Neisseria gonorrhoeae: Difference between revisions
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Neisseria gonorrhoeae
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*Causes '''gonorrhea''' |
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==Epidemiology== |
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*Resistance |
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**About 50% resistance to [[fluoroquinolones]] |
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**Rates of MDR gonorrhea is increasing in Canada, mostly driven by [[azithromycin]] resistance |
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**XDR gonorrhea is still rare in Canada [[CiteRef::martin2019mu]] |
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==Clinical Manifestations== |
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===Anorectal gonorrhea=== |
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*Often asymptomatic |
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*Can cause anorectal pain, discharge, and pruritis |
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*Anal intercourse not required, especially in women |
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===Disseminated gonococcal infection=== |
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*Classically presents with tenosynovitis (often of wrists) or frank arthritis, with pustular lesions |
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*Diagnosed with genital testing for gonorrhea, ± blood cultures or arthrocentesis |
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== Diagnosis == |
== Differential Diagnosis == |
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* Other causes of [[urethritis]] or [[septic arthritis]] |
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==Diagnosis== |
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== Management == |
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* Urethritis |
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** First-line: [[ceftriaxone]] 250 mg IM once plus [[azithromycin]] 1 g PO once |
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** Second-line: [[gentamicin]] 240 mg IM once (in 2 doses) plus [[azithromycin]] 2 g PO once |
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** Second-line: [[ciprofloxacin]] 500 mg PO once plus azithromycin 2 g PO once |
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* Disseminated gonococcal infection |
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** Arthritis: [[ceftriaxone]] 2 g IV q24h for 7 days, plus [[azithromycin]] 1 g PO once |
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** Meningitis: [[ceftriaxone]] 2 g IV q24h for 10-14 days, plus [[azithromycin]] 1 g PO once |
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** Endocarditis: [[ceftriaxone]] 2 g IV q24h for 28 days, plus [[azithromycin]] 1 g PO once |
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** Ophthalmia: [[ceftriaxone]] 2 g IV once, plus [[azithromycin]] 1 g PO once |
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{{DISPLAYTITLE:''Neisseria gonorrhoeae''}} |
{{DISPLAYTITLE:''Neisseria gonorrhoeae''}} |
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Revision as of 22:29, 28 August 2020
- Causes gonorrhea
Epidemiology
- Resistance
- About 50% resistance to fluoroquinolones
- Rates of MDR gonorrhea is increasing in Canada, mostly driven by azithromycin resistance
- XDR gonorrhea is still rare in Canada 1
Clinical Manifestations
Anorectal gonorrhea
- Often asymptomatic
- Can cause anorectal pain, discharge, and pruritis
- Anal intercourse not required, especially in women
Disseminated gonococcal infection
- Classically presents with tenosynovitis (often of wrists) or frank arthritis, with pustular lesions
- Diagnosed with genital testing for gonorrhea, ± blood cultures or arthrocentesis
Differential Diagnosis
- Other causes of urethritis or septic arthritis
Diagnosis
- Resistance
- MDR gonorrhea: resistance to one of azithromycin or a cephalosporin
- XDR if resistance to both azithromycin and a cephalosporin
Management
- Urethritis
- First-line: ceftriaxone 250 mg IM once plus azithromycin 1 g PO once
- Second-line: gentamicin 240 mg IM once (in 2 doses) plus azithromycin 2 g PO once
- Second-line: ciprofloxacin 500 mg PO once plus azithromycin 2 g PO once
- Disseminated gonococcal infection
- Arthritis: ceftriaxone 2 g IV q24h for 7 days, plus azithromycin 1 g PO once
- Meningitis: ceftriaxone 2 g IV q24h for 10-14 days, plus azithromycin 1 g PO once
- Endocarditis: ceftriaxone 2 g IV q24h for 28 days, plus azithromycin 1 g PO once
- Ophthalmia: ceftriaxone 2 g IV once, plus azithromycin 1 g PO once
Further Reading
References
- ^ I Martin, P Sawatzky, V Allen, B Lefebvre, LMN Hoang, P Naidu, J Minion, P Van Caeseele, D Haldane, RR Gad, G Zahariadis, A Corriveau, G German, K Tomas, MR Mulvey. Multidrug-resistant and extensively drug-resistant Neisseria gonorrhoeae in Canada, 2012–2016. Canada Communicable Disease Report. 2019;45(2/3):45-53. doi:10.14745/ccdr.v45i23a01.
