Neisseria gonorrhoeae: Difference between revisions

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==Background==
==Background==
*Commonly known as gonorrhea or "GC"
*Fastidious [[gram-negative cocci]]


==Clinical Features==
==Clinical Features==


==Differential Diagnosis==
==Differential Diagnosis==
*[[Sore Throat (DDx)]]
*[[Pelvic Inflammatory Disease (PID)]]
*[[Arthritis]]


==Workup==
{{STD DDX}}
{{Bullous rashes DDX}}
 
==Evaluation==
===Workup===
*Dependent upon the infected organ
*PCR or culture on Thayer-Martin agar (most common)


==Management==
==Management==
{{Presumed GC chlamydia of cervix, urethra, or rectum}}
{{Presumed GC chlamydia of pharynx}}
===Specific Disease Processes===
*[[Cervicitis]]
*[[Gonorrheal conjunctivitis|Conjunctivitis]]
*[[Epididymitis]]
*[[Infectious tenosynovitis]]
*[[Orchitis]]
*[[Pelvic inflammatory disease]] (PID)
*[[Proctitis]]
*[[Septic arthritis]]
*[[Urethritis]]
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2010</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Category'''
| align="center" style="background:#f0f0f0;"|'''Antibiotic'''
| align="center" style="background:#f0f0f0;"|'''[[N. gonorrhoeae]]'''
|-
| [[Penicillins]]||[[Penicillin G]]||0
|-
| ||[[Penicillin V]]||0
|-
| Anti-Staphylocccal [[Penicillins]]||Methicillin||0
|-
| ||Nafcillin/Oxacillin||0
|-
| ||Dicloxacillin||0
|-
| Amino-[[Penicillins]]||[[AMP]]/[[Amox]]||0
|-
| ||[[Amox-Clav]]||+
|-
| ||[[AMP-Sulb]]||+
|-
| Anti-Pseudomonal [[Penicillins]]||[[Ticar-Clav]]||+
|-
| ||[[Pip-Tazo]]||+
|-
| [[Carbapenems]]||Doripenem||+
|-
| ||[[Ertapenem]]||+
|-
| ||[[Imipenem]]||+
|-
| ||[[Meropenem]]||+
|-
| ||[[Aztreonam]]||+
|-
| [[Fluroquinolones]]||[[Ciprofloxacin]]||+*
|-
| ||[[Ofloxacin]]||+*
|-
| ||[[Levofloxacin]]||+*
|-
| ||[[Moxifloxacin]]||+*
|-
| ||Gemifloxacin||
|-
| ||Gatifloxacin||+*
|-
| 1st G [[Cephalo]]||Cefazolin||+
|-
| 2nd G [[Cephalo]]||[[Cefotetan]]||+/-
|-
| ||[[Cefoxitin]]||+/-
|-
| ||[[Cefuroxime]]||+/-
|-
| 3rd/4th G [[Cephalo]]||[[Cefotaxime]]||+/-
|-
| ||Cefizoxime||+/-
|-
| ||[[CefTRIAXone]]||+
|-
| ||Ceftaroline||+
|-
| ||[[CefTAZidime]]||+/-
|-
| ||[[Cefepime]]||+
|-
| Oral 1st G [[Cephalo]]||Cefadroxil||0
|-
| ||[[Cephalexin]]||0
|-
| Oral 2nd G [[Cephalo]]||Cefaclor||+/-
|-
| ||Cefproxil||+/-
|-
| ||Cefuroxime||+/-
|-
| Oral 3rd G [[Cephalo]]||Cefixime||+
|-
| ||Ceftibuten||+/-
|-
| ||Cefpodox/ Cefdinir/ Cefditoren||+
|-
| [[Aminoglycosides]]||[[Gentamicin]]||0
|-
| ||Tobramycin||0
|-
| ||[[Amikacin]]||0
|-
| ||[[Chloramphenicol]]||+
|-
| ||[[Clindamycin]]||0
|-
| [[Macrolides]]||Erythromycin||+/-
|-
| ||[[Azithromycin]]||+/-
|-
| ||Clarithromycin||+/-
|-
| Ketolide||Telithromycin||+
|-
| Tetracyclines||[[Doxycycline]]||+/-
|-
| ||Minocycline||+/-
|-
| Glycylcycline||Tigecycline||+
|-
| Sulfonamides||[[TMP-SMX]]||+/-
|-
| Urinary Agents||[[Nitrofurantoin]]||+
|-
| ||Fosfomycin||+
|-
| Other||[[Rifampin]]||+
|-
| ||[[Metronidazole]]||0
|-
| ||Quinupristin-dalfoppristin||+
|-
| ||[[Linezolid]]||
|-
| ||Daptomycin||0
|-
| ||Colistimethate||0
|-
| ||Telavancin||0
|-
| ||[[Vancomycin]]||0
|}
===Key===
{{Template:Antibacterial Spectra Key}}
==Table Overview==
{{Clinically Relevant Bacteria}}


==Disposition==
==Disposition==
*Depends on clinical features/presentation


==See Also==
==See Also==
*[[STDs]]
*[[STDs]]
*[[Microbiology (Main)]]


==Sources==
==References==
<references/>
<references/>


[[Category:ID]]
[[Category:ID]]
[[Category:GU]]
[[Category:Urology]]

Latest revision as of 18:40, 23 December 2020

Background

Clinical Features

Differential Diagnosis

Sexually transmitted diseases

Vesiculobullous rashes

Febrile

Afebrile

Evaluation

Workup

  • Dependent upon the infected organ
  • PCR or culture on Thayer-Martin agar (most common)

Management

Presumed GC/chlamydia of cervix, urethra, or rectum (uncomplicated)[1]

Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.

Standard

  • Gonorrhea
    • Ceftriaxone IM x 1
      • 500 mg, if weight <150 kg
      • 1 g, if weight ≥150 kg
  • Chlamydia


Ceftriaxone contraindicated

^Additional chlamydia coverage only needed if treated with cefixime only

Partner Treatment

Presumed GC/chlamydia of the pharynx (uncomplicated)[2]

Standard
Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.

  • Gonorrhea
    • Ceftriaxone IM x 1
      • 500 mg, if weight <150 kg
      • 1 g, if weight ≥150 kg
  • Chlamydia


Ceftriaxone contraindicated

  • No reliable alternative treatments are available for pharyngeal gonorrhea
    • For persons with a history of a beta-lactam allergy, a thorough assessment of the reaction is recommended.[3]
    • For persons with an anaphylactic or other severe reaction (e.g. Stevens Johnson syndrome) to ceftriaxone, consult an infectious disease specialist for an alternative treatment recommendation.


Test of Cure
CDC recommends a repeat culture be obtained 7-14 days after initial treatment only in persons with pharyngeal gonorrhea.

Specific Disease Processes

Antibiotic Sensitivities[4]

Category Antibiotic N. gonorrhoeae
Penicillins Penicillin G 0
Penicillin V 0
Anti-Staphylocccal Penicillins Methicillin 0
Nafcillin/Oxacillin 0
Dicloxacillin 0
Amino-Penicillins AMP/Amox 0
Amox-Clav +
AMP-Sulb +
Anti-Pseudomonal Penicillins Ticar-Clav +
Pip-Tazo +
Carbapenems Doripenem +
Ertapenem +
Imipenem +
Meropenem +
Aztreonam +
Fluroquinolones Ciprofloxacin +*
Ofloxacin +*
Levofloxacin +*
Moxifloxacin +*
Gemifloxacin
Gatifloxacin +*
1st G Cephalo Cefazolin +
2nd G Cephalo Cefotetan +/-
Cefoxitin +/-
Cefuroxime +/-
3rd/4th G Cephalo Cefotaxime +/-
Cefizoxime +/-
CefTRIAXone +
Ceftaroline +
CefTAZidime +/-
Cefepime +
Oral 1st G Cephalo Cefadroxil 0
Cephalexin 0
Oral 2nd G Cephalo Cefaclor +/-
Cefproxil +/-
Cefuroxime +/-
Oral 3rd G Cephalo Cefixime +
Ceftibuten +/-
Cefpodox/ Cefdinir/ Cefditoren +
Aminoglycosides Gentamicin 0
Tobramycin 0
Amikacin 0
Chloramphenicol +
Clindamycin 0
Macrolides Erythromycin +/-
Azithromycin +/-
Clarithromycin +/-
Ketolide Telithromycin +
Tetracyclines Doxycycline +/-
Minocycline +/-
Glycylcycline Tigecycline +
Sulfonamides TMP-SMX +/-
Urinary Agents Nitrofurantoin +
Fosfomycin +
Other Rifampin +
Metronidazole 0
Quinupristin-dalfoppristin +
Linezolid
Daptomycin 0
Colistimethate 0
Telavancin 0
Vancomycin 0

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

Table Overview

Gram Positives
Cocci
Clusters
Pairs/Chains
Other
Rods
Gram Negatives
Cocci
Rods
Lactose Fermenters
Lactose Non-Fermenters
Other
Rods/Cocci
Anaerobes

Disposition

  • Depends on clinical features/presentation

See Also

References

  1. ↑ Cyr SS et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Center for Disease Control and Prevention. 2020. 69(50):1911-1916
  2. ↑ Cyr SS et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Center for Disease Control and Prevention. 2020. 69(50):1911-1916
  3. ↑ CDC. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2015;64(No. RR-3). https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm.
  4. ↑ Sanford Guide to Antimicrobial Therapy 2010
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