National Gonorrhea Therapy Monitoring Study

Abstract

To monitor the efficacy of the 1972 United States Public Health Service recommended treatment regimens for uncomplicated gonorrhea, we studied 9008 patients who were randomly assigned either to aqueous procaine penicillin G, 4.8 million units intramuscularly plus 1 g of oral probenecid, or to one of the three other recommended regimens. Among the 3871 patients re-examined within three to seven days after therapy, the penicillin-probenecid regimen was successful in 96.8 per cent, whereas the cure rates of the ampicillin-probenecid, tetracycline, and spectinomycin regimens were 92.8, 96.2, and 94.8 per cent, respectively. In clinics comparing the regimens, penicillin G-probenecid was as effective as tetracycline, but more effective than ampicillin-probenecid (P less than 0.05) and spectinomycin (P less than 0.01). However, in patients re-examined three to 14 days after treatment, only the ampicillin-probenecid regimen was significantly less effective than penicillin probenecid (P less than 0.01). Despite these differences in results, all four regimens recommended by the Public Health Service provided effective therapy for uncomplicated gonorrhea.

In Vitro Activity of HR 756, a New Cephalosporin, Against Neisseria gonorrhoeae

“…gonorrhoeae have been reported to be cefamandole, cefoxitin, and cefuroxime (2,3,5,8,10,11). Our studies have confirmed that cefamandole and cefoxitin are effective in vitro against N. gonorrhoeae; however, HR 756 was much more active than either of these two antibiotics.…”

Effect of penicillin and spectinomycin given for urethritis and cervicitis with Neisseria gonorrhoeae: high prevalence of penicillin-resistant isolates.

“…Since the completion of the clinical study, we initiated a surveillance program to monitor the emergence of resistant strains to spectinomycin using sensitivity testing with 100 pg-spectinomycin disk and agar dilution. We have documented only a few sporadic (2) cases in a four year period, but a cautious approach to the widespreaduse of spectinomycin is recommended. Public health officials in the area must remain vigilant in their surveillance effort and be alert to the introduction or emergence of spectinomycin-resistant strain.…”

A Brief History of Evolving Diagnostics and Therapy for Gonorrhea: Lessons Learned

“…Oral regimens desirable for convenience, avoiding therapeutic injections and the need to store parentally administered drugs. Therapy came to include oral penicillin-like drugs (ampicillin and amoxicillin) which were widely preferred over injectable procaine penicillin/probenecid despite documentation of slightly lower treatment efficacy (1, 21). A four-day course of tetracycline had also been demonstrated 96.2% effective for uncomplicated gonorrhea in the National Gonorrhea Therapy Monitoring Study, but had the disadvantages of requiring patient medication adherence to complete the course of therapy and being contraindicated in pregnancy (21).…”

“…These media provided an important tool to better define the high prevalence of gonorrhea and laid the groundwork for increased U.S. Public Health Service (USPHS) emphasis on gonorrhea control. Using recently developed Thayer-Martin medium, the National Gonorrhea Therapy Monitoring Study (initiated in 1972 by the USPHS’s CDC) systematically evaluated 4 regimens for gonorrhea therapy, confirming the efficacy of aqueous procaine penicillin G plus probenecid (96.8%), ampicillin plus probenecid (92.8%), tetracycline (96.2%) and spectinomycin (94.8%) (21). These studies provided validation for the first formal CDC recommendations for gonorrhea therapy which had been released in 1972 (1).…”