TOC for penicillin resistant gonorrhoea
B i.e. Ceftriaxone Neisseria gonorrhea is a gram negative, aerobic, non-motile, non-sporeforming, diplo/mono-cocciQ, exclusively a human pathogen that principally infects host columnar epithelium. It is oxidase positive like other Neisseria species, from which it is distinguished by their ability to grow on selective media & to utilize glucose but not maltose, sucrose or lactose. Gonorrhoea is, the second most common (after Chlamydia trachomatis which is the most common) genital /sexually transmitted infection in US, UK and other developed countriesQ (Harrison 1442; Rook's 34.24). The incidence of gonorrhea is higher in developing countriesQ than industrialized nations predominantly affecting young, nonwhite, unmarried, less educated urban population. (Harrison 1220) Chlamydia trachomatis is the most common cause of non gonococcal urethritis (NGU) and postgonococcal urethritis (PGU)Q. PGU refers to NGU developing in men 2-3 weeks after treatment of gonococcal urethritis with single doses of agents such as penicillin or cephalosporins which lack activity against Chlamydia. In US most of acute urethritis cases are NGU and C. trachomatis is implicated in most (30-50%) of these casesQ. The other causes of NGU are Ureaplasma urealyticum, Mycoplasma genitalium, Trichomonas vaginalis and herpes simplex virus (HSV). Gonorrhoea is a STD which commonly manifests as cervicitis (primary site of infection in females), urethritis (most common/primary site of infection in males presenting as rapid onset severe burning dysuria with profuse purulent discharge)Q, proctitis & conjunctivitis. If untreated it can 1/t local complications such as endometritis, salpingitis, tuboovarian abscessQ, baholinitis, peritonitis and perihepatitis (Fitz-Hugh Cuis Syndrome) in females; peri urethritis and epididymitisQ in male patients and ophthalmia neonatorum in new borns. Disseminated gonococcemia is uncommon & 1/t skin lesions, tenosynovitis, ahritis and in rare cases endocarditis & meningitis. Because of ascending spread of infection testis is spared or (uncommonly) last to be involvedQ only after urethritis, prostatitis, epididymitis in gonorrhea. Single dose regimens of 3rd generation cephalosporins ceftriaxone (IM) and cefixime (oral) are the mainstays of therapyQ for uncomplicated gonococcal infection of urethra, cervix, rectum, or pharynx. Septinomycin is an alternative (2nd) regimen for uncomplicated gonococcal infections in penicillin allergic patients. All 3 drugs are suitable for pregnant & breast feeding women. The new management for complaints of urethral discharge involves a combined modality of treatment for N. gonorrhea and C. trachomatisQ as most cases are d/t coinfection with both pathogens and incorporate an agent eg. azithromycin or doxycycline that is effective agenist chlamydial infection. Pregnant women who should not take doxycycline, should receive concurrent treatment with a macrolide antibiotic for possible chlamydial infection. Feature Gonococcus Syphilis Infect/ EpididymisQ TestisQ Involve Resistant structure (not involve) TestisQ EpididymisQ Infection Urethrae Blood spread (i.e. (i.e. testis is through Epididymis is involved & involved & epididymis is testis is spared) spared)
Ciprofloxacin
Ceftriaxone
Streptomycine
Erythromycin