The problems of ^-lactam and quinolone resistance in Neisseria gonorrhoeae are increasing, and selection of a particular drug will depend on sensitivity testing and a knowledge of resistance patterns in different geographical locations. Effective treatment requires exposure of the organism briefly to a high concentration of the drug. Single-dose regimens are practicable as well as being obviously desirable for social reasons, including compliance. The following schedules are effective:
Uncomplicated anogenital infections: amoxicillin with probenecid by mouth; spectinomycin i.V., cefotaxime i.m. or ciprofloxacin by mouth may be used for penicillin-allergic patients.
Pharyngeal gonorrhoea responds less reliably, and i.m. cefotaxime is recommended.
Coexistent infection. Chlamydia trachomatis is frequently present with Neisseria gonorrhoeae; tetracycline by mouth for 7 days or a single oral dose of azithromycin lg will treat the chlamydial urethritis.
The vast majority of cases of urethritis with pus in which gonococci cannot be identified are due to sexually-transmitted organisms, usually Chlamydia trachomatis and sometimes Ureaplasma urealyticum. Tetracycline or azithromycin by mouth is effective.
Several pathogens are involved including Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma hominis and there may be superinfection with bowel and other urogenital tract bacteria. A combination of antimicrobials is usually required, e.g. metronidazole plus doxycycline by mouth.
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