Neisseria gonorrhoeae

Neisseria gonorrhoeae infection may be asymptomatic in both men and women. The current USPSTF recommendation is for screening women at risk. Men with penile gonorrhea typically present with purulent penile discharge and dys-uria with N. gonorrhoeae infection. Mucopurulent discharge, dysuria, pelvic pain, and dyspareunia are typical symptoms in women. In patients who engage in anal intercourse, anal discharge, rectal pain, and bleeding can be presenting symptoms. Gonococcal pharyngitis is within the differential of exudative pharyngitis in sexually active patients. When symptomatic, throat pain, tonsillar exudates, and anterior cervical adenopathy may be present.

Testing for gonorrhea can be done using liquid-based Pap technologies, cervical or urethral swabs, or urine for nucleic acid amplification. In men with visible discharge, a Gram stain with white blood cells (WBCs) and gram-positive intra-cellular diplococci has a high degree of sensitivity. Culture testing may be preferred for suspected pharyngeal and rectal specimens pending FDA approval of other methods.

Again, physicians may opt to treat patients with mucopu-rulent cervicitis or urethritis presumptively for gonorrhea and Chlamydia while waiting for confirmatory testing. Fluo-roquinolone therapy is no longer recommended because of widespread resistance (Table 16-11).

Because reinfection with gonorrhea is common for several months after treatment, it may be advisable to retest patients with confirmed gonorrhea in the 3 months after treatment. Similarly, STIs may be an indicator of risk behavior, and a complete risk history and testing for other STIs is advisable if not completed at the initial visit.

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