Full Answer
What are the CDC recommended regimens for uncomplicated gonococcal infections?
CDC recommended regimens for uncomplicated gonococcal infections, 2020 For persons weighing ≥150 kg (300 lb), 1 g of IM ceftriaxone should be administered. If chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally twice...
What are the possible complications of gonorrhea due to gonococcal infections?
Rarely, DGI is complicated by perihepatitis associated with gonococcal PID, endocarditis, or meningitis. Certain strains of N. gonorrhoeae that cause DGI can cause minimal genital inflammation, and urogenital or anorectal infections are often asymptomatic among DGI patients.
What is the primary site for uncomplicated gonococcal infections?
In women, the endocervical canal (inner portion of the cervix) is the usual site of original gonococcal infection, although urethral colonization and infection of Skene or Bartholin glands also are common. What is the primary site for uncomplicated local gonococci infections in men? a.Epididymis c.Urethra b.Lymph nodes d.Prostate C
What are the symptoms of gonococcal infections in women?
Among women, gonococcal infections are commonly asymptomatic or might not produce recognizable symptoms until complications (e.g., PID) have occurred. PID can result in tubal scarring that can lead to infertility or ectopic pregnancy.
What are the complications from non treatment for gonorrhea?
Untreated gonorrhea can lead to major complications, such as:Infertility in women. ... Infertility in men. ... Infection that spreads to the joints and other areas of your body. ... Increased risk of HIV/AIDS. ... Complications in babies.
What is the major public health concern with gonorrhea today?
Untreated gonorrhea can cause serious and permanent health problems in both women and men. In women, gonorrhea can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). The symptoms may be quite mild or can be very severe and can include abdominal pain and fever 13.
What are the complications of gonococcal urethritis?
Consequences. Gonococcal urethritis (GU) can lead to rare systemic infection associated with fever, small tender papules, and petechiae. Tenosynovitis and arthritis can occur, as can corneal scarring after eye infections. Hematogenous spread can lead to endocarditis and meningitis.
What problem has occurred recently in treatment of gonorrhea?
What problem has recently occurred with the treatment of gonorrhea? B. The gonorrhea bacteria has developed resistant to some antibiotics. Because of this, the CDC recommends only one class of antibiotics to treat gonorrhea– the cephalosporins.
How does gonorrhea affect health and wellbeing?
In women, gonorrhoea can spread to the reproductive organs and cause pelvic inflammatory disease (PID). This is estimated to occur in 10 to 20% of cases of untreated gonorrhoea. PID can lead to long-term pelvic pain, ectopic pregnancy and infertility.
What is the epidemiology of gonorrhea?
The World Health Organization (WHO) estimated the pooled 2016 global prevalence of urogenital gonorrhea (the proportion of the world's population with gonorrhea in a given year) to be 0.9% in women and 0.7% in men, corresponding to a total of 30.6 million gonorrhea cases worldwide.
What damage does gonorrhea cause?
Untreated gonorrhea can cause infections of the fallopian tubes, cervix, uterus, and abdomen. This is called pelvic inflammatory disease (PID). It can permanently damage the reproductive system and make you infertile (not able to have children). PID is treated with antibiotics.
What is a common complication of gonorrhea and chlamydia?
If left untreated, gonorrhea can lead to the same long-term health complications as chlamydia, including PID, as well as disseminated gonococcal infection.
What are the side effects of gonorrhea in males?
In men, gonorrhea can cause a painful condition in the tubes attached to the testicles, which can, in rare cases, lead to infertility. Rarely, untreated gonorrhea can also spread to your blood or joints. This condition can be life-threatening. Untreated gonorrhea may also increase your chances of getting or giving HIV.
Why is it difficult to treat gonorrhea?
"The ongoing progression of antibiotic resistance has now been combined with a lack of alternatives." What makes gonorrhea so hard to treat is its ability to acquire resistance genes and mutations that enable it to survive and adapt to each new threat.
How effective is treatment for gonorrhea?
Gonorrhea can be cured with the right treatment. CDC recommends a single dose of 500 mg of intramuscular ceftriaxone. Alternative regimens are available when ceftriaxone cannot be used to treat urogenital or rectal gonorrhea.
Is it hard to treat gonorrhea?
Gonorrhea is usually super easy to get rid of. Your nurse or doctor will prescribe antibiotics to treat the infection. Some strains of gonorrhea resist the antibiotics and are hard to treat, so your doctor may give you two antibiotics, in shot and pill form. Sometimes you only have to take one pill.
How long after a gonorrhea test can you return?
Any person with pharyngeal gonorrhea should return 7–14 days after initial treatment for a test of cure by using either culture or NAAT; however, testing at 7 days might result in an increased likelihood of false-positive tests. If the NAAT is positive, effort should be made to perform a confirmatory culture before retreatment, especially if a culture was not already collected. All positive cultures for test of cure should undergo antimicrobial susceptibility testing. Symptoms that persist after treatment should be evaluated by culture for N. gonorrhoeae (with or without simultaneous NAAT) and antimicrobial susceptibility. Persistent urethritis, cervicitis, or proctitis also might be caused by other organisms (see Urethritis; Cervicitis; Proctitis).
How long should I take antimicrobial therapy for DGI?
Treatment for DGI should be guided by the results of antimicrobial susceptibility testing. Length of treatment should be determined based on clinical presentation. Therapy for meningitis should be continued with recommended parenteral therapy for 10–14 days. Parenteral antimicrobial therapy for endocarditis should be administered for >4 weeks. Treatment of gonococcal perihepatitis should be managed in accordance with the recommendations for PID in these guidelines.
What is a failure in cephalosporin treatment?
Cephalosporin treatment failure is the persistence of N. gonorrhoeae infection despite recommended cephalosporin treatment ; such failure is indicative of infection with cephalosporin-resistant gonorrhea among persons whose partners were treated and whose risk for reinfection is low. Suspected treatment failure has been reported among persons receiving oral and injectable cephalosporins ( 852 – 855, 857, 859, 861, 863, 864, 867, 875, 894 ). Treatment failure should be considered for persons whose symptoms do not resolve within 3–5 days after recommended treatment and report no sexual contact during the posttreatment follow-up period and persons with a positive test of cure (i.e., positive culture >72 hours or positive NAAT >7 days after receiving recommended treatment) when no sexual contact is reported during the posttreatment follow-up period ( 874 ). Treatment failure should also be considered for persons who have a positive culture on test of cure, if obtained, if evidence exists of decreased susceptibility to cephalosporins on antimicrobial susceptibility testing, regardless of whether sexual contact is reported during the posttreatment follow-up period.
How effective is ceftriaxone?
Although clinical data confirm that a single injection of ceftriaxone 250 mg is >99% (95% confidence interval [CI]: 97.6%–99.7%) effective in curing anogenital gonorrhea of circulating isolates (MIC = 0.03 µ g/mL), a higher dose is likely necessary for isolates with elevated MICs ( 880, 881 ). Effective treatment of uncomplicated urogenital gonorrhea with ceftriaxone requires concentrations higher than the strain MIC for approximately 24 hours; although individual variability exists in the pharmacokinetics of ceftriaxone, a 500-mg dose of ceftriaxone is expected to achieve in approximately 50 hours MIC >0.03 µ g/mL ( 880, 881 ). The pharmacokinetics of ceftriaxone might be different in the pharynx with longer times higher than the strain MIC likely needed to prevent selection of mutant strains in the pharynx ( 882 ).
How long does doxycycline help with chlamydia?
If chlamydial infection is identified when pharyngeal gonorrhea testing is performed, treat for chlamydia with doxycycline 100 mg orally 2 times/day for 7 days. No reliable alternative treatments are available for pharyngeal gonorrhea. 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.
Is pharyngeal infection asymptomatic?
The majority of gonococcal infections of the pharynx are asymptomatic and can be relatively common among certain populations ( 800, 801, 888 – 890 ). Although these infections rarely cause complications, they have been reported to be a major source of community transmission and might be a driver of antimicrobial resistance ( 891, 892 ). Gonococcal infections of the pharynx are more difficult to eradicate than infections at urogenital and anorectal sites ( 862 ). Few antimicrobial regimens reliably cure >90% of gonococcal pharyngeal infections ( 883, 884 ). Providers should ask their patients with urogenital or rectal gonorrhea about oral sexual exposure; if reported, pharyngeal testing should be performed.
Is spectinomycin effective for pharyngeal infections?
Spectinomycin is effective (98.2% in curing uncomplicated urogenital and anorectal gonococcal infections) but has poor efficacy for pharyngeal infections ( 883, 887 ). It is unavailable in the United States, and the gentamicin alternative regimen has replaced the need for spectinomycin, if a cephalosporin allergy exists, in the United States.
What is the best treatment for chlamydia?
Combination therapy, using a highly effective gonococcal therapeutic agent with cotreatment for chlamydia, has been recommended since 1985. In 2007, based on data from CDC's Gonococcal Isolate Surveillance Project*(GISP) indicating widely disseminated quinolone-resistant gonococcal strains in the United States, CDC no longer recommended fluoroquinolones for treatment, leaving cephalosporins as the only remaining recommended antimicrobial class (6). Availability of sensitive C. trachomatisnucleic acid amplification tests were widespread by 2010, but CDC recommended gonococcal dual therapy with a cephalosporin (ceftriaxone 250 mg IM or cefixime 400 mg orally) and either azithromycin or doxycycline (4) to reflect concerns regarding emerging gonococcal resistance. By 2011, the minimum inhibitory concentrations (MICs) of cefixime necessary to inhibit N. gonorrhoeaegrowth in vitro were increasing. In 2012, cefixime was no longer a recommended gonococcal regimen (7), with ceftriaxone and azithromycin combination therapy the only recommended regimen for uncomplicated gonorrhea (5). Since publication of the 2015 Sexually Transmitted Diseases (STD) Treatment Guidelines, concerns regarding antimicrobial stewardship have increased, especially the impact of antimicrobial use on the microbiome and data indicating azithromycin resistance (elevated MICs) for gonorrhea and other organisms (1,3). Pharmacokinetic and pharmacodynamic modeling has also affected the understanding of optimal antimicrobial dosing for N. gonorrhoeaetreatment. This update provides the rationale for the change in gonorrhea treatment recommendations to a higher dose (500 mg) of ceftriaxone and removal of azithromycin from the recommended regimen.
Why is it important to monitor for ceftriaxone resistance?
Continuing to monitor for emergence of ceftriaxone resistance will be essential to ensuring continued efficacy of recommended regimens.
What is antimicrobial stewardship?
The 2019 report on antimicrobial resistance threats in the United States (3) highlights that antimicrobial stewardship, i.e., the development, promotion, and implementation of activities to ensure the appropriate use of antimicrobials, remains a major public health concern. Data continue to document the impact of antimicrobials on the microbiome and on pathogenic organisms. A recent investigation comparing children who received twice-yearly azithromycin with children who received placebo found that the gut’s resistome, a reservoir of antimicrobial resistance genes in the body, had increased determinants of macrolide and nonmacrolide resistance, including beta-lactam antibiotics, among children receiving azithromycin (10). A higher proportion of macrolide resistance in nasopharyngeal Streptococcus pneumoniaewas demonstrated in communities receiving mass administration of oral azithromycin (11). Azithromycin resistance has been demonstrated in another STI, Mycoplasma genitalium, and sexually transmissible enteric pathogens (e.g., Shigellaand Campylobacter) (12–14). In addition, evidence supports increasing concern for the efficacy of azithromycin to treat chlamydial infections, especially rectal infections (15,16).
When will the CDC update the treatment guidelines for gonococcal infection?
Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020
Does ceftriaxone help with gonorrhea?
Emerging antimicrobial resistance affects gonorrhea treatment recommendations and other STIs. CDC recommends ceftriaxone monotherapy for treatment because N. gonorrhoeaeremains highly susceptible to ceftriaxone, azithromycin resistance is increasing, and prudent use of antimicrobial agents supports limiting their use. Continuing to monitor for emergence of ceftriaxone resistance through surveillance and health care providers’ reporting of treatment failures will be essential to ensuring continued efficacy of recommended regimens.
Is ceftriaxone a bactericidal?
Pharmacokinetic and pharmacodynamic considerations. Ceftriaxone is a bactericidal third-generation cephalospor in with widely variable pharmacokinetics (17). Efficacy is best predicted by time that the serum free (i.e., unbound) drug concentration remains higher than the organism’s MIC (fT>MIC). Although no human data exist confirming the length of time above the MIC required to eradicate gonorrhea at different anatomic sites, using Monte Carlo modeling, ceftriaxone has been estimated to require concentrations higher than the strain MIC for approximately 20–24 hours for effective urogenital gonorrhea treatment (18). A 250 mg ceftriaxone dose does not reliably achieve levels higher than an MIC ≥0.125 μg/mL for an extended duration (18). A murine model was used to estimate pharmacokinetic and pharmacodynamic parameters needed for cure at urogenital sites for both susceptible and resistant strains of N. gonorrhoeae(19). Investigators evaluated the efficacy of various ceftriaxone doses (0.06–30 mg/kg body weight). The lowest ceftriaxone dose that was 100% effective at eradicating the susceptible organism (MIC = 0.008 μg/mL) 48 hours after treatment was 5 mg/kg body weight, which corresponded to an fT>MICof 23.6 hours, consistent with the Monte Carlo simulation (18,19). Translating into human doses, a 500-mg dose corresponds to 5 mg/kg body weight (80–100 kg) human, whereas 250 mg only corresponds to 3 mg/kg body weight for an 80 kg person.
Does ceftriaxone affect the pharynx?
The pharynx tends to be screened less often (1) than other anatomic sites, and globally, most reported ceftriaxone-based regimen treatment failures have involved treatment of pharyngeal gonorrhea (20). Ceftriaxone concentrations tend to be more variable in the pharynx, and treatment of N. gonorrhoeaelikely requires longer times above the strain’s MIC (21,22). Continued uncertainty regarding ceftriaxone pharmacokinetics and pharmacodynamics in treating pharyngeal gonorrhea and the higher likelihood of treatment failures at this site strengthen the recommendation for an increase in the ceftriaxone dosage to 500 mg.
Why is the ascent of gonococci facilitated?
a.Ascent of gonococci is facilitated because the cervical plug disintegrates during menstruation.
What is the endocervical canal?
In women, the endocervical canal (inner portion of the cervix) is the usual site of original gonococcal infection, although urethral colonization and infection of Skene or Bartholin glands also are common.
What is the only cause of syphilis?
T. pallidum is the only cause of syphilis.
What is the only stage of syphilis that has significant morbidity and mortality?
Stage IV, tertiary syphilis, is the only stage during which significant morbidity and mortality occur, including destructive skin, bone, and soft-tissue lesions (see Box 26-2).
How long does it take for a rash to go away after birth?
a.Generalized skin rash 4 to 6 days after birth
What is the most common local complication in women?
Acute salpingitis, or pelvic inflammatory disease (PID), is the most common local complication in women. Approximately 10% of women with untreated cervical gonorrhea develop PID.
Is Neisseria gonorrhoeae positive?
Microscopic evaluation of Gram-stained slides of clinical specimens is deemed positive for Neisseria gonorrhoeae if gram-negative diplococci with the typical "kidney bean" morphologic appearance are found inside polymorphonuclear leukocytes. Such a finding is considered adequate for the diagnosis of gonococcal urethritis in a symptomatic man. The other options are not relevant to the diagnosis of this condition.
Why is the ascent of gonococci facilitated?
Ascent of gonococci is facilitated because the bacteria may adhere to sperm and be transported to the fallopian tubes.
Where is the gonococcal infection?
In women, the endocervical canal (inner portion of the cervix) is the usual site of original gonococcal infection, although urethral colonization and infection of Skene or Bartholin glands also are common. The other options are not usually associated with gonococcal infections.
What is the most common local complication in women?
Acute salpingitis, or pelvic inflammatory disease (PID), is the most common local complication in women. Approximately 10% of women with untreated cervical gonorrhea develop PID.
What is the only stage of syphilis that has significant morbidity and mortality?
Stage IV, tertiary syphilis, is the only stage during which significant morbidity and mortality occur, including destructive skin, bone, and soft-tissue lesions (see Box 26-2).
Can gonorrhea and chlamydial infections coexist?
The coexistence of chlamydial infection with gonorrhea frequently occurs. No coexistence exists with the other options.
Can Treponema pallidum be cultured in vitro?
Because Treponema pallidum cannot be cultured in vitro, early definitive diagnosis of primary or secondary syphilis depends on darkfield microscopy of a specimen taken from a chancre, regional lymph node, or other lesion. The remaining options are not relevant.
Is Neisseria gonorrhoeae positive?
Microscopic evaluation of Gram-stained slides of clinical specimens is deemed positive for Neisseria gonorrhoeae if gram-negative diplococci with the typical "kidney bean" morphologic appearance are found inside polymorphonuclear leukocytes. Such a finding is considered adequate for the diagnosis of gonococcal urethritis in a symptomatic man. The other options are not relevant to the diagnosis of this condition.