All
about GONORRHEA
Gonorrhea remains the second most commonly reported modifiable disease in the United States. The incidence
of gonorrhea in the United States for 2012 was 107.5 cases per 100,000 persons which is
an increase of 4 percent
since 2011 . the highest rates in women of
any ethnicity were in the groups
aged 20 to24 years and
15 to 19 years . Its prevalence in prenatal prevalence of 5 to 10 percent . Risk
factors include single marital
status adolescence poverty drug
abuse prostitution other STIs and lack of prenatal care. Gonococcal infection in up to 40 percent of
infected women . In most
pregnant women gonococcal infection is
limited to the lower genital tract- the
cervix urethra and periurethral and vestibular glands. Acute salplingitis is rare
in pregnancy but pregnant women
account for a disproportionate
number of disseminated
gonococcal infections .
Gonococcal
infection may have deleterious effects
in any trimester. There is an association between untreated gonococcal Cervicitis
and septic abortion as well as infection
after voluntary abortion. Preterm
delivery prematurely
ruptured membranes chorioamnionitis and postpartum
infection are reported to be more common in women infected with Neisseria gonorrhoeae. Bleich and coworkers
reviewed outcomes of 32 pregnant
women admitted to parkland Hospital for disseminated gonococcal
infection. Although all the women promptly responded to appropriate antimicrobial therapy one stillbirth was attributed to gonococci
sepsis.
Screening and treatment
The U.S Preventative Services Task Force
recommends gonorrhea screening
for all sexually active women ,
including pregnant women if they
are at increased risk . Risk
factors include age < 25 years prior
gonococcal infection, other STIs prostitution new or multiple sexual partners drug use and inconsistent conform use . for
women who test positive screening for syphilis chamydia trachomatis
and HIV should precede treatment, if possible. If chlamydial testing is unavailable presumptive
therapy is given. Screening for gonorrhea
in women is by culture or nucleic
acid amplification tests Rapid
tests for gonorrhea although available
do not yet reach the sensitivity or
specificity of culture or NAAT .
Gonorrhea
treatment has evolved during the past
decade due to the ability of N gonorrhoeae to rapidly develop
antimicrobial resistance .
Rapid development of fluoroquinolone
resistance caused the CDC to remove
that therapeutic class from its treatment guidelines in 2007. The Gonococcal Isolate
Surveillance to monitor trends in
gonococcal antimicrobial agents currently recommended for gonorrhea treatment
. this global public health
threat has led the CDC in 2012
to change the gonorrhea
treatment recommendations.
The updates recommendations for treatment of uncomplicated gonococcal
infection during pregnancy.
The increased Ceftriaxone dose of 250 mg should be given along with 1 gram of azithromycin. The
latter provides another drug with a different mechanism of action
against N gonorrhoeae and treats chlamydial co infections. Cefixime
tablets should be reserved for situations that preclude
Ceftriaxone treatment. If they are used a test of cure should be performed
1 week after treatment. Azithromycin 2 grams
orally as a single dose can be used in cephalosporin allergic women.
However this treatment should be limited due to emerging macrolide resistance . Treatment is also recommended for sexual contacts. A test of cure is
unnecessary if symptoms resolve
but because gonococcal
reinfection is common a second
screening in late pregnancy should be considered for women treated
earlier.
Disseminated Gonococcal Infections
Gonococcal bacteremia may cause disseminated infections that manifest
as petechial or pustular skin
lesions arthralgias septic arthritis or tenosynovitis. For treatment the Centers for Disease Control and Prevention has recommended Ceftriaxone
1000 mg intramuscularly or intravenously
every 24 hours . treatment should be continued for 24 to 48
hours after improvement and
therapy is then changed
to an oral gent to complete 1
week of therapy , Prompt recognition
and antimicrobial treatment will
usually result in favorable outcomes in
pregnancy . Meningitis and
endocarditis rarely complicate pregnancy but they may be fetal
. For gonococcal endocarditis Ceftriaxone 1000 to 2000
mg IV every 12 hours should be
continued for at least 4 weeks
and for meningitis , 10 to 14 days
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