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Ed: Bachmann LH. Springer; Share on: Facebook Twitter. Show references Gonorrhea: CDC fact sheet detailed version. Centers for Disease Control and Prevention. Accessed Sept. Ghanem KG. Clinical manifestations and diagnosis of Neisseria gonorrhoeae infection in adults and adolescents. Office on Women's Health. Merck Manual Professional Version. Chlamydia, gonorrhea, and nongonococcal urethritis.
Mayo Clinic; Speer ME. Gonococcal infection in the newborn. When treatment failures are minimized, the potential spread of resistant disease is also reduced. Also, antibiotic therapy should be effective at all anatomical sites, well tolerated and easy to comply with preferably single-dose therapy at the point of care, i.
New recommendations for the treatment of gonorrhea have been published to address the increased prevalence of N. Updated guidelines are also available from British Columbia and Saskatchewan. Treatment guidelines for gonococcal infection in adults 2 , 5 , 11 , 12 , 20 , Cefixime mg PO as a single dose plus azithromycin 1 g PO as a single dose not preferred in men who have sex with men.
Cefixime mg PO as a single dose plus treatment against Chlamydia trachomatis. Ceftriaxone mg IM as a single dose plus treatment against C. If ceftriaxone is not available or injection cannot be administered—e. If history of cephalosporin or penicillin severe allergy and if N. Drugs of choice in penicillin or cephalosporin-allergic patients 2 , 5 , 11 , 20 , Patients with a history of a severe allergic reaction to penicillin or any allergic reaction to cephalosporins should receive an alternate therapy for gonorrhea that does not include either of these drug classes.
Azithromycin monotherapy is only recommended in cases of contraindications to cephalosporins e. The guidelines address the increasing resistance to cephalosporins, with recommendations varying based on the geographic region. Canadian guidelines recommend either intramuscular IM ceftriaxone or oral cefixime as the preferred antibiotic of choice.
In contrast, the CDC and organizations in other countries advocate only parenteral cephalosporins as first-line therapy. Similar to the international guidelines, Ontario also recommends parenteral cephalosporins as the preferred regimen, given local reports of resistance to oral cefixime.
Both Canada and the United States recommend the lower mg dose, while Europe and the UK propose a higher dose of mg. All guidelines currently recommend co-treatment with azithromycin for C. The reasons for co-treatment include the high rate of coinfection and antigonococcal activity of azithromycin and doxycycline. Each year the program reports rising numbers of gonorrhea cases, with an increasing proportion resistant to at least 1 antibiotic.
Between and , no reported isolates were resistant to either ceftriaxone or cefixime. However, a shift occurred in the modal minimum inhibitory concentration MIC for both drugs, including a combined total of isolates with decreased susceptibility. Among these isolates, more exhibited reduced susceptibility to cefixime than to ceftriaxone. The mechanism for resistance was largely due to alterations in the penA, porB1b and mtrR genes, 23 which diminish b-lactam binding to the cell wall, decrease permeability of cephalosporins and increase drug efflux from the cell, respectively.
A total of 4 isolates with decreased susceptibility MIC of 0. In , 3 isolates resistant to cefixime were reported, 2 with MICs of 0. Clinical cases of cephalosporin treatment failures in Canada are only recent. A retrospective cohort study published in from a Toronto sexual health clinic described treatment failure with cefixime.
Nine individuals were reported to have failed cefixime in the treatment of urethral, rectal or pharyngeal gonococcal infections. The other 4 were not considered treatment failures as their records did not include information as to possible sexual reexposure.
In contrast, an Alberta study reported treatment failures in pharyngeal infections with cefixime mg in Prior to this study, most clinical failures were reported internationally. In Austria in , 1 case of cefixime failure was reported in an MSM. In most cases, ceftriaxone was prescribed following identification of the treatment failure. The use of the cephalosporins in the treatment of gonorrhea is a concern, regardless of whether ceftriaxone or cefixime at an elevated dose of mg is used as first-line therapy.
Note only does the lack of alternative therapies limit clinicians in tailoring therapies based on safety considerations such as drug allergies, pregnancy and adverse effects, but the focus on one class for therapy has historically led to a rapid rise in resistance.
The newest guidelines address the issue of increasing resistance to the cephalosporins with the knowledge that choices are limited once this class is no longer effective. The Canadian guidelines are unique, as they continue to recommend oral cefixime with an increased dose to overcome rising MICs. The mg dose of cefixime is off-label use; however, the Canadian guidelines state that it is safe and effective and provides a prolonged time above the MIC when compared with the mg dose.
A study compared both the mg and mg doses of cefixime with IM ceftriaxone mg in patients with uncomplicated N. In the 3 cases of treatment failure 1 case with cefixime mg and 2 cases with cefixime mg , the cefixime MIC ranged from 0. Untreated gonorrhea in females can lead to pelvic inflammatory disease PID. Gonorrhea can also cause infertility in males due to complications of epididymitis infection of the tubes that transport sperm.
Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Centers for Disease Control and Prevention. Gonorrhea - CDC fact sheet detailed version. Sexually Transmitted Infections Treatment Guidelines, CDC fact sheet: What gay, bisexual and other men who have sex with men need to know about sexually transmitted diseases.
Planned Parenthood. Gonococcal conjunctivitis: a case report of an unusual mode of transmission. J Pediatr Adolesc Gynecol. Sexually transmitted diseases and infertility. Am J Obstet Gynecol. Actively scan device characteristics for identification.
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