Treatment and Prevention of Gonorrhea

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Treatment and Prevention of Gonorrhea
« on: July 01, 2018, 06:51:38 PM »
Treatment

If you test positive for gonorrhea, the infection can be cured with antibiotics. The Centers for Disease Control and Prevention (CDC) recommends people infected with gonorrhea get treated with two antibiotics concurrently because that is more effective than taking one antibiotic and decreases the risk for antibiotic resistance.

The recommended treatment regimen for gonorrhea in the United States is dual therapy using a single 250 mg injection of ceftriaxone (Rocephin) and a single dose of azithromycin (Zithromax), 1 gram orally.

Until recently, the fluoroquinolone group of antibiotics (including ciprofloxacin or Cipro) was the most effective treatment for gonorrhea. However, a large percentage of gonococcus strains in the United States have become resistant to fluoroquinolones so treatment with this antibiotic group is no longer recommended. The CDC carefully monitors antibiotic resistance rates for gonorrhea. Alternate antibiotics may occasionally be used to treat gonorrhea but usually only when an allergy or other problem prevents treatment with ceftriaxone.

If you are pregnant and are infected with gonorrhea, you can be treated without harming the fetus, but some drugs are less effective or less safe than in nonpregnant women. Therefore, it is critical that you tell your health care professional that you are pregnant.

It is important for pregnant women with gonorrhea to be treated because they can spread the infection to their newborn infant. Infants with gonorrhea may be born prematurely. They also may experience eye inflammation (conjunctivitis) or widespread blood infection (sepsis).

Detecting infection in newborns, which is often without symptoms, requires sensitive and specific methods, including tissue culture and gram stains. The most common symptom is conjunctivitis that develops two to five days after birth. Gonorrhea can involve not only the eyes, but less frequently, the infant's genital tract and rectum as well. Recommended treatment for neonatal gonorrhea is ceftriaxone, either as an intravenous or intramuscular injection. Eyedrops are used routinely in hospitals soon after birth to prevent gonococcal conjunctivitis.

If symptoms persist in spite of a full course of appropriate treatment, the gonococcal organism may have become resistant to some antibiotics and may require a repeat culture and an alternate antibiotic. Health departments can work with community providers to test for resistant organisms and develop an appropriate antibiotic treatment plan.

Treatment is recommended for all sexual partners who may have been exposed to gonorrhea; that includes all partners with sexual contact within 60 days prior to symptoms or a diagnosis of gonorrhea or your most recent sexual partner if more than 60 days since last sexual activity.

Some clinics and doctors' offices offer what is called expedited partner therapy (EPT). Patients are given a prescription or the medications that treat gonorrhea to give to their partner(s) without the clinician assessing the partner. There are legal and ethical debates about this approach, and it does have some limitations (including loss of screening and counseling opportunities and the rare potential for adverse reactions to antibiotics), but in some cases, it may be the most effective way to stop the spread of gonorrhea, because many infected partners have no symptoms and are reluctant to seek treatment. EPT is legal in many U.S. states and cities. Click here for more information on its legal status.

Reinfection can occur if partners do not get diagnosed and treated. Therefore, it is important that you abstain from sexual contact until your partner has been tested and completed treatment (seven days after a single-dose regimen or after completion of a seven-day regimen). Since partners frequently are not treated in a timely fashion and resume sex too soon, reinfection is very common. Therefore, it is important that you return to your provider to have a test for reinfection three months after treatment or whenever you can after a month following treatment.

Treating PID

Pelvic inflammatory disease (PID) treatment begins with an antibiotic regimen that primarily provides coverage against gonorrhea and chlamydia. Treatment should begin as soon as a diagnosis is made, because immediate therapy has been shown to reduce the risk of long-term damage from PID. Oral therapy and a muscular injection are most commonly used. In certain cases, medication may be administered via injection into the veins. Hospitalization is recommended in the following circumstances:

surgical emergencies such as appendicitis cannot be excluded
pregnancy
allergy to orally available antibiotics
severe illness, nausea, vomiting or high fever
presence of tubo-ovarian abscess
no response to oral therapy
While medication can stop PID, some women may need surgery to remove scar tissue and blockages caused by long-term infection.


Prevention

Protecting yourself from gonorrhea requires the same care and attention needed to prevent other sexually transmitted infections (STIs). If you have already been infected, you should be vigilant in getting treated and in preventing reinfection, which can increase your risk of infertility. Abstinence is one sure way to avoid infection, as the spread of gonorrhea is almost always limited to sexual contact. It is safe to have sex in a mutually monogamous relationship in which neither partner has an STI, but it can be difficult to know with certainty that your partner is monogamous.

If you have sex, make sure you use a condom correctly at all times. Also know that your risk for gonorrhea infection increases with the more sexual partners you have. If you have any risk factors for gonorrhea, you should ask your health care professional to test you at least once a year. Some of the risk factors are young age, being sexually active, having multiple sex partners and having had prior STIs.

Here are other tips for avoiding gonorrhea:

Ask about the sexual history of current and future sex partners.
Reduce your number of sex partners. A mutually monogamous relationship between two uninfected people is safe.
Always use a condom from start to finish during any type of sex (vaginal, anal and oral). Use latex condoms rather than natural membrane condoms. If used properly, latex condoms offer greater protection against STIs, including HIV.
Women who have sex with women can use latex gloves and condoms for genital and anal stimulation with the fingers or with sex toys (dildos, vibrators, etc.). A dental dam (flat, latex barrier), non-microwavable plastic wrap or a condom cut lengthwise and placed over the vagina is advisable for oral-genital sex.
Use only water-based lubricants with condoms. Do not use saliva or oil-based lubricants such as petroleum jelly or vegetable shortening because they may make the condom thinner and more likely to tear. The U.S. Food and Drug Administration requires a warning on the labels of over-the-counter vaginal contraceptives that contain the spermicide nonoxynol-9 stating that those contraceptives do not protect against infection from HIV (human immunodeficiency virus, the AIDS virus) or other STIs. The FDA's warning also advises consumers that use of vaginal contraceptives containing nonoxynol-9 can increase vaginal irritation, which may increase the possibility of transmitting the AIDS virus and other STIs from infected partners. If you decide to use a spermicide with a condom, it is preferable to use spermicide in the vagina according to manufacturer's instructions.