Neisseria gonorrhoeae

Background

• Commonly known as gonorrhea
• Fastidious gram-negative cocci

Differential Diagnosis

• Sore Throat (DDx)
• Pelvic Inflammatory Disease (PID)
• Arthritis

Sexually transmitted diseases

• HPV
• HSV-2
• Trichomonas
• Chlamydia
• HIV
• HBV
• Gonorrhea
• Syphilis

Vesiculobullous rashes

Febrile

• Diffuse distribution
  • Varicella
  • Smallpox
  • Disseminated gonococcal disease
  • DIC
  • Purpural fulminans
• Localized distribution
  • Necrotizing fasciitis
  • Hand-foot-and-mouth disease

Afebrile

• Diffuse distribution
  • Bullous pemphigoid
  • Drug-Induced bullous disorders
  • Pemphigus vulgaris
  • Phytophotodermatitis
  • Erythema multiforme major
• Localized distribution
  • Contact dermatitis
  • Herpes zoster
  • Dyshidrotic eczema
  • Burn
  • Dermatitis herpetiformis
  • Erythema multiforme minor
  • Poison Oak, Ivy, Sumac dermatitis
  • Bullosis diabeticorum

Evaluation

Workup

• Dependent upon the infected organ
• PCR or culture on Thayer-Martin agar (most common)

Management

• Proctitis
• Epididymitis
• Infectious Tenosynovitis
• Septic Arthritis (General)
• Orchitis
• Gonorrheal Conjunctivitis

Antibiotic Sensitivities

Category	Antibiotic	N. gonorrhoeae
Penicillins	Penicillin G	0
	Penicillin V	0
Anti-Staphylocccal Penicillins	Methicillin	0
	Nafcillin/Oxacillin	0
	Dicloxacillin	0
Amino-Penicillins	AMP/Amox	0
	Amox-Clav	+
	AMP-Sulb	+
Anti-Pseudomonal Penicillins	Ticar-Clav	+
	Pip-Tazo	+
Carbapenems	Doripenem	+
	Ertapenem	+
	Imipenem	+
	Meropenem	+
	Aztreonam	+
Fluroquinolones	Ciprofloxacin	+*
	Ofloxacin	+*
	Levofloxacin	+*
	Moxifloxacin	+*
	Gemifloxacin
	Gatifloxacin	+*
1st G Cephalo	Cefazolin	+
2nd G Cephalo	Cefotetan	+/-
	Cefoxitin	+/-
	Cefuroxime	+/-
3rd/4th G Cephalo	Cefotaxime	+/-
	Cefizoxime	+/-
	CefTRIAXone	+
	Ceftaroline	+
	CefTAZidime	+/-
	Cefepime	+
Oral 1st G Cephalo	Cefadroxil	0
	Cephalexin	0
Oral 2nd G Cephalo	Cefaclor	+/-
	Cefproxil	+/-
	Cefuroxime	+/-
Oral 3rd G Cephalo	Cefixime	+
	Ceftibuten	+/-
	Cefpodox/ Cefdinir/ Cefditoren	+
Aminoglycosides	Gentamicin	0
	Tobramycin	0
	Amikacin	0
	Chloramphenicol	+
	Clindamycin	0
Macrolides	Erythromycin	+/-
	Azithromycin	+/-
	Clarithromycin	+/-
Ketolide	Telithromycin	+
Tetracyclines	Doxycycline	+/-
	Minocycline	+/-
Glycylcycline	Tigecycline	+
Sulfonamides	TMP-SMX	+/-
Urinary Agents	Nitrofurantoin	+
	Fosfomycin	+
Other	Rifampin	+
	Metronidazole	0
	Quinupristin-dalfoppristin	+
	Linezolid
	Daptomycin	0
	Colistimethate	0
	Telavancin	0
	Vancomycin	0

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

Disposition

• Depends on clinical features/presentation

See Also

• STDs
• Microbiology (Main)

References

Authors

Ross Donaldson