Gonorrhoea in pregnancy

Diagnosis and treatment of gonorrhoea is similar to in the non-pregnant. Endocervical swabs are safe, though care should be taken especially if placenta praevia is suspected.

Gonococcal infection during pregnancy is associated with preterm birth and low birth weight (1):

• intrapartum infection of the infant occurs in 30-42% of vaginal deliveries in women with gonorrhoea, most commonly resulting in purulent conjunctivitis (ophthalmia neonatorum), which may progress to blindness, and occasionally disseminated infection which can be fatal
• globally, the prevalence of gonorrhoea in pregnancy is estimated to be 1.85%, with higher rates among women in low-income countries, in women living with HIV, and in young people

Management:

• seek specialist advice
• in gonococcal infection in pregnancy
  • a systematic review concerning treatment of gonorrhoea in pregnancy (2) found that various antibiotic treatments (amoxicillin plus probenecid, spectinomycin, ceftriaxone, cefixime) were effective for curing gonorrhoea in pregnant women. There were no reports of serious adverse effects
    • recommended treatment of isolated gonorrhoea in pregnancy (3) is either cefixime 400mg single oral dose (4) or ceftriaxone 250mg IM or 3g amoxicillin plus 1g probenecid orally or cefotaxime 500mg IM or spectinomycin 2g IM
    • tetracyclines and fluoroquinolones should be avoided in pregnancy
  • consider concurrent chlamydia infection - about 50% of women with gonococcal infection harbour concurrent chlamydial infection (3)

References:

1. Ross S, Pinto-Sander N, Iwuji C. Diagnosis and management of gonorrhoea. BMJ 2025; 389 :e084789.
2. Brocklehurst P. Antibiotics for gonorrhoea in pregnancy. In: The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd. Search date 2001; primary sources Cochrane Pregnancy and Childbirth Group Register, and The Cochrane Controlled Trials Register.
3. Prescriber 2005; 16(6):14-24.
4. BASHH (2005) National guideline on the diagnosis and treatment of gonorrhoea in adults. British Association for Sexual Health and HIV.