Gonococcal

Canadian Guidelines on Sexually Transmitted Infections - Gonococcal Infections

Diagnosis:

- First catch urine recommended for both Chlamydia trachomatis and Neisseria gonorrhoeae NAAT testing.

- Urethral swab for N. gonorrhoeae culture should also be submitted for:

• sexual assault

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

• regimen other than recommended has been used

• antimicrobial resistant organism identified on culture

• persistent signs or symptoms post-therapy

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

• disseminated gonococcal infection

• uncertain compliance.

- 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