1. STDs
2. Gonorrhoea
3. Treatment

Gonorrhoea Treatment Singapore | Shim Clinic

Gonorrhoea treatment clinic, Singapore. Private and confidential service. Definitions, references, and latest news.

Gonorrhoea Treatment is usually with

• Ceftriaxone injection.
• Spectinomycin injection.

TREATMENT

Recommended regimens

Uncomplicated infection in adults – urethral, endocervical and rectal infection

1. Ceftriaxone 500 mg i/m single dose + azithromycin 1-2g stat or doxycycline 100 bid x 1-2 weeks [IV, C]

Alternative Regimens (for those with allergy)

1. Cefotaxime 1g i/m single dose + azithromycin 1-2g stat or doxycycline 100 bid x 1-2 weeks [1b]
   or
2. Spectinomycin 2g i/m single dose + azithromycin 1-2g stat or doxycycline 100 bid x 1-2 weeks [1b, A]
   or
3. Azithromycin 2g stat [II, C] (not as monotherapy)
   or
4. Aztreonam 1g i/m single-dose dose with azithromycin 1-2g stat or doxycycline 100 bid x 1-2 weeks [1b]
   

(Aztreonam has been used in some patients at DSC when other alternatives were unavailable)

It is important to emphasize that treatment of GC should be accompanied with anti-chlamydia therapy. This not only treats concurrent infection, but there is evidence to suggest that concurrent administration of azithromycin would slow down the possibility of the development of cephalosporin resistant strains of GC.

Note: The fluroquinolones (e.g. ciprofloxacin, ofloxacin, norfloxacin) are contraindicated as > 70% of isolates in Singapore and the region are resistant.

Gonococcal infection in pregnancy

• Cephalosporins [IV, C] in the recommended dosages are safe and effective in pregnancy.
• Spectinomycin [Ib, A] can be administered to women who are unable to tolerate cephalosporins.
• Simultaneous treatment for chlamydial infection with azithromycin 1g stat or erythromycin 500 mg orally qid x 7 – 14 days is advocated.

Pharyngeal infection

1. Ceftriaxone 500 mg i/m single dose with azithromycin 1g stat or doxycycline 100 bid x 1 week [IV, C].

Disseminated gonococcal infection or DGI

Hospitalisation under specialist care is recommended.

1. Ceftriaxone 1g i/m or i/v daily
   or
2. Cefotaxime 1g i/v 8 hourly
   or
3. Spectinomycin 2 g i/m 12 hourly

Therapy should continue for 24-48 hours after improvement begins, and can be converted to an oral cephalosporin therapy for a total of 7 days. Anti-chlamydia therapy should be given at the same time.

Gonococcal acute epididymitis and epididymo-orchitis

Ceftriaxone 500 mg i/m daily x 1 to 3 days with doxycycline 100mg bid x 2 weeks [III, B].

Adult gonococcal ophthalmia

Ceftriaxone 1g i/m single dose with with azithromycin 1g stat or doxycycline 100 bid x 1 week. With lavage of the infected eye with normal saline [IV, C].

Topical antibiotics alone do not eradicate the infection and rigid adherence to topical therapy is not essential. All patients should be referred for ophthalmologic assessment.

Neonatal gonococcal ophthalmia

1. Ceftriaxone 25-50 mg/kg i/m single dose not to exceed 125 mg
   or
2. Cefotaxime 100 mg/kg i/m single dose. With lavage of the infected eye with normal saline.

Topical antibiotics alone do not eradicate the infection. All patients should be referred for ophthalmologic assessment.

Screen the mother and her sexual partners for gonorrhoea and other STIs. The mother should be treated on epidemiological grounds.

Uncomplicated gonococcal infections in older children – urethral, vulvovaginal, cervical, pharyngeal, rectal infections.

Children who weigh > 45 kg or are above 12 years of age should be treated with adult regimens.

Children who weigh < 45 kg or are 12 years of age or younger should be treated as follows:

1. Ceftriaxone 125 mg i/m single dose with azithromycin 1g stat or doxycycline 100 bid x 1 week (if older than 12 years).
   or
2. Cefotaxime 125 mg i/m single dose with azithromycin 1g stat or doxycycline 100 bid x 1

week (if older than 12 years).

Drugs Not Recommended

The following drugs are not recommended for treating gonococcal infection in Singapore as they are either ineffective or have not been adequately evaluated:

• All tetracyclines (they are given as part of anti-chlamydia therapy, not as primary treatment for GC)
• All penicillins
• All fluoroquinolones
• Erythromycin
• Rifampicin
• Kanamycin
• Trimethoprim/sulfamethoxazole

FOLLOW-UP

• Test-of-cure is recommended in all cases, in particular for pharyngeal GC.
• All treatments are less effective at eradicating pharyngeal infection and test-of-cure is recommended following treatment of infection at this site.
• In the DSC Clinic test-of-cure and assessment for post-gonococcal urethritis (PGU) is performed after 14 days.
• Test-of-cure is done using urethral smear. In cases of possible antibiotics resistance, cultures should be performed.
• Patients with gonococcal ophthalmia should have cultures done daily while on therapy and again on the 5th and 14th days after completion of therapy.
• Serologic tests for syphilis and HIV should be performed; if negative they should be repeated at 3 months after the last risky exposure.

Gonorrhoea treatment:

• Ceftriaxone (Rocephin®)
• Cefuroxime (Zinnat®)
• Spectinomycin (Trobicin®)
• Gentamicin (Garamycin®)

References

• Gonorrhoea treatment @ Wikipedia