Neisseria gonorrhoeae

Background

  • Commonly known as gonorrhea or "GC"
  • Fastidious gram-negative cocci

Differential Diagnosis

  • Sore Throat (DDx)
  • Pelvic Inflammatory Disease (PID)
  • Arthritis

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.

Specific Disease Processes

Antibiotic Sensitivities[4]

Category Antibiotic N. gonorrhoeae
PenicillinsPenicillin G0
Penicillin V0
Anti-Staphylocccal PenicillinsMethicillin0
Nafcillin/Oxacillin0
Dicloxacillin0
Amino-PenicillinsAMP/Amox0
Amox-Clav+
AMP-Sulb+
Anti-Pseudomonal PenicillinsTicar-Clav+
Pip-Tazo+
CarbapenemsDoripenem+
Ertapenem+
Imipenem+
Meropenem+
Aztreonam+
FluroquinolonesCiprofloxacin+*
Ofloxacin+*
Levofloxacin+*
Moxifloxacin+*
Gemifloxacin
Gatifloxacin+*
1st G CephaloCefazolin+
2nd G CephaloCefotetan+/-
Cefoxitin+/-
Cefuroxime+/-
3rd/4th G CephaloCefotaxime+/-
Cefizoxime+/-
CefTRIAXone+
Ceftaroline+
CefTAZidime+/-
Cefepime+
Oral 1st G CephaloCefadroxil0
Cephalexin0
Oral 2nd G CephaloCefaclor+/-
Cefproxil+/-
Cefuroxime+/-
Oral 3rd G CephaloCefixime+
Ceftibuten+/-
Cefpodox/ Cefdinir/ Cefditoren+
AminoglycosidesGentamicin0
Tobramycin0
Amikacin0
Chloramphenicol+
Clindamycin0
MacrolidesErythromycin+/-
Azithromycin+/-
Clarithromycin+/-
KetolideTelithromycin+
TetracyclinesDoxycycline+/-
Minocycline+/-
GlycylcyclineTigecycline+
SulfonamidesTMP-SMX+/-
Urinary AgentsNitrofurantoin+
Fosfomycin+
OtherRifampin+
Metronidazole0
Quinupristin-dalfoppristin+
Linezolid
Daptomycin0
Colistimethate0
Telavancin0
Vancomycin0

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
This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.