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Gonorrhea infection

ბოლო მიმოხილვა: 13 Dec 2025
ბოლო განახლება: 02 May 2025

შეჯამება

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • urethral discharge in men
  • tenderness and/or swelling of the epididymis
  • mucopurulent or purulent exudate at the endocervix
Полная информация

Другие диагностические факторы

  • pelvic pain in women
  • urethral irritation in men
  • dysuria in men
  • tenderness and/or swelling of testis
  • tenderness and/or swelling of prostate
  • anal pruritus
  • mucopurulent discharge from the rectum
  • rectal pain
  • tenesmus
  • rectal bleeding
  • vaginal discharge
  • cervical friability
  • uterine, adnexal, or cervical motion tenderness
  • uterine mass
  • anterior cervical lymphadenopathy
  • conjunctivitis
  • fever
  • skin lesions (papules, bullae, petechiae, or necrotic) at extremities
  • polyarthritis
  • purpuric rash
  • positive Brudzinski and Kernig sign
  • seizures
  • focal cerebral signs
  • murmur
  • ophthalmia neonatorum
  • rhinitis
  • urethritis (infantile)
  • vaginitis
Полная информация

Факторы риска

  • age 20 to 24 years
  • men who have sex with men (MSM)
  • black ancestry
  • current or prior history of STI
  • multiple recent sex partners
  • inconsistent condom use
  • risk factors of partner
  • history of sexual or physical abuse
  • substance use
  • past incarceration
  • high-morbidity community
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • nucleic acid amplification test (NAAT)
  • culture
  • urinalysis in men
  • Gram stain of urine sediment
  • Gram stain of urethral discharge
  • HIV test
  • syphilis test
Полная информация

Исследования, проведение которых нужно рассмотреть

  • transvaginal ultrasound
  • pelvic CT/MRI
Полная информация

Алгоритм лечения

Острый

nonpregnant >45 kg: urogenital/anorectal or pharyngeal infection (excluding complicated genitourinary infection)

nonpregnant >45 kg: complicated genitourinary infection

nonpregnant >45 kg: disseminated gonococcal infection

pregnant: uncomplicated urogenital/anorectal or pharyngeal infection (excluding complicated genitourinary infection)

pregnant: complicated infection

neonate

child ≤45 kg

ПРОДОЛЖЕНИЕ

recurrent/resistant: urogenital/anorectal infection or pharyngitis

Составители

Авторы

Sheldon Morris, MD, MPH

Assistant Professor

Division of Infectious Diseases

Department of Medicine

UCSD Antiviral Research Center

Division of Family Medicine

Department of Family and Preventive Medicine

UCSD La Jolla Family and Sports Medicine

San Diego

CA

Раскрытие информации

SM has received research funding via his institution from Merck, Gilead Sciences, National Institutes of Health, California HIV/AIDS Research Program, and California Institute for Regenerative Medicine. He has completed a National Institutes of Health contract for research study on the Visby Medical Sexual Health Test. He holds stock in Bristol Myers Squibb and Pfizer. He is a co-founder of Aspera Biomedicines and a consultant for Primmune Therapeutics. SM is an author of a number of references cited in this topic.

Рецензенты

Vani Dandolu, MD, MPH

Associate Professor

Ob/Gyn and Urology

Director

Division of Urogynecology

Associate Residency Program Director

Temple University Hospital

Philadelphia

PA

Раскрытие информации

VD declares that he has no competing interests.

Eva Jungmann, FRCP MSc

Consultant in Genitourinary and HIV Medicine

Archway Centre & Mortimer Market Centre

London

UK

Раскрытие информации

EJ declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Centers for Disease Control and Prevention. Gonococcal isolate surveillance project (GISP). 30 August 2021 [internet publication].Полный текст

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.Полный текст  Аннотация

Miller WC, Ford CA, Morris M, et al. Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA. 2004 May 12;291(18):2229-36.Полный текст  Аннотация

Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae - 2014. MMWR Recomm Rep. 2014;63(RR-02):1-19.Полный текст  Аннотация

Fifer H, Saunders J, Soni S, et al. 2018 UK national guideline for the management of infection with Neisseria gonorrhoeae. Int J STD AIDS. 2020 Jan;31(1):4-15.Полный текст  Аннотация

US Preventive Services Task Force; Davidson KW, Barry MJ, Mangione CM, et al. Screening for chlamydia and gonorrhea: US Preventive Services Task Force recommendation statement. JAMA. 2021 Sep 14;326(10):949-56.Полный текст  Аннотация

World Health Organization. WHO guidelines for the treatment of Neisseria gonorrhoeae. 2016 [internet publication].Полный текст

Centers for Disease Control and Prevention. Guidance on the use of expedited partner therapy in the treatment of gonorrhea. 18 August 2021 [internet publication].Полный текст

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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