Gonococcal cultures should confirm the diagnosis. Children with ophthalmia neonatorum or suspected gonococcal infection should be treated with ceftriaxone in a single or mg per kg dose intravenously or intra-muscularly. Niceria gonorrhea this is also in agreement with study done in other part of Ethiopia where most of the isolates were resistant to commonly used antibiotics 23 Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. These infections most commonly develop within Niceria gonorrhea gonoerhea five days after birth, because the Identical twins gender is exposed to tonorrhea cervical exudates during delivery. In perinatal infectionthe primary manifestation is infection of the eye neonatal conjunctivitis or ophthalmia neonatorum when the newborn is exposed to N.
Girl pornstar names. Subjects and Method
Evans, Ellena M. Neisseria is a large genus of bacteria that colonize the mucosal surfaces of many animals. Gonorrhea is a sexually transmitted disease that causes damage to the mucous membranes of organs lined with cylindrical Sperm feet footjobs urethra, uterus, rectum, pharynx, conjunctiva of eyes. Journal of Bacteriology. Family VIII. Log in. Urine samples have a lower sensitivity and, therefore, a higher chance of false negatives than do endocervical samples. Neisseria gonorrhoeae infections are acquired by sexual contact and usually affect the mucous Niceria gonorrhea of the urethra in males and the endocervix and urethra in females. Testing neonates who have ophthalmia neonatorum for N. The genomes of at Niceria gonorrhea 10 Neisseria species have been completely sequenced. Supplemental tests which permit differentiation among gram-negative diplococci that produce acid only from glucose.
The causative organism is highly adapted to the genital tract and often causing asymptomatic and undetected infection in females in which Acquisition of gonococcal infection late in pregnancy can adversely affect labor and delivery as well as the well-being of the fetus.
- For women, a vaginal sample is recommended in the absence of a pelvic exam.
- Because investigations of sexual abuse may be initiated on the basis of a laboratory diagnosis of gonorrhea, it is important that only strains of N.
- Neisseria gonorrhoeae , also known as gonococcus singular , or gonococci plural is a species of Gram-negative diplococci bacteria isolated by Albert Neisser in
- Basic Fact Sheet Detailed Version.
The causative organism is highly adapted to the genital tract and often causing asymptomatic and undetected infection in females in which Acquisition of gonococcal infection late in pregnancy can adversely affect labor and delivery as well as the well-being of the fetus. The aims of this study were to determine the prevalence and drug susceptibility pattern of Neisseria gonorrhea among symptomatic women in Hawassa Referral Hospital.
A cross-sectional study was conducted from December 1 to February 30, at Hawassa Referral Hospital. All women who visited gynecology outpatient department OPD with suspected gonococcal infection were included.
Endocervical swab was collected by the attending physician. The presence of gonorrhea was confirmed by culture, gram staining and biochemical tests. Antimicrobial sensitivity test was performed using disc diffusion method and the result was interpreted accordingly.
Of the total cases examined, 11 5. Despite low rates of gonorrhea infection, it is important to focus on high-risk populations reproductive age group because of the great physical and emotional costs of the disease. A high resistance for quinolones, the commonly used antibiotics was observed for this laboratory-based diagnosis is recommended. Gonorrhoeae is a sexually transmitted disease caused by the bacteria Neisseria gonorrhea for which humans are the only natural host 1.
The advent of sulfonamide in and penicillin in antibiotic therapy for the treatment of gonococcal infection led to a rapid decrease in gonorrhea prevalence. In the late s, with the onset of the HIV epidemic and a coincident widespread use of barrier contraceptives, the incidence of gonococcal infection again declined 1.
In the absence of a national gonococcus screening program, little is known about the prevalence of gonococcal infection in women of reproductive age group in Ethiopia. To our knowledge the last gonococcal study in reproductive age group of women in Ethiopia was done before 20 years 3.
The STI surveillance system in the country is weak. The Integrated Disease Surveillance Team of the Ministry of Health in reported that there is under reporting of STI cases including gonorrhea in most part of the country. Except for the adult prevalence of HIV 4. This is because the pattern of reporting from health institutions is not uniform.
Some health institutions report using syndrornic approach while others use etiologic approach 4. The drug resistance varies greatly among countries. Therefore having prevalence's data as well as the drug susceptibility pattern within consecutive year is important especially for gonorrhea, the highly drug resistant bacteria 5. There is no up to date data about the prevalence and resistance pattern of gonorrhea in Ethiopia even if it is often incomplete due to; clinical presentation not specific enough for diagnosis based solely on symptoms also in lack of proper reporting mechanisms.
The major objective of this study was to assess the prevalence of Neisseria gonorrhea and their antimicrobial susceptibility patterns among symptomatic women attending a gynecology outpatient department in Hawassa referral hospital.
Expected margin of error d was 0. All women of reproductive age group who attended gynecology out patient at Hawassa Referral Hospital with suspected STIs were included in the study.
Women of reproductive age group 15—44 years with any one of the sign and symptom for STIs such as pain during sexual intercourse, a painful or burning sensation when urinating and abnormal vaginal discharge were included. Others with symptoms indicating development of Pelvic Inflammatory Disease PID like cramps and pain, bleeding between menstrual periods, vomiting, and fever were also included in the study.
Women who have no sign and symptom for STIs, women on recent antibiotic treatment, and those who were outside the reproductive age group were excluded from the study. Clinical examination was done by physician to all patients who were attending gynecological OPD.
All relevant data were obtained by attending physician and was transferred to the questionnaire prepared for this study. Two swabs were collected from each patient from endocervical canal by the physician one for gram stain and the other for culture. The samples were immediately delivered and inoculated to appropriate media in Microbiology Laboratory of Hawassa Referral Hospital. While one of the two swabs taken from individual patient was used for gram stain the other was inoculated on to nonselective chocolate agar and selective agar modified Thayer-Martin medium Oxoid, Basingstoke, and Hampshire, UK, England.
Some fastidious strains, such as the arginine-, hypoxanthine-and uracil-requiring strains, are more susceptible to the concentrations of vancomycin or trimethoprim used in the selective media which can grow in nonselective chocolate agar. Neisseria gonorrhea is differentiated from other Neisseria species, Moraxella species, Kingella species and other commensals based on the production of acid from glucose only and not from maltose, lactose, sucrose and fructose.
In general all positive cultures were identified by their characteristic appearance on the media, Gram staining reaction and confirmed by the pattern of biochemical reactions using the standard method. Gonococcal specimens were sub cultured from the selective primary medium to a chocolate agar to obtain a pure culture of the specimen.
From a pure culture of 3—5 selected colonies of bacteria were transferred to a tube with a straight wire and prepared a suspension in 2. Sterile swab was used to distribute the bacteria evenly over the entire surface of chocolate agar. The criteria used to select the antimicrobial agents tested were based on their availability and frequent prescriptions for the management of gonococcal infection.
Reference strain from the EHNRI laboratory stock was also used as a quality control throughout the study for culture and antimicrobial susceptibility testing. Prevalence rate was calculated for the positive cases of examined subjects and separately by age groups. Logistic regression and Fisher exact test analysis were used to estimate adjusted odds ratios. The level of significance was set at 0.
Official permission from the study site was obtained. Written informed consent was obtained from study participants. The laboratory test results were given for participants and proper treatment was also delivered for positive individuals. On their visit, patients were interviewed and examined clinically. One hundred sixty three The age ranged from 15 to 44 years with a mean of Most of the study subjects, Description of the demographic data of patients investigated for gonococcal infection at Hawassa University Referral Hospitals, Hawassa, Ethiopia Dec— Feb Among casess, 11 5.
Of the 11 patients who were positive for gonococcal infection, 6 Of the 25 pregnant women included in the study, one 4. Association between prevalence of gonococcal infection and demographic characteristics of patients investigated for gonococcal infections at Hawassa University Referral Hospital, Hawassa, Ethiopia Dec —Feb Bacteriologic Examination: Of the endocervical specimens examined by Gram stain, 21 9. Of the endocervical specimens cultured on chocolate and MTM, 16 7.
Oxidase tests were done for all culture positives and for colony resembling Neisseria gonorrhea in chocolate agar even in the absence of growth in MTM. Among the 23 Oxidase tested, 15 In general, from a total of 16 culture positive on MTM and from 15 of Oxidase positives only 11 were isolated as Neisseria gonorrhea by further biochemical tests Oxidation or utilization of carbohydrates and reported as Neisseria gonorrhea Table 4.
The lowest susceptibility was observed for penicillin and Tetracycline. No resistance was found to Ceftriaxone and cefixime. However, low level of susceptibility to quinolones ciprofloxacin Gonococcal infection has a disproportionate impact on the health of women. In women, it is often chronic, presenting with vague or no symptoms, but may lead to severe complications such as chronic pelvic inflammatory disease, ectopic pregnancy, and infertility.
Because of the lack of diagnostic and treatment facilities, limited opportunity for seeking medical care, and poor health-care-seeking behavior. The impact of gonococcal infection on ill health tends to be more severe among women In Ethiopia, twenty years back the prevalence of Neisseria gonorrhea was done on women attending gynecologic, obstetric and family planning clinics to correlate the serological diagnosis of gonorrheae with clinical evidence of pelvic infection.
So comparison with results from this study is not easy as the methodology of the studies were unrelated 3. The overall prevalence of Gonococcal infection among reproductive age group of women in this study is almost similar with findings from Laos 3.
The prevalence in this study is higher compared to other reports like Jordan 2. The likely reason might be due to lack of differential diagnosis which can lead to increase number of untreated patient. As resistance was developed for most of the drugs ordered in syndromic management and consequently increase rate of transmission also lead to drug resistance. On the other hand, the prevalence of gonococcal infection in our study was lower compared southern Mozambique 13 , India 14 and Nigeria This Variation In the prevalence of gonococcal infections in different area might offer an explanation for this difference.
Besides these, today's treatment is almost universal, making the rigorous exclusion of gonorrhoeae, up to one-third of female gonorrhoeae contacts eventually found to be negative Also it is known gonorrhoeae and drug resistance vary greatly among countries and in regions even in sub region of the developing world, because of sociodemographic factors, the treatment algorithm and the way the case diagnosed and treated varies in every region.
In our study, patients who came from rural areas had 4 fold increase risk of developing infections. This is because they lack treatment facilities, limited opportunities for seeking medical care and as they have poor health-careseeking behavior are less likely to be diagnosed, and treated effectively for gonococcal infection.
Regarding age group, there is no statistically significant difference in the frequency of gonococcal infections among different age groups but, the highest prevalence was observed in age group 20—24 years. This might be because of the sexual active age groups are at risk of STIs and the unsafe sex practice might be higher in rural area where in our study the dominating study groups were living.
The other reason for the highest burden among the young women could be due to the fact that young is at greater disadvantage due to the absence of information necessary for early recognition of disease symptoms The other possible explanation, they might have practice of unsafe sex or they might be victim for rape, even though, our questionnaire hasn't addressed these factors are important for acquiring the infection.
The high level of resistance to penicillin and tetracycline found in our study has been widely reported throughout the world, USA 20 , Australia 18 and Romania 21 due to emergence of penicillin resistant beta-lactamase producing strains.
There was no resistance to ceftriaxone and cefixime. The possible explanation for this might be these drugs are expensive, not intensively used and not easily available outside the hospitals beyond this these drugs are newer compared to the others.
The absence of resistance to third-generation cephalosporines cefixime and ceftriaxone in our study make these drugs excellent choices as first-line treatment. According to syndromic case management principle set by Ministry of health 22 the drugs ciprofloxacin, Tetracycline and spectinomycin prescribed for patients suspected for gonococcal infections have shown resistance.
And this is also in agreement with study done in other part of Ethiopia where most of the isolates were resistant to commonly used antibiotics 23 , This may be because of the intensive use of antimicrobial agent, easy availability and indiscriminate use of these drugs outside the hospitals, and many antibiotics are available over the counter for Self-medication.
The cephalosporin drugs; Cefixime, Ceftriaxone and cefpodoxime were effective antibiotics for the treatment of Neisseria gonorrhea which are responsible to cause endocervical infections. This might be because these agents are expensive and not commonly used. However, the present study showed a high level of resistance to ciprofloxacin compared to the study in Central African Republic, Cameroon, and Madagascar It will be real that Scientists are worried gonorrhea will soon become untreatable with these antibiotics This leads to conclusion that if the problem won't be attended to on time, it will become very difficult to treat the infection.
In conclusion despite low rates of gonorrhea infection, it is important to focus on high-risk populations reproductive age group because of the great physical and emotional costs of the disease. Future studies should focus on identifying behavioral or environmental factors to address differences in predictors within groups.
Rectal pain, tenesmus, and bleeding are more common in MSM. To see the full article, log in or purchase access. Baron EJ. Disseminated gonococcal infection presents as a few skin lesions that are limited to the extremities. Any person with pharyngeal gonorrhea who is treated with an alternative regimen should return 14 days after treatment for a follow-up with either culture or NAAT. It is this area that is protected by latex during sexual intercourse.
Niceria gonorrhea. Upcoming Events
Three levels of diagnosis are defined on the basis of clinical findings or the results of laboratory diagnostic tests. A definitive diagnosis of gonorrhea must be obtained for medicolegal purposes.
A Presumptive diagnosis of gonorrhea is made on the basis of one of the following three criteria:. Table 1. Characteristics of N. Freshly isolated strains of N. T1 colonies predominate in the first culture of an isolate; in subsequent subcultures, T3 colonies predominate and T1 colonies may not be observed. Gonococcal colonies may vary in appearance as shown in the T3 colonies pictured here.
The clear, golden-brown pigmentation apparent after incubation for 48 h. Compare with those of N. Although strains of some organisms do not grow on medium on which polysaccharide is detected, polysaccharide may be detected in the growth inoculated onto the plate. Depending on the acid detection test used, several strains of Neisseria and related species may be misidentified as N.
Table 2. Supplemental tests which permit differentiation among gram-negative diplococci that produce acid only from glucose. Although enzyme substrate tests are intended to be used only for the identification of Neisseria spp. Thus, additional tests must be performed to differentiate between these species. Table 3. Supplemental tests which permit differentiation among Neisseria and related species that produce hydroxyprolylaminopeptidase.
In the case of presumptive identifications, it is important that the clinician receiving this report understands that additional tests may be required to confirm a presumptive identification before medicolegal actions are taken. Such identifications should only be made only on the basis of identification of an isolate of N. Isolates should be identified by at least two 2 tests that involve different principles e.
Isolates should be preserved in case additional or repeated testing is needed. Presumptive identifications of N. Laboratorians are reminded that problems have been identified with most tests for the rapid identification of N. Laboratorians should be familiar with these problems, and with supplemental tests that should be performed to confirm the identity of an isolate as N. Baron EJ. Coordinating ed. EJ Baron. American Society for Microbiology, Washington, D. Bovre K.
Family VIII. Neisseriaceae Prevot, p. In NR Krieg ed. Manual of Systematic Bacteriology, vol. Given the high rate of asymptomatic infection, all pregnant women should be tested for gonorrhea infection.
Traditionally, the bacterium was thought to move attached to spermatozoa, but this hypothesis did not explain female to male transmission of the disease. A recent study suggests that rather than "surf" on wiggling sperm , N. For N. Transmission can be reduced by using latex barriers e. Spermicides, vaginal foams, and douches are not effective for prevention of transmission. The current treatment recommended by the CDC is a dual antibiotic therapy.
This includes an injected single dose of ceftriaxone a third-generation cephalosporin along with azithromycin administered orally. Antibiotic resistance in gonorrhea has been noted beginning in the s. Gonorrhea was treated with penicillin, but doses had to be progressively increased to remain effective. By the s, penicillin- and tetracycline-resistant gonorrhea emerged in the Pacific Basin. These resistant strains then spread to Hawaii, California, the rest of the United States, and Europe.
Fluoroquinolones were the next line of defense, but soon resistance to this antibiotic emerged, as well. Since , standard treatment has been third-generation cephalosporins, such as ceftriaxone, which are considered to be our "last line of defense". Recently, a high-level ceftriaxone-resistant strain of gonorrhea called H was discovered in Japan.
Lab tests found it to be resistant to high concentrations of ceftriaxone, as well as most of the other antibiotics tested. Within N. However, because of N. As a gram negative bacteria, N. Neisseria gonorrhoeae is named for Albert Neisser, who isolated it as the causative agent of the disease gonorrhea in In , Albert Neisser isolated and visualized N.
Until this point, researchers debated whether syphilis and gonorrhea were manifestations of the same disease or two distinct entities. He erroneously concluded that both syphilis and gonorrhea were indeed the same disease when the man developed the copper-colored rash that is classic for syphilis.
One researcher, Ricord, took the initiative to perform inoculations of gonorrheal pus on patients of a mental hospital, with zero cases of syphilis. From Wikipedia, the free encyclopedia. Neisseria gonorrhoeae Gram-stain of gonococcal urethritis. Note distribution in neutrophils and presence of both intracellular and extracellular bacteria.
Zopf Trevisan . Main article: Gonorrhoea. Created by J. Curated by A. Parte since Retrieved 7 July Pelvic Inflammatory Disease. Infobase Publishing. Sherris Medical Microbiology 4th ed. McGraw Hill. Retrieved 7 December Microbial Cell. Review of medical microbiology and immunology Thirteenth ed. New York. Henrich Humana Press. October Clinical Microbiology Reviews. Bibcode : Natur. PLoS Biol. Lay summary — New Scientist 19 April Molecular Microbiology.
Journal of Bacteriology. Planned Parenthood Advocates of Arizona. Retrieved 31 August Steven Microbiology Spectrum. Infection and Immunity. Infection, Genetics and Evolution. Broad Institute. Retrieved 8 April Mobile Genetic Elements. Lay summary — ScienceDaily 14 February Cancer Epidemiology. Optimum conditions and quantitation of adherence of isolated pili to human cells in vitro". Journal of Clinical Investigation.
Nature Reviews Microbiology. BBC News. Retrieved 6 March Retrieved 5 December Comprehensive Approach to Infections in Dermatology. JP Medical Ltd. Clinical Infectious Diseases. Todar, Kenneth. Todar's Online Textbook of Bacteriology. Gonorrhea at eMedicine " Neisseria gonorrhoeae ". Diseases of the skin and appendages by morphology. Freckles lentigo melasma nevus melanoma.
Aphthous stomatitis oral candidiasis lichen planus leukoplakia pemphigus vulgaris mucous membrane pemphigoid cicatricial pemphigoid herpesvirus coxsackievirus syphilis systemic histoplasmosis squamous-cell carcinoma.
Diagnosis and Treatment of Neisseria gonorrhoeae Infections - American Family Physician
KARL E. Patient information: See related handout on gonorrhea , written by the author of this article. The most common site of Neisseria gonorrhoeae infection is the urogenital tract. Men with this infection may experience dysuria with penile discharge, and women may have mild vaginal mucopurulent discharge, severe pelvic pain, or no symptoms. Other N. Infections that occur in the neonatal period may cause ophthalmia neonatorum.
If left untreated, N. Disseminated gonococcal infection presents as a few skin lesions that are limited to the extremities. These legions start as papules and progress into bullae, petechiae, and necrotic lesions. The most commonly infected joints include wrists, ankles, and the joints of the hands and feet. Urogenital N.
When multiple sites are potentially infected, culture is the only approved diagnostic test. Treatments for uncomplicated urogenital, anorectal, or pharyngeal gonococcal infections include cephalosporins and fluoroquinolones. Fluoroquinolones should not be used in patients who live in or may have contracted gonorrhea in Asia, the Pacific islands, or California, or in men who have sex with men.
Gonorrhea infection should prompt physicians to test for other sexually transmitted diseases, including human immunodeficiency virus. Neisseria gonorrhoeae infections may present as a broad range of symptoms and can affect urogenital, anorectal, pharyngeal, and conjunctival areas. Severe cases can lead to disseminated gonococcal infections, endocarditis, and meningitis; and in women, to pelvic inflammatory disease PID.
Two methods for detecting N. Culture techniques are considered the tests of choice; but nonculture techniques, which are less labor-intensive and are similar in accuracy to cultures, have replaced culture techniques in some instances. The newest nonculture technique is the nucleic acid amplification test. This test has good sensitivity 92 to 96 percent and specificity 94 to 99 percent compared with cultures.
Uncomplicated gonococcal infections of the cervix, urethra, or rectum should be treated with a single mg dose of ceftriaxone Rocephin administered intramuscularly.
Oral regimens to treat pelvic inflammatory disease should continue for 14 days. Women younger than 25 years who are sexually active should be screened annually for gonococcal infections. Fluoroquinolones should not be used to treat gonorrhea in men who have sex with men. The most common site of N. In women it can infect the endocervix and, if an ascending infection develops, it can cause PID.
Men may develop urethritis and, occasionally, epididymitis. In women, common symptoms include odorless vaginal discharge; vaginal bleeding, particularly after intercourse; and dyspareunia.
Many women have no symptoms, however. The cervix tends to bleed easily when rubbed with a cotton-tipped swab. Gonorrhea infections do not cause vaginitis, but other concomitant infections may produce vaginal findings.
Ten to 20 percent of women with gonorrhea develop ascending infection that causes acute salpingitis with or without endometritis, also known as PID. PID can negatively affect fertility, causing infertility in 15 percent of patients 2 ; 50 percent of patients who have three or more episodes of PID develop infertility. The Centers for Disease Control and Prevention CDC recommends that physicians maintain a low threshold for diagnosing PID because of significant negative sequelae associated with this infection.
Transvaginal ultrasonography or magnetic resonance imaging shows thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex. Information from reference 2. In women with urogenital disease, the nucleic acid amplification test can detect gonorrhea by endocervical or urine sample.
Urine samples have a lower sensitivity and, therefore, a higher chance of false negatives than do endocervical samples. Unlike women, men with urogenital infections are usually symptomatic. The normal incubation period is two to six days after exposure. Symptoms include purulent penile discharge and dysuria. The discharge may present at the meatus, which may be erythematous.
Discharge may be expressed by milking the penis. The patient may or may not have a fever. On examination, the epididymis is swollen and tender to palpation. Culture or nonculture techniques can diagnose urogenital gonorrhea in men. Nucleic acid amplification tests using urine samples provide similar results to that of the urethral swab technique. Gonorrhea infections in the rectal area are most common in women and in men who have sex with men MSM. Perianal contamination from a cervical infection or a direct infection from anal intercourse can cause anorectal infections in women.
In MSM, the infection is caused by direct exposure through anal intercourse. Most rectal gonococcal infections are subclinical. If present, symptoms can include anal pruritus and mucopurulent discharge, usually with a bowel movement. Rectal pain, tenesmus, and bleeding are more common in MSM. Severe gonococcal rectal infections may be difficult to differentiate from inflammatory bowel disease.
Although data suggest that nucleic acid amplification tests can detect rectal gonorrhea infections, 3 the CDC recommends the culture technique for a diagnosis. Pharyngeal infections caused by N. On physical examination, the pharynx may be erythematous or have exudates. Anterior cervical lymphadenopathy also may be present. Most cases of pharyngeal infection will spontaneously resolve with no treatment and usually do not cause adverse sequelae. Treatment should be initiated, however, to reduce the potential for spreading the infection.
There are two distinct categories of gonococcal infections in children. During the neonatal period and the first year of life, gonorrhea infections can cause neonatal conjunctivitis ophthalmia neonatorum ; pharyngitis; rectal infections; and, in rare cases, pneumonia.
These infections most commonly develop within two to five days after birth, because the neonate is exposed to infected cervical exudates during delivery. Almost all new gonococcal infections in children older than one year are caused by sexual abuse.
However, identifying and treating gonorrhea-related ophthalmia neonatorum is important because, if left untreated, it can cause perforation of the globe of the eye and blindness. Infants at risk of gonococcal conjunctivitis are those who did not receive prophylaxis for ophthalmia neonatorum, those whose mothers had no prenatal care, and those whose mothers have a history of STDs or substance abuse.
Common findings include inflammation of the conjunctiva and mucopurulent discharge from the eye. Testing neonates who have ophthalmia neonatorum for N. If intracellular gram-negative diplococci are present, N. Gonococcal cultures should confirm the diagnosis. Preadolescent children most commonly contract gonococcal infections through sexual abuse. Pharyngeal and rectal infections also may be present, but they are usually asymptomatic.
A culture method should be used to test children for N. Food and Drug Administration has not approved them for use in children. Specimens from the vagina, pharynx, urethra, or rectum should be used to isolate N.
Disseminated infection is rare but can occur 1 to 3 percent of adults who have gonorrhea Septic emboli can cause polyarticular tenosynovitis and dermatitis in these patients.
Patients with disseminated gonorrhea usually have no urogenital symptoms. The skin lesions typically are few and are limited to the extremities; they start as papules and progress into hemorrhagic pustules.
Bullae, petechiae, or necrotic lesions also may be present. The skin lesions usually are resolved if the gonorrhea continues to disseminate. Skin lesions and blood cultures usually are negative for N. The joints most commonly affected by disseminated gonorrhea are the wrists, ankles, and the joints of the hands and feet. The axial skeleton rarely is involved. Initial aspiration of the joint may be negative for infection. If untreated, however, the patient will develop septic arthritis, which will most likely involve elbows, wrists, knees, or ankles.
Fluid cultures usually do not grow the organism. Disseminated gonorrhea also may present as bacterial endocarditis, meningitis, and myocarditis, although the incidences of these presentations have declined with the advent of antibiotic therapy. The CDC's treatment guidelines for uncomplicated gonococcal infections are included in Table 2.
Therefore, the CDC advises against using f luoroquinolones to treat gonorrhea infection in patients who live or may have acquired infection in Asia, the Pacific islands including Hawaii , and California. PID can be treated on an outpatient basis if the patient does not meet hospitalization criteria Table 3. Doxycycline is best administered orally because intravenous doxycycline can be painful and can adversely affect veins. Cefoxitin, single 2-g dose IM administered concurrently with probenecid Benemid , single 1-g dose orally.
Duration of oral regimens is 14 days. Pharyngeal gonococcal infections are more difficult to treat than urogenital or anorectal infections because few antibiotic regimens can reliably cure this infection.
The CDC recommends ceftriaxone in a single mg dose intramuscularly or ciprofloxacin Cipro in a single mg dose orally, because these regimens have been shown to effectively treat pharyngeal gonorrhea. Children with ophthalmia neonatorum or suspected gonococcal infection should be treated with ceftriaxone in a single or mg per kg dose intravenously or intra-muscularly.
Fluoroquinolones should be avoided in children who weigh less than 99 lb 45 kg , because they are at risk of articular cartilage damage. Patients with suspected disseminated gonococcal infection should be hospitalized initially.