Sexually Transmitted Diseases (STDs In Men) (cont.)
Gonorrhea
What is gonorrhea?
Gonorrhea is an STD that is caused by the bacteria
Neisseria gonorrhea. In women, this infection often causes no symptoms and can
therefore often go undiagnosed. In contrast, men usually have the symptoms of
urethritis, burning on urination, and penile discharge. Gonorrhea can also
infect the throat (pharyngitis) and the rectum (proctitis). Proctitis results in
diarrhea (frequent bowel movements) and an anal discharge (drainage from the rectum).
Gonorrhea can also cause epididymitis and orchitis. What is more, gonorrhea can
cause systemic disease (throughout the body) and most commonly results in
swollen and painful joints or skin rash. Many patients with gonorrhea also are
infected with Chlamydia.
Symptoms of gonorrhea usually develop in men within 4 to 8 days after genital
infection, although in some cases they may occur after a longer time period.
How is gonorrhea diagnosed?
Gonorrhea may be diagnosed by demonstration of the characteristic bacteria
when urethral secretions are examined microscopically. Gonorrhea can also be
diagnosed by a culture from the infected area, such as the urethra, anus, or
throat. In patients with systemic gonorrhea with, for example, arthritis or skin
involvement, the organism can occasionally be cultured from the blood. Newer,
rapid diagnostic tests that demonstrate the genetic material of N. gonorrhea
are also available.
How is gonorrhea treated?
The treatment of uncomplicated gonorrhea affecting the
urethra or rectum is usually a single-dose injection of ceftriaxone 125 mg.
Because of developing bacterial strains that are resistant to certain
antibiotics, ceftriaxone is the recommended treatment for all patients in Hawaii
and California, for men who have sex with other men, and for persons who
acquired the infection in certain parts of the world. In all other patient
populations, alternative treatments include oral doses of cefixime (Suprax) 400
mg, ciprofloxacin (Cipro) 500 mg, ofloxacin (Oflox) 400 mg, cefpodoxime 400 mg,
or levofloxacin 250 mg daily. An intramuscular injection of 2 g of spectinomycin is also an alternative
treatment.
Many patients with gonorrhea are simultaneously infected with chlamydia.
Patients treated for gonorrhea, therefore, should also be treated for chlamydia
with a single dose of azithromycin 1 gram or doxycycline 100 mg twice per day
for 7 days, both of which are taken by mouth. Throat infection (pharyngitis)
caused by gonorrhea is somewhat more difficult to treat than genital infection.
Recommended antibiotics for treatment of gonococcal pharyngitis include
ceftriaxone 125 g intramuscularly, ciprofloxacin 500 mg orally, and ofloxacin
400 mg orally.
Systemic gonorrheal infections involving the skin and/or
joints is generally treated with either daily injections of ceftriaxone 1 gram
in the muscle tissue (intramuscularly) or in the vein (intravenously) every 24
hours, or cefotaxime or ceftizoxime 1 gram intravenously every 8 hours. If the
patient does not need admission to the hospital or is stable enough for discharge, the treatment can
be one of the quinolone antibiotics (ciprofloxacin 500 mg twice per day
orofloxacin 400 mg once daily) for 14 days, along with the treatment for
Chlamydia. However, the increasing development of bacteria resistant to
quinolones, make these drugs less reliable in certain geographic areas,
including Hawaii and other Pacific areas, and possibly California. Another
option for the treatment of disseminated (throughout the body) gonococcal
infections is spectinomycin 2 g intramuscularly every 12 hours.
What should a person do if exposed to someone with gonorrhea?
A person who is sexually exposed to an individual that
is infected with gonorrhea should seek medical attention. If the last sexual contact was within
60 days of the partner's diagnosis, the person should be treated for both
gonorrhea and Chlamydia. People whose last sexual contact was more than 60 days
before the partner's diagnosis should be evaluated for symptoms and have
diagnostic studies performed. Treatment for individuals whose exposure was
relatively in the more distant past should be limited to those who have symptoms
or positive diagnostic tests.
Next: Human Immunodeficiency Virus »
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