Gonorrhea
- The most commonly STD in daily practice.
- Caused by Neisseria Gonorrhoeae, a diplococcus gram negative bacteria.
The symptom are dysuria ( feel pain or burning during urination ) and the specific symptom in man is thick, yellow penile discharge.
- There is no symptom in almost 40% woman who had infected by Neisseria gonorrhoeae bacteria, other woman feel need to urinate often, itching and burning of the vagina, usually with
a thick yellow/green discharge, irritation of the vagina, bleeding between menstrual periods.
- Gonococcal throat infection should be considered in people who complain of sore throat and have other signs of gonococcal infection
- In the newborn causes irritation of the mucous membranes in the eyes (if not treated, can cause blindness).
- The infection is transmitted from one person to another through vaginal, oral, or anal sexual relation.
- N. gonorrhoeae have been reported resistans to penicillins, tetracyclines, spectinomycin, and fluoroquinolones so don’t use it.
- Culture of penile discharge is golden standart in diagnostic, but microscopic examination is more simple, faster and cheaper. ( you will find a diplococcus gram negative bacteria )
- Drug of choice refered to CDC is Ceftriaxone 125 mg IM in a single dose or Cefixime 400 mg orally in a single dose. I prefer cefixime 400mg single dose and in my experience all patient have cured except patient with secondary infection.
- If chlamydial infection has not been ruled out, co-treatment with doxycycline 100 mg twice daily or azithromycin should be provided because patients with urogenital gonococcal infections often are coinfected with Chlamydia trachomatis
- Some patient may be have secondary infection by bacteria, so if your patient uncure with regimen above, provide culture urethra discharge. I found streptococcus which sensitive to erythromycin in several cases
- Ceftriaxone or spectinomycin 2 g in a single intramuscular (IM) dose are the options recommended by CDC for treating pregnant women with urogenital and rectal gonorrhea; in pregnant women with pharyngeal infection ceftriaxone is recommended. The only other regimen studied in pregnancy is cefixime 400 mg with a treatment efficacy of 96.2% for uncomplicated cervical and rectal infections (95% CI 88.8-99.6%).
- Patient with penicillin and cephalosporin allergy may be use azithromycin. Azithromycin 2 grams orally is effective against uncomplicated gonococcal infection
