Download full-text

Full-text

Available from: Robert D Kirkcaldy, Oct 15, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Gonorrhea, caused by Neisseria gonorrhoeae is the second most prevalent bacterial sexually transmitted infection. The disease causes serious reproductive complications such as pelvic inflammatory disease, ectopic pregnancy, and infertility, and can facilitate human immunodeficiency virus transmission. Numerous antimicrobial agents have been used for the treatment of gonorrhea since sulfanilamides were introduced in 1936. Unfortunately, N. gonorrhoeae readily develops resistance to antimicrobial agents. Strains with decreased susceptibility to oral third generation cephalosporin (cefixime) are currently emerging. The US Centers for Disease Control and Prevention (CDC) no longer recommends cefixime at any dose as a first-line regimen for treatment of gonococcal infections, but recommends combination therapy with ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days as the most reliably effective treatment for uncomplicated gonorrhea.
    Full-text · Article · Jan 2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The Centers for Disease Control and Prevention guidelines for pharyngeal gonorrhea treatment recommend dual therapy with intramuscular ceftriaxone and either azithromycin or doxycycline. Few clinical data exist to support this recommendation. Methods: We conducted a retrospective analysis of patients diagnosed with pharyngeal gonorrhea during 1993-2011, at a sexually transmitted disease clinic in Seattle, Washington, and compared the proportion of repeat positive tests for pharyngeal gonorrhea 7-180 days following treatment among persons receiving different drug regimens. Associations of treatment regimens were assessed using relative risks through Poisson regression models with log link and robust standard errors. Results: A total of 1440 cases of pharyngeal gonorrhea were diagnosed during the study period, 25% of which (n = 360) underwent retesting. Among retested patients, the risk of repeat positive test was lowest among persons receiving an oral cephalosporin and azithromycin (7%, reference group), and highest among those receiving an oral cephalosporin alone (30%; relative risk [RR], 3.98; 95% confidence interval [CI], 1.70-9.36) or in combination with doxycycline (33%; RR, 4.18; 95% CI, 1.64-10.7). The risk of repeat test positivity did not significantly differ between persons treated with an oral cephalosporin and azithromycin and those treated with ceftriaxone alone (9.1%; RR, 0.81; 95% CI, .18-3.60) or ceftriaxone combined with azithromycin or doxycycline (11.3%; RR, 1.20; 95% CI, .43-3.33). Conclusions: In this retrospective study, dual therapy with an oral third-generation cephalosporin and azithromycin was comparable to ceftriaxone-based regimens in the treatment of pharyngeal gonorrhea. Combination oral therapy with doxycycline was associated with an elevated risk of persistent or recurrent infection.
    No preview · Article · Feb 2013 · Clinical Infectious Diseases
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pregnant women in the United States are underscreened for chlamydia and gonorrhea, despite recommendations for broad testing. This puts women and infants at risk of complications from untreated infections. Nurses and other clinicians who care for pregnant women have a responsibility to be up-to-date in their knowledge of screening guidelines and to provide appropriate counseling to pregnant women based on their individual risk factors.
    No preview · Article · Apr 2013 · Nursing for Women s Health
Show more