Treatment of uncomplicated gonococcal infections
- Heidi Swygard, MD, MPH
Heidi Swygard, MD, MPH
- Associate Clinical Professor of Medicine
- University of North Carolina at Chapel Hill
- Arlene C Seña, MD, MPH
Arlene C Seña, MD, MPH
- Associate Professor of Medicine
- University of North Carolina at Chapel Hill
- Myron S Cohen, MD
Myron S Cohen, MD
- Professor of Medicine, Microbiology, Immunology and Public Health
- University of North Carolina at Chapel Hill
Gonococcal infections, including urethritis, cervicitis, epididymitis, and proctitis, are a significant cause of morbidity among sexually active men and women. The treatment of these sexually transmitted infections (STIs) has evolved over the years, mainly due to the emergence of antibiotic resistance.
Urogenital, anogenital, pharyngeal, and ocular gonococcal infections that are not associated with bacteremic or ascending spread of the pathogen to other organs are considered uncomplicated. This topic will address the treatment of these gonococcal infections, with a focus on urogenital infections. The discussion in this topic is largely consistent the 2015 sexually transmitted disease (STD) treatment guidelines from the United States Centers for Disease Control and Prevention .
The clinical manifestations and diagnosis of gonorrhea are discussed elsewhere. The treatment of complicated infections, such as disseminated gonococcal infection and pelvic inflammatory disease, is found elsewhere. (See "Epidemiology and pathogenesis of Neisseria gonorrhoeae infection" and "Cutaneous manifestations of gonorrhea" and "Clinical manifestations and diagnosis of Neisseria gonorrhoeae infection in adults and adolescents" and "Disseminated gonococcal infection" and "Pelvic inflammatory disease: Treatment", section on 'Recommended regimens'.)
Therapeutic principles — It is desirable for a therapeutic gonococcal regimen to:
●Be highly effective at all anatomic sites of infection
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- GENERAL BACKGROUND
- Therapeutic principles
- ANTIBIOTIC RESISTANCE
- - Cefixime
- - Ceftriaxone
- APPROACH TO TREATMENT
- Preferred regimen for urogenital infection
- - Efficacy of ceftriaxone
- - Dosing of ceftriaxone
- - Rationale for dual therapy
- Alternate regimens
- - Other cephalosporins with azithromycin
- - Other azithromycin combinations
- - Spectinomycin
- Other gonococcal infections
- - Pharyngeal infection
- - Conjunctivitis
- - Epididymitis
- - Proctitis
- - Pelvic inflammatory disease
- - Disseminated gonococcal infection
- Specific populations
- - Penicillin allergic patients
- - Pregnant women
- PATIENT COUNSELING
- Sexual activity
- HIV counseling and testing
- Pregnancy testing
- PATIENT FOLLOW-UP
- Test of cure
- Monitoring for and managing treatment failure
- POSTGONOCOCCAL URETHRITIS
- PUBLIC HEALTH ISSUES
- Management of sexual partners
- - Expedited partner therapy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS