Gonococcal ophthalmia and disseminated infections in adults and youth 9 years or older 39 40
| Situation/Infection | Preferred initial therapy while awaiting ... |
| Arthritis | Ceftriaxone 2 g IV/IM daily for 7 days [ ... |
| Meningitis | Ceftriaxone 2 g IV/IM daily for 10–14 da ... |
| Endocarditis | Ceftriaxone 2 g IV/IM daily for 28 days ... |
| Ophthalmia | Ceftriaxone 2 g IV/IM in a single dose [ ... |
Full Answer
How to cure gonorrhea without going to the Doctor?
CDC now recommends a single 500 mg intramuscular dose of ceftriaxone for the treatment of gonorrhea. Alternative regimens are available when ceftriaxone cannot be used to treat urogenital or rectal gonorrhea. Although medication will stop the infection, it will not repair any permanent damage done by the disease.
What is the best treatment for gonorrhea?
Gonorrhea Treatment If you have this STD, the CDC now recommends a single 500-mg IM dose (1000 mg in patients weighing ≥150 kg) of the third-generation ceftriaxone. The antibiotic azithromycin (...
How long does it take to cure gonorrhea?
Reflecting concern about emerging gonococcal resistance, CDC’s 2010 STD treatment guidelines recommended dual therapy for gonorrhea with a cephalosporin plus either azithromycin or doxycycline, even if NAAT for C. trachomatis was negative at the time of treatment (851)However, during 2006–2011, the minimum concentrations of cefixime needed to inhibit in …
What is the first line treatment for gonorrhea?
Aug 18, 2016 · Ceftriaxone and azithromycin are the recommended first-line regimen for most N gonorrhoeae infections. To reduce repeat infections and the growth of potential resistance to dual therapy, the prevention measures discussed in this article must be emphasized in both preexposure and postexposure patient populations.
What is the best treatment for gonorrhea?
Adults with gonorrhea are treated with antibiotics. Due to emerging strains of drug-resistant Neisseria gonorrhoeae, the Centers for Disease Control and Prevention recommends that uncomplicated gonorrhea be treated with the antibiotic ceftriaxone — given as an injection — with oral azithromycin (Zithromax).
What antibiotics are given to allergic people?
If you're allergic to cephalosporin antibiotics, such as ceftriaxone, you might be given oral gemifloxacin (Factive) or injectable gentamicin and oral azithromycin.
What to ask when making an appointment?
When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. Make a list of: Your symptoms, if you have any, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began.
What test can help identify bacteria in your urethra?
Urine test. This can help identify bacteria in your urethra.
Can gonorrhea be tested for chlamydia?
Testing for other sexually transmitted infections. Your doctor may recommend tests for other sexually transmitted infections. Gonorrhea increases your risk of these infections, particularly chlamydia, which often accompanies gonorrhea.
Can HIV be tested for?
Testing for HIV also is recommended for anyone diagnosed with a sexually transmitted infection. Depending on your risk factors, tests for additional sexually transmitted infections could be beneficial as well.
How to diagnose gonorrhea?
Urogenital gonorrhea can be diagnosed by testing urine, urethral (for men), or endocervical or vaginal (for women) specimens using nucleic acid amplification testing (NAAT) 19. It can also be diagnosed using gonorrhea culture, which requires endocervical or urethral swab specimens.
What is gonorrhea caused by?
What is gonorrhea? Gonorrhea is a sexually transmitted disease (STD) caused by infection with the Neisseria gonorrhoeae bacterium. N. gonorrhoeae infects the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in women and men. N.
How many cases of gonorrhea in the US?
Gonorrhea is a very common infectious disease. CDC estimates that approximately 1.6 million new gonococcal infections occurred in the United States in 2018, and more than half occur among young people aged 15-24. 1 Gonorrhea is the second most commonly reported bacterial sexually transmitted infection in the United States. 2 However, many infections are asymptomatic, so reported cases only capture a fraction of the true burden.
How long does it take for gonorrhea to show up in men?
When present, signs and symptoms of urethral infection in men include dysuria or a white, yellow, or green urethral discharge that usually appears one to fourteen days after infection 5. In cases where urethral infection is complicated by epididymitis, men with gonorrhea may also complain of testicular or scrotal pain.
What is STDCCN in healthcare?
Health care providers with STD consultation requests can contact the STD Clinical Consultation Network (STDCCN). This service is provided by the National Network of STD Clinical Prevention Training Centers and operates five days a week. STDCCN is convenient, simple, and free to health care providers and clinicians. More information is available at www.stdccn.org
What is a detailed fact sheet?
Detailed fact sheets are intended for individuals with specific questions about sexually transmitted diseases. Detailed fact sheets include specific testing and treatment recommendations as well as citations so the reader can research the topic more in depth.
Can gonorrhea cause testicular pain?
In cases where urethral infection is complicated by epididymitis, men with gonorrhea may also complain of testicular or scrotal pain. Most women with gonorrhea are asymptomatic 6, 7. Even when a woman has symptoms, they are often so mild and nonspecific that they are mistaken for a bladder or vaginal infection 8, 9.
Can you take azithromycin with ceftriaxone?
Combining oral azithromycin with either oral gemifloxacin ( Factive) or injectable gentamicin may be helpful if you’re allergic to ceftriaxone. That medication is in a class of drugs known as cephalosporin antibiotics. Never share your medication.
Can you have gonorrhea if you don't have it?
And you’ll want to get treated as soon as possible. If you don’t, gonorrhea can cause a number of long-term health problems for both women and men.
Can you share antibiotics with your doctor?
Never share your medication. Also, be sure to tell your doctor about any drug allergies you have, especially to antibiotics. Ask them about possible side effects and what to do if you experience any negative ones.
How does gonorrhea pass from person to person?
female reproductive tract (the fallopian tubes, cervix, and uterus) Gonorrhea passes from person to person through oral, anal, or vaginal sex without a condom or other barrier method. The best protections against transmission are abstinence and proper condom or barrier method usage.
How long does gonorrhea stay in your body?
In rare instances, gonorrhea can continue to cause damage to the body, specifically the urethra and testicles. The condition will stay in the body for a few weeks after the symptoms have been treated. Pain may also spread to the rectum.
What is ectopic pregnancy?
An ectopic pregnancy is when a fertilized egg implants outside the uterus. Gonorrhea may also pass to a newborn infant during delivery. People with a penis may experience scarring of the urethra. Gonorrhea may also cause a painful abscess to develop in the interior of the penis.
How long does it take for a colony of gonorrhea to grow?
A colony of gonorrhea bacteria will grow if gonorrhea is present. A preliminary result may be ready within 24 hours. A final result will take up to 3 days.
What happens when gonorrhea spreads to the bloodstream?
When gonorrhea spreads to the bloodstream, arthritis, heart valve damage, or inflammation of the lining of the brain or spinal cord may occur. These are rare but serious conditions.
What are the complications of gonorrhea?
People with a vagina are at greater risk for long-term complications from an untreated transmission. Untreated, the bacteria may ascend up the reproductive tract and involve the uterus, fallopian tubes, and ovaries.
What do public health officials do?
Public health officials will identify, contact, test, and treat any sexual partners of the person diagnosed to help prevent the spread. Health officials will also contact other people these individuals may have had sexual contact with. The emergence of antibiotic-resistant strains of gonorrhea is a growing challenge.
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).
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 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.
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 penicillin a cross reactivity?
The risk for penicillin cross-reactivity is highest with first-generation cephalosporins but is rare (<1%) with third-generation cephalosporins (e.g., ceftriaxone and cefixime) ( 631, 680, 896 ). Clinicians should first thoroughly assess a patient’s allergy history, including type of reaction, associated medications, and previous prescription records. If IgE-mediated penicillin allergy is strongly suspected, dual treatment with single doses of IM gentamicin 240 mg plus oral azithromycin 2 g can be administered ( 885, 886 ). If a patient is asymptomatic and the treating facility is able to perform gyrase A ( gyrA) testing to identify ciprofloxacin susceptibility (wild type), oral ciprofloxacin 500 mg in a single dose can be administered. Providers treating persons with IgE-mediated cephalosporin or penicillin allergy should refer to the section of these guidelines regarding evaluation (see Management of Persons Who Have a History of Penicillin Allergy).
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.
How to treat a pharynx infection?
1 The CDC currently recommends that patients with uncomplicated gonococcal infections of the pharynx be treated with a regimen consisting of a single dose of ceftriaxone 250 mg IM in addition to a single oral dose of azithromycin 1 g . Clinical trials showed that the treatment of pharyngeal infections with ceftriaxone resulted in a cure rate of 98.9%. 1
Why is azithromycin preferred over tetracycline?
1 Azithromycin is preferred over a tetracycline because it has a lower rate of N gonorrhoeae resistance.
Why do men need condoms?
Because males with a gonococcal infection often are asymptomatic, they may remain undiagnosed for an extended period of time, which makes prevention a key priority in high-risk male populations. Consistent use of male condoms should be recommended to all patients. 1.
What antibiotics are used for gonorrhea?
Since the 1930s, gonorrhea has been treated with, and developed resistance to, sulfonamides, penicillin, tetracycline, spectinomycin, quinolones, macrolides, and some cephalosporins. 7 Antimicrobial stewardship, prescriber awareness, and appropriate patient education can help prevent N gonorrhoeae from developing resistance to ceftriaxone.
How often should I be tested for N gonorrhoeae?
Men who have had sexual contact with other males within the preceding year should be screened at least annually at the site of possible exposure (i.e., urethral, rectal, or pharyngeal). Men aged <35 years and women aged <30 years who reside in correctional facilities should be screened for N gonorrhoeae at the time of intake, regardless of risk factors. Pregnant women aged <25 years should be screened at the first prenatal visit. 1
What are the risk factors for N gonorrhoeae?
Risk factors for N gonorrhoeae include sexual contact with new or multiple partners, sexual contact with an individual who has concurrent partners, and sexual contact with a person who is currently infected with N gonorrhoeae.
What is the World Health Organization's action plan for gonorrhoeae?
In 2012, the World Health Organization developed a global action plan to reduce antibiotic resistance to N gonorrhoea e.10 The plan includes encouraging early detection and effective treatment, fostering patient compliance, educating patients, improving surveillance and laboratory capacities, increasing advocacy, and ensuring that appropriate legislative and regulatory mechanisms are in place. 10 Fostering patient compliance is especially important when multidose treatment regimens are employed.
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. trachomatis nucleic 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. gonorrhoeae growth 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. gonorrhoeae treatment. 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.
What is the cause of STIs?
Sexually transmitted infections (STIs) caused by the bacteria Neisseria gonorrhoeae (gonococcal infections) have increased 63% since 2014 and are a cause of sequelae including pelvic inflammatory disease, ectopic pregnancy, and infertility and can facilitate transmission of human immunodeficiency virus (HIV) ( 1, 2 ).
How long does it take for gonorrhea to be retested?
Because reinfection within 12 months ranges from 7% to 12% among persons previously treated for gonorrhea ( 29, 30 ), persons who have been treated for gonorrhea should be retested 3 months after treatment regardless of whether they believe their sex partners were treated.
Can you take azithromycin while pregnant?
During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia. Alternative regimens for uncomplicated gonococcal infections of the cervix, urethra, or rectum if ceftriaxone is not available: Gentamicin 240 mg IM as a single dose plus azithromycin 2 g orally as a single dose OR.
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.
Does ceftriaxone help with gonorrhea?
Emerging antimicrobial resistance affects gonorrhea treatment recommendations and other STIs. CDC recommends ceftriaxone monotherapy for treatment because N. gonorrhoeae remains highly susceptible to ceftriaxone, azithromycin resistance is increasing, and prudent use of antimicrobial agents supports limiting their use.
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 go norrhea ( 20 ). Ceftriaxone concentrations tend to be more variable in the pharyn x, and treatment of N. gonorrhoeae likely 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.
