Uncomplicated Gonorrhea Research Articles

The emergence of Neisseria gonorrhoeae with decreased susceptibility to ciprofloxacin in Cleveland, Ohio: epidemiology and risk factors.

Until 1992, almost all strains of Neisseria gonorrhoeae that had been tested in the United States were susceptible to fluoroquinolones, including ciprofloxacin. However, among men with urethral gonococcal infections who attended one sexually transmitted disease clinic in Cleveland, Ohio, the prevalence of gonococci with decreased susceptibility to ciprofloxacin increased from 2% in 1991 to 16% in 1994. To describe the emergence of and risk factors for gonococcal urethritis caused by gonococci with decreased susceptibility to ciprofloxacin. Resistance to ciprofloxacin was considered to be decreased if the mean inhibitory concentration was at least 0.12 microgram/mL, and was less than or equal to 0.25 microgram/mL; this definition did not equate with the definition of clinical resistance. Case-control study. An urban sexually transmitted disease clinic. 51 case-patients and 106 controls. Pulsed-field gel electrophoresis was used to identify individual genotypes of ciprofloxacin-resistant and ciprofloxacin-susceptible isolates. 55 of the 746 isolates of N. gonorrhoeae that were tested (7.4%) had decreased susceptibility to ciprofloxacin, and the prevalence of N. gonorrhoeae with decreased susceptibility significantly increased during the study period. Case-patients were significantly less likely to have gram-negative diplococci seen on microscopic examination of urethral discharge (P < or = 0.01) and were less likely to be treated for gonococcal urethritis than were controls (P < or = 0.001). Molecular typing suggested the spread of a single genotype of N. gonorrhoeae. Strains of gonococci with decreased susceptibility to ciprofloxacin appear to have become endemic in Cleveland, Ohio. The clinical significance of these isolates is not clear, but the potential for the emergence of clinically important resistance may preclude the use of fluoroquinolones as an alternative treatment for uncomplicated gonorrhea.

Surveillance of Antibiotic Resistance: Learning to Live with Bias

The introduction of antibacterial drug therapy in the 1940s led to a dramatic reduction in illness and death from infectious diseases over the next 50 years. Worldwide, antimicrobial drugs have saved the lives of hundreds of millions of people for whom premature death or crippling complications would have been unavoidable. However, the emergence of drug-resistant bacteria, fungi, and viruses is reversing the miracles of the previous 50 years. As we approach the 21st century, the choices of effective therapy for common infections will be more limited, much more expensive, or, in some cases, simply absent. We may be faced with the specter of hospital wards with patients dying of common, untreatable, infectious diseases. In recent years, a series of developments have highlighted the emergence of drug-resistant organisms. These include the following: * Once exquisitely susceptible to penicillin, drug-resistant Streptococcus pneumoniae infections have become common in some communities. S pneumoniae is the cause of at least 7,000,000 cases of middle ear infection in children, 500,000 cases of pneumonia, 50,000 cases of bacteremia, and 3,000 cases of meningitis; this pathogen causes at least 40,000 deaths per year in the United States. The proportion of strains with high levels of resistance to penicillin increased 60-fold between 1987 and 1992.1 In some regions of the United States, the proportion of strains resistant to penicillin is as high as 30%.2,3 * Antimicrobial resistance to penicillins and tetracyclines has emerged in Neisseria gonorrhoeae, the causative agent of gonorrhea, to the extent that expensive agents such as broad-spectrum cephalosporins and fluoroquinolones currently are recommended for the treatment of uncomplicated gonorrhea.4 * Hospital-acquired (nosocomial) infections aff ct approximately 2 million hospitalized patients in he United States, contributing to 80,000 deaths each y ar. Drug-resistant nosocomial pathogens are making some of these infections difficult (as with Staphylococcus aureus) or impossible (vancomycinresistant Enterococcus) to treat and are driving up costs of hospital care and mortality.5 * Foodborne diseases cause millions of illnesses each year in the United States. Periodic monitoring of Salmonella has shown a steady increase in the prevalence of antimicrobial resistance in this pathogen from 17% in 1980 to 31% in 1990.6 Epidemic dysentery due to Shigella dysenteriae type 1 is now a major threat in southern Africa.' This disease caused over 20,000 deaths 20 years ago in Latin America, where it could reemerge. Antimicrobial therapy for S dysenteriae can be life-saving, but widespread prevalence of drugresistant strains makes treatment expensive or imposs ble in some developing countries. This list could go on to discuss fungi, viruses, mycobacteria, and other microorganisms developing antimicrobial resistance. How do we know these

Surveillance of Antibiotic Resistance: Learning to Live With Bias

The introduction of antibacterial drug therapy in the 1940s led to a dramatic reduction in illness and death from infectious diseases over the next 50 years. Worldwide, antimicrobial drugs have saved the lives of hundreds of millions of people for whom premature death or crippling complications would have been unavoidable. However, the emergence of drug-resistant bacteria, fungi, and viruses is reversing the miracles of the previous 50 years. As we approach the 21st century, the choices of effective therapy for common infections will be more limited, much more expensive, or, in some cases, simply absent. We may be faced with the specter of hospital wards with patients dying of common, untreatable, infectious diseases. In recent years, a series of developments have highlighted the emergence of drug-resistant organisms. These include the following: * Once exquisitely susceptible to penicillin, drug-resistant Streptococcus pneumoniae infections have become common in some communities. S pneumoniae is the cause of at least 7,000,000 cases of middle ear infection in children, 500,000 cases of pneumonia, 50,000 cases of bacteremia, and 3,000 cases of meningitis; this pathogen causes at least 40,000 deaths per year in the United States. The proportion of strains with high levels of resistance to penicillin increased 60-fold between 1987 and 1992.1 In some regions of the United States, the proportion of strains resistant to penicillin is as high as 30%.2,3 * Antimicrobial resistance to penicillins and tetracyclines has emerged in Neisseria gonorrhoeae, the causative agent of gonorrhea, to the extent that expensive agents such as broad-spectrum cephalosporins and fluoroquinolones currently are recommended for the treatment of uncomplicated gonorrhea.4 * Hospital-acquired (nosocomial) infections aff ct approximately 2 million hospitalized patients in he United States, contributing to 80,000 deaths each y ar. Drug-resistant nosocomial pathogens are making some of these infections difficult (as with Staphylococcus aureus) or impossible (vancomycinresistant Enterococcus) to treat and are driving up costs of hospital care and mortality.5 * Foodborne diseases cause millions of illnesses each year in the United States. Periodic monitoring of Salmonella has shown a steady increase in the prevalence of antimicrobial resistance in this pathogen from 17% in 1980 to 31% in 1990.6 Epidemic dysentery due to Shigella dysenteriae type 1 is now a major threat in southern Africa.' This disease caused over 20,000 deaths 20 years ago in Latin America, where it could reemerge. Antimicrobial therapy for S dysenteriae can be life-saving, but widespread prevalence of drugresistant strains makes treatment expensive or imposs ble in some developing countries. This list could go on to discuss fungi, viruses, mycobacteria, and other microorganisms developing antimicrobial resistance. How do we know these

Trial of single-dose spectinomycin in treatment of uncomplicated gonorrhea in estonia

Trial of single-dose spectinomycin in treatment of uncomplicated gonorrhea in estonia

Fleroxacin. A review of its pharmacology and therapeutic efficacy in various infections.

The fluoroquinolone antibacterial agent fleroxacin has a broad spectrum of in vitro activity which encompasses most Gram-negative species (particularly Enterobacteriaceae) and a number of Gram-positive organisms, including methicillin-sensitive staphylococci. It is available as oral and intravenous formulations. In clinical trials, fleroxacin has been evaluated in the treatment of uncomplicated urinary tract infections (single or multiple once-daily oral doses of 200 or 400mg), gonorrhoea and chancroid (single oral doses of 200 or 400mg), complicated urinary tract, nonpneumococcal lower respiratory tract and skin and soft tissue infections and typhoid fever (multiple once-daily oral or intravenous regimens, usually 400 mg/day), bacterial enteritis, and traveller's diarrhoea (single or multiple once-daily oral doses of 400mg). Bacteriological cure rates were generally around 90% or higher in complicated and uncomplicated urinary tract infections, uncomplicated gonorrhoea (approximately 100%), pyelonephritis, bacterial enteritis and typhoid fever, and exceeded 80% in lower respiratory tract, and skin and soft tissue infections and chancroid. These cure rates were similar to, or better than, those achieved with standard comparator antibacterial agents such as penicillins, cephalosporins, cotrimoxazole, or other quinolones. Fleroxacin 400mg once daily also achieved bacteriological cure in approximately 80% of patients with bone and joint infections in preliminary studies. In Japanese studies using a lower dosage of 200 or 300 mg/day, fleroxacin was reported to be bacteriologically effective in a range of infections, including urinary tract and upper and lower respiratory tract infections. Fleroxacin has a relatively long elimination half-life, which allows once-daily administration, and it appears to have less propensity for interactions with other medications in comparison to many other fluoroquinolones. Its tolerability profile is typical of this class of compound, with adverse events mostly relating to the gastrointestinal tract, CNS, and skin and appendages (including phototoxicity). Recent pooled tolerability data from worldwide clinical trials indicate that adverse events are reported by approximately 27% of patients receiving 200 mg/day orally or 400 mg/day orally or intravenously, and 17% of those receiving a single oral dose of 400mg. These exceed incidences reported for established fluoroquinolones, possibly indicating recent trends towards increased rates of reported adverse effects with these agents. However, in direct comparative studies with twice-daily fluoroquinolones, fleroxacin 400mg once daily produced a similar incidence of adverse effects to ofloxacin 800 mg/day and a slightly higher incidence than ciprofloxacin 1000 mg/day, while fleroxacin 200mg once daily produced a similar incidence to norfloxacin 800 mg/day.(ABSTRACT TRUNCATED AT 400 WORDS)

Plasmid-mediated antimicrobial resistance in Neisseria gonorrhoeae in Kingston, Jamaica: 1990-1991.

Gonococcal infections caused by antimicrobial-resistant strains of Neisseria gonorrhoeae have spread into many geographic areas and have increased in prevalence since the mid 1970s. Surveillance of antimicrobial-resistant gonococcal strains of Jamaica from 1981 to 1983 indicated that fewer than 3% of strains of produced beta-lactamase (penicillinase-producing Neisseria gonorrhoeae); approximately 4% of strains were resistant to penicillin, and 12% were resistant to tetracycline. To measure the frequency and nature of antimicrobial resistance in Neisseria gonorrhoeae isolates in Kingston, Jamaica, from 1990 to 1991 and to assess the effectiveness of prescribed treatment regimens. Urethral isolates of Neisseria gonorrhoeae from 116 heterosexual men with uncomplicated gonorrhea, representing 7.1% (116/1633) men attending the STD Comprehensive Health Centre from October 1990 through March 1991 who had positive Gram-stained smears, were characterized by auxotype, serovar, presence of the TetM determinant, and plasmid content. Antimicrobial susceptibilities to penicillin, cefoxitin, ceftriaxone, ciprofloxacin, tetracycline, and spectinomycin were determined by an agar dilution method. A total of 80.2% (93/116) of the isolates exhibited plasmid-mediated resistance to penicillin, tetracycline, or both: penicillinase-producing Neisseria gonorrhoeae (13/116; 11.2%), tetracycline-resistant Neisseria gonorrhoeae (25/116; 21.6%), and penicillinase-producing/tetracycline-resistant Neisseria gonorrhoeae, (55/116;47.4%). Isolates with chromosomally mediated resistance to penicillin, tetracycline, or both, accounted for 5.2% (6/116) of the isolates. Penicillinase-producing Neisseria gonorrhoeae, tetracycline-resistant Neisseria gonorrhoeae, and penicillinase-producing/tetracycline-resistant Neisseria gonorrhoeae belonging to multiple auxotype/serovar classes were isolated repeatedly through the study period. Infections caused by Neisseria gonorrhoeae exhibiting plasmid-mediated resistance to penicillin, tetracycline, or both, have become prevalent and endemic in Kingston, Jamaica. Therefore, all gonococcal infections should be treated with antimicrobial therapies known to be active against penicillin-resistant and tetracycline-resistant organisms to reduce gonorrhea transmission.

The Use of Fluoroquinolones in Sexually Transmitted Diseases in Southeast Asia

This paper reviews the use of the fluoroquinolone antibiotics in the management of sexually transmitted diseases (STD) in Southeast Asia. Numerous clinical trials performed in the region have shown that the quinolones are highly effective for treating uncomplicated gonorrhoea. Norfloxacin 800 mg, ofloxacin 400 mg, ciprofloxacin 250 mg, and pefloxacin 400 mg in single oral doses have yielded excellent clinical results. Overall cure rates were greater than 95%, with full eradication of penicillinase-producing Neisseria gonorrhoeae in all studies. Strains of gonococci resistant to the quinolones have already emerged and should be closely monitored. However, this has not become a serious problem to date, as large scale evaluation has shown that the quinolones remain highly efficacious for the treatment of gonorrhoea. These antibiotics in single doses are not effective for postgonococcal urethritis (PGU); therefore, concomitant use of an antichlamydial regimen for all patients with gonorrhoea is recommended. The quinolones are also highly effective for chancroid. Excellent results, with cure rates approaching 100%, were achieved with single oral doses of ciprofloxacin 500 mg, norfloxacin 800 mg, and ofloxacin 400 mg. Widespread use of these drugs in STD treatment regimens may be one of the main factors causing a dramatic decline in the number of cases of chancroid seen in recent years. Ofloxacin in variable dosages for a period of 10 to 21 days was found to be effective in nongonococcal urethritis (NGU). However, when compared with the tetracyclines, it is less cost effective and can thus be regarded as an alternative treatment for NGU.

Multicenter Trial of Single- Dose Azithromycin vs. Ceftriaxone in the Treatment of Uncomplicated Gonorrhea

Multicenter Trial of Single- Dose Azithromycin vs. Ceftriaxone in the Treatment of Uncomplicated Gonorrhea

Persistence of Neisseria gonorrhoeae strains with decreased susceptibilities to ciprofloxacin and ofloxacin in Cleveland, Ohio, from 1992 through 1993.

Twenty-five isolates of beta-lactamase-negative strains of Neisseria gonorrhoeae exhibiting decreased susceptibilities to ciprofloxacin (MIC, > or = 0.125 microgram/ml) were isolated from men with uncomplicated gonococcal urethritis in Cleveland, Ohio, from January 1992 through June 1993. The strains belonged to three auxotype-serovar classes: Pro-IB-1 (2 isolates), Pro-IB-2 (21 isolates), and Pro-IB-3 (2 isolates). MICs for strains were in the intermediate or resistant categories for penicillin, the intermediate or susceptible categories for tetracycline (with the exception of one strain that had acquired the 25.2-MDa TetM-containing plasmid) and cefoxitin, and the susceptible categories for ceftriaxone and cefixime (MICs, < or = 0.25 microgram/ml) and spectinomycin (MIC, < or = 256 micrograms/ml). MICs for strains were also in the susceptible category for ofloxacin (MIC, 0.25 microgram/ml) and in categories higher than susceptible for ciprofloxacin (MICs, 0.125 to 0.25 microgram/ml) and ofloxacin (MIC, 0.5 microgram/ml). The diameters of zones of inhibition for these strains ranged from 31 to 39 mm for ciprofloxacin to 28 to 35 mm for ofloxacin. The persistence of these strains over an 18-month period supports the need for routine sentinel surveillance and monitoring of gonococcal isolates, particularly posttreatment isolates, for resistance to quinolones when these agents are used for the primary therapy of uncomplicated gonorrhea.

Cefetamet pivoxil in the treatment of uncomplicated gonorrhea

We studied the efficacy and safety of cefetamet pivoxil (CAT), an oral aminothiazolyl cephalosporin, in a series of open, comparative multicenter studies in 207 women (four study centers) with uncomplicated gonorrhea, and summarized and pooled the results with those of earlier open dose-finding trials (360 men; six study centers). We compared single-dose treatment regimen of CAT—over the range of 400–1500 mg—with spectinomycin, thiamphenicol, ampicillin, or amoxicillin plus probenecid. The overall cure rates were 100% in 88 women treated with 1500 mg CAT and in 137 men treated with 1200 or 1500 mg CAT, 98% (114 of 116 men) in those treated with 800 or 1000 mg CAT, and 93% (42 of 45 men) in those treated with 400 or 500 mg CAT; the composite cure rate of the comparators was 97%. The tolerability of CAT ( n = 428) compared favorably (1.8% adverse events) with that of the standard drugs ( n = 139) (4.3% adverse events). Single-dose treatment with 1500 mg CAT is effective and safe in adults with uncomplicated gonorrhea.

Cefuroxime axetil

Cefuroxime is the first commercially-available second-generation cephalosporine to be widely used in therapy; it is a semi-synthetic cephalosporin obtained from the 7-cephalosporanic acid nucleus of cephalosporin C. Cefuroxime axetil is the acetoxyethyl ester of cefuroxime. The majority of micro-organisms associated with respiratory infections are highly sensitive to cefuroxime. These include Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes and the other streptococci (excluding group D streptococci), and Moraxella catarrhalis. Bacteria sensitive to cefuroxime include the enterobacteria ( Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Salmonella and Shigella and Straphylococcus aureus (methicillin-sensitive strains). The pharmacokinetic studies show that the maximum plasma concentration of cefuroxime after oral administration of 250 mg and 500 mg of cefuroxime axetil after a meal are respectively 4.6 and 7.9 mg/l. The absolute bioavailability of tablets is 68% (extremes 63–73%) after oral administration of 500 mg cefuroxime axetil. The protein binding is 33±5.7%. Tissue diffusion was studied in the interstitial fluid, the bronchial mucosa, the tonsils, and the bronchial secretions. Cefuroxime axetil is available as capsule-shaped tablets containing 125, 250 or 500 mg. An oral suspension dosage form for paediatric purposes is also available as granules in multidose bottles and sachets. Constitution gives a suspension containing 125 mg or 250 mg cefuroxime (as cefuroxime axetil). Cefuroxime axetil is indicated for the treatment of infections caused by susceptible bacteria. Indications include: lower respiratory tract infections (e.g., acute and chronic bronchitis and pneumonia); upper respiratory tract infections (e.g., ear, nose and throat infections such as otitis media, sinusitis tonsillitis and pharyngitis); genito-urinary tract infections (e.g., pyelonephritis, cystitis and urethritis, gonorrhoea, acute uncomplicated gonococcal urethritis and cervicitis); and skin and soft tissue infections (e.g., furunculosis, pyoderma and impetigo). For most infections, a dose of 250 mg twice daily is appropriate. In some urinary tract infections, 125 mg twice daily has been shown to be effective. If pneumonia is suspected or in more severe lower respiratory tract infection, doses of 500 mg bd should be used. Uncomplicated gonorrhoea has been shown to respond to a single 1-g dose of cefuroxime axetil. Adverse reactions to cefuroxime have generally been mild and transient in nature (gastrointestinal disturbances, including diarrhoea, nausea and vomiting).

Ceftizoxime interpretive criteria for in vitro susceptibility tests with Neisseria gonorrhoeae

Ceftizoxime was tested in triplicate against 100 clinical strains of Neisseria gonorrhoeae in accordance with National Committee for Clinical Laboratory Standards guidelines to establish susceptibility testing interpretive criteria. The MICs for 50 and 90% of the strains tested were 0.008 and 0.03 microgram/ml, respectively. These results confirm those of other studies reporting ceftizoxime's excellent activity against gonococci. Because no resistant strains were identified, a breakpoint MIC of < or = 0.5 microgram/ml was selected, with a correlate zone diameter of > or = 32 mm. Ceftizoxime appears to represent an alternative to other beta-lactamase-stable beta-lactams for cost-effective therapy of uncomplicated gonorrhea.

Gonorrhea.

Preview Despite a recent decline in total cases, gonorrhea is on the rise in the adolescent population, particularly in black teenagers. Increases in sexual activity, drug abuse, and gonococcal resistance to antibiotics have contributed to the changing epidemiology of the disease. Dr Hawley explains how prevention and detection of gonorrhea can be improved and describes new, single-dose treatment with oral antibiotics.

Multicenter Trial of Fleroxacin Versus Ceftriaxone in the Treatment of Uncomplicated Gonorrhea

In a multicenter, randomized, open, comparative trial, patients with uncomplicated gonorrhea were treated with 400 mg of oral fleroxacin or 250 mg of intramuscular ceftriaxone. A total of 458 men and 447 women were enrolled. Of these, 312 men (68%) and 245 women (55%) were evaluable for efficacy. The treatment groups were demographically similar. Among evaluable men, fleroxacin eradicated 154 of 155 (99%; 95% confidence interval [CI]: 98.1-100%) urethral and 2 of 2 pharyngeal infections, while ceftriaxone eradicated 156 of 156 (95% CI: 99.4-100%) urethral and 5 of 5 pharyngeal infections. Among evaluable women, fleroxacin eradicated 127 of 128 (99%; 95% CI: 97.7-100%) cervical, 20 of 20 anorectal, 16 of 16 urethral, and 7 of 7 pharyngeal infections, while ceftriaxone eradicated 108 of 108 (95% CI: 99.1-100%) cervical, 24 of 24 anorectal, 25 of 25 urethral, and 9 of 9 pharyngeal infections. Adverse events were reported by 68 (16%) of 426 subjects in the fleroxacin group and 20 (5%) of 380 in the ceftriaxone group (p < 0.0001). The most common adverse events reported by the patients who received fleroxacin were nausea (5%), headache (3%), and vaginitis (3%). One patient had severe vomiting, 19 participants had adverse reactions classified as moderate, and 48 patients had mild adverse reactions. Fleroxacin was highly effective in the treatment of uncomplicated gonorrhea and represents an oral alternative to ceftriaxone. Adverse events were more common with fleroxacin than with ceftriaxone.

Open study of the safety and efficacy of a single oral dose of azithromycin for the treatment of uncomplicated gonorrhoea in men and women.

An open, non-comparative study was undertaken to assess the safety and efficacy of a single 1 g oral dose of azithromycin in patients with uncomplicated gonorrhoea. One hundred and eighteen patients (105 male, 13 female) took part in the study. Only patients culture-positive for Neisseria gonorrhoeae were evaluated. The majority of male patients (84) had urethral gonorrhoea, but four had rectal and two pharyngeal infections. Four patients had positive cultures at more than one site (two urethral and rectal; two urethral and pharyngeal). All nine female patients had infection of the cervix only. Bacteriological eradication of N. gonorrhoeae was achieved in 76/82 (93%) patients with positive urethral cultures, 9/9 with positive cervical, 4/4 with positive rectal, and 2/2 with positive pharyngeal cultures. Twenty-two patients (18 males, four females) had concomitant chlamydial infection. Chlamydia trachomatis was eradicated in all patients who returned for follow-up assessment and in whom culture was done. Azithromycin was very well tolerated, with only two patients reporting mild-to-moderate side-effects. This study shows that single-dose azithromycin is effective in uncomplicated gonorrhoea and in mixed gonococcal and chlamydial infections.

Evaluation of Treatment with Single-dose Ampicillin/Sulbactam with Probenecid or Ceftriaxone in Patients with Uncomplicated Gonorrhea

Evaluation of Treatment with Single-dose Ampicillin/Sulbactam with Probenecid or Ceftriaxone in Patients with Uncomplicated Gonorrhea

Resistance of recent Neisseria gonorrhoeae isolates in Nigeria and outcome of single-dose treatment with ciprofloxacin.

One hundred four patients (71 males, 33 females) with acute gonococcal urethritis or cervicitis were treated with a single oral 250 mg dose of ciprofloxacin at Jos University Teaching Hospital, Jos, Nigeria. All gonococcal strains were isolated from appropriate pre-treatment swabs. Penicillinase-producing Neisseria gonorrhoeae (PPNG) accounted for 72.8% of all isolates. In vitro sensitivity of gonococcal isolates to ciprofloxacin was 100%, while that to penicillin, ampicillin and co-trimoxazole was below 15%. Of the 104 patients treated with ciprofloxacin, 73 (70%) attended a follow-up visit. Seventy-three (100%) patients showed clinical cure and elimination of N. gonorrhoeae from the respective site of infection. Post-gonococcal urethritis or cervicitis believed to be due to concomitant chlamydial infection was found in 22 (30.1%) patients--18 males and four females. No adverse reactions were reported by any patient. Our findings show that a single oral dose of ciprofloxacin (250 mg) is well tolerated and effective in the treatment of uncomplicated gonorrhoea and is particularly useful in regions with a high prevalence of PPNG.

Patterns of antibiotic susceptibility of gonococci isolated in Hong Kong, 1987-1990.

Among the 14,528 strains of Neisseria gonorrhoeae isolated from the Government Social Hygiene Sexually Transmitted Disease (STD) Clinics in Hong Kong between 1987 and 1990, there has been a trend toward a decrease in the percentage of penicillin resistant strains in both penicillinase-producing and nonpenicillinase producing N. gonorrhoeae (PPNG and non-PPNG) and an increase in moderate resistant strains, whereas the proportion of sensitive strains has remained stable, except for a small increase in 1990. Presently, PPNG still accounts for 31% of all isolates. In early 1991, 100 consecutive isolates were tested for minimum inhibitory concentrations (MIC) against 6 commonly used antibiotics. Although ofloxacin has been used as the first-line treatment for gonorrhea for the last 5 years, there is still no sign of in vitro resistance. Two isolates with high-level tetracycline resistance (MIC greater than 16 mg/l) were detected that have not been seen before. Sensitivity to spectinomycin, cefuroxime, and ceftriaxone has also been maintained, and these drugs can probably be recommended as alternative treatments in noncompliant cases. Analysis of location of contact shows an increasing proportion of cases of gonorrhea from overseas, particularly from parts of China. Comparison with the limited information published in the region shows that the population sampled can be very heterogeneous. With the continued flux of international travel, one should be extremely careful when trying to get an accurate assessment of epidemiologic data.

Diagnosis and treatment of urethritis in men

AbstractUrethritis in men may be divided into gonococcal or non‐gonococcal. These cannot be distinguished by symptoms and signs. Gram stain and culture remain the best methods for diagnosing uncomplicated lower genital tract gonorrhoea. Uncomplicated gonorrhoea responds to a single dose of a suitable antimicrobial, the choice of dose and drug depending on antimicrobial sensitivity. In non‐gonococcal urethritis, Chlamydia trachomatis may be identified in up to 58% of cases by cell culture or antigen identification methods, such as immunofluorescence or enzyme assay, with cell culture being the gold standard. Chlamydia responds to a minimum 6‐day course of a tetracycline or erythromycin, though longer courses are frequently prescribed. Resolution of symptoms, signs and evidence of urethritis may be a problem. Management of urethritis includes sexual partner notification, examination, investigation and treatment. Rapid accurate diagnosis and effective treatment are vital to prevent complications, to control spread, and to minimize the role of gonococci and chlamydia in the transmission of human immunodeficiency virus (HIV) infection.

Evaluation of Treatment with Single-dose Ampicillin/Sulbactam with Probenecid or Ceftriaxone in Patients with Uncomplicated Gonorrhea

This study compared ampicillin/sulbactam plus probenecid with ceftriaxone for treatment of uncomplicated gonorrhea. Of the 297 men and women who were enrolled and randomized to receive either ampicillin/sulbactam (1.0 g/0.5 g) with probenecid (1 g) or ceftriaxone (0.25 g), 274 patients were evaluable. Both ampicillin/sulbactam and ceftriaxone were administered by intramuscular injections. Patients were gonococcal contacts, had positive culture results for Neisseria gonorrhoeae, or had clinical evidence of gonorrhea. Specimens for gonococcal cultures were collected from the cervix (female patients), urethra, rectum, and pharynx at pretreatment and test-of-cure visits. The presence of N. gonorrhoeae and a test-of-cure visit were required for drug efficacy analysis. Of the 274 evaluable patients, 195 (71.2%) had positive culture results for N. gonorrhoeae. Cure was achieved in 93 (94.9%) of 98 patients receiving ampicillin/sulbactam with probenecid and in 96 (99.0%) of 97 patients receiving ceftriaxone. Penicillinase-producing N. gonorrhoeae strains were found in 21 (10.8%) patients; these were eradicated by either ampicillin/sulbactam with probenecid (N = 9) or ceftriaxone (N = 12). Overall, the two drug regimens were very well tolerated and no serious adverse effects were noted. Ampicillin/sulbactam with probenecid may be useful as single-dose therapy in patients with uncomplicated genitorectal gonorrhea.