Gonococcus Treatment & Management

  • Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 17, 2010
 

Medical Care

  • It is important to treat all sexual partners simultaneously to prevent reinfection.
  • It is prudent to examine all sexual partners for other venereal diseases (eg, gonorrhea, syphilis).
  • Treatment consists of systemic antibiotics; topical antibiotics are relatively ineffective in the treatment of eye disease.
  • Since 1993, fluoroquinolones (ie, ciprofloxacin, ofloxacin, levofloxacin) have been used frequently in the treatment of gonorrhea because of their high efficacy, ready availability, and convenience as a single-dose, oral therapy. However, the prevalence of fluoroquinolone resistance in N gonorrhoeae has been increasing and is becoming widespread in the United States, thereby necessitating changes in treatment regimens.
    • Beginning in 2000, fluoroquinolones were no longer recommended for the treatment of persons with gonorrhea who acquired their infections in Asia or the Pacific Islands (including Hawaii); in 2002, this recommendation was extended to California.
    • In 2004, the Centers for Disease Control and Prevention (CDC) recommended that fluoroquinolones not be used in the United States to treat gonorrhea in men who have sex with men (MSM). This report, based on data from the Gonococcal Isolate Surveillance Project (GISP), summarizes data on fluoroquinolone-resistant N gonorrhoeae (QRNG) in heterosexual males and in MSM throughout the United States. This report also updates the CDC's Sexually Transmitted Diseases Treatment Guidelines (2006) regarding the treatment of infections caused by N gonorrhoeae. On the basis of the most recent evidence, the CDC no longer recommends the use of fluoroquinolones for the treatment of gonococcal infections and associated conditions (eg, PID).
    • Consequently, only one class of drugs, cephalosporins, is still recommended and available for the treatment of gonorrhea.[1]
    • Current recommended treatment is ceftriaxone 125 mg intramuscularly in a single dose or cefixime 400 mg orally in a single dose or 400 mg by suspension (200 mg/5 mL). Spectinomycin (2 g IM) can be given to patients who are allergic to penicillin; however, it is not currently available in the United States.[3]
    • Concurrent treatment of chlamydia should be given for 3-6 weeks, to include oral tetracycline 500 mg 4 times a day, oral doxycycline 100 mg twice a day, or oral erythromycin stearate 500 mg 4 times a day. Azithromycin can be given as a single 1-g dose.
  • If the eye is involved beyond the conjunctiva (ie, cornea, vitreous), then dosages are similar to those of disseminated infection, and topical antibiotics are added. See Endophthalmitis, Bacterial.
  • If the cornea is involved or if corneal involvement cannot be excluded due to lid swelling or chemosis, some physicians treat with a 3-day course of intravenous antibiotics (eg, ceftriaxone 1 g IV q12-24h).
  • Also see the clinical guideline summary from the American Academy of Ophthalmology, Conjunctivitis.[4]
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Contributor Information and Disclosures
Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS  Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Fernando H Murillo-Lopez, MD  Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. [Guideline] Centers for Disease Control and Prevention (CDC). Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. Apr 13 2007;56(14):332-6. [Medline].

  2. [Guideline] U.S. Preventive Services Task Force (USPSTF). Screening for gonorrhea: recommendation statement. National Guideline Clearinghouse. 2005.

  3. [Guideline] Centers for Disease Control and Prevention (CDC). Updated recommended treatment regimens for gonococcal infections and associated conditions - United States, April 2007. Accessed July 17, 2007. [Full Text].

  4. [Guideline] American Academy of Ophthalmology Cornea/External Disease Panel. Conjunctivitis. National Guideline Clearinghouse. 2008.

  5. Harkins T. Sexually transmitted diseases. Optom Clin. 1994;3(4):129-56. [Medline].

  6. Isenberg SJ, Apt L, Campeas D. Ocular applications of povidone-iodine. Dermatology. 2002;204 Suppl 1:92-5. [Medline].

  7. Kestelyn P, Bogaerts J, Meheus A. Gonorrheal keratoconjunctivitis in African adults. Sex Transm Dis. Oct-Dec 1987;14(4):191-4. [Medline].

  8. Lee JS, Choi HY, Lee JE, Lee SH, Oum BS. Gonococcal keratoconjunctivitis in adults. Eye. Sep 2002;16(5):646-9. [Medline].

  9. Reed K, Jones MW. PPNG conjunctivitis. J Am Optom Assoc. Jun 1984;55(6):425-7. [Medline].

  10. Schwab L, Tizazu T. Destructive epidemic Neisseria gonorrheae keratoconjunctivitis in African adults. Br J Ophthalmol. Jul 1985;69(7):525-8. [Medline].

  11. Tight RR. Gonococcal conjunctivitis. JAMA. May 14 1982;247(18):2499. [Medline].

  12. Ullman S, Roussel TJ, Culbertson WW, Forster RK, Alfonso E, Mendelsohn AD, et al. Neisseria gonorrhoeae keratoconjunctivitis. Ophthalmology. May 1987;94(5):525-31. [Medline].

  13. Ullman S, Roussel TJ, Forster RK. Gonococcal keratoconjunctivitis. Surv Ophthalmol. Nov-Dec 1987;32(3):199-208. [Medline].

  14. Wan WL, Farkas GC, May WN, Robin JB. The clinical characteristics and course of adult gonococcal conjunctivitis. Am J Ophthalmol. Nov 15 1986;102(5):575-83. [Medline].

  15. Zajdowicz TR, Kerbs SB, Berg SW, Harrison WO. Laboratory-acquired gonococcal conjunctivitis: successful treatment with single-dose ceftriaxone. Sex Transm Dis. Jan-Mar 1984;11(1):28-9. [Medline].

 
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