Turning now to the treatment of gonorrhea.
The susceptibility of Neisseria gonorrhoeae
across geographic areas is quite variable.
There are some areas in the world
where highly resistant gonococci are common.
And the same thing can be said for certain populations
of individuals with gonorrhea.
But when we're trying to select an appropriate therapy,
our therapy should be approximately 100% effective
against Neisseria gonorrhoeae.
Agents that are less than 95% effective
should be avoided altogether.
So if on that special occasion
that you were only treating Neisseria gonorrhoeae,
the agent of choice would be ceftriaxone, a third generation cephalosporin,
and it is given in a single dose.
And the efficacy does approach a 100% --
the efficacy is more than 98%.
But if a patient is unable to tolerate
or is allergic to beta-lactam antibiotics,
other therapies are required.
And because they may not have 100% cure rate,
then 1 week after treatment
we would need to document by culture
or by the nucleic acid amplification test,
that the patient has been cured.
If you had to use, for example, a fluoroquinolone
azithromycin,
or spectinomycin.
But back to something I pointed out earlier,
if you remember, I said that about
20% of patients who have gonorrhea
will come down with non-gonococcal urethritis
if you treat only the gonorrhea.
That's the main reason that
when you're treating, you should treat for both.
So you give not only ceftriaxone in a single dose
but you give a single dose of azithromycin -- 1 gram
and that should cover both organisms,
Neisseria gonorrhoeae and Chlamydia trachomatis.
So the treatment, as we mentioned,
for Chlamydia trachomatis is azithromycin,
but if a patient cannot take a macrolide antibiotic,
then we would go to doxycycline.
And it's not as effective in a single dose,
so we have to give 7 days,
depending upon the susceptibility
in various geographic areas and in various populations.
The question then comes,
"How do we manage the sexual partners
of patients who have gonorrhea?"
Well, certainly they should be notified,
and they should be tested for both infections,
and while we're at it,
tested for other common sexually transmitted diseases
for example, like HIV infection.
That would be ideal.
Sometimes that's not possible,
so we have something called expedited partner therapy,
which would be treating a partner without examination.
This is certainly not ideal among physicians
and it's actually not permitted in many countries.
And it is prohibited in some United States' states,
particularly Kentucky, West Virginia, and South Carolina.
So you have to see a physician in those states.
So once treated, how long do you have to wait
before sexual intercourse can resume?
Somebody with urethritis should abstain from sexual intercourse
for at least 7 days after they've been treated,
so as to not expose the partner to these organisms.
Sexually active women less than 25 years of age,
or certain women in risks group such as sex workers,
really should have a pelvic exam
and annual testing for Neisseria gonorrhoeae and Chlamydia trachomatis.
That's the ideal.
They certainly should have
a nucleic acid amplification test
on self-collected urine or a vaginal swab.
This is something that they can do
in the privacy of their own home.
And it's always wise to get an annual HIV test
for those persons at risk.
How do we prevent urethritis?
Well, many would recommend condoms,
they are certainly highly protective against
the transmission of sexually transmitted diseases
from infected secretions.
But I'm here to point out that the protection is not complete.
Condoms may not stay on,
there may be small rents in the condom,
and it can be contagious
if the condom is not effective.
So another way to prevent urethritis
would be to have a monogamous relationship with a partner
who's never had these infections.
And then, of course, abstinence would be fool-proof.
And this brings us to the end of our discussion of urethritis.