GONORRHOEA – MANAGEMENT 2

Uncomplicated genital, anal or pharyngeal infections

Single dose regimens cure most cases of uncomplicated gonorrhoea. Treatment for chlamydia may also be given particularly if local experience is that postgonococcal urethritis is common. Sexual abstinence is of benefit during therapy. Admission to hospital is usually indicated for children with gonorrhoea. Pharyngeal infections are less responsive to treatment than genital infections.

Penicillin susceptible infection (first line treatment where PPNG is uncommon)

Adults:

Amoxycillin 3 g given with 1 g probenecid as a single oral dose for anogenital infections and as a daily dose for 3 days for oropharyngeal infection or Aqueous procaine penicillin G 3 g intramuscularly (1.5 g at 2 sites) with probenecid 1 g orally as a single dose.

Children:

Amoxycillin 50 mg/kg given with probenecid 25 mg/kg as a single oral dose or Aqueous procaine penicillin G 100,000 units/kg intramuscularly with probenecid 25 mg/kg orally as a single dose.

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INVESTIGATION IN GENITAL ULSERS 2

Demonstration of spirochaetes by dark ground microscopy confirms the diagnosis of early syphilis. Antibiotics or antiseptics should not be used until satisfactory examination has been completed. Dark ground examination is not suitable for oral lesions.

Although the diagnosis can usually be made on clinical grounds, HSV infection should be confirmed by culture of the virus or, more rapidly, by examination of smears for multinucleated cells and characteristic intranuclear inclusions (Tzank smear) or by the use of commercially available kits for the detection of HSV antigens by ELISA or immunofluorescence techniques (see p.34).

The diagnosis of donovanosis is established by the demonstration of the causative organisms in smears from scrapings or in biopsies from lesions. The organism can be identified as bipolar rods in large mononuclear cells (see p.30). The features of chancroid and of lymphogranuloma venereum are described on pages 31 and 32 respectively.

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