Gonorrhea

Pharmacotherapeutics of Gonorrhea

1. Gonorrhea Dr. V.S. Swathi Assistant Professor

2. Definition Gonorrhea is a sexually transmitted disease caused by Neisseria gonorrhoea that can affect both men and women, mainly affects genitals, rectum and throat.

3. Epidemiology 98 million new cases of Gonorrhea occur annually, according to WHO estimates Prevalence of gonorrhoea ranges from 0-19% in India from 2000-2009

4. Types Gonorrhea of genital tract- Affects genitals Gonorrhea of rectum- Affects rectum Gonorrhea of eyes- Affects eyes Gonorrhea of throat- Affects throat Gonorrhea of joints- Affects joints

5. Risk factors Younger age New sex partner Persons with multiple sex partners Previous gonorrhoea diagnosis Persons with other sexually transmitted diseases

6. Etiology It is caused by Neisseria gonorrhoea It is transmitted through sexual contact

7. Pathogenesis

8. Clinical Presentation Genital tract- men- Painful when urination Pus like discharge from tip of penis Genital tract- women- Increased vaginal discharge Painful urination Painful intercourse Vaginal bleeding between periods Abdominal/ pelvic pain

9. Rectum Itching Pus like discharge from rectum Bleeding Eyes Eye pain Sensitivity of light Pus like discharge from one/ both eyes Throat Sore throat Swollen lymph nodes in the neck Joints Red, swollen and painful joints

10. Complications Infertility in men and women Septic Arthralgia Blindness to babies of infected mothers Epididymitis Prostatitis Inguinal lymphadenopathy Urethral stricture Pelvic inflammatory disease

11. Diagnosis Gram staining Culture sensitivity test Enzyme immune assay DNA probe techniques Nucleic acid amplification techniques

12. Non Pharmacological Treatment Counselling on safe sex practices

13. Treatment Algorithm

14. Drugs used in treatment of Gonorrhea Drug Category Mode of action Dose Adverse affects Ceftrioxone Cephalosporin It inhibits bacterial cell wall synthesis 250mg-IM-once Injection site reactions Eosinophilia Thrombocytosis Diarrhoea Transaminitis Cefotaxime Cephalosporin It inhibits bacterial cell wall synthesis 0.5g-IM-once Injection site reactions Eosinophilia Pseudomembranous colitis Nephrotoxicity Hepatotoxicity Azithromycin Macrolides It inhibits bacterial protein synthesis 1g-PO-once Diarrhoea Abdominal pain Cramping Vaginitis Dyspepsia Erythromycin Macrolides It inhibits bacterial protein synthesis 0.5% ointment Burning in eyes Stinging in eyes Redness in eyes Irritation in eyes Temporary blurred vision

15. Resources https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839552/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735573/ https://www.sciencedirect.com/science/article/pii/S1876034117301326?via%3Dihub https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874098/ http://www.ijmm.org/article.asp?issn=0255-0857;year=2015;volume=33;issue=1;spage=39;epage=42;aulast=Bharara