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The editors are deeply appreciative for the excellent contributions of Dr Leroy Knodel over all 10 editions of this book. This chapter was in preparation at the time of Dr Knodel's death. We thank Dr. Bryson Duhon for his timely work to complete the chapter.

Content Update

December 29, 2019

2019 CDC Antibiotic-Resistance Threats Report: In November 2019 the U.S. Centers for Disease Control and Prevention (CDC) released an updated report on antibiotic resistance threats, last published in 2013. The report includes the latest national infection and death estimates, including 2.8 million antibiotic-resistant infections occurring in the U.S. each year and over 35,000 deaths. The report also notes 223,900 cases of Clostridiodes difficile in 2017 with at least 12,800 deaths. The report provides data on 18 antibiotic-resistant bacteria and fungi in three categories based on level of concern to human health – urgent, serious, and concerning. The report serves as a reference for information on antibiotic resistance and provides the latest estimates on antibiotic resistance burden.


Patient Care Process for Genital Infection due to Neisseria gonorrhoeae



  • Patient characteristics (e.g., age, sex, pregnant)

  • Patient medical history (personal and family)

  • Social history, including sexual history

  • Current medications

  • Objective data

    • Blood pressure (BP), heart rate (HR), respiratory rate (RR), height, weight

    • Laboratory data including urine NAATs for gonorrhea and chlamydia, and/or urethral or vaginal cultures

    • Signs and symptoms consistent with gonorrhea (dysuria, mucopurulent urethral or vagina discharge)


  • Presence of additional STIs (chlamydia, syphilis, HIV etc.)

  • Presence of extra-genital infection

  • Ability/willingness to obtain follow up testing as needed

  • Ability/willingness to notify sexual partners

  • Emotional status (e.g., presence of anxiety, depression)


  • Drug therapy regimen including, dose, route, frequency, and duration (Table 117-4)

  • Monitoring parameters including efficacy (e.g., retest 3 months after treatment) and safety; frequency and timing of follow-up

  • Patient education (e.g., purpose of treatment, notification of sexual partners, safe sexual practices, drug-specific information)

  • Self-monitoring for resolution of gonorrhea symptoms, and if not resolved to seek follow-up for re-evaluation

  • Referals to other providers when appropriate (e.g., HIV care, behavioral health)


  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up (e.g., 3-month retest)

  • Offer expedited partner therapy for patient’s sexual partner(s) and partner education

Follow-up: Monitor and Evaluate

  • Resolution of symptoms (e.g., dysuria, mucopurulent urinary or vaginal discharge); In absence of symptom resolution after treatment, assess for resistance by obtaining culture and susceptibilities

  • Presence of adverse effects (e.g., rash or gastrointestinal upset)

  • Patient adherence to treatment plan

  • Re-evaluation of laboratory tests in specific time frames (e.g., 3 months for retest)

*Collaborate with patient, caregivers, and other health professionals


For the chapter in the Wells Handbook, please go to Chapter 46. Sexually Transmitted Infections.



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