Control of gonorrhoea

Moran, John S.; Marcus, Stanley

doi:10.1016/s0140-6736(95)91539-7

Cited by 4 publications

(9 citation statements)

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“…Specifically, the mosaic penA allele, a key genetic determinant associated with decreased cephalosporin susceptibility, appears to have evolved through recombination with penA genes from commensal Neisseria species (18)(19)(20). In addition, pharyngeal infections are more difficult to eradicate than urogenital or rectal infections (21,22) and are typically asymptomatic, which may provide an optimal setting for selection of resistance mutations. It is notable that the first identified N. gonorrhoeae strain with high-level resistance to ceftriaxone was isolated from the pharynx (8).…”

mentioning

confidence: 99%

Comparison of Antimicrobial Susceptibilities of Pharyngeal, Rectal, and Urethral Neisseria gonorrhoeae Isolates among Men Who Have Sex with Men

Kidd

Zaidi

Asbel

et al. 2015

Antimicrob Agents Chemother

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N eisseria gonorrhoeae has developed resistance to multiple antimicrobials that were previously recommended for treatment, including penicillin, tetracycline, and ciprofloxacin (1). Currently, the only recommended treatment for gonorrhea in Europe and the United States is dual treatment with ceftriaxone and azithromycin (2, 3). However, decreases in susceptibilities to cephalosporins (4-7) and reports of cefixime and ceftriaxone treatment failures worldwide (8-10) indicate that the emergence of cephalosporin-resistant gonorrhea could be imminent. Because there are limited remaining effective therapeutic options for gonorrhea (11, 12), ceftriaxone resistance in N. gonorrhoeae would present significant challenges for individual case management and gonorrhea control in the community. As a result, surveillance of antimicrobial susceptibilities among N. gonorrhoeae strains will be increasingly critical to inform gonorrhea treatment recommendations.N. gonorrhoeae can infect the urogenital tract, rectum, and pharynx through sexual contact, and infection at extragenital sites may facilitate the acquisition or development of resistance mutations. Rectal infection and exposure to fecal lipids provide selective pressure for mutations such as those in the mtr locus, which confer resistance to hydrophobic molecules and drugs (13-16). Pharyngeal infection supplies the opportunity for genetic reassortment between N. gonorrhoeae and other Neisseria species that colonize the pharynx (17, 18). Specifically, the mosaic penA allele, a key genetic determinant associated with decreased cephalosporin susceptibility, appears to have evolved through recombination with penA genes from commensal Neisseria species (18)(19)(20). In addition, pharyngeal infections are more difficult to eradicate than urogenital or rectal infections (21,22) and are typically asymptomatic, which may provide an optimal setting for selection of resistance mutations. It is notable that the first identified N. gonorrhoeae strain with high-level resistance to ceftriaxone was isolated from the pharynx (8). Furthermore, high rates of resistance and elevated MICs are frequently observed among gay men, bisexual men, and other men who have sex with men (MSM) (7, 23), among whom extragenital infections are common (24-26).Globally, surveillance for N. gonorrhoeae antimicrobial susceptibilities is conducted mostly with urogenital isolates (5, 6, 27), and there are few published data comparing the susceptibilities of urogenital, rectal, and pharyngeal isolates. Although some reports

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confidence: 99%

Comparison of Antimicrobial Susceptibilities of Pharyngeal, Rectal, and Urethral Neisseria gonorrhoeae Isolates among Men Who Have Sex with Men

Kidd

Zaidi

Asbel

et al. 2015

Antimicrob Agents Chemother

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“…Another randomized controlled trial conducted among 252 pregnant women found a cure rate of 95% (95% CI, 90.6%-99.9%) for ceftriaxone (250 mg im), a cure rate of 89% (95% CI, 82.5%-96.0%) for amoxicillin (3 g po) plus probenecid (1 g po), and a cure rate of 95% (95% CI, 90.6%-99.9%) for spectinomycin (2 g im) [145]. Additional reviews of the treatment of gonorrhea in pregnancy are available [146][147][148]. On the basis of such data, a pregnant women infected with N. gonorrhoeae should be treated with a recommended or alternative cephalosporin.…”

Section: Special Situationsmentioning

confidence: 99%

“…Persons who can not tolerate cephalosporins or quinolones should be treated with spectinomycin, if available. Because spectinomycin is not adequately effective against pharyngeal infections, patients who have suspected or known pharyngeal infection should have a pharyngeal culture evaluated 3-5 days after treatment, to verify eradication of infection [148]. An additional treatment option for patients, including pregnant women, with a documented history of severe allergic reaction to penicillins or cephalosporins is 2 g of azithromycin.…”

Section: Special Situationsmentioning

confidence: 99%

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Update on the Management of Gonorrhea in Adults in the United States

Newman

Moran

Workowski

2007

Clinical Infectious Diseases

171

110

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Gonorrhea, the second most commonly reported notifiable disease, is an important cause of cervicitis, urethritis, and pelvic inflammatory disease. The selection of appropriate therapy for gonorrhea (i.e., safe, highly effective, single dose, and affordable) is complicated by the ability of Neisseria gonorrhoeae to develop resistance to antimicrobial therapies. This article reviews the key questions and data that informed the 2006 gonorrhea treatment recommendations of the Centers for Disease Control and Prevention. Key areas addressed include the criteria used to select effective treatment for gonorrhea, the level of antimicrobial resistance at which changing treatment regimens is recommended, the epidemiology of resistance, and the use of quinolones, cephalosporins, and other classes of antimicrobials for the treatment of uncomplicated gonorrhea.

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“…Globally the World Health Organization in 2011 estimated that about 88 million new cases of gonococcal infections occurred in 2005. Around 95% of infected males are symptomatic [2] . An estimated 10%-20% of infected women develop the following complications [2] ; Pelvic inflammatory disease, ectopic pregnancy, infertility, and adverse pregnancy conditions.…”

Section: Introductionmentioning

confidence: 99%

High Prevalence of Drug Resistant Neisseria Gonorrhoeae in Males With Urethral Discharge at the STD Clinic Mulago Hospital Uganda

2022

AJMI

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Among the treatable sexually transmitted infections (STIs), Neisseria gonorrhoeae is considered to be most important because of its ever evolving antibiotic resistance. Currently third generation cephalosporins are recommended as first-line drugs in many countries. Unfortunately, resistance to these cephalosporins (cefixime and ceftriaxone) has been reported elsewhere. The objectives of the study were to determine the prevalence of Neisseria gonorrhoea in adult males presenting to Mulago hospital with urethral discharge and to determine the level of resistance of Neisseria gonorrhea to the commonly available antimicrobial agents at the clinic focusing on extended-spectrum cephalosporins. In a cross sectional study, we enrolled 112 adult males aged 18-65 yrs with urethral discharge at the STD clinic Mulago Hospital. Prevalence of gonorrhoea was determined based on Gram staining and/or N. gonorrhea isolation at culture. Antimicrobial susceptibility testing was determined with the Kirby-Bauer disk diffusion method and with the Nitrocefin tests for β-lactamase production. Among 112 adult male patients aged 18-65 years with urethral discharge,the prevalence of N. gonorrhea was at 81.3%. Resistance to drugs was identified at the following rates: tetracycline 100%, ciprofloxacin 94.8%, cotrimoxazole 91.4%, penicillin 82.8%, cefixime 20.7%, ceftriaxone 5.2%, spectinomycin 1.7%, and azithromycin 0%. According to this study drug resistance to commonly available antimicrobials for N. gonorrhea is very high among isolates from patients attending the STI clinic, Mulago Hospital Kampala, Uganda. Ceftriaxone, spectinomycin and azithromycin appeared to be the most useful drugs in the treatment of N. gonorrhea infection at the clinic. This work was completed in November 2017.

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Control of gonorrhoea

Cited by 4 publications

References 4 publications

Comparison of Antimicrobial Susceptibilities of Pharyngeal, Rectal, and Urethral Neisseria gonorrhoeae Isolates among Men Who Have Sex with Men

Comparison of Antimicrobial Susceptibilities of Pharyngeal, Rectal, and Urethral Neisseria gonorrhoeae Isolates among Men Who Have Sex with Men

Update on the Management of Gonorrhea in Adults in the United States

High Prevalence of Drug Resistant Neisseria Gonorrhoeae in Males With Urethral Discharge at the STD Clinic Mulago Hospital Uganda

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