MHR: Gonococcal Inf
meduploader - 05-07-09 22:33

Test all pregnant women for gonorrhea at the first prenatal visit if they are at risk for acquisition (defined as report of new or multiple sex partners) or if they live in an area with high prevalence.
Screen for gonorrhea and chlamydia in all patients by the third trimester
Screen young women (under age 25) at risk for STD acquisition if they are seeking care in a clinic with high gonorrhea prevalence
Screen men who have sex with men on an annual basis or more frequently depending on risk behavior.
Use any approved test, including culture, nucleic acid probe ( cervical probe for N.gonorrheae) , and nucleic acid amplification methods, for screening
Consider gonorrhea as a possible cause of proctitis in women who have been exposed through receptive anal sex.
Recognize that pharyngeal infection with N. gonorrhoeae is usually asymptomatic but occasionally causes mild sore or “scratchy” throat.
DGI occurs more commonly in women than in men
In men with urethral discharge  perform a Gram stain smear of urethral secretions.
In women with mucopurulent cervicitis or PID  obtain DNA Probe or nucleic acid amplification of discharge and urine ( not gram stain)
Obtain urine for nucleic acid amplification tests at least 1 hour after last void, and be sure that it contains the initial 15 to 20 mL of the urine stream (“first catch”).
Proctitis or Pharyngitis  get cultures ( not gram stain)
If DGI (rash, arthritis) is suspected, obtain blood cultures and also cultures from mucosal sites exposed during sex (e.g., cervix, urethra, oropharynx, and rectum), even if no signs or symptoms are evident at these sites.
Test for other common STDs
Chlamydia
HIV
Syphilis
When gonorrhea is suspected in the setting of urethritis, cervicitis, or proctitis, also consider infection with C. trachomatis, which can cause presentations identical to gonorrhea.
In men whose urethritis does not respond to antibiotic treatment for gonorrhea and chlamydia, consider less common causes of urethritis, including T. vaginalis.
Among women with pelvic pain, also consider noninfectious etiologies, including ovarian cyst, ectopic pregnancy, endometriosis, ovulation, and gastrointestinal causes
In case of DGI, D/D includes other causes of acute, nontraumatic, oligoarticular arthritis in young adults, including Reiter's syndrome, Lyme disease, and various viral infections.
Hospitalization Indicated only if
Patients with DGI if they are moderately severely or severely ill (including temperature more than 38.0°C [100.4°F] or inability to take oral antibiotics).
All patients with documented or suspected gonococcal endocarditis or meningitis
Hospitalize women with PID in any of the following circumstances:
If surgical emergencies, such as appendicitis, cannot be excluded
Pregnancy
Failure to respond to previously administered oral or outpatient parenteral antibiotics
Inability to take oral therapy ( VOMITING/ NAUSEA)
Severe illness (nausea and vomiting, high fever, hemodynamic instability)
Presence of tubo-ovarian abscess
IMMUNOCOMPROMISED STATES
For Disseminated Gonococcal infection 
Hospitalize the patient
Obtain blood, cervical and pharyngeal cultures
Start IV therapy with Ceftriaxone 1gm/d until clinical improvement occurs and then switch to oral antibiotics to complete total 7 days of Therapy
Oral choices : Cefixime 400/d, cefpodoxime 400 bid
Counsel persons with gonorrhea to abstain from sexual contact for at least 1 week after treatment and until all sex partners have been treated  OTHERWISE, RE-INFECTION CAN OCCUR!