Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:11

642 Gonorrhea

■Culture: gold standard, requires selective media for non-sterile sites

(Thayer-Martin), incubation in high C02 environment, sensitivity

80–95%

■Non-culture assays: EIA, DFA, DNA probe, nucleic acid amplification

(SDA, TMA, PCR), sensitivity 85–95%, specificity 95%

■Blood culture: positive in 20–30% of DGI cases

Other Tests

■Genital infection: CT co-infection in 20–30% of GC cases

■DGI: synovial fluid analysis – leukocytosis; synovial fluid culture –

rarely positive if synovial WBC is <20,000/mm3

differential diagnosis

■Male urethritis: CT, HSV, trichomoniasis, UTI, prostatitis

■Female urogenital infection: CT, HSV, trichomoniasis, vaginitis, UTI

■DGI: meningococcemia, septic arthritis, Reiter’s syndrome

management

What to Do First

■Obtain specimens from exposed sites for Gram stain and culture.

■Hospitalization recommended for DGI; examine for evidence of

endocarditis and meningitis

General Measures

■Test for concomitant STDs: CT, syphilis, HIV

■Treat for possible CT co-infection (including DGI cases)

■Report case to local public health authorities and refer sexual part-

ners for evaluation and treatment.

■Screen for complement deficiency (C5-C9) with recurrent DGI; con-

sider in all DGI cases.

specific therapy

Indications

■Positive Gram-stained urethral, endocervical, or synovial specimen

■Positive culture from any site

■Sexual contact to GC-infected patient

Treatment Options

■Uncomplicated genital, rectal, pharyngeal infections in adults

Cefixime (not currently available)

OR Cefpoxime

➣OR Ceftriaxone