Wednesday, December 24, 2014

A 19-year-old man comes to clinic complaining of 2 days of severe dysuria and urethral discharge.

A 19-year-old man comes to clinic complaining of 2 days of severe dysuria and urethral discharge.

Urine analysis shows pyuria. He reports unprotected sexual contact with a new partner within the past week. DNA
probe is positive for N. gonorrhea.

Uretheral discharge with pus


Which of the following is the most effective therapy?

A. Intravenous ceftriaxone
B. Intramuscular penicillin
C. Oral azithromycin
D. Oral cefixime
E. Oral levofloxacin

The answer is D. Because of emerging resistance, treatment recommendations for gonorrhea require frequent updating. Fluoroquinolones and penicillin are no longer generally recommended in the United States because of resistance. Current effective therapies use single-dose therapies to maximize adherence.

Oral cefixime or intramuscular ceftriaxone are effective for urethritis, cervicitis, and proctitis. Azithromycin is no longer effective for gonorrhea because of resistance, but it should be administered because of the presumption of chlamydial co-infection. Doxycycline also an option for co-treatment in nonpregnant women. Patients with uncomplicated infection who receive therapy do not require a test of cure. Patients should be instructed to contact sexual partners for screening and therapy.

Recent studies have demonstrated that the provision of medications or prescriptions to treat gonorrhea and chlamydia in sexual partners diminishes the risk of reinfection in the affected patient.


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