Gonorrhea: Testing and Treatment of the gonococcal Urethritis
- Gonorrhea (1/2): Etiology, Signs and Symptoms
- Gonorrhea (2/2): Diagnosis and Treatment
Review-Literature: (CDC Guidelines, 2006) (Moran, 2003) (Schneede et al, 2003).
Diagnosis of Gonorrhea
Urethral swab:
should be done 4 h after voiding with inoculation of different culture media:
Two microscope slides:
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].
Blood agar plates:
to detect Enterococcus, Streptococcus, Staphylococcus aureus ...
Special media:
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.
Further pathogen collection:
swab specimens collected from anus, pharynx, cervix, depending on history and symptoms.
study of the sexual partner:
to avoid a ping-pong-infection a detailed history and examination of any sexual partner is necessary.
Urin analysis:
after the urethral swab is collected, an urine culture from midstream should be started.Serologic diagnosis:
to exclude Syphilis, inappropriate for Chlamydia.
Treatment of Gonorrhea
Standard treatment:
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.
Alternative treatments:
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.
Prevention:
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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References
- Center for Disease Control and Prevention.:
- Sexually transmitted diseases treatment guidelines 2006.
in: MMWR
2006; 55 (No. RR-11): 1–93.
- Moran 2003 MORAN, J.:
- Gonorrhea.
In: Clin Evid
(2003), Nr. 10, S. 1854–62
- Schneede u.a. 2003 SCHNEEDE, P. ; TENKE, P. ; HOFSTETTER, A. G.:
- Sexually transmitted diseases (STDs)-a synoptic overview for
urologists.
In: Eur Urol
44 (2003), Nr. 1, S. 1–7
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Deutsche Version: Gonorrhoe: Diagnose und Therapie der gonorrhoischen Urethritis.
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Dr. med. Dirk Manski
man...@urologielehrbuch.de