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  #1  
Old 08-05-2012
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Default Treatment of Gonorrhoea

A 23 yr homeless women presents to you clinic with sore throat and a mucopurulent vaginal discharge. physical examination shows mucopurulent endocervical discharge. Microscopic examination of a smear of endocervical secretions shows gram-negative intracellular diplococci. She is allergic to cephalosporins.

What is the most appropriate therapy?

A. Azithromycin 1g orally in a single dose
B. Azithromycin 2g orally in a single dose
C. Spectinomycin and Azithromycin 1g orally in a single dose
D. Azithromycin 1g orally in a single dose and Doxycycline 100 mg orally twice a day for 7 days
E.
Spectinomycin and Doxycycline 100 mg orally twice a day for 7 days

Please post the reason behind your answer choice so that everyone benefits from the discussion.
Thank You
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Old 08-05-2012
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D...........

allergic to penicillin so can give 1gm Azithro single dose instead.
Have to also treat for Chlamydia so give the Doxy as well.

Last edited by haga; 08-05-2012 at 11:55 AM.
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Quote:
Originally Posted by Novobiocin View Post
A 23 yr homeless women presents to you clinic with sore throat and a mucopurulent vaginal discharge. physical examination shows mucopurulent endocervical discharge. Microscopic examination of a smear of endocervical secretions shows gram-negative intracellular diplococci. She is allergic to cephalosporins.

What is the most appropriate therapy?

A. Azithromycin 1g orally in a single dose
B. Azithromycin 2g orally in a single dose
C. Spectinomycin and Azithromycin 1g orally in a single dose
D. Azithromycin 1g orally in a single dose and Doxycycline 100 mg orally twice a day for 7 days
E.
Spectinomycin and Doxycycline 100 mg orally twice a day for 7 days

Please post the reason behind your answer choice so that everyone benefits from the discussion.
Thank You

may be C.....spectinomycin is used to treat gonorrhea, especially in patients who are allergic to penicillins....and Azithro for chlamydia......!!!!!
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Try again. Let me highlight the important words/phrases in this vignette.

Quote:
Originally Posted by Novobiocin View Post
A 23 yr homeless women presents to you clinic with sore throat and a mucopurulent vaginal discharge. physical examination shows mucopurulent endocervical discharge. Microscopic examination of a smear of endocervical secretions shows gram-negative intracellular diplococci. She is allergic to cephalosporins.
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spectinomycin is used to treat gonorrhea
Where?
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Quote:
Originally Posted by Novobiocin View Post
Try again. Let me highlight the important words/phrases in this vignette.



Where?
http://en.wikipedia.org/wiki/Spectinomycin
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Quote:
Originally Posted by K06100 View Post
This antibiotic is no longer available in the United States.

Quote:
Uses

It is given by injection to treat gonorrhea, especially in patients who are allergic to penicillins. This antibiotic is no longer available in the United States. A resistance-conferring gene for spectinomycin can also be used as a selection marker in bacteria for molecular cloning purposes. Furthermore, Spectinomycin is used as a selection agent for transformed plant cells that contain the selectable marker gene Spcr [2].
Quote:
Spectinomycin, which is useful in persons who cannot tolerate cephalosporins, is expensive, must be injected, and is not available in the United States (updates available at: www.cdc.gov/std/treatment) (310). However, it has been effective in published clinical trials, curing 98.2% of uncomplicated urogenital and anorectal gonococcal infections. Spectinomycin has poor efficacy against pharyngeal infection (51.8%; 95% CI = 38.7%–64.9%) (306).
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Quote:
Originally Posted by Novobiocin View Post
This antibiotic is no longer available in the United States.
now what i can do is only to request them to start making it again...otherwise my answer will be wrong.........
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plz reveal the answer now.......
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Originally Posted by K06100 View Post
now what i can do is only to request them to start making it again...otherwise my answer will be wrong.........
That's not gonna happen since the drug is expensive and the insurance companies don't want it prescribed here.
Also, it's not good for pharyngeal infection.


Or you can try again since I have highlighted the key points.
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plz reveal the answer now.......
You only have two choices left to decide among.
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Quote:
Originally Posted by Novobiocin View Post
That's not gonna happen since the drug is expensive and the insurance companies don't want it prescribed here.
Also, it's not good for pharyngeal infection.


Or you can try again since I have highlighted the key points.
I go with D.......guess..
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I go with D.......guess..
So, how does a 7 day BD prescription works for a homeless?
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Spectinomycin was discontinued by Pfizer in 2005 because of low demand (it wasn't used for anything except gonorrhea tx in cephalosporin-allergic pts).

The alternative is, unfortunately, B. Azithromycin 2g in a single dose. Unfortunate because of the emerging drug-resistant gonorrhea strains...
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and the answer is ???
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