Treatment and Prevention of Gonorrhea

Treatment

History Taking:

Sexual Orientation
Number of Sexual partners in the past 2 months
Exposure to STD contact including gonorrhea
Prior STD history, treatment
Time and day of last sexual activity

Diagnostic Tests

Gonorrheal infection may be suspected based on history, symptoms, and clinical evidence obtained by physical examination. However, identification of the pathogenic organism is necessary to confirm the diagnosis and to rule out other problems. In men the diagnosis is confirmed by gram-stained smear of the discharge from the penis. Culture of the discharged from the penis is usually reserved for those whose smears are negative in the presence of strong clinical evidence.

Gram stained cervical smears are inadequate for diagnosing gonorrhea in women. These smears are negative in about 50 percent of women having gonorrhea and are falsely positive in some cases. Therefore, cultures from the cervix, urethra, throat, and anus are usually taken. Due to the great length of time required to obtain reports of cultures for gonorrhea, treatment is usually begun on presumptive basis.

Interventions

Administering Medications

Therapy for gonorrhea presents a greater problem than for syphilis, because the gonococcus tends to develop resistance to antibiotics. It is also believed that inadequate therapy is common in the United States. Several drug regimes are in use. Emphasis is on single-dose treatment, because it avoids the need for follow-up and patient cooperation.

The treatment regimen recommended by the CDC is as follows:

Ceftriaxone (Rocephin), 125 milligrams intramuscular in a single dose
Alternative therapy; spectinomycin, 2 grams intramuscular once; ciprofloxacin, 500 milligrams by mouth once; or ofloxacin, 400 milligrams by mouth once

*These are classified as antibacterials/antibiotics necessary to treat gonococcal infections.

Spectinomycin is recommended by the CDC for the treatment of persons with resistant strains of Neisseria gonorrhoeae.

Due to the inconvenience of intramuscular injections and concern about the possible needle sticks associated with intramuscular injections in persons who may also have HIV, a recent study using oral medication was undertaken. Persuant to the study, the following recommendations were made by the CDC for the treatment of uncomplicated gonococcal infections; ceftriaxone, 125 milligrams intramuscular in a single dose, or cefixime, 400 milligrams orally in a single dose, or ciprofloxacin, 500 milligrams orally in a single dose, or ofloxacin, 400 milligrams orally in a single dose, plus a regimen effective against possible coinfection with Chlamydia trachomatis, such as doxycycline, 100 orally twice daily for seven days.

Prevention

Prevention of gonorrhea and its complications can be achieved in threes stages. The first and the most crucial stage, primary intervention, is prevention of the disease. The second stage, secondary prevention, involves prevention of complications of the disease such as PID. The third stage, tertiary prevention, is reversal of the damage caused by the disease, such as tubal reconstruction.

Early treatment of infected persons is the most effective method to prevent new infection of sexual partners. Mechanical barriers such as condoms used with spermicides may reduce but not prevent gonorrhea. Education to acquaint people with the symptoms of gonorrhea, the efficacy of condoms, and the availability of diagnostic and treatment resources is also important.