Uncomplicated Gonorrhea In Women Research Articles

Grepafloxacin versus cefixime as single-dose therapy for uncomplicated gonorrhea in women

Grepafloxacin versus cefixime as single-dose therapy for uncomplicated gonorrhea in women

Grepafloxacin Versus Cefixime as Single‐Dose Therapy for Uncomplicated Gonorrhea in Women

Objective: To compare the efficacy and tolerance of single-dose grepafloxacin with cefixime for treatment of uncomplicated gonorrhea in women. Methods: Women attending nine sexually-transmitted-disease clinics in the United States who had suspected uncomplicated gonorrhea were enrolled in an open study. Participants were randomized to receive single oral doses of grepafloxacin (400 mg) or cefixime (400 mg), and efficacy was evaluated in those who returned for follow-up assessment 5 to 10 days later. The primary measure of efficacy was microbiological response to therapy as determined by pre- and posttreatment culture results for Neisseria gonorrhoeae. Results: Of 380 patients enrolled, 124 in the grepafloxacin group and 131 in the cefixime group were evaluated for microbiological response. Cervical gonococcal infections were eradicated in 99% of patients in both treatment groups, with only one persistent infection in each group. All pharyngeal (n = 15) and rectal (n = 32) gonococcal infections treated with grepafloxacin were cured, whereas 5 of 16 (31%) pharyngeal and 1 of 38 (3%) rectal infections failed to respond to cefixime. Although a third (123 of 386) of N. gonorrhoeae pretreatment isolates were resistant to penicillin or tetracycline, this had no impact on cure rates. Both drugs were well tolerated, with vaginitis being the most common treatment-related adverse event in each group. Conclusions: This study shows that single-dose grepafloxacin is at least as effective as cefixime for treating women with uncomplicated cervical gonorrhea. Grepafloxacin also appears to be highly effective against extragenital infections.

Treatment of Uncomplicated Gonorrhea in Women with Single-dose Cefonicid

The efficacy of cefonicid (1.0 g given in a single intramuscular dose) was assessed in 50 women with uncomplicated infections due to beta-lactamase-negative strains of Neisseria gonorrhoeae. Forty-three (96%) of 45 cervical infections but only 23 (82%) of 28 anorectal infections were eradicated; overall, 44 (90%) of 49 women were cured of anogenital gonorrhea. Cefonicid failed to eradicate six (55%) of 11 pharyngeal gonococcal infections and 17 (85%) of 20 endocervical infections with Chlamydia trachomatis. Cefonicid had good activity against N. gonorrhoeae in vitro; 41 (98%) of 42 isolates were inhibited by less than or equal to 1.0 micrograms/ml. However, because of its poor efficacy against anorectal and pharyngeal gonococcal infections, single-dose cefonicid is not suitable for the treatment of gonorrhea in women or homosexually active men.

Halting the Spread of Uncomplicated Gonorrhoea in Women

Halting the Spread of Uncomplicated Gonorrhoea in Women

Treatment of uncomplicated gonorrhoea in women with a combination of rifampicin and erythromycin.

One hundred women with uncomplicated gonorrhoea (in five cases due to penicillinase producing strains of Neisseria gonorrhoeae (PPNG)) were treated with a single oral dose of rifampicin 900 mg and erythromycin stearate 1 g. N gonorrhoeae was reisolated from the oropharynx of one patient, who was infected with a PPNG strain, but was eradicated from the genital tract in 100% of cases. The combination eradicated Chlamydia trachomatis from only 10 (28%) of the 36 patients infected. Side effects were predominantly mild and consisted of transient nausea. The treatment merits evaluation in areas with a high incidence of PPNG strains.

1200 mg Rifampicin (Rimactan<sup>®</sup>) als Einzeldosisbehandlung der unkomplizierten Gonorrhoe der Frau

40 women were treated for uncomplicated genital gonorrhoea, verified by culture, with a single oral dose of 1,200 mg rifampicin (Rimactan). The ages ranged between 15 and 51 years. In 33 patients that could be evaluated, the gonorrhoea was cured. In 8 of 18 patients the preexistent vaginal discharge improved. 4 women experienced six different side effects which were probably related to rifampicin. The 1,200-mg rifampicin oral one-dose treatment is a reliable, efficient, and well-tolerated therapy of uncomplicated gonorrhoea in women.

Treatment of uncomplicated gonorrhoea in women with talampicillin in a single oral 1.5 g dose.

Four hundred and sixty women with uncomplicated gonorrhea were treated with a single oral dose of 1.5 g talampicillin. The success rate among those who attended for at least one follow-up examination after treatment was 99.14%. The antibiotic was well tolerated and no side effects were reported. Talampicillin given under supervision has proved to be the most effective and safest treatment in this area. A smaller dosage of talampicillin than ampicillin is required, the drug is better tolerated by the patient, and the time of nursing staff is saved.

Management of gonococcal pelvic inflammatory disease.

Information that has become available since 1974 on the management of pelvic infections unrelated to abortions, the puerperium, or pelvic surgery, with an emphasis on those associated with Neisseria gonorrhoeae are summaried. Attention is directed to both diagnosis (clinical, bacteriologic) and therapy (hospitalized patients, outpatients, indications for hospitalization, and IUDs). Most investigators classify acute pelvic inflammatory disease (PID) as gonococcal or nongonococcal on the basis of the presence or absence of N. gonorrhoeae in cervical specimens. As compared with patients who have nongonococcal pelvic inflammatory disease, patients who have gonococcal disease are often younger, more likely to have elevated temperatures, and more often experience pain in the first 10 days of the menstrual cycle. It is not possible to differentiate gonogoccal from nongonococcal pelvic inflammatory disease without the aid of laboratory tests. N. gonorrhoeae can be isolated from the cervix in 20-80% of acute PID. Much of the variation can be explained by differences in the prevalences of gonorrhea in different populations. In populations with high prevalence of gonorrhea, most cases of acute PID are associated with gonorrheal infection. Where gonorrhea is less common, N. gonorrhoeae is isolated from the cervix in fewer than half of cases of acute PID. Neisseria gonorrhoeae can be demonstrated in the fallopian tube or peritoneal cavity of 8-70% of patients with PID whose cervical cultures yield N. gonorrhoeae. When N. gonorrhoeae is isolated from the lower genital tract of a patient who has acute pelvic inflammatory disease, causal significance is appropriately ascribed to that organism. The use of gram staining of cervical specimens to diagnose uncomplicated gonorrhea in women has been discouraged due to low sensitivity and specificity compared with cultures on selective medium. Comparative evaluation of studies of therapy of acute pelvic inflammatory disease is hampered by differences in criteria for diagnosis of cases, in indications for hospitalization and surgical treatment, in durations of therapy and follow-up, and in criteria for cure. The information available is insufficient to justify recommending a change in the 1974 schedules for therapy of hospitalized patients. Results of 2 studies of treatment of outpatients with PID are summarized in a table. Cunningham et al. reported satisfactory bacteriologic and clinical cure rates for gonococcal PID after use of the currently recommended treatment schedules. McCormack et al. obtained satisfactory results with a 5-day course of spectinomycin HCI administered to a small number of patients. Sweet recommended that hospitalization be considered for all patients with acute PID, as is the practice of many facilities in Sweden. It is now clearly documented that users of IUDs have a 3-9 fold greater risk of developing PID as compared with nonusers. All patients treated for acute PID should be followed closely to monitor their responses to therapy. Controlled therapeutic trials of acute PID should ensure similarity of case definition and identification of "cure."

Evaluation of a Serologic Test for Gonorrhea in a Low-Risk Female Population

This is a report of an evaluation of a new serologic test for gonorrhea--the Gonosticon Dri-Dot Test--as compared to the standard Thayer-Martin culturing technics in a low-risk female population. The Gonosticon Dri-Dot Test detected only 50% of the gonorrhea cases discovered by the conventional culture method. Furthermore, the serologic technic accounted for 17% false-positives, indicating that a reactive Gonosticon test is not necessarily consistent with active gonococcal infection. The efficacy of the Thayer-Martin culture plate diagnostic procedure for uncomplicated gonorrhea in women was reaffirmed by this study.

Treatment of Uncomplicated Gonorrhea in Women with a Single Oral Dose of Amoxicillin

Amoxicillin was used to treat acute uncomplicated gonorrhea; 89 women were given a single oral dose of either 3.0 g of amoxicillin or 2.0 g of amoxicillin plus 0.5 g of probenecid. The cervix, pharynx, and rectum of each patient were cultured, and the patients were asked to return for follow-up visits after three to five and seven to 10 days, when all three sites were again cultured. There was at least one follow-up examination on 82 of the 89 patients. The failure rate in patients denying reexposure to gonorrhea were 4.6% in those treated with the 3-g regimen and 10.5% in those receiving the 2-g regimen with probenecid. There were also three patients in each treatment group in whom the reisolations of gonococci at follow-up were felt to be due to reexposure to gonorrhea. Although 40% initially had positive rectal cultures, there were no failures at the rectal site. In contrast, two of four patients with pharyngeal gonorrhea were failures. It is concluded that the two single-dose oral regimens of amoxicillin are adequate therapy for uncomplicated genital and rectal gonorrhea in women but may not be adequate for pharyngeal gonorrhea. Amoxicillin has an antibacterial spectrum comparable to that of ampicillin [1]. The superior oral absorption of amoxicillin [2, 3] might allow oral treatment regimens for uncomplicated gonorrhea at least as effective as established single-dose oral ampicillin regimens. Possibly, the inconvenience and minor side effects of high-dose oral ampicillin regimens might be ameliorated by using lower doses of amoxicillin to achieve comparable serum levels of antibiotic. We decided to test the efficacy

Gonorrhea in women: treatment with sulfamethoxazole and trimethoprim.

After publication of a study describing the successful oral treatment of men suffering from uncomplicated gonorrhea with sulf amethoxazole-trimethoprim, this combination of drugs was used to treat women suffering from gonococcal urethritis and cervicitis. In every case, the diagnosis was confirmed by culture of Neisseria gonorrhoeae. Sulfamethoxazole-trimethoprim was given in the form of Bactrim (Roche) ; two tablets (each one containing 400 mg of sulf amethoxazole and 80 mg of trimethoprim) were taken night and morning for five days. One hundred and sixteen infections in 115 women were treated. Only two therapeutic failures were observed, and another two women were reinfected within a month of treatment, one on two occasions. Skin reactions to treatment were mild and infrequent. Hematologic investigation did not reveal any evidence of blood dyscrasias. This oral preparation can be recommended for the treatment of uncomplicated gonorrhea in women who can be relied upon to take it as directed.