eMedicine Specialties > Emergency Medicine > Infectious Diseases
Gonorrhea: Follow-up
Updated: Oct 20, 2008
Follow-up
Further Inpatient Care
- Hospitalization is recommended for initial treatment of disseminated gonococcal infection (DGI) (especially for patients who are unlikely to return for follow-up doses of antibiotics), purulent joint infections, meningitis, and endocarditis.
- Hospitalization is recommended for initial treatment of pelvic inflammatory disease (PID) cases in the presence of the following factors:
- Tubo-ovarian abscess
- Pregnancy
- Failure of outpatient treatment
- Severe symptoms, such as severe pain, high fever, or persistent nausea and vomiting
- Immunodeficiency
- Gonococcal conjunctivitis
- Uncertain diagnosis, with any possibility of ectopic pregnancy or appendicitis masquerading as PID
- Abdominal peritonitis or perihepatitis
Further Outpatient Care
- Patients with DGI or PID who are treated on an outpatient basis must receive follow-up care within 72 hours.
- Early follow-up care and culture with antibiotic sensitivities is indicated for patients with unresolved or recurrent symptoms.
- Follow-up for test of cure is indicated for all pharyngitis cases treated with spectinomycin, as its efficacy is less than 60%.
- Instruct patients with uncomplicated cases to follow up with a primary care or public health provider to reduce the risk of future infection.
Deterrence/Prevention
- All patients with gonococcal infection should refer all their sex partners (whether symptomatic or asymptomatic) for evaluation and treatment.
- All infants born to mothers with untreated gonococcal infection should be treated prophylactically with a single dose of ceftriaxone 25-50 mg/kg IV or IM, not to exceed 125 mg.
- All neonates should undergo prophylaxis for ophthalmia neonatorum with silver nitrate (1%) aqueous solution OU once or erythromycin (0.5%) ophthalmic ointment OU once.
- Condoms offer partial protection and should be recommended.5
For a CME/CE activity, see Brief Video May Help Reduce Incidence of Sexually Transmitted Infections.
Complications
Complications from gonococcal infection may include the following:
- Urethral scarring in men possibly leading to decreased fertility or to bladder-outlet obstruction
- Scarring of the upper reproductive tract in women with PID possibly leading to infertility, chronic pelvic pain, and ectopic pregnancy
- Possible prematurity, neonatal infection, and miscarriage resulting from gonococcal infections in pregnant women
- Possible corneal scarring and permanent vision impairment or blindness resulting from gonococcal ophthalmic infection
- Possible sepsis in infants following neonatal exposure to maternal gonorrhea
- Possible permanent neurologic sequelae resulting from gonococcal meningitis
- Destruction of joint articular surfaces
- Destruction of cardiac valves
- Death from congestive heart failure (CHF) or meningitis
Prognosis
- Most gonococcal infections respond quickly to cephalosporin therapy.
- Prognosis is excellent if therapy is initiated promptly and completed.
Patient Education
- Patients should be counseled about the risks of complications following gonococcal infection and the risk of other STDs.
- Patients always should be instructed to refer any sex partners for prompt evaluation and treatment.
- Patients should avoid sexual contact until medication is finished and until their partners are fully evaluated and treated. They should avoid unprotected contact thereafter.
- For excellent patient education resources, visit eMedicine's Sexually Transmitted Diseases Center. Also, see eMedicine's patient education articles Sexually Transmitted Diseases and Gonorrhea.
- Patient education materials are also available at Centers for Disease Control and Prevention (CDC) Web site (Sexually Transmitted Diseases – Gonorrhea) and from many local public health departments.
Miscellaneous
Medicolegal Pitfalls
- Failure to diagnose surgical emergencies, such as ectopic pregnancy or appendicitis, in patients with a clinical diagnosis of PID
- Failure to treat for co-infection with chlamydia
- Failure to instruct patients to refer partners for treatment
- Failure to evaluate pediatric infections as cases of child sexual abuse
- Failure to evaluate the possibility of abuse in cases involving incapacitated or elderly patients
- Failure to send cultures to confirm the clinical diagnosis in cases with associated legal issues
- Failure to send cultures and begin prophylactic treatment following sexual assault
- Failure to recognize those patients who require hospitalization and inpatient therapy
More on Gonorrhea |
| Overview: Gonorrhea |
| Differential Diagnoses & Workup: Gonorrhea |
| Treatment & Medication: Gonorrhea |
 Follow-up: Gonorrhea |
| References |
| « Previous Page |
References
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Goodyear-Smith F. What is the evidence for non-sexual transmission of gonorrhoea in children after the neonatal period? A systematic review. J Forensic Leg Med. Nov 2007;14(8):489-502. [Medline].
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Availability of cefixime 400 mg tablets--United States, April 2008. MMWR Morb Mortal Wkly Rep. Apr 25 2008;57(16):435. [Medline].
Warner L, Stone KM, Macaluso M, et al. Condom use and risk of gonorrhea and Chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis. Jan 2006;33(1):36-51. [Medline].
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Peeling RW, Holmes KK, Mabey D, et al. Rapid tests for sexually transmitted infections (STIs): the way forward. Sex Transm Infect. Dec 2006;82 Suppl 5:v1-6. [Medline].
Peter NG, Clark LR, Jaeger JR. Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain. Cleve Clin J Med. Mar 2004;71(3):233-9. [Medline].
Ross JD. Systemic gonococcal infection. Genitourin Med. Dec 1996;72(6):404-7. [Medline].
Spigarelli MG. Urine gonococcal/Chlamydia testing in adolescents. Curr Opin Obstet Gynecol. Oct 2006;18(5):498-502. [Medline].
Thompson EC, Brantley D. Gonoccocal endocarditis. J Natl Med Assoc. Jun 1996;88(6):353-6. [Medline].
Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55:1-94. [Medline]. [Full Text].
Workowski KA, Berman SM, Douglas JM Jr. Emerging antimicrobial resistance in Neisseria gonorrhoeae: urgent need to strengthen prevention strategies. Ann Intern Med. Apr 15 2008;148(8):606-13. [Medline].
Further Reading
Keywords
gonorrhea, STD, sexually transmitted disease, Neisseria gonorrhoeae infection, N gonorrhoeae infection, gonococcal cervicitis, pelvic inflammatory disease, PID, salpingitis, endometritis, tubo-ovarian abscess, abdominal peritonitis, Fitz-Hugh-Curtis syndrome, epididymitis, epididymo-orchitis, conjunctivitis, disseminated gonococcal infection, DGI, neonatal eye infection, gonococcal urethritis, endocervicitis, human immunodeficiency virus, HIV, genital infections, migratory polyarthritis, septic arthritis, gonococcal endocarditis, gonococcal meningitis, penicillinase-producing N gonorrhoeae, PPNG, chronic pelvic pain, septic abortion, chorioamnionitis in pregnancy, infertility, ectopic pregnancy, child sexual abuse, viral hepatitis, pharyngitis, secondary gonococcal bacterialconjunctivitis, bilateral conjunctivitis, purulent conjunctivitis, ophthalmia neonatorum, neonatal gonococcal infection, purulent gonococcal arthritis, tenosynovitis, , vulvovaginitis, hemorrhagic lesions, erythema nodosum, urticaria, erythema multiforme, intrauterine device, IUD
