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National Guidelines On Diagnosis and Treatment Of.1
National Guidelines On Diagnosis and Treatment Of.1
Guideline Article
Dermatology and Venereology
OPEN
3
Department of Dermatology, General Hospital of Tianjing Medical University, Tianjing 300052, China; 4 Department of
Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, China; 5 Department of Neurology, Ditan Hospital of Capital
Medical University, Beijing 100050, China; 6 Department of Dermatology, Shanghai Hospital for Skin Disease and STD of Tongji
University, Shanghai 200050, China; 7 Department of Dermatology, The First Affiliated Hospital of Kunming Medical University,
Kunming, Yunnan 650032, China; 8 Department of Dermatology, The 5th People’s Hospital of Suzhou, Suzhou, Jiangsu 215007
China; 9 Department of Dermatology, The First Affiliated Hospital of General Hospital of PLA, Beijing 100048, China; 10 Department
of Dermatology, The Skin Disease Hospital of Southern Medical University, Guangzhou, Guangdong 510091 China; 11 Department
of Dermatology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang 310020, China.
Abstract
Gonorrhea is one of the main sexually transmitted diseases in China. It mainly affects the genitourinary tract, and its
clinical manifestations vary from asymptomatic to complicated types. The diagnosis of gonorrhea should be based on
the patient’s epidemiological history, clinical manifestations, and laboratory examination results. Treatment should be
prompt and standardized and should involve the recommended treatment regimens. Patients should be appropriately
followed up after treatment. The antimicrobial resistance of gonococcal isolates has become a severe problem of clinical
concern. In order to provide technical guidance of the diagnosis and treatment of gonorrhea for health care workers, the
authors developed the guidelines based on the version of 2014, which will be of important in the standardizing medical
care of gonorrhea, and further facilitating control and prevention of the disease.
Keywords: gonorrhea, diagnosis, treatment, guidelines
Introduction
Gonorrhea is a classic sexually transmitted disease caused
#
This Gonorrhea Guidelines in Chinese has been published on Chinese Journal by infection with the bacterium Neisseria gonorrhoeae (N.
of Dermatology, 2020,53(3):168-179. gonorrhoeae). It is characterized primarily by suppurative
∗ Corresponding author: Dr. Qian-Qiu Wang, Hospital for Skin Diseases (Institute
inflammation of the urogenital mucosa, and the most
of Dermatology), Chinese Academy of Medical Sciences and Peking Union
Medical College and National Center for STD Control, Chinese Centers for common manifestations are urethritis in men and cervicitis
Disease Control and Prevention, Nanjing, Jiangsu 210042, China. in women. The most frequent local complications of
E-mail: wangqianqiunj@126.com.
gonorrhea are epididymitis in men and pelvic inflammatory
Conflicts of interest: The authors reported no conflicts of interest.
disease in women. Other sites of primary infection include
Copyright © 2020 Hospital for Skin Diseases (Institute of Dermatology), Chinese
the pharynx, rectum, and conjunctiva. Spread of N.
Academy of Medical Sciences, and Chinese Medical Association, published by
Wolters Kluwer, Inc. gonorrhoeae through the blood can result in disseminated
This is an open access article distributed under the terms of the Creative gonococcal infections, but these are rare in clinical settings.
Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-
ND), where it is permissible to download and share the work provided it is
properly cited. The work cannot be changed in any way or used commercially
Diagnosis
without permission from the journal.
Epidemiological history
International Journal of Dermatology and Venereology (2020) 3:3
Received: 15 December 2019, Accepted: 5 January 2020 Factors associated with gonorrhea include high-risk sexual
doi: 10.1097/JD9.0000000000000072 behavior, a history of multiple sexual partners or partners
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Wang et al., Int J Dermatol Venereol (2020) 3:3 International Journal of Dermatology and Venereology
Patients with confirmed gonorrhea antimicrobial sensitivity should be tested. Patients con-
Patients confirmed as having gonorrhea are those with an firmed to have undergone failed treatment can be treated
appropriate epidemiological history and clinical manifes- with an increased dose of ceftriaxone (consisting of 1–2 g
tations who also have positive results on one or more injected intramuscularly or administered intravenously for
laboratory tests. three days). Alternatively, patients can be switched to
spectinomycin treatment or administered a single intra-
Treatment muscular injection of 240,000 IU of gentamicin.29-30
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of 100 mg doxycycline twice daily or 450 mg clindamycin necessary for patients with gonococcal arthritis except for
four times daily for 14 consecutive days. Intravenous those with gonococcal arthritis of the hip joint. Joint
doxycycline may induce pain at the injection site and has exudates, however, should be repeatedly aspirated. Anti-
no advantage over oral doxycycline in patients who tolerate biotics should not be directly injected into joint cavities.
the latter. Pregnant and lactating women should avoid Nonsteroidal anti-inflammatory drugs can relieve pain and
tetracycline and doxycycline, and metronidazole should be help prevent recurrent joint exudate.
avoided during the first trimester of pregnancy.1,31
Gonorrhea during pregnancy
Gonorrhea at other sites Treatment regimens in pregnant women are dependent on
Gonorrheal conjunctivitis the type of infection, although erythromycin or amoxicillin
Newborns should be treated with 25–50 mg/kg intrave- is recommended for pregnant women with suspected or
nous or intramuscular ceftriaxone once daily for three confirmed C. trachomatis coinfection. Pregnant women
consecutive days, with the total dose not exceeding 125 should never be treated with fluoroquinolones or tetracy-
mg. Children weighing <45 kg should be treated with 50 cline32
mg/kg ceftriaxone administered intramuscularly or intra-
venously once daily for three days, with a maximum dose Follow-up
of 1 g. Children weighing ≥45 kg should be treated with
the regimen for adults, consisting of 1 g ceftriaxone Following treatment with the recommended regimens,
administered intramuscularly or intravenously once daily patients with uncomplicated gonorrhea in the genitouri-
for three days or 2 g intramuscular spectinomycin once nary tract should be screened by gonococcus culture if they
daily for three days. The eyes should be washed every hour experience persistent symptoms or signs of gonorrhea,
with normal saline. Spectinomycin should not be admin- gonococcal infection of the pharynx, pelvic inflammatory
istered to newborns. Mothers of infected newborns should disease or disseminated gonococcus infection, or infection
be examined, and those with gonorrhea should be treated. during pregnancy. Patients who have sexual contact with
Newborns should be hospitalized and checked for untreated sexual partners should also be screened, as
disseminated infection. should all children who have been treated for gonorrhea.
N. gonorrhoeae cultures should be performed at least five
Gonorrheal pharyngitis days after the completion of treatment, and nucleic acid
Patients with gonococcal pharyngitis should be treated amplification tests should be performed at least three
with a single dose of 1 g ceftriaxone administered weeks after treatment completion. Treatment failure or
intramuscularly or intravenously or a single dose of 1 g infection with antimicrobial-resistant strains should be
cefotaxime administered intramuscularly. If C. trachoma- reported.
tis infection cannot be excluded, additional anti-C. The diagnosis and treatment of gonococcal epididymitis
trachomatis treatment is warranted. Spectinomycin is should be reevaluated if the symptoms do not improve
not recommended because of its poor efficacy in patients significantly within three days after treatment. Patients
with gonococcal pharyngitis. with gonococcal pelvic inflammatory disease should be
followed up within three days after treatment, although
Disseminated gonorrhea patients with fever should be followed up within 24 hours.
Newborns should be treated with 25–50 mg/kg/day If their condition does not improve, they should be
ceftriaxone administered intravenously or intramuscularly admitted to the hospital. Patients should experience
once daily for 7–10 days; if meningitis is present, treatment obvious clinical improvement within three days (abate-
should continue for up to 14 days. Children weighing <45 ment of fever, abdominal or adnexal tenderness, or
kg are treated for gonococcal arthritis with 50 mg/kg cervical motion tenderness). Patients who do not improve
ceftriaxone administered intramuscularly or intravenously within three days may need to be admitted to the hospital
once daily for 7–10 days. Children weighing <45 kg are for treatment, other diagnostic tests, or surgical consulta-
treated for gonococcal meningitis or endocarditis with 25 tion. Patients with gonococcal meningitis and endocarditis
mg/kg ceftriaxone administered intramuscularly or intra- should be referred to an appropriate specialist.
venously twice daily for 14 days (meningitis) or 28 days
(endocarditis). Children weighing >45 mg are treated Sexual partner management
similarly as adults. Hospitalization is recommended to
check for endocarditis or meningitis. Treatment consists of Adult patients with gonorrhea are required to have their
1 g ceftriaxone administered intramuscularly or intrave- sexual partners checked and treated for gonorrhea. All
nously once daily for at least 10 days. Patients with individuals who had sexual contact with the patient before
gonococcal meningitis should be treated for about two the onset of symptoms or within two months before
weeks, and those with gonococcal endocarditis should be diagnosis should be notified and examined for N.
treated for more than four weeks. If C. trachomatis gonorrhoeae and C. trachomatis. Patients should be
infection cannot be excluded, additional anti-C. tracho- instructed to avoid sexual intercourse before treatment
matis treatment is warranted. Note: Open drainage is not is completed or when they and their partners still have
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symptoms. When a neonate is diagnosed with gonococcal meta-analysis. J Clin Med 2019;8(12):E2182. doi:10.3390/jcm
8122182.
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