Definition
Gonorrhea is one of the most widespread sexually transmitted diseases in the world. Also known as blenorrhagia or blenorrhea, the infection mainly affects the genitourinary system and is transmitted by any form of unprotected sexual contact, from coitus to fellatio, from anal intercourse to cunnilingus and, more rarely, through indirect exposure to secretions infected genitals (e.g. mixed use of towels, sheets, objects for erotic use, etc.).
Causes
Gonorrhea is an infectious disease caused by the bacterium Neisseria gonorrhoeae (or Neisser's gonococcus) predominantly sexually transmitted. To grow and reproduce, this microorganism needs a warm and humid environment. Therefore, the urethra in men, the urogenital tracts in women and the anal mucosa represent ideal habitats. More rarely, the bacterium can settle in the mouth and throat, in the rectum or even in the eye causing a series of more or less serious symptoms.
Symptoms
In popular jargon, gonorrhea is commonly called "discharge", due to the typical symptoms with which it occurs in men: a secretion from the penis first liquid, then copious and muco-purulent, associated with urethral burning, redness of the urethral meatus, stranguria (pain when urinating) and dysuria (difficulty urinating). These symptoms usually appear 2-7 days after infection. In women, at least in the initial stages, there may be an asymptomatic picture or stranguria and abnormal vaginal secretions may appear.If gonorrhea is neglected and not adequately treated, in humans, the infection can spread to the prostate and epididymides (small ducts located in each testicle), causing prostatitis, epididymitis and vesiculitis. In women, gonorrhea can become chronic and predispose to pelvic inflammatory disease. A possible complication in both sexes is infertility.
The information on Gonorrhea - Drugs to Treat Gonorrhea is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Gonorrhea - Medicines to Treat Gonorrhea.
Gonorrhea is an infectious disease caused by a bacterium (Neisseria gonorrhoeae), therefore it can be effectively treated with antibiotics, alone or in combination, administered orally and parenterally. The choice of the drug is made by the doctor on the basis of the site involved in the disease (oro-pharynx, uro-genital, etc.) and the outcome of laboratory tests, including the antibiogram. An emerging and very alarming problem consists, in fact, in the diffusion of strains of Neisseria gonorrhoeae multi-resistant to traditional antibiotic treatments (such as ciprofloxacin and cephalosporins) which, until a few years ago, were able to cure the disease. For this reason, it is important that the choice of drug is based on the characteristics of the strain identified during the diagnostic process to establish antimicrobial susceptibility.
Medicines
For the treatment of genital gonorrhea, WHO (World Health Organization) guidelines recommend the combination of azithromycin and ceftriaxone (or, alternatively, cefixime). To limit the development of drug resistance, monotherapy is possible after confirmation of the antibiogram (examination allows to evaluate the sensitivity of bacterial strains to different antibiotics) and involves the use of only one of the following active ingredients: ceftriaxone, cefixime and spectinomycin.
The following are the classes of drugs most used in therapy and some examples of pharmacological specialties: it is up to the doctor to choose the active ingredient and dosage most suitable for the patient, based on the severity of the disease, the state of health of the patient and the his response to the cure:
Macrolides: among the macrolide antibiotics, the drug most used in therapy against gonorrhea is azithromycin:
- Azithromycin: In most cases, recommended therapy is the same day administration, preferably concurrently and under direct observation, of a single dose of ceftriaxone (250 mg) for intramuscular injection and a single dose of azithromycin (1 g) orally. Alternatively, if cefriaxone is not available, a single dose of cefixime 400 mg with a single oral dose of azithromycin (1 g) is combined. Single dose oral 2 g azithromycin monotherapy has been shown to be 99% effective against uncomplicated urogenital gonorrhea. However, monotherapy is no longer recommended due to concerns about macrolide resistance that may develop in the future gonorrhea.
Cephalosporins
- Ceftriaxone: is an antibiotic belonging to the third generation cephalosporin group; it exhibits a structure and antimicrobial activity in vitro similar to those of cefotaxime and ceftizoxime. Ceftriaxone in a single 250 mg injection provides sustained and elevated bactericidal levels in the blood. Extensive clinical experience indicates that ceftriaxone is safe and effective for the treatment of uncomplicated gonococcal infections in all anatomical sites (cervix, urethra, rectum, pharynx). Single dose injectable cephalosporin regimens (other than ceftriaxone 250 mg IM) that are safe and generally effective against uncomplicated urogenital and gonococcal anorectal infections include: ceftizoxime (500 mg IM), cefoxitin (2 g IM with probenecid 1 g per route oral) and cefotaxime (500 mg IM). None of these injectable cephalosporins offer any advantage over ceftriaxone for urogenital infection and the efficacy of pharyngeal infection is less certain. Several other antimicrobials are active against Neisseria gonorrhoeae, but none have substantial advantages over the recommended regimen and efficacy data (especially for pharyngeal infection) are limited.
- Cefixime: is a third generation cephalosporin that inhibits the synthesis of the bacterial wall (a mechanism similar to that caused by penicillins). A 400 mg oral dose of cefixime should only be considered as an alternative cephalosporin regimen, as it does not provide high or sustained bactericidal blood levels such as a 250 mg IM dose of ceftriaxone; furthermore, it demonstrates limited efficacy for the treatment of pharyngeal gonorrhea.
Tetracyclines
- Doxycycline: In patients who have an "allergy to" azithromycin or who vomit the drug immediately after taking, doxycycline (100 mg orally twice daily for 7 days) can be used instead of azithromycin as a second antimicrobial alternative when used in combination with ceftriaxone or cefixime.
Other antibiotics
- Spectinomycin: is a bacteriostatic antibiotic related, from a chemical point of view, to aminoglycosides. Spectinomycin is useful in people who cannot tolerate cephalosporins, but it is expensive and has poor efficacy against pharyngeal infection. However, the drug has been shown to be effective in clinical trials, treating 98.2% of non-urogenital and anorectal gonococcal infections. If available, spectinomycin is an effective alternative for the treatment of urogenital and anorectal infections.
Important notes on therapy
- The spontaneous regression of the symptoms of gonorrhea is not synonymous with recovery: in any case, it is of fundamental importance to consult a doctor, to receive a correct diagnosis, to establish adequate therapy as soon as possible and to avoid transmitting the infection to one's partner.
- After the therapy, it is advisable to wait at least one or two weeks, then repeat the laboratory tests to ensure complete recovery.
- Treatment should always be extended to the sexual partner, even if he has no symptoms, to avoid reinfection and limit the spread of gonorrhea.
- Recovery from gonorrhea is usually achieved within a few days, provided that treatment is timely and appropriate. Until complete recovery, it is important that the patient refrains from sexual intercourse and does not stop treatment after the first improvements.
- A common association is the association of gonorrhea and chlamydia (infection with Chlamydia trachomatis), a dangerous combination since, although relatively easy to control with antibiotic therapy, it increases the risk of complications in both sexes. In case of co-infection with chlamydia, the doctor modifies the therapy for the treatment of gonorrhea, combining other specific drugs.
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