Gonorrhea and Disseminated Gonococcemia
Saturday, January 01, 2011
Gonococcal infection may remain localized to one or several
mucosal surfaces or may become bloodborne, causing a characteristic
dermatitis-arthritis syndrome. The therapeutic strategy is to treat
the pathogenic microorganism with the most appropriate antibiotic.
Efficacy of treatment is dependent on the site of infection and the
sexual exposures of the infected person. The sexual partners of
persons with gonococcal infection are often asymptomatic carriers
and must be referred for evaluation and treatment.
- For uncomplicated urethral and cervical infection:
Intramuscular ceftriaxone 125 mg in one dose.
- For anal gonorrhea in women, standard treatments are effective,
but in men who have sex with men, ceftriaxone should be used (not
the alternate treatments listed below).
- Pharyngeal gonorrhea is harder to eradicate. Ceftriaxone 125 mg
intramuscularly in a single dose is recommended.
- For disseminated gonococcemia, salpingitis, prostatitis, and
arthritis: Hospitalization and treatment with ceftriaxone 1 g
intramuscularly or intravenously daily. Intravenous treatment is
continued for 24-48 hours after improvement is noted, then the
patient is switched to oral therapy with cefixime (or cefpodoxime)
400 mg orally twice daily to complete 1 week of treatment.
- Evaluate the patient for other sexually transmitted diseases
including HIV infection.
- Perform a pregnancy test in women who potentially could be
- Treat the patient with urethral, cervical, rectal, and
pharyngeal infection for coexistent chlamydial infection with
doxycycline 100 mg twice daily for 7 days or azithromycin 1 g
orally in a single dose.
- Children with localized infection who weigh 45 kg or more are
treated as adults. For children under 45 kg who have localized
disease, ceftriaxone 125 mg intramuscularly in a single dose is
recommended. For children of any weight with bacteremia and/or
arthritis, treat with ceftriaxone 50 mg/kg intramuscularly or
intravenously in a single dose daily for 7 days.
- For urethral or cervical disease: Cefixime (or cefpodoxime) 400
mg orally in a single dose, ciprofloxacin 500 mg orally in a single
dose, ofloxacin 400 mg orally in a single dose, levofloxacin 250 mg
orally in a single dose, spectinomycin 2 g intramuscularly in a
single dose (for patients allergic to both cephalosporins and
quinolones). Ceftizoxime 500 mg intramuscularly, cefoxitin 2 g
intramuscularly with probenecid 1 g orally, and cefotaxime 500 mg
intramuscularly are alternative single-dose intramuscular
treatments. (Men who have sex with men should not be treated with
quinolones because of increasing resistance).
- For pharyngeal disease: Nine regular strength tablets
(trimethroprim 80 mg, sulfamethoxazole 400 mg) orally every day for
5 days. Repeat pharyngeal culture if symptoms persist.
- For bacteremia (and arthritis): Cefotaxime 1 g intravenously
every 8 hours, or ceftizoxime 1 g intravenously every 8 hours, or
ciprofloxacin 400 mg intravenously every 12 hours, or ofloxacin 400
mg intravenously every 12 hours, or levofloxacin 250 mg
intravenously daily, or spectinomycin 2 g intramuscularly every 12
hours (for patients allergic to both cephalosporin and
- Gonococcal infection at all sites is a reportable disease.
Notify your local health department if you make this
- Evaluating for and treating other sexually transmitted
infections is important. Do a complete examination.
- Do not prescribe quinolones or tetracyclines for pregnant