Neisseria gonorrhoeae: Difference between revisions
From IDWiki
Neisseria gonorrhoeae
m (Text replacement - "Clinical Presentation" to "Clinical Manifestations") |
(added Management) |
||
| Line 1: | Line 1: | ||
| − | * |
+ | *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 [[CiteRef::martin2019mu]] |
| − | == |
+ | ==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 |
| − | == Diagnosis == |
+ | == Differential Diagnosis == |
| + | * Other causes of [[urethritis]] or [[septic arthritis]] |
||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| + | ==Diagnosis== |
||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| + | |||
| + | == 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 |
||
| + | |||
| ⚫ | |||
| + | |||
| ⚫ | |||
{{DISPLAYTITLE:''Neisseria gonorrhoeae''}} |
{{DISPLAYTITLE:''Neisseria gonorrhoeae''}} |
||
Revision as of 18:29, 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.
