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Gonorrhea and Chlamydia Trachomatis: Management

by John Fisher, MD
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    00:01 Turning now to the treatment of gonorrhea.

    00:05 The susceptibility of Neisseria gonorrhoeae across geographic areas is quite variable.

    00:15 There are some areas in the world where highly resistant gonococci are common.

    00:22 And the same thing can be said for certain populations of individuals with gonorrhea.

    00:30 But when we're trying to select an appropriate therapy, our therapy should be approximately 100% effective against Neisseria gonorrhoeae.

    00:45 Agents that are less than 95% effective should be avoided altogether.

    00:55 So if on that special occasion that you were only treating Neisseria gonorrhoeae, the agent of choice would be ceftriaxone, a third generation cephalosporin, and it is given in a single dose.

    01:15 And the efficacy does approach a 100% -- the efficacy is more than 98%.

    01:22 But if a patient is unable to tolerate or is allergic to beta-lactam antibiotics, other therapies are required.

    01:33 And because they may not have 100% cure rate, then 1 week after treatment we would need to document by culture or by the nucleic acid amplification test, that the patient has been cured.

    01:50 If you had to use, for example, a fluoroquinolone azithromycin, or spectinomycin.

    01:58 But back to something I pointed out earlier, if you remember, I said that about 20% of patients who have gonorrhea will come down with non-gonococcal urethritis if you treat only the gonorrhea.

    02:14 That's the main reason that when you're treating, you should treat for both.

    02:20 So you give not only ceftriaxone in a single dose but you give a single dose of azithromycin -- 1 gram and that should cover both organisms, Neisseria gonorrhoeae and Chlamydia trachomatis.

    02:38 So the treatment, as we mentioned, for Chlamydia trachomatis is azithromycin, but if a patient cannot take a macrolide antibiotic, then we would go to doxycycline.

    02:51 And it's not as effective in a single dose, so we have to give 7 days, depending upon the susceptibility in various geographic areas and in various populations.

    03:04 The question then comes, "How do we manage the sexual partners of patients who have gonorrhea?" Well, certainly they should be notified, and they should be tested for both infections, and while we're at it, tested for other common sexually transmitted diseases for example, like HIV infection.

    03:26 That would be ideal.

    03:28 Sometimes that's not possible, so we have something called expedited partner therapy, which would be treating a partner without examination.

    03:40 This is certainly not ideal among physicians and it's actually not permitted in many countries.

    03:49 And it is prohibited in some United States' states, particularly Kentucky, West Virginia, and South Carolina.

    03:59 So you have to see a physician in those states.

    04:07 So once treated, how long do you have to wait before sexual intercourse can resume? Somebody with urethritis should abstain from sexual intercourse for at least 7 days after they've been treated, so as to not expose the partner to these organisms.

    04:30 Sexually active women less than 25 years of age, or certain women in risks group such as sex workers, really should have a pelvic exam and annual testing for Neisseria gonorrhoeae and Chlamydia trachomatis.

    04:46 That's the ideal.

    04:49 They certainly should have a nucleic acid amplification test on self-collected urine or a vaginal swab.

    04:57 This is something that they can do in the privacy of their own home.

    05:02 And it's always wise to get an annual HIV test for those persons at risk.

    05:12 How do we prevent urethritis? Well, many would recommend condoms, they are certainly highly protective against the transmission of sexually transmitted diseases from infected secretions.

    05:24 But I'm here to point out that the protection is not complete.

    05:28 Condoms may not stay on, there may be small rents in the condom, and it can be contagious if the condom is not effective.

    05:42 So another way to prevent urethritis would be to have a monogamous relationship with a partner who's never had these infections.

    05:53 And then, of course, abstinence would be fool-proof.

    05:58 And this brings us to the end of our discussion of urethritis.


    About the Lecture

    The lecture Gonorrhea and Chlamydia Trachomatis: Management by John Fisher, MD is from the course Genital and Sexually Transmitted Infections. It contains the following chapters:

    • Gonorrhea and Chlamydia Trachomatis – Management
    • Urethritis – Etiology

    Included Quiz Questions

    1. ....the geographic location and population infected
    2. ...time of the year infected
    3. ...concomitant infection with Chlamydia trachomatis
    4. ...symptoms of the patient
    5. ...patient's allergies
    1. A single dose of ceftriaxone 250 mg intramuscularly PLUS a single dose of azithromycin 1g orally
    2. A single dose of ceftriaxone 250 mg intramuscularly only
    3. A single dose of ceftriaxone 250 mg intramuscularly PLUS a 7 day course of azithromycin
    4. A 7 day course of doxycycline PLUS a third generation cephalosporin
    5. A 3 day course of flouroquinolone treatmen
    1. If the patient is treated with an alternate antibiotic regimen due to allergie
    2. All patients with confirmed gonorroheal urethritis must have a test of cure
    3. Only patients with non-gonorrheal urethritis must have a test of cure
    4. All patients less than 25 years old
    5. All patients and partners of persons with any type of urethritis must have a test of cure after treatment
    1. Notifying the partner and testing for gonorrhea, chlamydia, and other common sexually transmitted disease
    2. Notifying the partner and test if they have symptoms
    3. Expedited anonymous partner therapy
    4. Provide the patient with home nucleic acid amplification test kit to give to their partner
    5. No treatment or evaluation beyond the patient themselves is recommended

    Author of lecture Gonorrhea and Chlamydia Trachomatis: Management

     John Fisher, MD

    John Fisher, MD


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