Gonorrhoea in Pregnancy
Clinical detail
Additional detail checked 2026-10-17 against the linked sources. This check covers the section below; the rest of the module retains its displayed verification status.
Gonorrhoea may be clinically silent at the cervix or pharynx. Site-specific testing and an explicit follow-up plan are important because pharyngeal infection and suspected resistance require additional steps.
Assessment & interpretation
- Use NAAT at the sites of exposure. Obtain culture with susceptibility testing when treatment failure is suspected.
- Offer chlamydia, syphilis and HIV testing, and assess pelvic pain, arthritis or systemic features for complicated infection.
Decisions that change management
- For uncomplicated infection, CDC uses ceftriaxone 500 mg IM once below 150 kg and 1 g IM once at 150 kg or above.
- In pregnancy, add pregnancy-appropriate chlamydia treatment if chlamydia has not been excluded. Seek specialist advice when a severe cephalosporin allergy prevents standard treatment.
Follow-up & safety-netting
- Pharyngeal infection needs a test of cure at 7–14 days. Routine test of cure is not required for appropriately treated uncomplicated urogenital or rectal infection.
- Retest at 3 months. Persistent symptoms require culture and susceptibility assessment, with reinfection considered.
- Arrange partner care and abstain from sex for 7 days after treatment and until partners are treated and symptoms have resolved.
Clinical pitfalls
- This is the labelled CDC regimen; adapt antimicrobial decisions to local resistance and current Indian guidance.
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
When admission or continued hospital care is needed
- Disseminated illness, joint involvement, sepsis, severe pelvic pain or suspected PID requires hospital/specialist assessment.
When clinic, day care or home care may be suitable
- Stable uncomplicated gonorrhoea is usually managed through outpatient STI/antenatal care with treatment and partner services.
Before going home
- The correct site/weight-based treatment has been given or arranged and partner/retesting plans are documented.
Discharge medicines and treatment changes
- Use the checked gonorrhoea regimen. Add pregnancy-appropriate chlamydia treatment only when indicated, not an automatic doxycycline pregnancy prescription.
Medicine doses — use only when indicated
Use the medicines selected for this patient. Listed alternatives are not instructions to prescribe all of them together. Confirm the actual remaining course, pregnancy/postnatal context and monitoring plan.
Document the completed injection and indication; do not repeat it routinely at home.
- Indication: Gonococcal cervicitis/urethritis; add pregnancy-appropriate chlamydia treatment if not excluded
- Allergy, pregnancy and chlamydia status; retest at 3 months, and pharyngeal infection test-of-cure at 7–14 days
Tests, pending results and their reviewer
- Pharyngeal gonorrhoea needs test of cure at 7–14 days; repeat testing at 3 months for reinfection. Persistent symptoms need earlier reassessment and resistance evaluation.
Home care and counselling
- Give partner-treatment and sex-avoidance instructions and explain why persistent symptoms must be reported.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
7–14 days for pharyngeal infection | Complete test of cure with the treating service. |
3 months | Retest for reinfection; arrange earlier review for symptoms or a resistance concern. |
Return urgently
- Fever, joint pain/swelling, severe pelvic pain or worsening systemic illness requires urgent assessment.
Open the complete discharge checklist →
Treatment
① Immediate stabilization — first minutes
③ First-line treatment & drug regimens
- Gonococcal cervicitis/urethritis; add pregnancy-appropriate chlamydia treatment if not excluded
- Allergy, pregnancy and chlamydia status; retest at 3 months, and pharyngeal infection test-of-cure at 7–14 days
④ Drug treatment detail (1 agents)
- Indication: Recommended CDC regimen for chlamydia in pregnancy
- Partner treatment, adherence/retained dose, symptoms; do not test NAAT too early after treatment
Monitoring
- NAAT test-of-cure ~2 wks (pregnancy)
- Pharyngeal sites considered per exposure
Post-treatment care
- Ophthalmia neonatorum prevention via cure; partner management
Diagnosis & assessment
- Haemodynamic instability -> sepsis pathway
Initial assessment
See treatment table for testing and regimens.
Principles & follow-up
Management principles
Sources (8)
2021-07 · updated 2025-12-22 (page review; guidance itself unchanged) · checked 2026-08-23 · verified-live
Open source ↗
CDC pages + wall chart: uncomplicated gonorrhoea cervix/urethra/rectum → ceftriaxone 500 mg IM single dose (<150 kg; 1 g if ≥150 kg); pharyngeal same; conjunctivitis 1 g IM; DGI 1 g IV/IM q24h; PID outpatient → ceftriaxone 500 mg IM ×1 + doxycycline 100 BD ×14 d + metronidazole 500 BD ×14 d; chlamyd…
· checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for sti-gonorrhoea. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/discharge c…
· checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for sti-chlamydia. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/discharge ch…
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.