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:
• Urethra (the tube that drains urine from the urinary bladder)
• Eyes
• Throat
• Vagina
• Anus
• Female 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 (6th Ed). New York, NY: McGraw-Hill.
• DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008):
Pharmacotherapy: A Pathophysiologic Approach (7th 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 (7th ed): New York, NY: McGraw-Hill.
