Update on the management of gonorrhea in adults in the United States.

Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (proposed), Atlanta, GA 30333, USA.
Clinical Infectious Diseases (Impact Factor: 9.42). 05/2007; 44 Suppl 3:S84-101. DOI: 10.1086/511422
Source: PubMed

ABSTRACT 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.


Available from: Kimberly A Workowski, May 29, 2015
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    ABSTRACT: Gonorrhea treatment is challenging because of the emergence of resistance, treatment failure with existing drugs, and the lack of alternative agents. This study investigates the feasibility of targeting previously recommended antimicrobials to specific population subgroups where the prevalence of infection susceptible to these antimicrobials is above the World Health Organization cautionary treatment threshold of 95%. Descriptive data from the Gonococcal Resistance to Antimicrobials Surveillance Programme for England and Wales were analyzed to investigate patient characteristics associated with infection with susceptible isolates using univariate and multivariable analyses. Of 6173 isolates from 2007 to 2011, 4684 (82%) were susceptible to penicillin, 3899 (68%) to ciprofloxacin, and 5240 (91%) to cefixime. All subgroups of the MSM population had fewer than 95% of isolates susceptible to penicillin, ciprofloxacin, or cefixime. Higher proportions of isolates from heterosexual patient subgroups were susceptible to these antimicrobials. Multivariable models identified the following associations between patient characteristics and infection with susceptible isolates: patients aged 13 to 24 years (penicillin: 92.3% susceptible adjusted odds ratio and associated 95% confidence interval [aOR CI] 1.84-2.97; ciprofloxacin: 88.3%, aOR CI 2.22-3.39; cefixime: 98.7%, aOR CI 1.29-3.52) patients of black ethnicity (penicillin: 93.9%, aOR CI 2.72-4.91; ciprofloxacin: 92.0%, aOR CI 3.94-6.7; cefixime: 99.1%, aOR CI 1.78-6.4), and patients with concurrent chlamydia (penicillin: 93.9%, aOR CI 1.8-3.22; ciprofloxacin: 91.7%, aOR CI 2.71-4.58; cefixime: 99.0%, aOR CI 1.27-4.54). This study demonstrated that of the previous first-line therapies, cefixime would be the only antimicrobial suitable for use for infection in heterosexual patients alone.
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    ABSTRACT: Disseminated gonococcal infection (DGI) occurs in only a small minority of mucosal infections with Neisseria gonorrhoeae. Clinical manifestations of DGI include skin lesions, fever and musculoskeletal involvement. Articular mani-festations include arthralgia, tenosynovitis, peri-arthritis and arthritis. Useful imaging techniques in DGI are multiphase bone scintigraphy and grey-scale ultrasonography with power Doppler modality. Sonography provides a reliable way to detect and aspirate fluid, which can be used for microbial diagnosis. Besides diagnostic purposes, cultivation allows de-termination of antimicrobial susceptibility, which may have implications for therapy. Since quinolone-resistant gonococ-cal infection continues to spread, treatment recommendations have changed to administration of cephalosporins in differ-ent parts of the world.
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