Neisseria gonorrhoeae

• 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

• Canadian Guidelines on Sexually Transmitted Infections