Gonorrhea
also see
Ophthalmia Neonatorum
- Gram negative diplococci
- 1 million new cases of gonococcal infection in US annually (2ndmost common
STD)
- Adolescents between 15-19 years have highest incidence of infection
- Concurrent infection with chlamydia is common
- Incubation period is 2-7 days
- may be associated with Fitz-Hugh-Curtis syndrome
Symptoms of infection vary with age
- Newborn:
- Prepubertal
- Genital tract-vaginitis, PID
- Likely abuse should initiate SCAN work-up
Sexually active adolescents or adults
- Females: commonly asymptomatic (51%) ; symptoms urethritis, endocervicitis,
and salpingitis
- Males: usually symptomatic (62%); typically urethritis
- Can have conjunctivitis, pharyngitis, or proctitis
- Reiter’s syndrome (reactive arthritis, urethritis, conjunctivitis)
- Disseminated gonococcal infection has two clinical syndromes.
Dissemination more common in females infected within 1 week of menstruation
- Tenosynovitis/ arthritis-dermatitis syndrome (fever, skin lesions
and polyarthralgias)
- Suppurative arthritis syndrome (less systemic
symptoms,monoatriculararthritis (most commonly knee))
Diagnosis
- Gram stains (gram negative diplococci) (50% sensitive in females)
- Culture (85% sensitivity)
- PCR or LCR (nucleic acid amplification tests) (85% sensitivity); Can be
done on urine
Treatment
- 1st line: ceftriaxone.
Quinolones
should not be used on west coast secondary to documented resistance
(single dose PO Cipro effective on East coast)
- Routine dual therapy for GC/chlamydia (azithrox
1 dose or doxycycline x 7 days)
- Non-disseminated:
- Disseminated:
- Ceftriaxone/cefotaxime x 7 days
- Increase to 14 days for meningitis
Key review points for STD's in general:
- Most common STD in adolescents = chlamydia; gonorrhea is #2
- CDC recommends testing all sexually active adolescents q year for
gonorrhea/chlamydia
- Neonatal conjunctivitis: topical PPX not effective for chlamydia.
Gonorrhea-requires IV cephalosporin; chlamydia-PO erythromycin; both need
saline irrigation
- Uncomplicated genital infections in adolescents/children > 8yrs: if poor
F/U or in areas of high incidence of concurrent infections, may use dual
therapy for gonorrhea & chlamydia without testing for both:
- Ceftriaxone x 1 (Ciprofloxacin or Ofoxacinx 1 on east coast) for
gonorrhea
- PLUS Doxycycline x 7 days or Azithromycinx 1 for chlamydia
- Complicated Gonococcal Infections require more prolonged therapy.
- Though the newer tests (PCR, LCR) are used routinely for testing of
adolescents, in the prepubertalchild evaluated for child abuse the gold
standard remains culture.
- Asymptomatic chlamydialinfection can persist for up to 3 years
- If febrile, r/o PID
CHLA Board Review 2005