N. gonorrhoeae, the causative agent of gonorrhea, is a gram-negative, nonmotile, non-spore-forming organism that grows singly and in pairs (i.e., as diplococci).
The ∼450,000 cases reported in the United States in 2016 probably represent only half the true number of cases because of underreporting, self-treatment, and nonspecific treatment without a laboratory diagnosis.
Except in disseminated disease, the sites of infection typically reflect areas involved in sexual contact.
NAATs, culture, and microscopic examination (for intracellular diplococci) of urogenital samples are used to diagnose gonorrhea; NAAT of urine samples is most sensitive. A single culture of endocervical discharge has a sensitivity of 80–90%.
See Table 86-2.
DIAGNOSIS | TREATMENT OF CHOICEa |
---|---|
Uncomplicated gonococcal infection of the cervix, urethra, pharynxb, or rectum | |
First-line regimen | Ceftriaxone (250 mg IM, single dose) plus Azithromycin (1 g PO, single dose) |
Alternative regimensc | Cefixime (400 mg PO, single dose) or ceftizoxime (500 mg IM, single dose) or cefotaxime (500 mg IM, single dose) or spectinomycin (2 g IM, single dose)d,e or cefotetan (1 g IM, single dose) plus probenecid (1 g PO, single dose)d or cefoxitin (2 g IM, single dose) plus probenecid (1 g PO, single dose)d plus Azithromycin (1 g PO, single dose) |
Epididymitis | Ceftriaxone (250 mg IM once) followed by doxycycline (100 mg PO bid for 10 days) |
Pelvic inflammatory disease | See text on specific syndrome |
Gonococcal conjunctivitis in an adult | Ceftriaxone (1 g IM, single dose)f |
Ophthalmia neonatorumg | Ceftriaxone (25–50 mg/kg IV, single dose, not to exceed 125 mg) |
Disseminated gonococcal infectionh | |
Initial therapyi | |
Pt tolerant of β-lactam drugs | Ceftriaxone (1 g IM or IV q24h; recommended) or cefotaxime (1 g IV q8h) or ceftizoxime (1 g IV q8h) |
Pts allergic to β-lactam drugs | Spectinomycin (2 g IM q12h)d |
Continuation therapyi | Cefixime (400 mg PO bid) |
Meningitis or endocarditis | See text for specific recommendationsj |
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