Gonococcal Proctitis in Pregnancy and Breast/Chest-Feeding
Managing gonococcal proctitis during pregnancy or while breast/chest-feeding requires a modified approach. The standard antibiotic options available in the general population are not all safe in this population, making careful regimen selection essential.
Clinical scenario
This protocol applies to individuals who are pregnant or breast/chest-feeding. Quinolones are not safe to use in this population. Gentamicin, sometimes considered in gonorrhoea management, must also be avoided during pregnancy. The range of appropriate treatment options is therefore more restricted than in non-pregnant adults.
Treatment approach (partial summary)
The preferred approach in this population involves a single-dose parenteral antibiotic. Where an alternative oral strategy is considered, it may only be used when isolate susceptibility has been confirmed.
Complete regimen details, the full list of options, and clinical decision points are available in the structured protocol below.
Clinical goals
Resolution of rectal symptoms — including anal discharge and perianal or anal pain. Confirmed microbiological clearance of Neisseria gonorrhoeae by NAAT, performed at least two weeks after treatment completion.
References
DOI: 10.1177/09564624251345195
Pregnant and breast/chest-feeding individuals should not be treated with quinolones.
Gentamicin should be avoided in pregnancy.
In addition, azithromycin should only be used if the isolate is known to be susceptible.
We recommend TOC using NAAT should be performed at least two weeks after treatment (GRADE 1B).
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