Managing Resistant Gonococcal Infections

Miss A, an 18-year-old patient, presents for contraceptive counseling. She wishes to use oral contraceptive pills and a low-dose option is prescribed. 

EXAMINATION AND ASSESSMENT
Although Miss A doesn’t need a pap test, based on her age, sexual history, and recommendations by the CDC, she provides a urine sample that is sent for chlamydia and gonorrhea testing. Miss A’s urine test comes back positive for gonorrhea. 

DISCUSSION
Miss A returns to the office to discuss her results. Based on current CDC recommendations, combination therapy of single doses of ceftriaxone 250mg IM plus azithromycin 1g orally is selected for her treatment. Miss A is upset about the diagnosis and particularly about the idea of getting a “shot,” since she is “deathly afraid” of needles and has been known to “pass out” when given injections or having a blood test.

Miss A states that she wants to take only oral medications, regardless of the cost.

TREATMENT PLAN
It is explained to Miss A that within the last month, the CDC has recommended that all cases of gonorrhea be treated with IM ceftriaxone in combination with an oral antibiotic (azithromycin or doxycycline) due to the emergence of resistance to oral medication options. Following the discussion, she agrees to receive IM treatment. She is advised to return to the clinic after one week for a “test of cure” culture to determine efficacy of the ceftriaxone in clearing the infection. Miss A is informed that, since this is a reportable infection, the health department for the state will be made aware and that she must alert all partners that could be potentially infected to be tested and to obtain the same treatment, if infected.