Gonorrhea and Chlamydia

1. A 22 yo G0 presents for STI screening after unprotected intercourse. She is diagnosed with gonorrhea. You recommend treatment with ceftriaxone 250 mg IM x 1 and azithromycin 1 g PO x 1. What is the reason for the addition of azithromycin to the treatment regimen for gonorrhea?

Coinfection rates with chlamydia are high. Azithromycin treats chlamydia

Azithromycin can be effective in treating gonorrhea

The addition of azithromycin as the potential to slow the spread of resistance to cephalosporins

A&C

A, B & C

Show Explanation

A theoretical basis exists for combination therapy using two antimicrobials with different mechanisms of action to improve treatment efficacy and potentially slow the emergence and spread of resistance to cephalosporins
Clinical trials have demonstrated the efficacy of azithromycin for the treatment of uncomplicated urogenital gonorrhea
Gonorrhea is more resistant to doxycycline than to azithromycin
Persons infected with N. gonorrhoeae frequently are coinfected with C. trachomatis; this finding has led to the longstanding recommendation that persons treated for gonococcal infection also be treated with a regimen that is effective against uncomplicated genital C. trachomatisinfection, further supporting the use of dual therapy that includes azithromycin.
Dual therapy with ceftriaxone and azithromycin should be administered together on the same day

2. A 30 yo G2P1001 presents for routine prenatal are care at 16 weeks. She is diagnosed with gonorrhea by a vaginal swab nucleic acid amplification test. Which of the following is not a risk of disseminated gonorrhea in pregnancy?

Show Explanation

Gonorrhea is caused by the gram negative bacteria Neisseria gonorrhoeae
Disseminated gonorrhea can lead to rare outcomes including septic arthritis, meningitis, endocarditis and skin pustules
Every pregnant patient should be screened during the first trimester and have a test of cure in approximately 3 weeks if treated for positive result
During pregnancy, disseminated gonorrhea can lead to multiple complications including septic abortion, chorioamnionitis, preterm labor, PPROM and neonatal purulent conjunctivitis (leading to risk of blindness).
Chlamydia (not gonorrhea) can cause neonatal pneumonia, usually about 4-12 weeks after birth

3. A 19 yo G0 presents for her first annual GYN exam. She reports being in a monogamous relationship for 6 months. You screen her for STIs, and her results are positive for chlamydia. You treat her with antibiotic therapy, and she requests testing for her boyfriend who does not have a doctor. In accordance with CDC guidelines, the next step should be:

Give her a lab slip for her partner to be tested

Refer her partner to a local health care provider

Provide prompt treatment for her partner

Have the patient return in 4 weeks for a test of cure

Show Explanation

The highest prevalence of chlamydia is in individuals younger than 24 years
Routine annual screening is recommended in sexually active women younger than 25 yearsØ Routine screening is also recommended in high-risk older patients (those with new sex partners, sex partner with concurrent partners or a sex partner with a STI)
Rates of reinfection can be as high as 25%
All sex partners should be referred for evaluation, testing and presumptive treatment if there has been sexual contact within 60 days preceding the patient’s diagnosis
If the provider is concerned that the sex partner will be unable to access prompt evaluation and appropriate treatment, timely treatment by expedited partner therapy should be considered
EPT should be offered after the clinician has assessed the risk of IPV associated with partner notification (it is not intended for use if the patient’s safety could be at risk)
After treatment of chlamydia, patients should abstain from intercourse for 7 days.