ceftibuten +/-
Cefpodox/ Cefdinir/ Cefditoren +
Aminoglycosides Gentamicin 0
Tobramycin 0
Amikacin 0
Chloramphenicol +
Clindamycin 0
Macrolides Erythromycin +/-
Azithromycin +/-
Clarithromycin +/-
Ketolide Telithromycin +
Tetracyclines Doxycycline +/-
Minocycline +/-
Glycylcycline Tigecycline +
Sulfonamides TMP-SMX +/-
Urinary Agents Nitrofurantoin +
Fosfomycin +
Other Rifampin +
Metronidazole 0
Quinupristin-dalfoppristin +
Linezolid
Daptomycin 0
Colistimethate 0
Telavancin 0
Vancomycin 0

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

Table Overview

Disposition

  • Depends on clinical features/presentation

See Also

References

  1. Cyr SS et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Center for Disease Control and Prevention. 2020. 69(50):1911-1916
  2. Cyr SS et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Center for Disease Control and Prevention. 2020. 69(50):1911-1916
  3. CDC. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2015;64(No. RR-3). https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm.
  4. Sanford Guide to Antimicrobial Therapy 2010