Recommendation Treatment of Gonoccal Infection

8/17/2019 Recommendation Treatment of Gonoccal Infection

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Recommendationtreatment of gonoccal

infection


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Gonococcal Infections in Adolescents and Adults


3/20

Uncomplicated gonoccal infectionsof cervix, uretrha, and rectum

Recommended Regimen

• Ceftriaxone 250 mg IM in a single dosePLUS

• Azithromycin 1g orally in a single dose

ALERGY : doxycycline 100 mg orally !"ice a day #or $days%

Alternative RegimensI# ce#!riaxone is no! a&aila'le:•

Cexime (00 mg orally in a single dosePLUS

• Azithromycin 1 g orally in a single doseALERGY : doxycycline 100 mg orally !"ice a day #or

$ days%


4/20

Spesial considerations

ALLERGI) )EP*AL+SP+RI,S :• Single doses o# oral gemioxacin -20 mg +r

single doses o# in!ram.sc.lar gentamicin 2(0mg %

PLUS• +ral azithromycin 2 g

PREG,A,)Y :• Ceftriaxone 250 mg in a single IM

dose• Azithromycin 1 g orally as a single

dose/

*I I,E)I+, :Persons "3o 3a&e gonorr3ea and *I in#ec!ions3o.ld recei&e !3e same treatment regimen

as those !ho are "I# negative$


5/20

Suspected Cephalosporin %reatment &ailure

• rea!men! #ail.re s3o.ld 'e considered :

1/ Persons "3ose sym4!oms do no! resol&e"i!3in -5 days a#!er a44ro4ria!e !rea!men!

and re4or! no sex.al con!ac! d.ring !3e 4os!6!rea!men! #ollo"6.4 4eriod

2/ Persons "i!3 a 4osi!i&e !es!6o#6c.re i/e/74osi!i&e c.l!.re 8$2 3o.rs or 4osi!i&e ,AA

9$ days a#!er recei&ing recommended!rea!men!% "3en no sex.al con!ac! isre4or!ed d.ring !3e 4os!6!rea!men! #ollo"6.44eriod


6/20

Uncomplicated Gonococcal Infections of the 'harynx

Recommended Regimen

• Ceftriaxone 250 mg IM in a single dosePLUS

• Azithromycin 1 g orally in a singledose


7/20

Gonococcal Con(unctivitis

Recommended Regimen

• Ceftriaxone 1 g IM in a singledosePLUS

• Azithromycin 1 g orally in asingle dose

)i i t d G l


8/20

)isseminated GonococcalInfection

rea!men! o# Ar!3ri!is and Ar!3ri!is6

erma!i!is SyndromeRecommended Regimen• Ceftriaxone 1 g IM or I e&ery 2(

3o.rsPLUS

• Azithromycin 1 g orally in asingle dose

Alternative Regimens• Cefotaxime 1 g I e&ery ; 3o.rs

+R• Ceftizoxime 1 g I e&ery ; 3o.rs

PLUS

• Azithromycin 1 g orally in a


9/20

ssem na e onococcaInfection

rea!men! o# Gonococcal Meningi!is

and Endocardi!isRecommended Regimen

• Ceftriaxone 12 g I e&ery 122(

3o.rsPLUS

• Azithromycin 1 g orally in a single

dose


10/20

*)UCA%I+

• Persons !rea!ed #or gonorr3ea s3o.ld 'e ins!r.c!ed!o a's!ain #rom sex.al ac!i&i!y #or $ days a#!er!rea!men! and .n!il all sex 4ar!ners are ade


11/20

&+--+. U'•

A !es!6o#6c.re is not needed #or 4ersons "3o recei&ea diagnosis o# uncomplicated urogenital or rectalgonorrhea "3o are !rea!ed "i!3 any o# !3erecommended or al!erna!i&e regimens

• 'haryngeal gonorrhea "3o is !rea!ed "i!3 anal!erna!i&e regimen should return /0 days aftertreatment #or a !es!6o# c.re .sing ei!3er c.l!.re or,AA/

• If the AA% is positive7 e=or! s3o.ld 'e made !o4er#orm a con>rma!ory c.l!.re 'e#ore re!rea!men!/ All4osi!i&e c.l!.res #or !es!6o#6c.re s3o.ld .ndergoantimicro1ial suscepti1ility testing$


12/20

&+--+. U'

• Men or "omen "3o 3a&e 'een !rea!ed #orgonorr3ea should 1e retested 2 monthsafter treatment regardless o# "3e!3er

!3ey 'elie&e !3eir sex 4ar!ners "ere !rea!ed/

• I# re!es!ing a! - mon!3s is no! 4ossi'le7clinicians should retest "3ene&er

4ersons nex! 4resen! #or medical care "i!3in/3 months follo!ing initial treatment$


13/20

4anagement of Sex 'artners

•

Recent sex partners i/e/7 4ersons 3a&ingsex.al con!ac! "i!3 !3e in#ec!ed 4a!ien! "i!3in!3e ?0 days 4receding onse! o# sym4!oms orgonorr3ea diagnosis% should 1e referred forevaluation, testing, and presumptive dualtreatment$

• o a&oid rein#ec!ion7 sex 4ar!ners s3o.ld 'einstructed to a1stain from unprotectedsexual in!erco.rse #or $ days a#!er !3ey and!3eir sex.al 4ar!ners% 3a&e com4le!ed !rea!men!and a#!er resol.!ion o# sym4!oms7 i# 4resen!/


14/20

Gonococcal Infections Among eonates


15/20

+phthalmia eonatorum 'rophylaxis andtreatment

Recommended Regimen( prophylaxis )

• *rythromycin 0/5@% o43!3almic

oin!men! in eac3 eye in a singlea44lica!ion a! 'ir!3

Recommended Regimen( %reatment 5• Ceftriaxone 2550 mgBg I or IM

in a single dose7 no! !o exceed 125

mg


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)GI and Gonococcal Scalp A1scessesin eonates

Recommended Regimens

• Ceftriaxone 2550 mgBgday I or IM in

a single daily dose #or $ days7 "i!3 ad.ra!ion o# 101( days i# meningi!is isdoc.men!ed+R

• Cefotaxime 25 mgBg I or IM e&ery 123o.rs #or $ days7 "i!3 a d.ra!ion o# 101(days i# meningi!is is doc.men!e


17/20

Gonococcal Infections Among Infants andChildren


18/20


19/20

4anagement o# Sex Par!ners

•

Recent sex partners i/e/7 4ersons 3a&ingsex.al con!ac! "i!3 !3e in#ec!ed 4a!ien! "i!3in!3e ?0 days 4receding onse! o# sym4!oms orgonorr3ea diagnosis% should 1e referred forevaluation, testing, and presumptive dualtreatment$

• o a&oid rein#ec!ion7 sex 4ar!ners s3o.ld 'einstructed to a1stain from unprotectedsexual in!erco.rse #or $ days a#!er !3ey and!3eir sex.al 4ar!ners% 3a&e com4le!ed !rea!men!and a#!er resol.!ion o# sym4!oms7 i# 4resen!/


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REERE,)E

• 3!!4:"""/cdc/go&s!d!g2015gonorr3ea/3!mCman64ar!
http://www.cdc.gov/std/tg2015/gonorrhea.htm#man-parthttp://www.cdc.gov/std/tg2015/gonorrhea.htm#man-parthttp://www.cdc.gov/std/tg2015/gonorrhea.htm#man-parthttp://www.cdc.gov/std/tg2015/gonorrhea.htm#man-part

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Recommendation Treatment of Gonoccal Infection