Antibiotics have been quite effective in the management of gonorrhea for many decades. They are curative when the patient and all sexual partners obtain treatment and abstain from sex while they take the medication. Issues of drug resistance, however, have led to a variety of alterations in the management of this disease.
There have also been significant changes in sexual practices. More people engage in anal and oral sex than in the first half of the 20th century and before. The specific antibiotic and dosage will depend on the location or extent of gonorrhea. Moreover, women are more likely to be asymptomatic when they have this disease, but they require antibiotic treatment as much as symptomatic men or women.
Penicillinase-Producing Neisseria gonorrhoeae
Penicillin was an excellent agent to cure an episode of gonorrhea several decades ago, and physicians found oral probenecid a useful drug at that time to enhance the bioavailability of penicillin. Nevertheless, penicillinase-producing Neisseria gonorrhoeae (PPNG) emerged in the United States during the 1970s, and these strains inactivated the penicillin. Hence, cephalosporins such as ceftriaxone became popular agents to successfully manage gonorrhea.
Resistance to cephalosporins became apparent in subsequent years. And the frequency of gonorrhea with Chlamydia trachomatis coinfection prompted medical doctors to use two-drug regimens in order to cover both microorganisms. Therefore, azithromycin and doxycycline have become common agents for most cases of gonorrhea in the United States today (Centers for Disease Control, 2011).
For several years, quinolones were the recommendation, but resistance to this group of drugs led to the use of other drugs.
Since gonorrhea is a well-known worldwide public health problem, there must be constant surveillance of drug resistance to Neisseria gonorrhoeae. The Gonococcal Isolate Surveillance Project (GISP) conducts that observation of resistance which the gonococcus has to various antimicrobial agents. Physicians must also consider that antibiotic resistance to this microbe will vary around the world, and he or she must inquire about travel to other countries whenever these patients present to a health care facility.
Antibiotic Choices
For uncomplicated gonorrhea which involves the cervix, urethra, and rectum in women, the recommendation is an appropriate cephalosporin in combination with azithromycin or doxycycline by mouth. Spectinomycin is also beneficial in the treatment of uncomplicated gonorrhea; however, this agent is not available in the United States. Pregnant women who have gonorrhea will also benefit from cephalosporin therapy; if they cannot take those agents, azithromycin is an acceptable alternative.
Finally, adults who develop conjunctivitis from gonorrhea require saline lavage of the eyes as well as ceftriaxone one gram intramuscularly as a single dose for treatment. Moreover, these patients should have therapy for chlamydia regardless of whether there is diagnostic confirmation of that microbe.
Sources
- Centers for Disease Control. (2011). Gonorrhea. Retrieved October 20, 2011.
- U.S. Department of Health and Human Services. Office on Women’s Health. (2011). Gonorrhea. Retrieved October 20, 2011.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.
Michael Koger - Dr. Koger obtained his medical education at Meharry Medical College and specialized in Internal Medicine.
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