Recent developments in gonorrhea and pelvic inflammatory disease

Gonorrhea remains the most commonly reported sexually transmitted infection, with a total of 2-2.5 million cases occurring annually in the United States. The annual incidence of gonococcal and nongonococcal pelvic inflammatory disease (PID) is 600,000-1,000,000 cases, 10-15% of which result in infertility due to bilateral tubal occulusion. PID results from ascending infection with sexually transmitted pathogens or components of the normal vaginal flora, or both. Uncomplicated gonorrhea usually is best treated with a single dose of ampicillin or procaine penicillin G (given with probenecid) or spectinomycin, in each case followed by a 7 day course of tetracycline or doxycycline to eradicate coexisting chlamydial infection. PID, both gonococcal and non-gonococcal, ideally should be treated in the hospital with parenteral antibiotics. Regimens utilizing various combinations of doxycycline, cefoxitin, clindamycin, aminoglyocosides, or metronidazole are recommended. The sexual partners of patients with gonorrhea or with PID (non-gonococcal as well as gonococcal) should be routinely examined and treated.