Overview
Gonorrhea in pregnant women can lead to significant maternal and neonatal complications, including preterm birth, neonatal conjunctivitis, and transmission of the infection to the newborn 1.Diagnosis
Nucleic Acid Amplification Tests (NAATs): Highly sensitive and specific for detecting Neisseria gonorrhoeae 1.
Culture: Gold standard for confirming diagnosis, though slower than NAATs 1.
Gram stain: Useful for rapid presumptive diagnosis, particularly in cervicovaginal specimens 1.Management
First-line treatment: Ceftriaxone 250 mg intramuscularly in a single dose, plus oral azithromycin 1 g as a single dose (Evidence: Strong 1).
Adjunctive measures: Partner notification and treatment are crucial to prevent reinfection and further transmission 1.Special Populations
Pregnancy: Early detection and treatment are essential to prevent vertical transmission and associated neonatal complications 1.
Neonates: Prophylactic ophthalmia treatment with topical antibiotics (e.g., erythromycin ointment) is recommended for all newborns delivered by infected mothers 1.Key Recommendations
Screen and treat pregnant women for gonorrhea using NAATs or culture, ideally in the first trimester and at delivery, to prevent neonatal complications (Evidence: Strong 1).
Administer ceftriaxone 250 mg IM and azithromycin 1 g orally as a single-dose regimen for confirmed cases of maternal gonorrhea during pregnancy (Evidence: Strong 1).
Apply prophylactic ophthalmia treatment to all neonates born to mothers with untreated or inadequately treated gonorrhea (Evidence: Moderate 1).References
1 Asmussen I. Ultrastructure of the umbilical artery from a newborn delivered at term by a mother who smoked 80 cigarettes per day. Acta pathologica, microbiologica, et immunologica Scandinavica. Section A, Pathology 1982. link