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Emergent Management of Gonorrhea

Overview

In emergency department (ED) patients who clinical presentation suggests gonorrhea, specimens from likely sites of infection should be sent to the laboratory to be cultured for N gonorrhoeae and Chlamydia species. Nucleic acid amplification tests (NAATs) may be used in addition to or in place of culture depending on availability and laboratory preferences.
The possibility of other sexually transmitted diseases (STDs) should be evaluated.

Begin appropriate antibiotic therapy for gonorrhea as soon as possible. Chlamydial infection is found frequently in patients with gonorrhea; thus, empiric antibiotic therapy should always provide coverage for both infections in any patients other than newborns. Gonococcal infection in HIV-positive patients is treated with the same regimen used for the general population.

Pain relief may be needed for patients with epididymitis, pelvic inflammatory disease, and disseminated gonococcal infection (DGI). Aspiration of purulent joint effusions may improve the patient’s comfort and recovery.

Partner diagnosis and treatment is important to prevent reinfection and complications. Counsel patients to abstain from sexual activity until after full treatment and testing and treatment of partners is complete. Patients should receive information and counseling to help them avoid future STDs and unwanted pregnancies.

Social services should be consulted immediately in cases of suspected sexual assault, child abuse, or elder abuse. Clinicians should be aware, however, that gonorrhea can be transmitted to children nonsexually (eg, spread of infection can occur via contaminated hands of infected caregivers).

For more information, see the Medscape Reference topic Gonorrhea.

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