Ceftriaxone for DGI

[wesb909]

I'm being treated preemptively for DGI by an infectious disease specialist.  He's putting me on ceftriaxone IM 500 mg daily for 10 days.  He absolutely refuses to use 1 g despite my protestation that all the treatment guidelines I've find say 1-2 g daily, saying that my case seems mild and that more than 500 mg IM would be dangerous or something (didn't quite get his point).  He also claims to have successfully treated many cases of more severe DGI with only 250 mg/day.  Would 500 mg really be enough or is he putting me at risk for treatment failure and further complications?  Should I go back and insist on 1 g / day?  So far, I'm tolerating the 500 mg shot quite well so I think I can handle 1 g.  Thanks.

[Edward W Hook, MD]

Acetowhite leasions are not always HPV but it would not be suprising if your wife had HPV, the infection is quite common.  

You should wait until her biopsy results are available to discuss their implications and management plan.  At that time, she should discuss the plan with her doctors.  in the meantime, I would not worry about back and forth sexual transmission of I were you.  

Your guilt is causing you to overinterpret her health issues.  You need to relax.

That will be all for this thread. EWH

[wesb909]

Doctor, a last question: my wife's colposcopy showed a few "acetowhite" areas (from which the biopsies were taken).  Does that mean that she definitely has HPV?  The biopsy result hasn't come out yet but her doctor will probably recommend cryotherapy.  But if I gave her HPV, doesn't that mean I'll just give it back to her after the cryotherapy and there will be no point?  She's due to have major surgery next month for something unrelated and may end up taking imanitib for a while.  Will that weaken her immune system making it hard for her to clear the HPV infection if present?  I'm really at a loss as to what to do with her situation.  Thanks and please let me know if you'd like me to post as a separate thread with a new fee.

[Edward W Hook, MD]

Both are the case. EWH

[wesb909]

Thanks, Dr. Hook. Again I really appreciate all that you're doing here and value your views immensely.  Just for clarity's sake: you mean it would cover it because there is no infection or it would cover it because a biopsy would not cause dissemination if an infection were present?

[Edward W Hook, MD]

Put another way, you want to know if a single injection of ceftriaxone would be sufficient to cover your wife's exposure toyou for an infection there is no evidence you have (not trying to be cure here but I want you to see the fallacy in the approach being taken).  the answer is yes, it would, even with the biopsies.

The antibiotics may make a difference but that would not mean that your problem is due to gonorrhea in any manner shape or form.   EWH

[wesb909]

The problem I have with CPPS is that I haven't had much pelvic pain to speak of. But I do have pain in all my limbs and my armpits and upper back.  The urologists and rheumatologists have thrown up their hands and I was referred by one of them to the ID doctor.  I truly and sincerely hope you're right that it's not DGI. (btw he's changed the order to 1g daily).

One last question: my wife is due to have a single 1 g shot this evening but she had a colposcopy yesterday with 5 biopsy samples taken. Did that put her at risk of disseminated infection???  Will the one shot tonight be sufficient if that's the case?  She hasn't had any symptoms other than an inflamed cervix.  I'm really terrified that the single shot won't be enough after  the biopsy.

[Edward W Hook, MD]

With all due respect to your doctor, the chance that you have DGI is close to zero.  At this juncture, it is quite difficult to say precisely what it is that you have but an STD at all is most unlikely.  I am likewise skeptical that further antibiotics are going to help.

I suggest that your review the CPPS (chronic pelvic pain syndrome) at Wikipedia.  This may provide some direction.  

Ceftriaxone is not cause the discharge and  having taken the ceftriaxone, which works in just a few hours.  If you had gonorrhea you would be less likely, not more likely to have a discharge present.  A modest amount of urethral discharge is common on awakening.  EWH

[wesb909]

Very sorry for the multiple posts: a day after the first IM dose, I noticed discharge for the first time ever (like prostate fluid) when I woke up this morning and that has freaked me out that this may really have been gonorrhea this whole time. :(

[wesb909]

I have also had tiny pink rashes (like mosquito bites) on some of my fingers, that resolved in 2 weeks then a couple of them came back a month later in the exact same spot.

[wesb909]

Thank you doctor that's very helpful. I meant presumptively (i.e. based on symptoms and history), not preemptively. My history is a bit convoluted but the symptoms I have started with frequent urination and a dramatic change in the consistency and volume of my semen. First, doctors treated me for Chlamydia then prostatitis with no result (no one ever raised the prospect of gonorrhea). One of them gave me a prostate massage, after which I've had aches and pains in my fingers, wrists, toes, knees, you name it, and a strange strain in my ankles and achilles that I can only control with painkillers. I also have sore forearms and legs. I tested negative using NAAT, but this was after the joint problems and after a lot of antibiotics, including cefixime long after the joint symptoms started. The ID doctor thinks it's possible that the multiple courses of active-but-not-effective antibiotics may have suppressed the symptoms somewhat and cleared it from my genital area but that the rest of the body may still carry the infection. Adding to the suspicion is that my wife has had inflammatory/ASCUS pap smears for a couple of months now. He says that at this point it's prudent to treat for DGI and see if the symptoms respond because there is no real test that can rule it out.

[Edward W Hook, MD]

Welcome to the Forum.  The recommendation to use higher doses of ceftriaxone to treat DGI, if what you have is DGI is not based on clinical trials and is probably more drug than is needed (I note you state you are being treated "preemptively" - might I ask what is the basis for the treatment?   Are you sure you even have gonorrhea?). The 500 mg dose should be fine for treatment of DGI.   The gonorrhea that cause DGI tend to be, on average, more sensitive to antibiotics than most other strains of the organism.  If you are taking the medication as daily intramuscular injections (rather than IV) the larger dose is more likely to give you a very sore rear end towards the final few days of your treatment.

I hope this comment is helpful.  EWH

[wesb909]

Sorry, I meant presumptively, not preemptively.