infectious diseases
Gonorrhea
Treatment of Gonorrhea
For uncomplicated infection, a single dose ofceftriaxone Concomitant treatment for chlamydial infection Treatment of sex partners For disseminated gonococcal infection (DGI) with arthritis, a longer course of parenteral antibiotics Uncomplicated gonococcal infectionof the urethra, cervix, rectum, and pharynx is treated with the following: A single dose ofceftriaxone500 mg IM (1 g IM for patients weighing ≥ 150 kg) Ifceftriaxoneis not available, usecefixime800 mg orally in a single dose. If chlamydial infection has not been excluded, treat for chlamydia withdoxycycline100 mg orally twice a day for 7 days. In patients who have adoxycyclineallergy, treat for chlamydia with a single dose ofazithromycin1 g orally. Patients who areallergic to cephalosporins(includingceftriaxone) are treated with Gentamicin240 mg IM in a single dose plusazithromycin2 g orally in a single dose 100 mg orally twice a day for 7 days ( Treatment reference ). Gonococcal purulent arthritis usually requires repeated synovial fluid drainage either with repeated arthrocentesis or arthroscopically. Initially, the joint is immobilized in a functional position. Passive range-of-motion exercises should be started as soon as patients can tolerate them. Once pain subsides, more active exercises, with stretching and muscle strengthening, should begin. Over 95% of patients treated for gonococcal arthritis recover complete joint function. Because sterile joint fluid accumulations (effusions) may develop and persist for prolonged periods, an anti-inflammatory drug may be beneficial. Posttreatment culturesare unnecessary if symptomatic response is adequate. However, for patients with symptoms for>7 days, specimens should be obtained, cultured, and tested for antimicrobial sensitivity. Patients should abstain from sexual activity until treatment is completed to avoid infecting sex partners. All sex partners who have had sexual contact with the patient within 60 days should be tested for gonorrhea and other STIs and treated if results are positive. Sex partners with contact within 2 weeks should be treated presumptively for gonorrhea (epidemiologic treatment). (EPT) involves giving patients a prescription or medications to deliver to their partner. EPT may enhance partner adherence and reduce treatment failure due to reinfection. It may be most appropriate for partners of women with gonorrhea or chlamydial infection. However, a health care visit is preferable to ascertain histories of medication allergies and to screen for other STIs ( Treatment reference ). 1.Centers for Disease Control and Prevention: Sexually Transmitted Infections Treatment Guidelines, 2021: Gonococcal Infections Among Adolescents and Adults. Accessed June 27, 2022. 