Epidemiology and Treatment of Oropharyngeal Gonorrhea

Hutt, David M.

doi:10.7326/0003-4819-104-5-655

Cited by 79 publications

(46 citation statements)

References 30 publications

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“…Many pharyngeal infections are restricted to the pharynx (46,84,85). Pharyngeal gonorrhoea has a high incidence: prevalence ratio, suggesting spontaneous resolution (86,87), in contrast to pharyngeal chlamydia, where a high prevalence: incidence ratio supports longer lived infection. Thus, pharyngeal chlamydia may play an important role in onward transmission (88).…”

Section: Chlamydia and Gonorrhoeamentioning

confidence: 99%

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

et al. 2018

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This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG’s document ‘Framework for guideline development and assessment’ published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for ‘Identification of problematic recreational drug and alcohol use’ section and ‘Sexual problems and dysfunctions in MSM’ section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years’ time, 2022.

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Section: Chlamydia and Gonorrhoeamentioning

confidence: 99%

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

et al. 2018

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“…As seen in the present investigation, pharyngeal gonococcal infections are usually more difficult to eradicate as compared with genitorectal infections (6). To control the spread of N. gonorrhoeae, identifying therapeutic regimens effective in eradicating gonococci from the oropharynx seems appropriate (6).…”

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confidence: 98%

“…To control the spread of N. gonorrhoeae, identifying therapeutic regimens effective in eradicating gonococci from the oropharynx seems appropriate (6). At the same time, pharyngeal infections are usually asymptomatic (6,17,20), undergo spontaneous cure (6,17), and are considered by some as unusual sources of transmission of N. gonorrhoeae (17,19).…”

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confidence: 99%

Clinical comparison of single-oral-dose cefuroxime axetil and amoxicillin with probenecid for uncomplicated gonococcal infections in women

Baddour

Mertz

et al. 1989

Antimicrob Agents Chemother

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Four hundred sixty-six female patients were enrolled in a randomized study that compared the clinical efficacies of single oral doses of cefuroxime axetil and amoxicillin with probenecid in the treatment of uncomplicated gonorrhea. Two hundred ninety-five patients had culture-positive gonococcal infections and completed the investigation. Cure rates for the patients treated with cefuroxime axetil and those treated with amoxicillin with probenecid were high (>95%) for genitorectal infections. Pharyngeal infections, however, were not uniformly eradicated by either cefuroxime axetil (60%) or amoxicillin with probenecid (64%). Approximately 13% of each patient group suffered adverse events, which were gastrointestinal in the majority and were transient. Compared with amoxicillin plus probenecid, cefuroxime axetil in a single oral dose was an equally safe and effective drug for the treatment of uncomplicated gonorrhea in women caused by penicillin-susceptible strains.Earlier studies (3, 4, 8-10, 12, 14, 16) examining the treatment of uncomplicated gonorrhea with a single dose of parenteral cefuroxime with and without oral probenecid demonstrated that this regimen was efficacious and well tolerated. Cefuroxime axetil, the ester prodrug of cefuroxime, was also shown to be effective (2,5,13,18) in the treatment of uncomplicated gonorrhea when administered in a single oral dose, with and without probenecid. Although these investigations with cefuroxime axetil provided much information on the treatment of urethral infections in men, the studies enrolled relatively few women. We therefore examined the efficacy of single-dose cefuroxime axetil in a large number of women with uncomplicated gonorrhea who were seen at sexually transmitted disease clinics of four different city or county health departments.

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“…Also, it should be noted that debate is ongoing over the clinical significance of pharyngeal gonorrhea, with suggestions that pharyngeal gonorrhea may spontaneously clear or otherwise not make a significant contribution to transmission of disease. [83][84][85][86][87] However, it is also recognized that pharyngeal carriage predisposes to disseminated gonococcal infection. 87 …”

Section: Diagnosis Of Pharyngeal and Rectal Gonorrheamentioning

confidence: 99%

Nucleic Acid Amplification Testing for Neisseria gonorrhoeae

Whiley

Tapsall

Sloots

2006

The Journal of Molecular Diagnostics

178

163

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Nucleic acid amplification tests (NAATs) for the detection of Neisseria gonorrhoeae became available in the early 1990s. Although offering several advantages over traditional detection methods, N. gonorrhoeae NAATs do have some limitations. These include cost, risk of carryover contamination, inhibition, and inability to provide antibiotic resistance data. In addition, there are sequence-related limitations that are unique to N. gonorrhoeae NAATs. In particular, falsepositive results are a major consideration. These primarily stem from the frequent horizontal genetic exchange occurring within the Neisseria genus, leading to commensal Neisseria species acquiring N. gonorrhoeae genes. Furthermore, some N. gonorrhoeae subtypes may lack specific sequences targeted by a particular NAAT. Therefore, NAAT false-negative results because of sequence variation may occur in some gonococcal populations. Overall, the N. gonorrhoeae species continues to present a considerable challenge for molecular diagnostics. The need to evaluate N. gonorrhoeae NAATs before their use in any new patient population and to educate physicians on the limitations of these tests is emphasized in this review.

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Epidemiology and Treatment of Oropharyngeal Gonorrhea

Cited by 79 publications

References 30 publications

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

Clinical comparison of single-oral-dose cefuroxime axetil and amoxicillin with probenecid for uncomplicated gonococcal infections in women

Nucleic Acid Amplification Testing for Neisseria gonorrhoeae

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