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Module 17110 lessonsRxPrep 2023 Chapter 23, reconciled with CDC STI treatment guidance, CDC 2024 doxycycline PEP guidance, current screening recommendations, and December 2025 FDA gonorrhea approvals

Gonococcal Infections

Map infection to every exposed site, select exact treatment by anatomy and weight, protect pregnancy and the newborn, recognize dissemination, preserve resistance evidence, and close partners and prevention.

01

Explain gonococcal mucosal infection, silent carriage, ascent, and dissemination.

02

Select NAAT and culture specimens for every exposed anatomic site.

03

Dose ceftriaxone correctly for uncomplicated infection using the 150 kg threshold.

04

Treat pharyngeal disease and complete its mandatory test of cure.

05

Place cefixime, allergy regimens, zoliflodacin, and gepotidacin within their exact boundaries.

06

Manage pregnancy, neonatal risk, and adult conjunctivitis.

07

Recognize and treat arthritis-dermatitis DGI, meningitis, and endocarditis.

08

Distinguish reinfection from treatment failure and preserve culture for AST.

09

Manage partners, abstinence, three-month retesting, and other STI testing.

10

Apply exposure-based screening, HIV PrEP, and population-specific doxy PEP guidance.

171.01

Lesson

Map the Infection to Every Exposed Surface

N. gonorrhoeae occupies mucosal sites independently. Symptoms at one site do not reveal what is happening at another.

What to learn
  • Gram-negative diplococcus
  • Mucosal attachment
  • Silent carriage
  • Ascending infection
  • Dissemination
Clinical pathwayMap every exposed surface
01ExposureDefine the compartment

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

02AttachmentSelect the evidence

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

03InflammationDeliver the intervention

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

04SpreadSecure the next decision

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

Start with site biology

Gonococci attach to columnar epithelium at the cervix, urethra, rectum, pharynx, and conjunctiva. Antigenic variation and local inflammation support reinfection rather than durable immunity.

Expect silence

Cervical, rectal, and pharyngeal infection is often asymptomatic. Urethritis can cause dysuria and discharge, but symptom absence cannot close the diagnosis.

Recognize ascent

Untreated cervical infection can ascend into PID, infertility, ectopic pregnancy, and chronic pelvic pain. Epididymitis and local complications can occur in other anatomy.

Keep dissemination visible

Bloodstream spread is uncommon but can produce skin lesions, tenosynovitis, polyarthralgia, septic arthritis, meningitis, or endocarditis even when genital symptoms are absent.

Quick check

0 of 1 answered
01What most directly prevents missed extragenital gonorrhea?
Answer every question to submit.
171.02

Lesson

Pair Each Question With the Right Specimen

NAAT answers whether gonococcal nucleic acid is present at a sampled site. Culture answers the additional resistance question when a viable isolate matters.

What to learn
  • Urine or vaginal NAAT
  • Rectal NAAT
  • Pharyngeal NAAT
  • Culture
  • AST
Clinical pathwayMatch site to specimen
01HistoryDefine the compartment

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

02NAATSelect the evidence

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

03CultureDeliver the intervention

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

04ASTSecure the next decision

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

Use site-specific NAAT

Collect an assay-approved vaginal, cervical, urine, rectal, or pharyngeal specimen from every exposed site. Patient-collected swabs can improve access when validated.

Preserve culture when needed

Culture is less sensitive than NAAT but supplies the viable isolate required for antimicrobial susceptibility testing. Transport and incubation conditions matter.

Test the connected infections

Every gonorrhea diagnosis should trigger chlamydia, syphilis, and HIV testing. Offer HIV PrEP when the HIV result is negative and clinical context supports it.

Interpret after treatment carefully

A positive pharyngeal NAAT at the early edge of follow-up can reflect residual nucleic acid. Confirm with culture before retreatment when possible.

Quick check

0 of 1 answered
01Which test is required to perform gonococcal susceptibility testing?
Answer every question to submit.
171.03

Lesson

Deliver Exact Ceftriaxone Exposure in One Visit

The CDC regimen is simple only after weight, site, allergy, pregnancy, and chlamydia status are known.

What to learn
  • 500 mg IM
  • 1 g IM
  • 150 kg threshold
  • Chlamydia status
  • Direct observation
Clinical pathwayDeliver exact exposure
01WeightDefine the compartment

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

02SiteSelect the evidence

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

03CeftriaxoneDeliver the intervention

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

04CloseSecure the next decision

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

Dose below 150 kg

Give ceftriaxone 500 mg IM once for uncomplicated cervical, urethral, rectal, or pharyngeal infection in adolescents and adults weighing less than 150 kg.

Dose at or above 150 kg

Give ceftriaxone 1 g IM once when weight is at least 150 kg. Document weight rather than estimating around the threshold.

Address chlamydia deliberately

If chlamydia has not been excluded, add doxycycline 100 mg orally twice daily for 7 days in a nonpregnant adult. Pregnancy follows its own chlamydia pathway.

Close administration safely

Review severe beta-lactam reactions, use trained IM technique, prepare for immediate reactions, and use on-site directly observed dosing when possible.

Quick check

0 of 1 answered
01What dose treats uncomplicated gonorrhea in an adult weighing 156 kg?
Answer every question to submit.
171.04

Lesson

Treat the Pharynx as the Resistance Boundary

Pharyngeal infection is often silent, harder to eradicate, and a potential reservoir for resistance. It has no reliable CDC alternative to ceftriaxone.

What to learn
  • Oral exposure
  • Ceftriaxone
  • No reliable alternative
  • Test of cure
  • Three-month retest
Clinical pathwayProtect the pharyngeal boundary
01TreatDefine the compartment

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

02WaitSelect the evidence

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

03Prove cureDeliver the intervention

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

04RetestSecure the next decision

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

Test after oral exposure

A patient with urogenital or rectal gonorrhea who reports oral exposure should also receive pharyngeal testing.

Use the reliable regimen

Give ceftriaxone 500 mg IM once below 150 kg or 1 g IM once at or above 150 kg. Severe ceftriaxone reaction requires expert consultation.

Prove cure

Obtain culture or NAAT 7 to 14 days after treatment. Testing at 7 days can produce more false-positive NAAT results, so confirm a positive NAAT with culture before retreatment when possible.

Retest for reinfection

Routine test of cure is not needed for correctly treated uncomplicated urogenital or rectal disease, but every treated patient should be retested at 3 months.

Quick check

0 of 1 answered
01What follow-up is mandatory after pharyngeal gonorrhea?
Answer every question to submit.
171.05

Lesson

Place Every Alternative Inside Its Boundary

Alternative and newly approved oral therapies expand access for selected uncomplicated urogenital infection. They do not erase site, population, resistance, or label limits.

What to learn
  • Cefixime
  • Gentamicin plus azithromycin
  • Zoliflodacin
  • Gepotidacin
  • Current label
Clinical pathwayKeep options inside the label
01BarrierDefine the compartment

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

02SiteSelect the evidence

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

03PopulationDeliver the intervention

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

04VerifySecure the next decision

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

Use cefixime for availability

If ceftriaxone is unavailable, cefixime 800 mg orally once is an alternative for selected uncomplicated urogenital or rectal infection. It is not an equivalent pharyngeal regimen.

Use the allergy regimen narrowly

For a severe cephalosporin allergy, gentamicin 240 mg IM plus azithromycin 2 g orally once can be considered. Vomiting and weaker pharyngeal evidence limit the regimen.

Know zoliflodacin

FDA approved Nuzolvence 3 g orally once in December 2025 for uncomplicated urogenital gonorrhea in eligible patients at least 12 years old and weighing at least 35 kg. Avoid use in pregnancy, obtain pregnancy testing when applicable, and follow the label's reproductive precautions.

Know gepotidacin

FDA approved Blujepa 3,000 mg orally followed by another 3,000 mg about 12 hours later for uncomplicated urogenital gonorrhea in eligible patients at least 12 years old and weighing at least 45 kg who have few or no treatment alternatives. Check QT, cholinergic, interaction, and administration warnings.

Quick check

0 of 1 answered
01What do the 2025 oral approvals not establish?
Answer every question to submit.
171.06

Lesson

Protect Pregnancy, Birth, and the Newborn

Maternal screening, immediate treatment, partner care, and newborn prophylaxis form one prevention chain. Established neonatal disease is a systemic emergency.

What to learn
  • Prenatal screening
  • Weight-based ceftriaxone
  • Pregnancy chlamydia plan
  • Ocular prophylaxis
  • Neonatal therapy
Clinical pathwayProtect parent and newborn
01ScreenDefine the compartment

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

02TreatSelect the evidence

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

03PreventDeliver the intervention

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

04EscalateSecure the next decision

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

Use the gonorrhea regimen in pregnancy

Give ceftriaxone 500 mg IM once below 150 kg or 1 g IM once at or above 150 kg. Severe cephalosporin allergy requires specialist consultation.

Do not default to doxycycline

When chlamydia is not excluded in pregnancy, use pregnancy-appropriate chlamydia guidance rather than automatically adding doxycycline.

Prevent neonatal disease

Screen patients younger than 25 and older patients with increased risk early in pregnancy, then repeat in the third trimester when risk remains. Ensure treatment and partner management are complete.

Treat disease, not just prophylaxis

Purulent neonatal conjunctivitis can progress rapidly and requires systemic evaluation and ceftriaxone or cefotaxime therapy. Routine ocular prophylaxis does not treat established infection.

Quick check

0 of 1 answered
01What should happen when neonatal gonococcal ophthalmia is suspected?
Answer every question to submit.
171.07

Lesson

Recognize the Systemic Pattern Before the Source Is Visible

DGI frequently presents through skin, tendon, and joint findings while the mucosal source remains asymptomatic.

What to learn
  • Pustular lesions
  • Tenosynovitis
  • Polyarthralgia
  • Septic arthritis
  • Deep-site infection
Clinical pathwayFind the silent source
01SkinDefine the compartment

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

02TendonSelect the evidence

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

03JointDeliver the intervention

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

04Deep siteSecure the next decision

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

Recognize arthritis-dermatitis syndrome

Look for petechial or pustular acral lesions, asymmetric polyarthralgia, tenosynovitis, or oligoarticular septic arthritis.

Collect the complete specimen set

Obtain NAAT and culture from all exposed mucosal sites plus blood, synovial fluid, skin, or CNS sites as clinically indicated. Test recovered isolates for susceptibility.

Treat sustained infection

Use ceftriaxone 1 g IM or IV every 24 hours for arthritis-dermatitis disease. After substantial improvement for 24 to 48 hours, AST-guided oral step-down can complete at least 7 total days.

Escalate CNS or valve infection

Use ceftriaxone 1 to 2 g IV every 12 to 24 hours. Treat meningitis for 10 to 14 days and endocarditis for more than 4 weeks with infectious-disease consultation.

Quick check

0 of 1 answered
01What regimen begins treatment for arthritis-dermatitis DGI?
Answer every question to submit.
171.08

Lesson

Preserve the Isolate Before It Disappears

A repeat positive test can reflect reinfection, inadequate exposure, wrong site therapy, or true resistance. The workup must preserve the evidence needed to distinguish them.

What to learn
  • Reinfection
  • Culture
  • AST
  • Expert consultation
  • Public-health report
Clinical pathwayPreserve resistance evidence
01AuditDefine the compartment

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

02CultureSelect the evidence

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

03ConsultDeliver the intervention

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

04ReportSecure the next decision

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

Audit the original treatment

Verify product, dose, weight, site, route, timing, vomiting, adherence, chlamydia management, symptoms, and partner treatment.

Separate reinfection from failure

Most apparent failures are reinfections. Review sexual exposure after treatment and whether partners received effective therapy.

Preserve resistance evidence

Collect culture, preferably with simultaneous NAAT, from every relevant site before retreatment when true failure is plausible. Send isolates for AST.

Escalate within 24 hours

Consult an infectious-disease or STI expert and report suspected cephalosporin treatment failure through local or state public health to CDC within 24 hours.

Quick check

0 of 1 answered
01What specimen is most important before retreatment when ceftriaxone failure is plausible?
Answer every question to submit.
171.09

Lesson

Close the Transmission System

Treatment succeeds at the population level only when partners, retesting, screening, HIV prevention, and barriers to care are addressed together.

What to learn
  • Sixty-day partners
  • Seven-day abstinence
  • Three-month retest
  • HIV PrEP
  • Doxy PEP
Clinical pathwayClose the transmission system
01PartnersDefine the compartment

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

02AbstainSelect the evidence

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

03RetestDeliver the intervention

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

04PreventSecure the next decision

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

Manage partners

Evaluate, test, and presumptively treat partners from the preceding 60 days. Consider expedited partner therapy only when lawful and timely evaluation is unlikely.

Give exact abstinence guidance

Avoid sex for 7 days after treatment and until all partners are treated and symptoms have resolved.

Schedule retesting and screening

Retest at 3 months. Screen sexually active women younger than 25 annually, older women by risk, and MSM at exposed sites at least annually or every 3 to 6 months when risk is increased.

Integrate HIV and doxy PEP

Test for HIV and offer PrEP when appropriate. Discuss doxy PEP with MSM and transgender women who had a bacterial STI in the prior 12 months, using 200 mg within 72 hours after sex and no more than 200 mg per 24 hours.

Quick check

0 of 1 answered
01When should a treated patient be retested for gonorrhea reinfection?
Answer every question to submit.
171.10

Lesson

Make Site, Host, and Public Health One Decision

A complete plan moves from exposure to specimen, regimen, administration, follow-up, partner care, and surveillance without dropping a handoff.

What to learn
  • Site
  • Host
  • Drug
  • Follow-up
  • Ownership
Clinical pathwayOwn the complete pathway
01SiteDefine the compartment

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

02HostSelect the evidence

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

03DrugDeliver the intervention

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

04Next actionSecure the next decision

Connect anatomy, susceptibility, host factors, follow-up, and transmission control.

Name every site

Document exposed and infected anatomy, specimen method, symptoms, and complications before choosing therapy.

Name every host modifier

Record weight, pregnancy, age, allergy phenotype, kidney and auditory risk, interactions, immune status, and ability to return.

Name every drug boundary

Separate CDC standard therapy, availability alternatives, severe-allergy options, and 2025 site-specific oral approvals.

Name every owner

Assign treatment, test of cure when required, three-month retesting, partner services, public-health reporting, HIV prevention, and urgent return precautions.

Quick check

0 of 1 answered
01Which plan is complete?
Answer every question to submit.

Module test

Check the connections.

Each attempt draws 10 questions from the complete 130 question bank.

130 questions in this module bank10 questions per attempt

Each attempt draws a fresh set and rearranges the answer choices.

References

Current clinical foundation.

Lecture material was synthesized with the following contemporary guidance. Verify local policy and current guidance before applying clinical information.

  1. CDC Gonococcal Infections Among Adolescents and Adults
  2. CDC STI Screening Recommendations
  3. CDC 2024 Doxycycline PEP Guideline
  4. FDA Approves Two Oral Gonorrhea Therapies
  5. FDA 2025 Novel Drug Approvals
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