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