Neisseria gonorrhoeae
| Neisseria gonorrhoeae | ||||||||||||||
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 Neisseria gonorrhoeae cultured on two different media types.
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| Neisseria gonorrhoeae Zopf, 1885 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Neisseria gonorrhoeae (also known as Gonococci) is a species of Gram-negative bacteria responsible for the sexually transmitted disease gonorrhoea.[1] Neisseria are highly fastidious cocci, requiring nutrient supplementation to survive. Thus, they grow on Chocolate agar (heated blood agar) with carbon dioxide. These cocci are facultatively intracellular and typically appear in pairs (diplococci).
Gonorrhoea symptoms include a purulent (or pus-like) discharge from the genitals which may be foul smelling, a burning sensation during urination and conjunctivitis commonly in neonates; that's why silver nitrate is used as a preventive measure. It also occurs occasionally in adults. Neisseria is usually isolated on a Thayer-Martin agar — an agar plate with 3 different antibiotics and nutrients which not only facilitate the growth of Neisseria species, but inhibit the growth of Gram-positive organisms and most bacilli and fungi. Further testing to differentiate the species includes testing for oxidase (all Neisseria show a positive reaction) and the carbohydrates maltose, sucrose, and glucose test in which N. gonorrhoeae will only oxidize (that is, utilize) the glucose.
If N. gonorrhoeae is resistant to the penicillin family of antibiotics, then ceftriaxone (a third-generation cephalosporin) is often used.
Patients should also be tested for Chlamydia infections, since co-infection is frequent.
Diagnosis
Pathology
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Treatment
- Gonococcal Infections [3]
- Gonococcal Infections in Adolescents and Adults
- Uncomplicated Gonococcal Infections of the Cervix, Urethra, and Rectum
- Preferred regimen : Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1g PO in a single dose
- Alternative regimen:Cefixime 400 mg PO single dose AND Azithromycin 1 g PO single dose.(If ceftriaxone is not available)
- Uncomplicated Gonococcal Infections of the Pharynx
- Preferred regimen:Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
- Gonococcal Conjunctivitis
- Preferred regimen :Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
- Management of Sex Partners
Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or gonorrhea diagnosis) should be referred for evaluation, testing, and presumptive dual treatment. If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated. To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present.
EPT with cefixime 400 mg and azithromycin 1 g can be delivered to the partner by the patient, a disease investigation specialist, or a collaborating pharmacy as permitted by law
Pregnant women infected with N. gonorrhoeae should be treated with dual therapy consisting of ceftriaxone 250 mg in a single IM dose and azithromycin 1 g orally as a single dose.
HIV Infection Persons who have gonorrhea and HIV infection should receive the same treatment regimen as those who are HIV negative. For more information, see appropriate treatment sections unde
Suspected Cephalosporin Treatment Failure
Suspected treatment failures first should be retreated routinely with the recommended regimen (ceftriaxone 250 mg IM plus azithromycin 1 g orally), because reinfections are more likely than actual treatment failures. However, in situations with a higher likelihood of treatment failure than reinfection, relevant clinical specimens should be obtained for culture (preferably with simultaneous NAAT) and antimicrobial susceptibility testing performed before retreatment. Dual treatment with single doses of oral gemifloxacin 320 mg plus oral azithromycin 2 g or dual treatment with single doses of intramuscular gentamicin 240 mg plus oral azithromycin 2 g can be considered, particularly when isolates are found to have elevated cephalosporin MICs (569). Persons with suspected treatment failure after treatment with the alternative regimen (cefixime and azithromycin) should be treated with ceftriaxone 250 mg as a single IM dose and azithromycin 2 g orally as a single dose. A test-of-cure at relevant clinical sites should be obtained 7–14 days after retreatment; culture is the recommended test, preferably with simultaneous NAAT and antimicrobial susceptibility testing of N gonorrhoeae if isolated. Clinicians should ensure that the patient’s sex partners from the preceding 60 days are evaluated promptly with culture and presumptively treated using the same regimen used for the patient.
:*Disseminated Gonococcal Infection
- Treatment of Arthritis and Arthritis-Dermatitis Syndrome
- Preferred regimen :Ceftriaxone 1 g IM/IV q24h for 7 daysAND Azithromycin 1 g PO in a single dose
- Alternative regimen :Cefotaxime 1 g IV q8h for 7 days OR Ceftizoxime 1 g IV q 8 h for 7 days AND Azithromycin 1 g PO in a single dose
- Treatment of Gonococcal Meningitis and Endocarditis
- Preferred regimen :Ceftriaxone 1-2 g IV q 12-24 h for 10-14 daysAND Azithromycin 1 g PO in a single dose
- Gonococcal Infections Among Neonates
- Preferred regimen :Erythromycin (0.5%) ophthalmic ointment in each eye in a single application at birth
- DGI and Gonococcal Scalp Abscesses in Neonates
- Preferred regimen :Ceftriaxone 25-50 mg/kg/day IM/IV qd for 7 days OR Cefotaxime 25 mg/kg IV /IM q12h for 7 days.
- Note: The duration of treatment is 10-14 days if meningitis is documented
- Treatment of Neonates Born to Mothers Who Have Gonococcal Infection in the Absence of Signs of Gonococcal Infection
- In the Absence of Signs of Gonococcal Infection
- Preferred regimen :Ceftriaxone 25-50 mg/kg/day IM/IV in a single dose, not to exceed 125 mg
- Gonococcal Infections Among Infants and Children
- Infants and Children Who Weigh ≤45 kg and Who Have Uncomplicated Gonococcal Vulvovaginitis, Cervicitis, Urethritis, Pharyngitis, or Proctitis
- Preferred regimen :Ceftriaxone 25-50 mg/kg/day IM/IV in a single dose, not to exceed 125 mg
- Children Who Weigh >45 kg and Who Have Uncomplicated Gonococcal Vulvovaginitis, Cervicitis, Urethritis, Pharyngitis, or Proctitis
- Preferred regimen : Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1g PO in a single dose
- Alternative regimen:Cefixime 400 mg PO single dose AND Azithromycin 1 g PO single dose.(If ceftriaxone is not available)
- Children Who Weigh ≤45 kg and Who Have Bacteremia or Arthritis
- Preferred regimen :Ceftriaxone 50 mg/kg (maximum dose: 1 g) IM or IV q 24 h for 7 days
- Children Who Weigh >45 kg and Who Have Bacteremia or Arthritis
- Preferred regimen :Ceftriaxone 1 g IM /IV q 24 for 7 days
References
- ↑ Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed. ed.). McGraw Hill. ISBN 0838585299.
- ↑ http://picasaweb.google.com/mcmumbi/USMLEIIImages
- ↑ "Chlamydial Infections".
de:Neisseria gonorrhoeae it:Neisseria gonorrhoeae hu:Neisseria gonorrhoeae nl:Neisseria gonorrhea no:Neisseria gonorrhoeae