NEISSERIA GONORRHOEAE (GONOCOCCUS) INFECTION CLINICAL FEATURES AND MANAGEMENT

NEISSERIA GONORRHOEAE (GONOCOCCUS) INFECTION CLINICAL FEATURES AND MANAGEMENT

Management A typical treatment regimen is ampicillin (3g) plusprobenecid (1 g orally). This combination allows single dose treatment, probenecid delaying excretion of the penicillin. Recommended alternative regimens areciprafloxacillin 500 mg orally, or ofloxacin 400 mg orally,both as a single dose. These are preferred for the treatmentof pharyngeal infection as ampicillin (and spectinomycin)has poor efficacy in eradicating infection from this site.The prevalence of penicillinase-producing strains in theUK is less than 5%, and quinolones remain highlyactive against these resistant strains. The prevalence ofquinolone-resistance strains in the UK is less than2%, but has risen since 1993. The prevalence of strainsresistant to both quinolones and penicillin is high in someparts of the world, particularly southeast Asia, and thisneeds to be considered in treating possible imported infection. In these cases alternative regimens includecefotaxime 500mg (i.m.) or spectinomycin 2mg (i.m.),both as a single dose.Coinfection with Chlamydia trachomatis occurs in up to20% of men and 40% of women presenting with gonohorroea,and should be suspected if symptoms persist a week after treatment of gonoccocal infection. Combining effectiveanti-microbial therapy against Chlamydia with single dose therapy for gonorrhoea at first presentation may be appropriate, and should be considered if there is doubtabout follow-up. Sexual contacts should be traced, examined and treated.

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