Pharmacotherapy of Gonorrhoea

PST 06106

Basic Pharmacotherapy

Session 14: Pharmacotherapy

of

Gonorrhea

Learning Objective

By the end of this session students are expected to be able to:

Define

gonorrhoea

Explain pathophysiology of gonorrhoea

Explain the clinical presentation of gonorrhoea

Outline diagnosis of gonorrhoea

Describe pharmacological treatment of gonorrhoea

Describe monitoring of gonorrhoea

therapy

Activity: Buzzing

•What

is

Gonorrhoea

?

Definition of

Gonorrhea

Gonorrhea

is a

sexually transmitted disease (

STD)

caused

by infection with the bacterium

Neisseria gonorrhoeae

.

It tends to infect warm, moist areas of the body, including the:

U

rethra

(the tube that drains urine from the urinary bladder)

E

yes

T

hroat

V

agina

A

nus

F

emale

reproductive tract

(the fallopian tubes, cervix, and uterus)

Definition of Gonorrhea

Gonorrhea is transmitted from person to person through unprotected oral, anal, or vaginal sex.

People with numerous sexual partners or those who don’t use a condom are at greatest risk of infection

.

Pathophysiology of

Gonorrhea

On contact with a mucosal surface lined by columnar, cuboidal, or

noncornified

squamous epithelial cells, the gonococci attach to cell membranes by means of surface pili and are then

pinocytosed

.

The virulence of the organism is mediated primarily by the presence of pili and other outer membrane proteins.

After mucosal damage is established,

polymorphonuclear

(PMN) leukocytes invade the tissue, submucosal abscesses form, and purulent exudates are secreted

.

Clinical Presentation of Gonorrhea

Individuals infected with gonorrhea can be;

symptomatic or asymptomatic,

have complicated or uncomplicated infections, and

Have infections involving several anatomic sites.

Complications

associated with untreated gonorrhea appear more pronounced in women, because most of them are asymptomatic

As a result, most of these patients develop serious complications, such as;

pelvic inflammatory disease (PID),

Infertility and ectopic pregnancies.

In other patients the gonococci invade the bloodstream and produce disseminated disease

Diagnosis of

Gonorrhea

Diagnosis of gonococcal infections can be made by ;

gram-stained smears,

culture, or

Methods based on the detection of cellular components of the gonococcus such as Enzyme immunoassay, DNA probe techniques, and nucleic acid amplification techniques (NAATs) are also used in clinical specimens.

Various stains have been used to identify gonococci microscopically, with the Gram stain the most widely used in clinical practice.

Gram-stained smears are positive for gonococci when gram-negative diplococci of typical kidney bean morphology are identified within PMN leukocytes.

Activity

: Small Group Discussion

What

is the

treatment

of Gonorrhoea?

Pharmacological treatment of gonorrhea

Uncomplicated gonococcal infection

Recommended Regimen

Ceftriaxone 250mg IM in a single dose

PLUS

Azithromycin 1g orally in a single dose

Alternative regimen

If ceftriaxone is not available.

Cefixime

400mg orally in a single dose

plus

Azithromycin 1g orally in a single dose

Treatment of various forms of

Gonorrhea

Infection

Monitoring Of Gonorrhea Therapy

It is recommended to obtain follow-up cultures at least 3 days after treatment

However the combination gonorrhea and chlamydial therapy rarely results in treatment failures, and routine follow-up of patients treated with a regimen is not necessary.

Persistence of symptoms following any treatment requires culture of the site(s) of gonorrheal infection, as well as susceptibility testing if gonococci are isolated.

Monitoring Of Gonorrhea

Therapy Cont..

In most cases, the presence of gonococci indicates reinfection rather than treatment failure and reflects the need for improved patient education and sex partner referral.

Persistence of symptoms also can be caused by other infectious causes, such as C. trachomatis

Key Points

Gonorrhea

is a sexually transmitted disease (STD).

It’s

caused by infection with the bacterium Neisseria

gonorrhoeae

Gonorrhea

passes from person to person through unprotected oral, anal, or vaginal

sex.

First

line drug treatment with

Cetriaxone

and Azithromycin is recommended

Evaluation

What

is Gonorrhoea?

What is the pathophysiology of Gonorrhoea?

What are the signs and symptoms of Gonorrhoea?

How is the treatment of Gonorrhoea?

References

Wells

BG,

DiPiro

J,

Schwinghammer

T (2013),

Pharmacotherapy Handbook

(6

th

Ed). New York, NY: McGraw-Hill.

DiPiro

JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008):

Pharmacotherapy: A Pathophysiologic Approach

(7

th

ed

): New York, NY: McGraw-Hill.

Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011)

Principles & Practice Study Guide: A Case-Based Care Plan Approach

: New York, NY: McGraw-Hill.

Schwinghammer

TL, Koehler JM (2009)

Pharmacotherapy Casebook: A Patient-Focused Approach

(7

th

ed

): New York, NY: McGraw-Hill.

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