Gonococcal Urethritis In Males Research Articles

2023 Korean Association of Urogenital Tract Infection and Inflammation guidelines for gonococcal infection.

The incidence of gonorrhea has increased significantly in recent years in the United States, especially among sexually active twenty-year-olds. Although the incidence of gonorrhea has decreased in Korea since the early 2000s, it is still common among people in their twenties. Nucleic acid amplification test (NAAT) is the most sensitive diagnostic test for detecting gonococcal infection. Gram-staining is a simple and useful laboratory test for diagnosing symptomatic male gonococcal urethritis. Although bacterial culture can be used to detect antimicrobial susceptibility, its sensitivity is lower than that of NAAT. Treatment for uncomplicated gonorrhea infection is a single intramuscular injection of ceftriaxone 500 mg. Doxycycline (100 mg twice daily for 7 days) is added if there is a possibility of co-infection with chlamydia. If ceftriaxone is difficult to use, spectinomycin 2 g can be injected intramuscularly in Korea. Patients with gonorrhea should have repeated examinations within three months at the exposure site because of a high risk of re-infection. A person diagnosed with gonorrhea should discuss the nature of the infection, the importance of informing partners, when sexual activity can resume, and how to reduce the risk of sexually transmitted infections.

Detection and Identification of Gonococci Resistance to Cephalosporin and Determination the Most Effective Empirical Treatment for Gonococcal Urethritis in Male Human in Egypt

Introduction: Gonorrhoeae and antimicrobial resistance AMR of gonococci is a major health problem today, because emerged resistance to last line empirical treatment for gonorrhoeae cephalosporins in many countries is predictable to be untreatable disease in near future. WHO GASP, WHO GLASS and WHO’s global action plan on AMR recommends to expand nationally and internationally to collect data to monitor AMR of gonococci for public health policies. Objective: Our aim is to detect resistance of gonococci to Cepha- losporins and determine the most effective empirical treatment for un-com- plicated gonococcal urethritis in males in Egypt. Methods: We depended in our methodology on selected gonococci from male urethral discharge specimens on Thyer Martien medium; collected 33 isolates during three years from 2017 to 2020; used antibiotics with MIC according to international standards and measuring IZD according to antimicrobial susceptibility testing reference ranges in international standards. Results: By statistical studies, resistance to cephalosporins was as follows: Cephradine 97%, Cefaclor 87.9%, Cefoxitin 97%, Ceftriaxone 90.9% and 42.4% to Cefepime, that shows hetero-genecity in resistance inside cephalosporin group; while resistance to Macrolides group represented by Azithromycin and Tetracyclins group represented by Doxycycline was as follows: Azithromycin 39.4%, Doxycycilne 27.3%; finally fluoroquinolones, the most effective group, resistance, was as: Levofloxacin 15.2%, Ciprofloxacin 15.2% and Ofloxacin 24.2%. Conclusion: The most effective empirical treatment for uncomplicated gonococcal urethritis in males in EGYPT is Fluoroquinolone; especially Levofloxacin ranks first susceptibility as 78.8% and 15.2% resistance followed by Ciprofloxacin susceptibility as 69.7% and 15.2% resistance, finally Ofloxacin susceptibility as 66.7% and 24.2% resistance; for Ceftriaxone not more recommended in EGYPT as empirical treatment for uncomplicated gonococcal urethritis, it is susceptibility as 6.1% and 90.9% resistance; in addition, we can use combination therapy of Fluoroquinolones with Azithromycin or Doxycycline, whose susceptibility is 30.3% for Azithromycin and 42.4% for Doxycycycline, while resistance is 39.4% for Azithromycin and 27.3% for Doxycycline. It is worth noting that only Cefepime in Cephalosporins group represents 42.4% susceptibility and 42.4% resistance; in addition to the Carbapenems group, it represents as 42.4% susceptibility for Imipenem and 45.5% resistance, then 42.2% susceptibility for Meropenem and 48.5% resistance, which can play role in combination therapy.

Remarkable increase of Neisseria gonorrhoeae with decreased susceptibility of azithromycin and increase in the failure of azithromycin therapy in male gonococcal urethritis in Sendai in 2015.

The antimicrobial resistance of Neisseria gonorrhoeae is a serious problem worldwide. In this study, we examined the susceptibility of N. gonorrhoeae isolated from male gonococcal urethritis in Sendai in 2014 and 2015. Furthermore, of all cases, we investigated the clinical efficacy of a single 2-g dose of extended-release azithromycin (AZM-SR) in the treatment of male gonococcal urethritis retrospectively. Sixty N. gonorrhoeae strains in 2014 and 54 strains in 2015 were isolated from male gonococcal urethritis and stored each year. The MIC of AZM was ≥1mg/L in 4 strains (6.7%) in 2014 and in 13 strains (24.1%) in 2015 and the number of strains having ≥1mg/L MIC increased significantly (P=0.016). Microbiological efficacy was evaluated in 32 and 29 of these patients, and the rates of treatment success were 93.8% and 79.3%, respectively. All of the treatment failures were caused by strains having a MIC of AZM of ≥0.5mg/L. In particular, the increase in the isolates having a MIC of AZM of ≥1mg/L was remarkable. Therefore, it was thought that the increase in these strains was the reason for the increase in treatment failures in 2015. Because no other drug is effective, it is currently necessary to use AZM-SR to treat gonococcal infections caused by ceftriaxone-resistant strains or patients allergic to ceftriaxone. To prevent a further increase in resistance to AZM, we should not use AZM-SR to treat normal cases of gonococcal infection.

Antimicrobial susceptibility and penicillin-binding protein 1 and 2 mutations in Neisseria gonorrhoeae isolated from male urethritis in Sapporo, Japan

The spread of antimicrobial-resistant Neisseria gonorrhoeae worldwide is a critical issue in the control of sexually transmitted infections. The purpose of this study was to clarify recent trends in the susceptibility of N. gonorrhoeae to various antimicrobial agents and to compare these data with our previous data. Minimum inhibitory concentrations (MICs) of various antimicrobial agents were determined in N. gonorrhoeae strains clinically isolated from male gonococcal urethritis. In addition, amino acid sequencing of penicillin-binding protein (PBP) 2, encoded by the penA gene, was analyzed so that genetic analysis of mosaic PBP 2 could clarify the susceptibility of the strains to cefixime and other cephalosporins. The susceptibility rate for ceftriaxone, cefodizime, and spectinomycin, agents whose use is recommended by the guideline of the Japanese Society of Sexually Transmitted Infections (JSSTI), was 100 %. The susceptibility rates of the strains to penicillin G and ciprofloxacin were lower than those in previous reports. Mosaic PBP 2 structures were detected in 51.9 % of the strains and the MICs of the strains with the mosaic PBP 2 to cefixime were much higher than those of the strains without the mosaic PBP 2. In the clinical situation, the treatment regimen recommended by the JSSTI remains appropriate; however, the susceptibility to cephalosporins should be intensively surveyed because strains with mosaic PBP 2 were commonly detected.

'Tissue paper sign': a highly specific marker of gonococcal urethritis in males

'Tissue paper sign': a highly specific marker of gonococcal urethritis in males

Clinical study of sitafloxacin in the treatment of male gonococcal urethritis

Clinical study of sitafloxacin in the treatment of male gonococcal urethritis

Lower dose of ciprofloxacin is adequate for the treatment of Neisseria gonorrhoeae in KwaZulu Natal, South Africa

The response of male gonococcal urethritis to a single 250 mg dose of ciprofloxacin versus 500 mg was studied. Both regimens were given in combination with doxycycline in the context of the local syndromic management protocol. There was no significant difference in response between the regimens, inclusive/exclusive of tetracycline susceptible isolates. One patient in the 250 mg arm failed to respond clinically but was microbiologically cured and four patients in the 500 mg arm failed microbiologically but responded clinically. All four isolates had ciprofloxacin MICs ≤0.007 mg/l.

High incidence of treatment failure of Neisseria gonorrhoeae isolates to ciprofloxacin in male gonococcal urethritis in Delhi.

Several treatment failures and widespread antimicrobial resistance to ciprofloxacin have been documented, subsequent to its initial recommendation in 1989 as a single dose alternative therapy for gonorrhoea. Still, it continues to be part of various treatment schedules in National STD control guidelines including India. This prompted us to study the current status of this drug in the treatment of gonorrhoea. Thirty-five male patients with gonococcal urethritis were included in the study. The susceptibility to penicillin, tetracycline, ciprofloxacin and ceftriaxone was determined by Kirby-Bauer disc diffusion method and minimum inhibitory concentration (MIC) of ciprofloxacin by agar plate dilution method. The clinical and bacteriological response was assessed on day 5 after treatment with single dose ciprofloxacin, 500 mg. The sensitivity pattern of Neisseria gonorrhoeae was observed to be: ceftriaxone 100%, azithromycin 100%, tetracycline 65.7%, penicillin 40% and ciprofloxacin 5.7% by disc diffusion method. The MIC for ciprofloxacin was below 0.06 microg/mL (sensitive) in one (2.5%) isolate only. On the fifth day a large number of treatment failures (88.5%) were seen with ciprofloxacin while none was noted one week after re-treatment with ceftriaxone. The location of endemic quinolone-resistant N. gonorrhoeae (QRNG) in New Delhi has increased alarmingly, resulting in an extremely high proportion of therapeutic failures, and thus requiring appropriate alterations in the presently recommended treatment regimens.

Increasing incidence of gonorrhea in Israel associated with countrywide dissemination of a ciprofloxacin-resistant strain.

The annual incidence of gonorrhea in Israel has sharply increased during the past 2 years. At the end of 1999, high-level ciprofloxacin-resistant strains of Neisseria gonorrhoeae (MIC90, > or =32 mcg/ml) also exhibiting decreased susceptibility to penicillin and tetracycline were isolated for the first time in southern Israel, as well as in other regions of the country. The incidence of male gonococcal urethritis in the south increased in a 1.5-year period from 3/100,000 to 12/100,000 ( P<0.05) in correlation with increased isolation of ciprofloxacin-resistant organisms. A marked increase in the incidence of gonorrhea was also encountered in Jerusalem, where ciprofloxacin resistance affected 54.5% of the isolates in 2000. Pulsed-field gel electrophoresis typing of gonococci from different areas of Israel indicated that all of the ciprofloxacin-resistant isolates belonged to identical or related strains. Since fluoroquinolone-resistant gonococci may emerge and disseminate extensively over a short period of time, continuous surveillance of antibiotic susceptibility among gonococcal isolates should be performed to guide empiric therapy.

Antimicrobial susceptibility and types of Neisseria gonorrhoeae in Greece. Data for the period 1990 to 1993.

Surveillance of the rapidly changing patterns of antimicrobial resistance of Neisseria gonorrhoeae is imperative for monitoring gonococcal infection. To describe the types and the antimicrobial susceptibility profile of a representative samples of gonococci isolated in Greece between 1990 and 1993. The antimicrobial susceptibilities, serovar/auxotypes classes, and plasmid contents of 263 consecutive isolates of N. gonorrhoeae, recovered from cases of male gonococcal urethritis, were determined. Penicillinase-producing N. gonorrhoeae (PPNG) were isolated at a rate of 6.1% and were mostly from imported cases of infection. Six (2.3%) of the isolates (one PPNG and five non-PPNG) were highly resistant to tetracycline, and one PPNG strain was resistant to norfloxacin and ciprofloxacin. Strains with chromosomal resistance to penicillin, tetracycline, erythromycin, and chloramphenicol accounted for 18.5%, 12.5%, 19%, and 16% of the isolates, respectively; much higher proportions of strains were intermediately susceptible to these antibiotics. Spectinomycin and cefotaxime were active against all gonococci studied. A shift to IB serovars and to sporadic types of strains was noted from previous years among the non-PPNG isolates. This is compatible with the marked increase in the rate of imported cases of infection caused by n on-PPNG strains. The emergence of high-level resistance to tetracycline and resistance to fluoroquinolones was ascertained. At the present, however, the main problem with gonococcal resistance in Greece seems to ensue from the increasing rates of chromosomally resistant strains. Moreover, the increasing frequency of imported gonococci underlines the necessity for continuous epidemiologic surveillance.

Clinical study on NM441 in male gonococcal urethritis

Clinical study on NM441 in male gonococcal urethritis

Application of urine sediment for diagnosis of gonococcal urethritis by enzyme immunoassay

We evaluated the usefulness of urine sediment from male gonorrhea patients for detecting gonococcal antigens by enzyme immunoassay, Gonozyme (Abbott Laboratories). Experiments for dilution rate of urine sediment with buffer provided in a kit indicated that dilution of sediment at 1:4-6 would be practical in performing Gonozyme. All urine sediment specimens from 18 gonorrhea patients showed positive by Gonozyme, and 68, except for 3, culture-negative control urine sediments, including 8 sediments from patients with chlamydial urethlitis, were negative. Based on comparing results of Gonozyme with those of culture, sensitivities and specificity were 88.9-100% and 95.6%, respectively. During storage of urine sediment at 5 degrees C for 7 days, absorbance values were stable. Therefore, urine sediment could be preserved or transported. We conclude that urine sediment is useful for diagnosis of gonococcal urethritis in males by Gonozyme.

Antimicrobial evaluation and clinical effects of S-1108 in male gonococcal urethritis

Antimicrobial evaluation and clinical effects of S-1108 in male gonococcal urethritis

Orally administered cefpodoxime proxetil for treatment of uncomplicated gonococcal urethritis in males: a dose-response study

An open-label, dose-response study of cefpodoxime proxetil (CPD), an expanded-spectrum cephalosporin, was conducted with 58 males with uncomplicated Neisseria gonorrhoeae infections with single doses of 600, 400, 200, 100, or 50 mg of CPD administered orally by tablet. CPD eradicated N. gonorrhoeae in all 50 evaluable patients (10 per group) at all doses studied. Eight of the isolates eradicated were beta-lactamase-producing organisms. Two patients reported three side effects, nausea, vomiting, and diarrhea, which were mild and resolved without intervention or sequelae. There were no clinically remarkable drug-related changes in vital signs or clinical laboratory assays. Results show that single oral doses of CPD are an effective and well-tolerated treatment for uncomplicated N. gonorrhoeae infection in males at doses as low as 50 mg.

Thiamphenicol in the Treatment of Male Gonococcal Urethritis

Thiamphenicol, an aminic derivative of hydrocarbilsulfonylpropandiol, was used for the treatment of acute, uncomplicated, gonococcal urethritis in 1,446 male patients. Each patient received one oral dose of 2.5 g of thiamphenicol, which was readministered after 48-72 hr if Neisseria gonorrhoeae continued to be present in urethral smears. Of the 1,446 patients treated, 1,230 patients underwent posttreatment evaluation at 48-72 hrs and at seven days. Twenty-eight patients (2.3%) did not respond to treatment; treatment was successful in 1,140 patients (92.7%) after only one dose, and in 62 (5.0%) after two doses. The overall rate of treatment success was 97.7%. Of 352 patients evaluated one month after treatment, serologic tests in 41 (12.6%) were positive for syphilis.

Clinical studies on DL-8280 in male gonococcal urethritis

Clinical studies on DL-8280 in male gonococcal urethritis

Treatment of gonococcal urethritis in males with a single dose of cefotaxime [proceedings

Journal Article Treatment of gonococcal urethritis in males with a single dose of cefotaxime Get access S. Hard, S. Hard St George's Hospital and National Bacteriological LaboratoryStockholm, Sweden Search for other works by this author on: Oxford Academic PubMed Google Scholar I. Moberg, I. Moberg St George's Hospital and National Bacteriological LaboratoryStockholm, Sweden Search for other works by this author on: Oxford Academic PubMed Google Scholar K. Wennberg K. Wennberg St George's Hospital and National Bacteriological LaboratoryStockholm, Sweden Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Antimicrobial Chemotherapy, Volume 6, Issue suppl_A, 1980, Page 289, https://doi.org/10.1093/jac/6.suppl_A.289 Published: 01 January 1980

Gentamicin in Gonococcal Urethritis of Filipino Males: Dosage and Response

Smears and cultures of urethral discharge, oxidase reactions, sugar fermentation, disk-susceptibility tests on gonococci, and gentamicin levels in serum were deter- mined in a study of the efficacy and safety of gentamicin in the treatment of gonococcal urethritis in males. Successively higher doses of gentamicin were in- jected intramuscularly into Filipino male patients in whom a diagnosis of un- complicated gonococcal urethritis was established. A total of 180 patients were treated; 160 of them were followed. A single intramuscular dose of 280 mg gave the most satisfactory results, with a dose range of 4.2-7.0 mg/kg per day (mean, 5.4). No immediate allergic reactions were noted, but two patients developed a delayed mild rash. No symptoms of ototoxicity were reported. No gonococcal strains resistant to gentamicin were encountered. Peak serum levels were found 30-60 min after injection. Only traces of the antibiotic were found 12 hr after injection. Gentamicin was found to be efficacious and safe for use in the treatment of uncomplicated gonococcal urethritis in Filipino males when given in a single intramuscular dose of 280 mg.

Gonococcal Urethritis In Vietnam

To the Editor:— The article on gonococcal urethritis in males in Vietnam ( 207 :946, 1969) could not be considered applicable to gonorrhea in the United States, for sociological and epidemiological reasons. The number of patients infected with relatively penicillin-resistant gonorrhea was not determined. There was a two-week period between the initial diagnosis and onset of and the retesting for infection. In the patients receiving medication orally, as with tetracycline, there was no confirmation that the patients took the medication as prescribed. The patients who were laboratory positive after the two-week period were labeled treatment failures. It would appear possible that most of these were actually cases of reinfection.

Gonococcal urethritis in males in Vietnam: three penicillin regimens and one tetracycline regimen

Gonococcal urethritis in males in Vietnam: three penicillin regimens and one tetracycline regimen