Warning:

This document is being maintained for historical purposes, but is now out of date. To view current guidelines please visit:

• STD Treatment Guidelines   at http://www.cdc.gov/STD/treatment

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1993 Sexually Transmitted Diseases Treatment Guidelines

09/24/1993

SUGGESTED CITATION
Centers for Disease Control and Prevention. 1993 Sexually
transmitted diseases treatment guidelines. MMWR 1993;42(No. RR-14):
{inclusive page numbers}.

CIO Responsible for this publication:
National Center for Prevention Services,
Division of Sexually Transmitted Diseases and HIV Prevention

Gonococcal Infections Among Children
     
     After the neonatal period, sexual abuse is the most common
cause of gonococcal infection among preadolescent children (see
Sexual Assault or Abuse of Children). Vaginitis is the most common
manifestation of gonococcal infection among preadolescent children.
PID following vaginal infection appears to be less common than
among adults. Among sexually-abused children, anorectal and
pharyngeal infections with N. gonorrhoeae are common and are
frequently asymptomatic.

Diagnostic Considerations -
     Because of the potential medical/legal use of the test results
for N. gonorrhoeae among children, only standard culture systems
for the isolation of N. gonorrhoeae should be used to diagnose N.
gonorrhoeae for these children. Nonculture gonococcal tests,
including Gram-stained smear, DNA probes, or EIA tests should not
be used; none of these tests have been approved by the FDA for use
in the oropharynx, rectum, or genital tract of children. Specimens
from the vagina, urethra, pharynx, or rectum should be streaked
onto selective media for isolation of N. gonorrhoeae. All
presumptive isolates of N. gonorrhoeae should be confirmed by at
least two tests that involve different principles, e.g.,
biochemical, enzyme substrate, or serologic. Isolates should be
preserved to permit additional or repeated analysis.

Recommended Regimen for Children -
     Children Who Weigh greater than 45 kg

     Children who weigh greater than or equal to 45 kg should be
administered the same treatment regimens as those recommended for
adults (see Gonococcal Infections).

     Children Who Weigh less than 45 kg
     The following treatment recommendations are for children with
uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis,
pharyngitis, or proctitis.

     Ceftriaxone 125 mg IM in a single dose.

Alternative Regimen -
     Spectinomycin 40 mg/kg (maximum 2 g) IM in a single dose.

Children Who Weigh less than 45 kg and Who Have Bacteremia,
Arthritis, or Meningitis

Recommended Regimen -
     Ceftriaxone 50 mg/kg (maximum 1 g) IM or IV in a single dose
     daily for 7 days.

NOTE: For meningitis, increase the duration of treatment to
10-14 days and the maximum dose to 2 g.

Follow-Up -
     Follow-up cultures of specimens from infected sites are
necessary to ensure that treatment has been effective.

Other Management Considerations -
     Only parenteral cephalosporins are recommended for use among
children. Ceftriaxone is approved for all gonococcal indications
among children; cefotaxime is approved for gonococcal ophthalmia
only. Oral cephalosporins (cefixime, cefuroxime axetil,
cefpodoxime) have not received adequate evaluation in the treatment
of gonococcal infections among pediatric patients to recommend
their use. The pharmacokinetic activity of these drugs among adults
cannot be extrapolated to children.

     All children with gonococcal infections should be evaluated
for coinfection with syphilis and C. trachomatis. For a discussion
of issues regarding sexual assault, refer to Sexual Assault or
Abuse of Children.

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