Gonorrhea Treatment & Management
- Author: Nicholas John Bennett, MB, BCh, PhD; Chief Editor: Russell W Steele, MD more...
Approach Considerations
As discussed in the Workup section, females with diagnosed or suspected sexually transmitted diseases (STDs) should have a concomitant pregnancy test. This guides further care and allows treatment with medications that are not approved for use in pregnancy.
Identification and treatment of the patient's partner and any partners of the partner are important to prevent reinfection and complications.
Prevention of neonatal disease is with the use of silver nitrate 1% eye drops or 1% tetracycline or 0.5% erythromycin ophthalmic ointment within 1 hour of birth.
Clinical Management
The main decision once a diagnosis of gonorrhea has been made, either definitively or presumptively, is whether to treat as an outpatient or to hospitalize.
For males, treatment is always outpatient for genital infection; however, admission may be necessary for complications such as disseminated gonococcal infection (DGI) or gonococcal arthritis.
In females, the decision is much more difficult, because the risk of complications is much higher. In light of high rates of noncompliance, reinfection, and poor follow-up, some clinicians advocate admitting the female whenever a question of a complication such as pelvic inflammatory disease (PID) is present, particularly in the adolescent population.
Many institutions have attempted to quantify abnormalities found on pelvic examination (ie, the PID score) in an attempt to admit those patients with a higher likelihood of complications.
In cases in which future fertility is at risk, most physicians are fairly aggressive, especially in situations in which the patient is very young or unfamiliar to them.
Consultations
In cases of suspected rape or child abuse, seeking specialist help (in the form of specialist nurses or physicians) to interview and collect specimens (if necessary) for testing is prudent.
Careful documentation of physical findings, even if apparently normal, is crucial for medicolegal reasons.
Notification of child-protective services is required if abuse is suspected.
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