Treatment Of Gonococcal Urethritis Research Articles

Brazilian Clinical Practice Guidelines for Sexually Transmitted Infections That Cause Urethral Discharge: Assessment According to the AGREE II and Critical Analysis Based on the WHO Recommendations.

Sexually transmitted infections (STI) can have severe consequences. In Brazil, case management is recommended by the Clinical Protocol and Therapeutical Guidelines for Comprehensive Care for People with STIs (PCDT-IST). This study assessed the quality of PCDT-IST (2021) and reviewed the main recommendations for the management of STI that cause urethral discharge compared with the World Health Organization (WHO) STI Guidelines. The PCDT-IST (2021) quality was independently assessed by 4 appraisers using the Appraisal of Guidelines Research and Evaluation instrument, version II (AGREE II). The PCDT-IST (2021) and the WHO Guidelines for the Management of Symptomatic STI (2021) were compared considering 14 different assessment domains. The PCDT-IST (2021) scores in the AGREE II domains were: Rigor of Development (58%), Applicability (35%), Editorial Independence (38%), Scope and Purpose (78%), Stakeholder Involvement (74%), and Clarity and Presentation (82%). The overall score was 67%, and all appraisers recommended the Brazilian guideline. Regarding the PCDT-IST (2021) and the WHO STI Guidelines (2021) comparation, 10 domains would be relevant for further reviewing the Brazilian recommendations: Diagnostic tests; Etiological approach; Treatment for recurrent urethral discharge; Treatment for urethritis without etiological agent identification; Treatment for gonococcal urethritis; Treatment for chlamydial urethritis; Retreatment for gonococcal infections; Treatment for Mycoplasma genitalium urethritis; Treatment for Trichomonas vaginalis urethritis; 10. Flowcharts. The PCDT-IST (2021) has a reasonable degree of quality. However, the domains of Applicability, Rigor of Development, and Editorial Independence must be better ensured. The guidelines comparison will help to select key topics that should be addressed with priority in the following national STI guidelines updates.

Multiple doses of cefodizime are necessary for the treatment of Neisseria gonorrhoeae pharyngeal infection

A single dose of cefodizime (CDZM), ceftriaxone (CTRX), or spectinomycin (SPCM) is recommended for the treatment of gonococcal urethritis or uterine cervicitis in the era of multidrug-resistant Neisseria gonorrhoeae; namely, cefozopran-resistant N. gonorrhoeae (CZRNG). N. gonorrhoeae pharyngeal infection is not so rare in Japan; however, the proper treatment regimen for this infection is not clear. We previously found that a single dose of CDZM completely eradicated multidrug-resistant N. gonorrhoeae in patients with urethritis and uterine cervicitis, so we tried a single 1.0-g dose of CDZM for the treatment of N. gonorrhoeae pharyngeal infection, including infections with CZRNG. The eradication rate of N. gonorrhoeae from the pharynx was 63.0% with a single 1.0-g dose of CDZM, while the rate for CZRNG with the same dose of CDZM was 38.5%. N. gonorrhoeae was completely eradicated from the pharynx when patients received one or two additional doses of CDZM. Therefore, we concluded that two to three doses of CDZM were necessary for the treatment of N. gonorrhoeae pharyngeal infection including infection with CZRNG.

Susceptibilities of Neisseria gonorrhoeae and Ureaplasma urealyticum Isolates from Male Patients with Urethritis to Several Antibiotics Including Telithromycin

Background: The minimal inhibitory concentrations (MICs) of erythromycin, azithromycin, clarithromycin, telithromycin, tetracycline, doxycycline, ciprofloxacin, ofloxacin, norfloxacin, levofloxacin, gemifloxacin and moxifloxacin against 78 Neisseria gonorrhoeae and 31 Ureaplasma urealyticum strains, which were isolated from patients with urethritis in Istanbul, were determined and compared. Additionally, the activities of penicillin and ceftriaxone against N. gonorrhoeae strains were explored. Methods: MICs were determined by agar and broth dilution methods for N. gonorrhoeae and U. urealyticum, respectively. Results: The susceptibility rates for penicillin and tetracycline in N. gonorrhoeae strains were 35.9 and 24.3%, respectively. All gonococcal strains were susceptible to ceftriaxone, with very low MICs (MIC₉₀ 0.008 µg/ml). Telithromycin was highly active against N. gonorrhoeae and U. urealyticum strains (MIC₉₀ 0.25 µg/ml for both). Ciprofloxacin was the most active quinolone against N. gonorrhoeae (MIC₉₀ 0.008 µg/ml) while quinolone resistance was detected in a single strain (1.3%). Conclusions: Tetracycline and penicillin should not be the option in empirical treatment of N. gonorrhoeae infections due to the very low susceptibility rates. Ceftriaxone continues to be the first choice antibiotic in the treatment of gonococcal urethritis.

Correlation between in vitro quinolone susceptibility of Neisseria gonorrhoeae and outcome of treatment of gonococcal urethritis with single-dose ofloxacin.

Correlation between in vitro quinolone susceptibility of Neisseria gonorrhoeae and outcome of treatment of gonococcal urethritis with single-dose ofloxacin.

Reduced clinical efficacy of pazufloxacin against gonorrhea due to high prevalence of quinolone-resistant isolates with the GyrA mutation. The Pazufloxacin STD Group.

Forty-two men with gonococcal urethritis were treated with an oral dosage of 200 mg of pazufloxacin, a new fluoroquinolone, three times daily for 3 days. Only 28 of the 42 men (66.7%) had negative culture results for Neisseria gonorrhoeae during follow-up. Of the 42 isolates, 41 could be recultured for antibiotic susceptibility testing and DNA sequencing. In 26 of the 41 isolates (63.4%), GyrA mutations with or without ParC mutations were identified. Among the 26 isolates, 23 contained a single GyrA mutation, 1 contained two GyrA mutations, and 2 contained three mutations including double GyrA and single ParC mutations. A single Ser-91-to-Phe mutation, which was detected in 14 of the 26 isolates, was the most common GyrA mutation, followed by an Ala-75 to Ser mutation and an Asp-95 to Asn or Gly mutation in GyrA. All three isolates with two or three mutations contained the Ser-91-to-Phe GyrA mutation. Eleven of the 14 isolates with the single Ser-91-to-Phe mutation within GyrA and all 3 isolates with two or three mutations persisted after pazufloxacin treatment. On the other hand, all 15 wild-type and 9 mutant isolates with a substitution at codon Ala-75 or Asp-95 were eradicated. The mean MIC of pazufloxacin for mutants with the single Ser-91-to-Phe mutation in GyrA was 66-fold higher than that for the wild type. The results obtained in this study suggest that a high prevalence of fluoroquinolone-resistant gonococcal isolates with the Ser-91-to-Phe mutation in GyrA reduced the efficacy of pazufloxacin as treatment for gonococcal urethritis.

Effectiveness of norfloxacin and ofloxacin for treatment of gonorrhoea and decrease of in vitro susceptibility to quinolones over time in Rwanda.

To study the effectiveness of single-dose norfloxacin and ofloxacin in the treatment of gonococcal urethritis in men, and to monitor in vitro antimicrobial susceptibility to these antibiotics over time. Centre Médico-Social de Bilyogo, Kigali, Rwanda. The only clinic in Rwanda using quinolones for the treatment of gonorrhoea. As part of a monitoring programme, men with gonococcal urethritis were evaluated after treatment with norfloxacin (800 mg) in 1986 and 1987, and after treatment with ofloxacin (400 mg) in 1989. Neisseria gonorrhoeae was eradicated from the urethra from 96.0% (189/197) and from 97.1% (166/171) men treated with norfloxacin and ofloxacin, respectively. Overall 38.2% of the pretreatment isolates produced penicillinase (PPNG isolates) and 20.4% (44/216) of the tested non-PPNG isolates were chromosomally resistant to penicillin (MIC > or = 2.0 mg/l). Resistance to tetracycline and thiamphenicol was common in both PPNG and non-PPNG and increased considerably in 1989. All isolates were susceptible to kanamycin, spectinomycin, ceftiaxone, norfloxacin, ofloxacin and ciprofloxacin. However, a higher number of isolates recovered in 1989 showed decreased susceptibility to the quinolones. Treatment failure occurred more often in subjects with isolates having MIC values > or = 0.06 mg/L of norfloxacin (p = 0.006). Seven out of 13 patients who did not respond to therapy had no signs nor symptoms of urethritis. Quinolone antibiotics are now indicated as a first line treatment of gonorrhoea in countries with a problem of antimicrobial multiresistance. However, antimicrobial susceptibility to the quinolones may decrease rapidly, and close monitoring of the in vitro susceptibility of N gonorrhoeae and the clinical effectiveness of the antibiotics is imperative.

DEPARTMENT OF CORRECTIONS

In the article by Parrott in the January 1989 issue of Pediatrics in Review, "Cystitis and Urethritis," Table 3 on page 222 outlined the 1982 MMWR guidelines for treatment of gonococcal urethritis. New guidelines were issued in 1985. Readers should check the revised schedules for details. Major changes include: (1) oral tetracycline alone is no longer acceptable therapy, (2) ceftriaxone (adult dose of 250 mg, IM) is one of the new acceptable regimens, and (3) the increasing incidence of penicillinase-producing Neisseria gonorrhoeae warrants community monitoring.

Ofloxacin, a New Quinolone for the Treatment of Gonorrhea

Forty-three patients with uncomplicated gonorrhea were treated with 400 mg of ofloxacin. All had cultures negative for Neisseria gonorrhoeae at follow-up within two weeks of treatment. Minimal side effects were reported. Ofloxacin appears to be satisfactory as a single-dose oral drug for the treatment of gonococcal urethritis, including those cases caused by penicillinase-producing strains of N. gonorrhoeae.

Current experience with thiamphenicol in uncomplicated gonococcal urethritis.

Use of thiamphenicol for the treatment of uncomplicated gonococcal urethritis was evaluated in 96 cases occurring between 1971 and 1975 and in 60 cases occurring between 1982 and 1983. Results in both groups of patients were nearly identical. Evidence indicates that gonococcal strains have not developed resistance to thiamphenicol during the ten years of its use. Thiamphenicol is still a highly effective agent for the treatment of gonococcal urethritis.

Treatment of gonococcal urethritis in men with a rifampicin-erythromycin combination.

A group of men with uncomplicated gonococcal urethritis were treated with a single oral dose of rifampicin (900 mg) and erythromycin stearate (1 g). Neisseria gonorrhoeae was isolated from four of 108 men at the first follow-up examination, and from none of 68 who attended a second follow-up examination. It is concluded that this rifampicin-erythromycin combination may be useful for the therapy of gonorrhea. It may be of particular value in the treatment of infections due to penicillin-resistant N. gonorrhoeae, since in vitro studies showed that both rifampicin and erythromycin were active against 20 strains of beta-lactamase-producing N. gonorrhoeae. The effect of this rifampicin-erythromycin combination against associated infections with Chlamydia trachomatis was disappointing. This organism was isolated from five of nine patients who had yielded isolates of C. trachomatis before treatment.

Comparison of piperacillin and penicillin in the treatment of uncomplicated gonorrhea

A total of 120 men with uncomplicated infections caused by beta-lactamase-negative, highly penicillin-susceptible strains of Neisseria gonorrhoeae were included in this study. They were randomly assigned to regimens of either piperacillin (2.0 g) or procaine penicillin G (4.8 X 10(6) U) intramuscularly, both delivered concomitantly with an oral dose of 1.0 g probenecid. A total of 103 patients completed the study, providing data from 112 infected sites: for the penicillin regimen--urethra, 46; pharynx, 5; and rectum, 4; for the piperacillin regimen--urethra, 53; pharynx, 3; and rectum, 1. In the penicillin group, there were no failures at any of the infected sites. In the piperacillin group, all except one pharyngeal infection were cured. Also, in the piperacillin group, four men visit, whereas no cases of this type occurred in the penicillin group. No major side effects were noted in either group. Clinically, piperacillin was as effective as procaine penicillin G in the treatment of gonococcal urethritis in men. Pharyngeal infection may be refractory to piperacillin therapy.

Rosaramicin Treatment of Gonococcal Urethritis in Men

The efficacies of two dosage regimens (2.0 g and 1.5 g each day for four days) of rosaramicin were compared in 40 men with acute uncomplicated gonococcal urethritis. After treatment 39 (97%) of 40 patients were asymptomatic and had negative cultures. Gastrointestinal side effects were reported for 12 (28%) of 43 patients; however, only two patients (5%) discontinued therapy because of side effects.

The treatment of gonococcal urethritis with cefotaxime

The treatment of gonococcal urethritis with cefotaxime

Single-dose minocycline in the treatment of gonococcal urethritis. Clinical efficacy in relation to bacterial resistance and its effects on associated Chlamydia trachomatis infections.

Seventy-two men with gonococcal urethritis were given a single 300-mg dose of minocycline. The failure rate was 13% and the trial was terminated at an early stage. Failure was correlated with increased resistance of Neisseria gonorrhoeae to minocycline. The activity of penicillin, spectinomycin, erythromycin, tetracycline, sulphamethoxazole, cefuroxime, cefotaxime, rosamicin, thiamphenicol, and piperacillin against N. gonorrhoeae were examined in vitro. With the exception of spectinomycin, parallel patterns of resistance to the other antibiotics and minocycline were found. Resistance to spectinomycin was not found, confirming the usefulness of this antibiotic in the treatment of gonorrhoea. The incidence of PGU was significantly lower after a single dose of minocycline than in previous studies.

Gonococcal Urethritis-Diagnosis and Treatment

For men with urethral discharge, a simple gram stained smear is 98% sensitive and over 99% specific in detecting gonococcal infection when compared to a single Thayer-Martin culture. The smear is less than 50% sensitive in asymptomatic urethritis. Neither Fluorescent antibody nor various serologic tests offer any diagnostic advantages over smears and/or cultures and they are not cost-effective. Treatment of gonococcal urethritis may be successfully accomplished with a variety of antibiotic regimens. Tetracycline hydrochloride (500 mg four times a day for 5 days) is highly effective, inexpensive, and is active against Chlamydia trachomatis; post gonococcal urethritis (PGU) is therefore uncommon. Aqueous Procaine Penicillin G (4.8 million units IM with 1 g of probenecid) has become the standard in the United States but suffers from higher cost, the need for refrigeration, occasional alarming toxic procaine reactions, and a high incidence of PGU. Spectinomycin 2 g IM remains expensive but is the regimen of choice for treatment failures and for Neisseria gonorrhoeae that produce penicillinase (PPNG). Other antibiotics active against PPNG are cotrimoxozole, cefoxitin, and cefuroxime. PNNG have now been reported from 27 countries throughout the world, but have attained significant prevalence in only a few areas of East Asia and West Africa. Because gonococcal patterns of antibiotic resistance are constantly changing, each region of the world needs to monitor treatment results and maintain some surveillance over sensitivity to antibiotics.

Immunofluorescence in the Diagnosis of Gonorrhoea

SUMMARY: A direct immunofluorescent (IF) staining method was used to demonstrate Neisseria gonorrhoeae in smears of patients' secretions. This method, Gram stained smears and cultures were used to investigate soldiers presenting with urethritis and 106 out of 184 men were diagnosed by one or more methods ,as suffering from gonorrhoea. Results of IF tests alone were positive in 2 cases but they were negative in 3 cases who had positive results by Gram stained smears and cultures. It is concluded that in men direct IF stained smears are less valuable in the diagnosis of gonorrhoea than in women. The IF technique ,was also used to investigate prostatic secretion three months after treatment for gonococcal urethritis. Immunofluorescent tests were helpful in the investigation of female contacts of servicemen who had recently had gonorrhoea. Five out of 14 such women had positive results by IF stained smears alone. There were no difficulties in starting the technique in Singapore and it is considered that it was as satisfactory there as it had been in London.

Gentamicin in the treatment of gonococcal urethritis. A microbiological, pharmacological, and clinical study.

Gentamicin in the treatment of gonococcal urethritis. A microbiological, pharmacological, and clinical study.

Treatment of gonococcal urethritis with a single dose of doxycycline monohydrate.

Treatment of gonococcal urethritis with a single dose of doxycycline monohydrate.

Spectinomycin and Penicillin G in the Treatment of Gonorrhea

Patients with uncomplicated gonorrhea received either 2.0 gm or 4.0 gm of spectinomycin hydrochloride or currently recommended doses of penicillin G procaine. Of 172 men reexamined within seven days after treatment of gonococcal urethritis, treatment failure rates were 17% for 2.4 mega units of penicillin G procaine, 0% for 2 gm of spectinomycin hydrochloride, and 3.4% for 4 gm of spectinomycin hydrochloride. Of 143 women, failure rates were 13% for 4.8 mega units of procaine penicillin G, 4.3% for 2 gm of spectinomycin hydrochloride, and 4.7% for 4 gm of spectinomycin hydrochloride. Pretreatment isolates of Neisseria gonorrhoeae from patients not cured with penicillin G procaine showed increased resistance to penicillin G ( P Neisseria gonorrhoeae shows significant positive correlation of resistance to penicillin G and spectinomycin ( P N gonorrhoeae from spectinomycin treatment failures showed increased resistance to spectinomycin.

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.