General Information

Antimicrobial resistance in N. gonorrhoeae remains an important challenge to controlling
gonorrhea; gonococcal strains may be resistant to penicillins, tetracyclines, spectinomycin, and
fluoroquinolones. Resistance to CDC-recommended doses of ciprofloxacin and ofloxacin exceeds
40% in some Asian countries. Fluoroquinolone-resistant strains of N. gonorrhoeae have also been
reported in the United States and Canada.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is a general term that refers to infection of the uterus (womb),
fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs.
It is a common and serious complication of some sexually transmitted diseases (STDs), especially
chlamydia and gonorrhea. Pelvic inflammatory disease can damage the fallopian tubes and tissues
in and near the uterus and ovaries. Pelvic inflammatory disease can lead to serious consequences
including infertility, ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the
womb), abscess formation, and chronic pelvic pain.

Pelvic inflammatory disease occurs when bacteria move upward from a woman's vagina or cervix
(opening to the uterus) into her reproductive organs. Many different organisms can cause Pelvic
inflammatory disease, but many cases are associated with gonorrhea and chlamydia, two very
common bacterial sexually transmitted diseases. A prior episode of Pelvic inflammatory disease
increases the risk of another episode because the reproductive organs may be damaged during
the initial bout of infection.

Sexually active women in their childbearing years are most at risk, and those under age 25 are
more likely to develop Pelvic inflammatory disease than those older than 25. This is partly because
the cervix of teenage girls and young women is not fully matured, increasing their susceptibility to
the sexually transmitted diseases that are linked to Pelvic inflammatory disease.


Symptoms of Pelvic inflammatory disease vary from none to severe. When Pelvic inflammatory
disease is caused by chlamydial infection, a woman may experience mild symptoms or no
symptoms at all, while serious damage is being done to her reproductive organs. Because of
vague symptoms, Pelvic inflammatory disease goes unrecognized by women and their health care
providers about two thirds of the time. Women who have symptoms of Pelvic inflammatory disease
most commonly have lower abdominal pain. Other signs and symptoms include fever, unusual
vaginal discharge that may have a foul odor, painful intercourse, painful urination, irregular
menstrual bleeding, and pain in the right upper abdomen (rare).

Prompt and appropriate treatment can help prevent complications of Pelvic inflammatory disease.
Without treatment, Pelvic inflammatory disease can cause permanent damage to the female
reproductive organs. Infection-causing bacteria can silently invade the fallopian tubes, causing
normal tissue to turn into scar tissue. This scar tissue blocks or interrupts the normal movement of
eggs into the uterus. If the fallopian tubes are totally blocked by scar tissue, sperm cannot fertilize
an egg, and the woman becomes infertile. Infertility also can occur if the fallopian tubes are partially
blocked or even slightly damaged. About one in ten women with Pelvic inflammatory disease
becomes infertile, and if a woman has multiple episodes of Pelvic inflammatory disease, her
chances of becoming infertile increase.

In addition, a partially blocked or slightly damaged fallopian tube may cause a fertilized egg to
remain in the fallopian tube. If this fertilized egg begins to grow in the tube as if it were in the uterus,
it is called an ectopic pregnancy. As it grows, an ectopic pregnancy can rupture the fallopian tube
causing severe pain, internal bleeding, and even death.

Scarring in the fallopian tubes and other pelvic structures can also cause chronic pelvic pain (pain
that lasts for months or even years). Women with repeated episodes of Pelvic inflammatory
disease are more likely to suffer infertility, ectopic pregnancy, or chronic pelvic pain.


Women can protect themselves from Pelvic inflammatory disease by taking action to prevent
sexually transmitted diseases or by getting early treatment if they do get an sexually transmitted

The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual
intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been
tested and is known to be uninfected.

Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of
chlamydia and gonorrhea.


The only current CDC-recommended options for treating Neisseria gonorrhoeae infections are
from a single class of antibiotics, the cephalosporins. Within this class, ceftriaxone, available only
as an injection, is the recommended treatment for all types of gonorrhea infections (i.e., urogenital,
rectal, and pharyngeal). The only oral agent recommended currently by CDC for treatment of
uncomplicated urogenital or rectal gonorrhea is a single dose of cefixime 400 mg (1). Availability of
cefixime had been limited since July 2002, when Wyeth Pharmaceuticals (Collegeville,
Pennsylvania) discontinued manufacturing cefixime tablets in the United States (2). Beginning in
April 2008, cefixime (Suprax®) 400 mg tablets are again available in the United States.

Oral cefixime is now being provided by Lupin Pharmaceuticals, Inc. (Baltimore, Maryland), which
received Food and Drug Administration approval in February 2004 to manufacture and market
cefixime. Lupin has been manufacturing and marketing cefixime oral suspension (100 mg/5 mL)
since February 2004 and cefixime oral suspension (200 mg/5 mL) since April 2007. Public health
pricing* will be available for the 400 mg cefixime tablets.

Source: CDC.gov
Gonorrhea is a sexually transmitted
disease (STD). Gonorrhea is caused
by Neisseria gonorrhoeae, a
bacterium that can grow and multiply
easily in the warm, moist areas of the
reproductive tract, including the
cervix (opening to the womb), uterus
(womb), and fallopian tubes (egg
canals) in women, and in the urethra
(urine canal) in women and men. The
bacterium can also grow in the
mouth, throat, eyes, and anus.
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