Sulfonamides were used as early as in 1935 for treatment of gonorrhea. In the beginning, all the strains of gono-cocci were sensitive to sulfonamides but subsequently, they developed resistance to these antibiotics. Penicillin is the drug of choice for penicillin-sensitive strains of N. gonorrhoeae.
Penicillin-resistant strains of N. gonorrhoeae:Initially, gono-cocci were highly sensitive to penicillin (minimal inhibitory con-centration, or MIC, 0.005 U/mL). However, since 1957, strains of gonococci with decreased sensitivity (MIC .0.1 U/mL) to penicillin have been documented. The concentration of peni-cillin required to inhibit the growth of gonococci has increased by many folds and is now considerably higher (2.4–4.8 MU).
· Most of them are beta-lactamase (penicillinase) producing by the virtue of plasmid transmission. These strains show high level of resistance to penicillin.
· Some strains of N. gonorrhoeae not producing beta-lactamase but yet showing resistance to penicillin have also been reported. This resistance is mediated chromosomally and is of low level.
Resistance to other antibiotics: Chromosomal-mediatedresistance to other antibiotics, such as tetracycline, erythromy-cin, and aminoglycosides, has also been reported.
· Tetracyclines are no longer given for gonococcal infection because of the prevalence of tetracycline resistance.
· Resistance to ciprofloxacin has also been increasingly docu-mented in Southeast Asia, Africa, and Australia.
Immediate saline irrigation and intravenous ceftriaxone are effective for treatment of gonococcal conjunctivitis. Local application of 0.5% of erythromycin ophthalmic ointment or 1% tetracycline or 1% silver nitrate ointment is effective for treatment of gonococcal ophthalmia neonatorum.
PID as such is a mixed infection of gonococci, Chlamydia, and other facultative anaerobic pathogens. The treatment, therefore, is by broad-spectrum antibiotics to cover all infect-ing organisms.