Neisseria gonorrhoeae: Difference between revisions
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Neisseria gonorrhoeae
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+ | ==Background== |
*Causes '''gonorrhea''' |
*Causes '''gonorrhea''' |
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+ | ===Microbiology=== |
| − | * |
+ | *[[Stain::Gram-negative]] [[Cellular shape::diplococcus]] |
| − | * |
+ | *Resistance |
**MDR gonorrhea: resistance to one of [[azithromycin]] or a [[cephalosporin]] |
**MDR gonorrhea: resistance to one of [[azithromycin]] or a [[cephalosporin]] |
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**XDR if resistance to both [[azithromycin]] and a [[cephalosporin]] |
**XDR if resistance to both [[azithromycin]] and a [[cephalosporin]] |
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==Management== |
==Management== |
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| + | *Anogenital and pharyngeal infection in people ≥9 years of age |
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| − | *Urethritis |
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**First-line: [[ceftriaxone]] 250 mg IM once plus [[azithromycin]] 1 g PO once |
**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 |
**Second-line: [[gentamicin]] 240 mg IM once (in 2 doses) plus [[azithromycin]] 2 g PO once |
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*Repeat screening at 6 months |
*Repeat screening at 6 months |
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+ | ===Test of Cure=== |
| − | * |
+ | *Done at 3 to 7 days if by culture or 14 to 21 days if NAAT |
| − | * |
+ | *Indications include: |
| − | ** |
+ | **Pharyngeal infection |
| − | ** |
+ | **Persistent signs or symptoms |
| − | ** |
+ | **Treated without ceftriaxone |
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+ | **Treated with fluoroquinolone, without susceptibility testing |
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+ | **Epidemiologic link to a resistant case |
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+ | **Documented microbiologic resistance |
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+ | **Epidemiologic link to treatment failure |
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+ | **Previous treatment failure |
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+ | **Uncertain adherence to treatment |
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+ | **Reexposure to untreated partener |
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+ | **Pregnancy |
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+ | **Disseminated gonococcal infection |
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+ | **Pediatric patient |
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+ | **[[Pelvic inflammatory disease]] with documented gonorrhea |
| − | ** |
+ | **Therapeutic abortion (increased risk of developing PID) |
==Further Reading== |
==Further Reading== |
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Revision as of 16:26, 10 September 2020
Background
- Causes gonorrhea
Microbiology
- Gram-negative diplococcus
- Resistance
- MDR gonorrhea: resistance to one of azithromycin or a cephalosporin
- XDR if resistance to both azithromycin and a cephalosporin
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
Management
- Anogenital and pharyngeal infection in people ≥9 years of age
- 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
- Repeat screening at 6 months
Test of Cure
- Done at 3 to 7 days if by culture or 14 to 21 days if NAAT
- Indications include:
- Pharyngeal infection
- Persistent signs or symptoms
- Treated without ceftriaxone
- Treated with fluoroquinolone, without susceptibility testing
- Epidemiologic link to a resistant case
- Documented microbiologic resistance
- Epidemiologic link to treatment failure
- Previous treatment failure
- Uncertain adherence to treatment
- Reexposure to untreated partener
- Pregnancy
- Disseminated gonococcal infection
- Pediatric patient
- Pelvic inflammatory disease with documented gonorrhea
- Therapeutic abortion (increased risk of developing PID)
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.
