Neisseria gonorrhoeae :Diagnosis and Treatment

Neisseria gonorrhoeae :Diagnosis and Treatment


Diagnosis

Gram’s staining

  • Best site to obtain a swab in asymptomatic gonorrhea should be endocervix.
  • Gram Staining of urethral exudates
  • Organism appear as diplococci
  • Predominantly within the polymorphs .

Culture

  • Inoculated on Thayer – Martin medium
  • Detection of gram-negative diplococci or monococci is usually specific.
  • Transport media
  • Gonococci do not tolerate drying.
  • If processing is to occur within 6 hrs:
  • non-nutritive swab transport systems such as Stuart or Amies medium,
  •  For longer holding periods:
  • culture media with self-contained CO2 generating systems
  •  JEM BEC or Gono-Pak system may be used
Treatment 
  • Gonococci produces beta lactamase, rendering penicillin treatment ineffective.
  • For uncomplicated gonococcal infection ceftriaxone is DOC (along with azithromycin or doxycyclin to cover chlamydial infection)

Recommended Rx of Gonococcal infection (Penicillinase producing NG) :

  • Gonococcal infection of cervix, urethra, pharynx, rectum
  • First line – Ceftriaxone, ciprofloxacin, ofloxacin
  • Alternatives – Spectinomycin, ceftizoxime, cefotetan.
  • Gonococcal conjuctivitis and ophthalmia neonatorum  and  Disseminated gonoccal infection (Gonococcal arthritis)
  • Ceftriaxone.
  • Patient tolerant to P-lactam drugs – 
  • ceftriaxone, cefotaxime, ceftizoxim.
  • Patient allergic to P-lactam drugs –
  •  ciprofloxacin, ofloxacin, spectinomycin.
  • Continuation therapy –
  •  Ciprofloxacin, ofloxacin, levofloxacin.
  • Gonococcal epididymitis – 
  • ceftriaxone followed by doxycycline.

Prevention and Control

  • Transmitted from males to females more frequently.
  • Condoms provide effective protection against transmission.
Exam Question
 

Diagnosis

Gram’s staining

  • Best site to obtain a swab in asymptomatic gonorrhea should be endocervix.

Treatment 

  • Gonococci produces beta lactamase, rendering penicillin treatment ineffective.
  • For uncomplicated gonococcal infection ceftriaxone is DOC (along with azithromycin or doxycyclin to cover chlamydial infection)
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