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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.

PATIENT CARE PROCESS

Patient Care Process for Genital Infection due to Neisseria gonorrhoeae

Image not available.

Collect

  • 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)

Assess

  • 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)

Plan*

  • 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)

Implement*

  • 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

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

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

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. All recommended treatment regimens for gonorrhea include antibiotic therapy directed against Chlamydia species because of the high prevalence of coexisting infections, unless chlamydia has been ruled out.

  • Image not available. Parenteral penicillin is the treatment of choice for all syphilis infections. For patients who are penicillin-allergic, few well-studied alternative agents are available, and most are oral medications that require 2 to 4 weeks of therapy to be effective. Patient compliance and thus efficacy are a concern when alternative regimens must be used.

  • Image not available. Chlamydia genital tract infections represent the most frequently reported communicable disease in the United States. In females, these infections are frequently asymptomatic or minimally symptomatic and, if left untreated, are associated with the development of pelvic inflammatory disease and attendant complications such as ectopic pregnancy and infertility. ...

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