Gonorrhea is caused by Neisseria gonorrhoeae and is one of the most common sexually transmitted diseases in the United States. The organism can infect several sites, including the cervix, urethra, rectum and pharynx. Because women with gonorrhea often do not exhibit symptoms, serious complications can occur as a result of untreated infection, such as pelvic inflammatory disease, ectopic pregnancy and infertility. Gonorrheal infection can spread throughout the body, resulting in skin lesions on the soles of the feet, palms and scalp; arthritis; and Fitz-Hugh-Curtis syndrome, a complication of pelvic inflammatory disease.
Treatment
According to the Centers for Disease Control and Prevention, or CDC, the class of antibiotics called fluoroquinolones should not be used in the treatment of gonorrhea because of increasing resistance throughout the United States. Instead, cephalosporins are recommended. Treatment regimens are explained in more detail below.
Uncomplicated Infection
For gonococcal infection of the cervix, urethra and rectum, the CDC recommends single-dose ceftriaxone 125 mg administered in the muscle or a single dose of 400 mg cefixime by mouth. For gonococcal infection of the rectum or pharynx, a single dose of ceftriaxone 125 mg should be given intramuscularly. In cephalosporin-allergic individuals, 2 g of azithromycin taken orally can be considered. Because chlamydia and gonorrhea often coexist, physicians should also consider treating the individual for chlamydia if this diagnosis has not been ruled out.
Disseminated Gonococcal Infection
An intravenous regimen of antibiotics should be administered for disseminated infection for at least 24 hours or until improvement in symptoms is seen. Specifically, 1 g of ceftriaxone is given every 24 hours, either intravenously or intramuscularly. After 48 hours, the individual should continue on antibiotics for at least a week. Options include 400 mg cefixime by mouth twice daily, a 400-mg cefixime suspension twice daily or 400 mg of cefpodoxime twice daily.
Pelvic Inflammatory Disease
For women who have pelvic inflammatory disease, the physician decides whether treatment should be initiated intravenously or orally based on severity of disease. There are several recommended intravenous regimens: 2 g of cefotetan every 12 hours, 2 g cefoxitin every six hours plus 100 mg doxycycline orally or intravenously every 12 hours, or 900 mg clindamycin every eight hours plus gentamicin administered as 2 mg/kg followed by a maintenance dose at 1.5 mg/kg every eight hours. For oral therapy, combinations of ceftriaxone or cefoxitin plus doxycycline with or without metronidazole should be used. Oral therapy should be taken for 14 days.
Tags: every hours, pelvic inflammatory, pelvic inflammatory disease, twice daily, cefixime mouth, cervix urethra