For a basis of these reports are taken "Training materials for diagnosis and treatment of the most common sexually transmitted infections (STIs), and skin diseases ", approved by the Academic Council of State TSNIKVI and Section №14 of the Academic Council of Ministry of Health of the Russian Federation on 4 July 2000
GONORRHEA
definition
Gonorrhea - infectious disease, sexually transmitted
Pathogen - Neisseria gonorrhoeae.
ICD X revision. section A.54
A 54.0. Gonococcal infection of the lower genital tract without periurethral abscess and accessory glands.
A 54.1. Gonococcal infection of the lower genital tract with periurethral abscess and accessory glands.
A 54.2. Gonococcal pelvic inflammation and other gonococcal infection of the urogenital organs.
A 54.3. Gonococcal eye infection.
A 54.4 Gonococcal infection of musculoskeletal system.
A 54.5. Gonococcal pharyngitis.
A 54 6 Gonococcal infection anorectal
A 54.8. Other gonococcal infections
The spectrum required diagnostic and therapeutic measures
1. Laboratory research
Verification of the diagnosis based on the detection of gonorrhea Neisseria gonorrhoeae using one of the methods:
- Microscopic examination of smears from the urethra, cervix, rectum (Gram stain) - Identification of typical Gram-negative diplococci;
- Cultures for the isolation of a pure culture of typical Gram-negative, oksidazopolozhitelnyh diplokokkov.
In girls and women over 60 years old - only with the definition of cultural studies of enzymatic properties of N. gonorrhoeae.
Multiplicity of research: before treatment, then after 7-10 days of treatment (for further study - according to indications).
2. blood analysis
- production complex of serological tests for syphilis
- determination of antibodies to HIV, hepatitis B and C.
Multiplicity studies: before treatment and again at 3 months (when the source is not established infection).
3. additional studies
- Clinical blood and urine analysis;
- biochemical analysis of blood and urine;
- Pelvic ultrasound.
The usefulness of provocations solved individually by the attending physician. Indications, volume and frequency are determined by further study the nature and severity of the clinical manifestations of gonococcal infection.
Management of Sex Partners
Mandatory testing and treatment is required for all sexual partners of patients with symptoms, if they had sex contact with a patient in the last 14 days, and examined and treated the last sexual partner, if the contact was previously. In the absence of symptoms in the patient examination and treatment shall be subject to all sexual partners in the last 90 days. During treatment from sex to abstain. During clinical supervision sexual activity without condom use is not recommended.
Treatment of gonorrhea of the lower genital tract without complications and 54.0
Recommended Regimens:
- ceftriaxone (Rocephin)
- 250 mg intramuscularly once
or
- ciprofloxacin
- 500 mg orally once.
Alternative schemes:
- ofloxacin
- 400 mg orally once
or
- spectinomycin (Trobitsin)
- 2.0 g once,
or
- tsefodizim
- V / m to 500 mg once.
Treatment of gonorrhea of the lower genital tract complications and gonorrhea and the upper sections of the pelvic organs and 54.1: 54.2
Disseminated gonococcal infection
The recommended regimen:
- ceftriaxone (Rocephin)
- 1.0 g / m or / in every 24 hours.
Alternative schemes:
- cefotaxime
- 1.0 g / in every 8 hours
or
- kanamycin *
- 1 million units / m per 12 hours;
* The drug should not be administered in the presence of ear diseases.
or
- tsiprofloksatsii
- 500 mg / in every 12 hours
or
- spectinomycin (Trobitsin)
- 2.0 / m per 12 hours.
Intravenous or intramuscular therapy basic or one of the alternative medications should last 7 days. It is recommended that in the hospital and continued for at least 24-48 hours. After the resolution of clinical symptoms can proceed to oral therapy with one of the following drugs:
- ciprofloxacin
- 500 mg orally every 12 hours
or
- ofloxacin
- 400 mg orally every 12 hours.
Notes on pharmacotherapy
In order to prevent the concomitant chlamydial yn fektsii all of the above treatment regimens must accompany the designation of one of the following preparations:
- azithromycin (Sumamed)
- 1.0 g of a single oral dose
or
- doxycycline
- at 100 mg every 12 hours for 7 days.
Upon detection of the association gonorrhea and trichomoniasis infection in conjunction with antimicrobial therapy should be prescribed drugs protistotsidnye schemes referred to in section Trichomoniasis.
treatment of pregnant women
Treatment of pregnant women is carried out at any stage in accordance with an established diagnosis. The drugs of choice are the macrolides (erythromycin), spectinomycin (Trobitsin), some cephalosporins (ceftriaxone - Rocephin) is contraindicated, tetracyclines, fluoroquinolones, aminoglycosides, chloramphenicol.
The recommended regimen:
- ceftriaxone (Rocephin)
- 250 mg / m once.
Alternative schemes:
- spectinomycin (Trobitsin)
- 2.0 g / m singly
or
- amoxicillin
- 1.0 g of 3 times per day administered for 1 day with the susceptibility to penicillin, to exclude the presence of strains penitsillinazoprodutsiruyuschih N gonorrhoeae.
Treatment of gonococcal infections of the eye and 54.3
The recommended regimen:
- ceftriaxone (Rocephin)
- 1.0 g / m once.
TREATMENT ophthalmia neonatorum
Recommended Regimens:
- ceftriaxone (Rocephin) 25-50 mg / kg body weight (maximum 125 mg) / m or / once.
- cefotaxime, 100 mg / kg body weight / m singly
locally:
- NaCl 0.9% solution of repeated washing of the conjunctiva.
Necessary examination and treatment of the mother and her sexual partner.
PREVENTION ophthalmia neonatorum
Recommended Regimens:
- silver nitrate aqueous solution was 1 to 2% singly-W drops in each eye,
or
- eritromitsinovaya 0.5-1% eye ointment once.
Treatment for gonococcal pharyngitis and 54.5
Used treatment regimen, outlined in "Treatment of uncomplicated gonorrhea of the lower genital tract"
Treatment of anorectal gonorrhea and 54.6
Used treatment regimen, outlined in "Treatment of uncomplicated gonorrhea of the lower genital tract"
Treatment of gonococcal infections in children
The recommended treatment regimen (with a body weight less than 45 kg.):
- ceftriaxone (Rocephin) 125 mg / m once
An alternative scheme:
- spectinomycin (Trobitsin) 40 mg per 1 kg body weight of not more than 2.0 g / m singly
When a body weight of 45 kg applied regimen for adults in view of contraindications to the use of drugs.
NEONATAL treatment of complications of gonococcal infection
Recommended treatment scheme:
- ceftriaxone (Rocephin) 25-50 mg per 1 kg of body weight / m or / 1 time per day for 7 days. Meningitis - at least 10-14 days.
An alternative scheme:
- Cefotaxime 25 mg per 1 kg of body weight / m or / in every 12 hours for 7 days. Meningitis - at least 10-14 days.
Prophylactic treatment of neonates born to mothers with gonorrhea
The recommended regimen:
- ceftriaxone (Rocephin) 25-50 mg per 1 kg body weight (maximum 125 mg) / m once.
Indications for treatment
Gonorrhea in children, pregnant women, during the complicated gonococcal infections (endometritis, oophoritis, pelvic inflammation, prostatitis, epididymitis, conjunctivitis, lesions of the cardiovascular system, nervous system, musculoskeletal system, and etc.).
the results of the treatment requirements
Eradication of Neisseria gonorrhoeae and resolution of clinical manifestations of gonococcal infection.
Tactics in the absence of treatment effect
- Determination of the sensitivity of N. gonorrhoeae to antibiotics.
- Determination of b-lactamase activity N. gonorrhoeae (if indicated).
- Purpose of the antibiotic (or drug combination) of other chemical groups.
