Review-Literature: (CDC Guidelines, 2006) (Moran, 2003) (Schneede et al, 2003).
should be done 4 h after voiding with inoculation of different culture media:
for Gram stain (gonococcus) and Giemsa stain (Chlamydia), if a microscopic pathogen detection is sought. Over 4 leukocytes/field with intracellular gram-negative diplococci can be seen in gonorrhea with high power microscopy [fig. microscopy of gonorrhea].
to detect Enterococcus, Streptococcus, Staphylococcus aureus ...
to detect Neisseria gonorrhoeae Martin-Lewis plates or Thayer-Martin agar should be used. Stuart medium to detect Mycoplasma and Ureaplasma. The detection of Chlamydia is done with direct DNA evidence from the swab or seldom by growing in McCoy cell culture.
swab specimens collected from anus, pharynx, cervix, depending on history and symptoms.
to avoid a ping-pong-infection a detailed history and examination of any sexual partner is necessary.
to exclude Syphilis, inappropriate for Chlamydia.
first choice for a known gonococcal etiology: ceftriaxone 250 mg i.m. once. The CDC recommends the subsequent treatment with doxycycline 100 mg 1-0-1 for 7 days. This reduces the likelihood of persistent urethritis by 50%, which is usually maintained by Chlamydia or Ureaplasma. Importance is the study and co-treatment of the sexual partner.
Ciprofloxacin 500 mg p.o. or Ofloxacin 300 mg p.o., followed by doxycycline 100 mg p.o. 1-0-1 for 7 days. This regimen is effective against most of urethritis pathogens. Alternative: Azithromycin 1 g p.o. once.
Use of condoms, treatment with intravaginal nonoxynol-9 containing Spermacides, antibiotic prophylaxis after sexual intercourse, treatment of newborns eyes with antibiotic ointment.
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Deutsche Version: Gonorrhoe: Diagnose und Therapie der gonorrhoischen Urethritis.
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Dr. med. Dirk Manski
man...@urologielehrbuch.de