Gonococcal infections: The Daily PANCE Blueprint

Gonococcal infections: The Daily PANCE Blueprint

A 22-year-old man presents to the clinic with a 3-day history of painful urination and purulent urethral discharge. He reports having unprotected sexual intercourse with a new partner 5 days ago. Gram stain of the urethral discharge shows numerous polymorphonuclear leukocytes and intracellular gram-negative diplococci. Culture confirms Neisseria gonorrhoeae infection. The patient is allergic to penicillin and reports a previous severe reaction to cephalosporins. Which of the following is the most appropriate treatment for this patient?

A. Azithromycin 2 g orally as a single dose
B. Doxycycline 100 mg orally twice daily for 7 days
C. Gentamicin 240 mg intramuscularly plus azithromycin 2 g orally, both as single doses
D. Ciprofloxacin 500 mg orally as a single dose
E. Cefixime 800 mg orally as a single dose

Answer and topic summary

Correct Answer: C. Gentamicin 240 mg intramuscularly plus azithromycin 2 g orally, both as single doses

For patients with a cephalosporin allergy, the CDC recommends an alternative regimen of gentamicin 240 mg IM in a single dose plus azithromycin 2 g orally in a single dose. This combination therapy is effective against Neisseria gonorrhoeae, including in patients who cannot receive cephalosporins. Clinical trials have shown this regimen to be highly effective, with one study demonstrating 100% cure rates (lower one-sided 95% CI bound: 98.5%) for uncomplicated gonococcal infections.

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Covered under ⇒ PANCE Blueprint Infectious Disease Bacterial DiseaseGonococcal infections

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