Enfermedad actual: Refiere que en el mes de abril, luego de 3 dias de haber tenido relaciones sexuales por unica vez con una nueva pareja, comenzo a tener una secrecion mucopurulenta por la uretra, en ese momento consulta a la guardia del hospital donde le recetan un "antibiotico inyectable" (sic) (ceftriaxona?? penicilina?).
refiere que los sintomas remiten pero luego de unos dias la sintomatologia regresa para mantenerse hasta el momento de la consulta.
Examen fisico:
Se constata la secrecion purulenta por uretra.
En la inspeccion de boca abdomen y torax no se constatan lesiones de aparicion reciente.
Factores de riesgo para ITS:
Multiples parejas sexuales
No usa metodos anticonceptivos de barrera.
Estudios solicitados:
Cultivo para gonococco
PCR para Chlamydia
presuncion diagnostica: ¿tratamiento inicial equivocado (penicilina)?¿resistencia a cefalosporinas?¿reinfeccion?¿uretritis no gonococcica?
Tratamiento: 1g de levofloxacina monodosis.
Clinicians who diagnose N. gonorrhoeae infection in a patient with suspected cephalosporin treatment failure should perform culture and susceptibility testing of relevant clinical specimens, consult a specialist for guidance in clinical management, and report the case to CDC through state and local public health authorities. Health departments should prioritize partner notification and contact tracing of patients with N. gonorrhoeae infection thought to be associated with cephalosporin treatment failure or associated with patients whose isolates demonstrate decreased susceptibility to cephalosporin.
Suspected Cephalosporin Treatment Failure or Resistance
Suspected treatment failure has been reported among persons receiving oral and injectable cephalosporins. Therefore, clinicians of patients with suspected treatment failure or persons infected with a strain found to demonstrate in vitro resistance should consult an infectious disease specialist, conduct culture and susceptibility testing of relevant clinical specimens, retreat with at least 250 mg of ceftriaxone IM or IV, ensure partner treatment, and report the situation to CDC through state and local public health authorities.
http://www.cdc.gov/std/treatment/2010/gonococcal-infections.htm
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