Review Question - QID 107231

This patient has an uncomplicated gonorrheal cervicitis which has been properly treated with IM ceftriaxone and doxycyline for possible chlamydia infection. The partners should also be treated in order to prevent reinfection.

Gonorrhea is caused by Neisseria gonorrhoeae, a gram-negative intracellular diplococci. It is the second most common sexually transmitted infection (behind chlamydia) and is a common cause of urethritis in men and cervicitis in women. Patients are treated with ceftriaxone for the gonorrheal infection and with either doxycycline or azithromycin for possible chlamydia co-infection.

Mayor et al. review the diagnosis and treatment of gonococcal infections. Although Neisseria gonorrhoeae most commonly infects the urogenital tract, it can also cause anorectal, pharyngeal, and conjunctival infections. They state that gonorrhea can be asymptomatic in a large proportion of patients and can lead to complications such as pelvic inflammatory disease (in women) or disseminated disease if left untreated. Gram stain of cervical swab or urethral smear, urine nucleic amplification tests, or urine polymerase chain reaction testing (in men) can all be used for diagnosis and have similar sensitivity and specificity.

Meyers et al. reviews the U.S. Preventive Services Task Force's (USPSTF) screening recommendations for sexually transmitted infections. The USPSTF recommends screening all sexually active women younger than 25 years of age for chlamydia and gonorrhea. They further recommend screening for chlamydia, gonorrhea, HIV, and syphilis in women with risk factors for sexually transmitted infections, such as unprotected sexual intercourse, having a new sexual partner, having multiple sexual partners, exchanging sex for drugs or money, or engaging in sex while under the influence of drugs or alcohol. Women older than 25 years of age who do not have any risk factors should not be screened for sexually transmitted diseases. The USPSTF recommends screening for HIV and syphilis only in men who are at high risk of infection.

Illustration A demonstrates a gram stain of an acute gonococcal urethritis showing Neisseria gonorrhoeae, a gram-negative intracellular diplococci.

Incorrect answers:
Answer 1: Treatment for possible syphilis co-infection is not recommended in patients who are diagnosed with gonorrhea.
Answer 3: It may be useful to closely follow the patient in order to watch for reinfection or complications, however, it is key that the partner receive treatment to prevent reinfection.
Answer 4: While the physician should encourage that the patient speak to her partner regarding her condition, this would be an inappropriate action.
Answer 5: This patient does not have any signs or symptoms of pelvic inflammatory disease and does not require an ultrasound at this time.