<prompt> TOC for penicillin resistant gonorrhoeaCiprofloxacinCeftriaxoneStreptomycineErythromycin  <response>: B i.e. Ceftriaxone Neisseria gonorrhea is a gram negative, aerobic, non-motile, non-sporeforming, diplomono-cocciQ, exclusively a human pathogen that principally infects host columnar epithelium. It is oxidase positive like other Neisseria species, from which it is distinguished by their ability to grow on selective media to utilize glucose but not maltose, sucrose or lactose. Gonorrhoea is, the second most common after Chlamydia trachomatis which is the most common genital sexually transmitted infection in US, UK and other developed countriesQ Harrison 1442; Rooks 34.24. The incidence of gonorrhea is higher in developing countriesQ than industrialized nations predominantly affecting young, nonwhite, unmarried, less educated urban population. Harrison 1220 Chlamydia trachomatis is the most common cause of non gonococcal urethritis NGU and postgonococcal urethritis PGUQ. PGU refers to NGU developing in men 2-3 weeks after treatment of gonococcal urethritis with single doses of agents such as penicillin or cephalosporins which lack activity against Chlamydia. In US most of acute urethritis cases are NGU and C. trachomatis is implicated in most 30-50 of these casesQ. The other causes of NGU are Ureaplasma urealyticum, Mycoplasma genitalium, Trichomonas vaginalis and herpes simplex virus HSV. Gonorrhoea is a STD which commonly manifests as cervicitis primary site of infection in females, urethritis most commonprimary site of infection in males presenting as rapid onset severe burning dysuria with profuse purulent dischargeQ, proctitis conjunctivitis. If untreated it can 1t local complications such as endometritis, salpingitis, tuboovarian abscessQ, baholinitis, peritonitis and perihepatitis Fitz-Hugh Cuis Syndrome in females; peri urethritis and epididymitisQ in male patients and ophthalmia neonatorum in new borns. Disseminated gonococcemia is uncommon 1t skin lesions, tenosynovitis, ahritis and in rare cases endocarditis meningitis. Because of ascending spread of infection testis is spared or uncommonly last to be involvedQ only after urethritis, prostatitis, epididymitis in gonorrhea. Single dose regimens of 3rd generation cephalosporins ceftriaxone IM and cefixime oral are the mainstays of therapyQ for uncomplicated gonococcal infection of urethra, cervix, rectum, or pharynx. Septinomycin is an alternative 2nd regimen for uncomplicated gonococcal infections in penicillin allergic patients. All 3 drugs are suitable for pregnant breast feeding women. The new management for complaints of urethral discharge involves a combined modality of treatment for N. gonorrhea and C. trachomatisQ as most cases are dt coinfection with both pathogens and incorporate an agent eg. azithromycin or doxycycline that is effective agenist chlamydial infection. Pregnant women who should not take doxycycline, should receive concurrent treatment with a macrolide antibiotic for possible chlamydial infection. Feature Gonococcus Syphilis Infect EpididymisQ TestisQ Involve Resistant structure not involve TestisQ EpididymisQ Infection Urethrae Blood spread i.e. i.e. testis is through Epididymis is involved involved epididymis is testis is spared spared 