Gonococcal

Canadian Guidelines on Sexually Transmitted Infections - Gonococcal Infections

Diagnosis:

- NAAT recommended for both Chlamydia trachomatis and Neisseria gonorrhoeae.  Urine specimens are acceptable for screening in females. In females undergoing speculum examination, vaginal (preferred) or endocervical swabs can be collected.

- Vaginal (preferred) or endocervical swab for N. gonorrhoeae culture should also be submitted for:

• sexual assault (see Prophylaxis, Sexual Assault)

• evaluation of PID

• treatment failure

• infection acquired abroad by patient or sexual contact.

- Test and treat, regardless of clinical signs/symptoms, all recent (60 days) sexual contacts. Patients should abstain from sexual intercourse during, and for 7 days after therapy, and until all their sexual partners are treated. Repeat treatment if re-exposed to untreated partner.

Test of cure:

- Test of cure by NAAT 2-3 weeks after completion of therapy should ideally be done in all cases and is especially recommended if:

• regimen other than recommended has been used

• antimicrobial resistant organism identified on culture

• case is linked to another case with antimicrobial resistance or treatment failure

• previous treatment failure in the individual

• re-exposure to an untreated partner

• persistent signs or symptoms post-therapy

• concomitant infection at non-genital site (e.g. eye, rectum, pharynx)

• PID or disseminated gonococcal infection

• uncertain compliance

• pregnancy

• therapeutic abortion.

- Repeat screening for individuals with a gonococcal infection is recommended 6 months post-treatment.

- Quinolones no longer recommended due to significant resistance. Ciprofloxacin 500mg PO + azithromycin 2g PO each x 1 dose may be considered if cephalosporin allergy AND known ciprofloxacin susceptibility. Test of cure recommended.

Neisseria gonorrhoeae

Cephalosporin-resistant N. gonorrhoeae or severe ceftriaxone and cefixime allergy