Internal Medicine

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

Gonorrhea 643

➣OR Ciprofloxacin*

➣OR Ofloxacin*

➣PLUS Azithromycin OR Doxycycline

■Alternative: Spectinomycin (not for pharyngeal infection)

■In pregnancy: cephalosporin (or Spectinomycin if penicillin allergic)

plus Erythomycin or Amoxacillin

■Gonococcal Conjunctivitis

➣Ceftriaxone 1 g single IM dose

➣Lavage infected eye with saline solution once.

■DGI

➣Ceftriaxone

➣Alternatives: Cefotaxime, Ceftizoxime, Ciprofloxacin*, Ofloxa-

cin*, Spectinomycin

➣Continue parenteral med for 24–48 h after improvement

➣THEN change to oral therapy with

➣Cefixime OR Ciprofloxacin OR Ofloxacin to complete 7–10 days

➣PLUS Azithromycin OR Doxycycline 7 days

*Note: increasing prevalence of fluoroquinolone-resistant GC in the

western US states and in MSM (men who have sex with men) nation-

wide. Must treat with a cephalosporin.

Side Effects & Contraindications

■Azithromycin: side effects: nausea, diarrhea, abdominal pain; safety

in pregnancy not known=B

■Cefixime: side effects: diarrhea; contraindicated with penicillin

allergy; pregnancy=B

■Ceftriaxone: side effects: pain with IM injection, phlebitis, diarrhea,

cholestasis; contraindicated with penicillin allergy; pregnancy=B

■Ciprofloxacin/Ofloxacin: side effects: GI intolerance, CNS stimula-

tion, dizziness; contraindicated in pregnancy (C) and patients <18

years

■Doxycycline: side effects: GI distress, photosensitivity, erosive

esophagitis; contraindicated in pregnancy (D) and growing children

follow-up

■If symptoms persist or recur, repeat cultures and sensitivities.

■DGI arthritis may require repeated joint aspirations or closed

irrigation; open drainage rarely required.

complications and prognosis

Male urethral infection