GYN

CMECNE

Gonorrhea: CDC Diagnosis and Treatment Guidelines

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Utilize the appropriate diagnostic test for gonorrhea
2. Select the appropriate ‘dual’ antibiotic approach when treating gonorrhea

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

CLINICAL ACTIONS:

Annual screening for gonococcal infection (GC) (N. gonorrhoeae) is recommended for all sexually active women aged <25 years and for older women at increased risk for infection (e.g., those who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has a sexually transmitted infection).

Diagnosis

Perform nucleic acid amplification testing (NAAT), which detects genetic material of N. gonorrhoeae
- More sensitive than culture
- Faster results than culture
- Easy to obtain from a vaginal swab
- Currently approved for genital (vaginal, endocervical) and urine samples
- Can NOT determine antibiotic resistance

Culture for N. gonorrhoeae
- Requires endocervical swab, not vaginal
- Available for rectal, oropharyngeal, and conjunctival gonococcal infection

NOTE: Obtain BOTH NAAT and culture in the case of treatment failure to determine bacterial susceptibility to antibiotics

SYNOPSIS:

Specific microbiologic diagnosis of infection with N. gonorrhoeae should be performed in all persons at risk for, or suspected to have, gonorrhea. A specific diagnosis can potentially reduce complications, reinfections, and transmission. The CDC no longer recommends combination therapy for uncomplicated GC

KEY POINTS:

For Uncomplicated Gonococcal Infections of the Cervix, Urethra and Rectum

<150 kg (300 lb): Ceftriaxone 500 mg IM as a single dose
≥150 kg (300 lb): 1 g of IM ceftriaxone
If chlamydial infection has not been excluded
- Treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days
- During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia

If Ceftriaxone is Unavailable

Gentamicin 240 mg IM as a single dose plus azithromycin 2 g orally as a single dose or
Cefixime 800 mg orally as a single dose | If treating with cefixime, and chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days | During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia

Uncomplicated Gonococcal Infections of the Pharynx

<150 kg (300 lb): Ceftriaxone 500 mg IM as a single dose
≥150 kg (300 lb): 1 g of IM ceftriaxone
If chlamydial infection has not been excluded
- Treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days
- During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia

Note: No reliable alternative treatments are available for pharyngeal gonorrhea

Additional Notes

Instruct patient to abstain from sexual activity for 7 days after treatment and until all sex partners are adequately treated (7 days after receiving treatment and resolution of symptoms, if present)
Test for other STIs, including chlamydia, syphilis and HIV
A test-of-cure is not needed for persons who receive a diagnosis of uncomplicated urogenital or rectal gonorrhea who are treated with any of the recommended or alternative regimens
In the case of pharyngeal gonorrhea treated with an alternative regimen, the patient should return 14 days after treatment for a test-of cure using either culture or NAAT
- If NAAT positive, do a confirmatory culture and antimicrobial susceptibility testing
Retest after 3 months
- Recurrence may not be treatment failure but rather reinfection
- In States where legally allowed (see learn more below), consider Expedited Partner Therapy (EPT) which allows the patient herself to provide medications to her partner when there are limited public health services to treat a partner, or concern that the partner will not have access to treatment
Treat women with HIV with the same recommended regimen
Consult infectious disease specialist in case of allergies to cephalosporin

Learn More – Primary Sources:

CDC: Gonococcal Infections in Adolescents and Adults

CDC Gonorrhea Fact Sheet for your patients

Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020

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