Chapter 9 : Gonorrhea

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The purpose of this chapter is (i) to review the pathophysiology of gonorrhea during pregnancy, (ii) to summarize epidemiologic data regarding gonorrhea among pregnant women, and (iii) to discuss the manifestations of maternal and infant infections, with special emphasis on principles of prevention and management. is a sexually transmitted bacterium which infects columnar and transitional epithelium of the genitourinary tract, including the urethra, endocervix, and anal canal, and the conjunctivae and pharynx. The majority of pregnant women with gonorrhea are asymptomatic; the proportion of symptomatic patients among pregnant women with gonorrhea has been reported to be as low as 1.2%. Pregnant women who are diagnosed with uncomplicated gonococcal infections or who are the sexual partners of men with gonorrhea should be treated with ceftriaxone (125 mg intramuscularly) in a single dose or with cefixime (400 mg orally) in a single dose. Due to the higher risk of pharyngeal gonorrhea in pregnant women, it may be preferable to treat them with ceftriaxone, since the efficacy of cefixime for treating pharyngeal gonorrhea has not been established. The problem of low utilization of prenatal care in populations with a high prevalence of gonorrhea must be promptly addressed, and strategies to reach high-risk women for diagnosis and treatment outside the context of prenatal care require exploration. Urine screening for sexually transmitted pathogens in facilities attended by underserved high-risk pregnant women is a promising alternative.

Citation: Morse S, Beck-Sagué C. 1999. Gonorrhea, p 151-174. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch9
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Table 1

Prevalence of infection in selected populations of pregnant women in developing and developed countries, 1970 to 1989

Citation: Morse S, Beck-Sagué C. 1999. Gonorrhea, p 151-174. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch9
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Table 2

Adverse outcomes of pregnancy associated with infection

Citation: Morse S, Beck-Sagué C. 1999. Gonorrhea, p 151-174. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch9
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Table 3

Recommended regimens for perinatal infection

Citation: Morse S, Beck-Sagué C. 1999. Gonorrhea, p 151-174. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch9

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