Exam 2 - Gonorrhea

Question 1

Most common organism causing gonorrhea

Answer 1

Neisseria gonorrheae

Question 2

Most common locations for neisseria gonorrhea to infect

Answer 2

Mucocutaneous surfaces of GU tract, pharynx, conjunctivia, anus

Question 3

True/false: gonorrhea is the second most common reportable infectious disease in the U.S.

Answer 3

True

Question 4

Is it common to have a coinfection with chlamydia?

Answer 4

Yes - due to antibiotic resistance

• Treatment for gonorrhea should include chlamydia to reduce incidence of PID

Question 5

Is it possible to have vertical transmission in the neonate for gonorrhea?

Answer 5

Yes - can cause ocular infections

• Typically asymptomatic until complications occur
• Incubation period of 3-10 days

Question 6

What is disseminated gonococcal infection (DGI)?

Answer 6

Rare and life threatening infection caused by neisseria gonorrhea

• Can occur if gonorrhea is undiagnosted and untreated
• Can progress to septic arthritis, joint pain, effusions in wrist, knees, ankles

Question 7

Gonorrhea: signs and symptoms

Answer 7

• Vaginal discharge
• Bleeding, spotting
• Dysuria, dyspareunia
• Labia edema
• Pain

Question 8

Gonorrhea: physical exam findings

Answer 8

• Lymphadenopathy
• Cervical motion tenderness
• Cervicitis –> red, inflamed cervix with unusual discharge
  
  • Erythema, friability, purulent exudate
• Uterine or adnexal tenderness
• Masses associated with PID –> tubal scarring and infertility

Question 9

Gonorrhea: diagnostic testing

Answer 9

NAAT testing –> specimen from cervix, vagina, anus, pharynx

Question 10

Why is co-treatment (dual treatment) now required for gonorrhea treatment?

Answer 10

Evolving multidrug resistance

Question 11

Gonorrhea: treatment (for uncomplicated infections)

Answer 11

Ceftriaxone 250mg IM single dose OR cefiximine (Suprax) 400mg PO single dose

AND

Azithromycin 1g PO once OR doxycyline 100mg PO BID for 7 days

Question 12

What treatment alternatives are available for patients with PCN/cephalosporin allergies?

Answer 12

Gentamicin + azithromycin OR

Gemifloxacin + azithromycin

Question 13

Is test of cure for gonorrhea and chlamydia recommended?

Answer 13

No - ONLY if pregnant or symptoms persist following treatment

Question 14

Gonorrhea: patient and partner treatment

Answer 14

• Patient and partner can come in for treatment (within 60 days or for most recent partner) via expedited partner therapy (EPT) or patient-delivered partner therapy (PDPT)
  
  • Extra dose for partner provided in prescription or separate prescription
• Legal protections for EPT provided in most states

Question 15

Gonorrhea: patient education

Answer 15

Test for reinfection at 3 months

• A second infection increases risk for PID and ectopic pregnancies
• Strongest risk factor for reinfection is past infection