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: 8.89). 05/2007; 44 Suppl 3(3):S84-101. DOI: 10.1086/511422
Source: PubMed


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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Available from: Kimberly A Workowski
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    • "Accordingly, new antimicrobials for treatment of gonorrhoea are essential to develop. There are few new compounds in sight [3,6,16,64]. The new fluoroketolide solithromycin (class: macrolides) has recently been investigated and showed an activity superior to that of most other antimicrobials previously or currently recommended for treatment of gonorrhoea [23]. "
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    ABSTRACT: Background Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major public health concern worldwide. In Vietnam, knowledge regarding N. gonorrhoeae prevalence and AMR is limited, and data concerning genetic characteristics of N. gonorrhoeae is totally lacking. Herein, we investigated the phenotypic AMR (previous, current and possible future treatment options), genetic resistance determinants for extended-spectrum cephalosporins (ESCs), and genotypic distribution of N. gonorrhoeae isolated in 2011 in Hanoi, Vietnam. Methods N. gonorrhoeae isolates from Hanoi, Vietnam isolated in 2011 (n = 108) were examined using antibiograms (Etest for 10 antimicrobials), Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST), and sequencing of ESC resistance determinants (penA, mtrR and penB). Results The levels of in vitro resistance were as follows: ciprofloxacin 98%, tetracycline 82%, penicillin G 48%, azithromycin 11%, ceftriaxone 5%, cefixime 1%, and spectinomycin 0%. The MICs of gentamicin (0.023-6 mg/L), ertapenem (0.002-0.125 mg/L) and solithromycin (<0.016-0.25 mg/L) were relatively low. No penA mosaic alleles were found, however, 78% of the isolates contained an alteration of amino acid A501 (A501V (44%) and A501T (34%)) in the encoded penicillin-binding protein 2. A single nucleotide (A) deletion in the inverted repeat of the promoter region of the mtrR gene and amino acid alterations in MtrR was observed in 91% and 94% of the isolates, respectively. penB resistance determinants were detected in 87% of the isolates. Seventy-five different NG-MAST STs were identified, of which 59 STs have not been previously described. Conclusions In Vietnam, the highly diversified gonococcal population displayed high in vitro resistance to antimicrobials previously recommended for gonorrhoea treatment (with exception of spectinomycin), but resistance also to the currently recommended ESCs were found. Nevertheless, the MICs of three potential future treatment options were low. It is essential to strengthen the diagnostics, case reporting, and epidemiologic surveillance of gonorrhoea in Vietnam. Furthermore, the surveillance of gonococcal AMR and gonorrhoea treatment failures is imperative to reinforce. Research regarding novel antimicrobial treatment strategies (e.g., combination therapy) and new antimicrobials is crucial for future treatment of gonorrhoea.
    Full-text · Article · Jan 2013 · BMC Infectious Diseases
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    • "Neisseria gonorrhoeae is a fastidious gram-negative diplococci . It is an important cause of cervicitis, urethritis, and pelvic inflammatory disease (PID) [1]. This organism also causes septic arthritis or a distinct syndrome of disseminated gonococcal infection (DGI), with tenosynovitis, skin lesions, and polyarthralgia [2]. "
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    ABSTRACT: Disseminated gonococcal infection (DGI) is an uncommon complication of Neisseria gonorrhoeae infection, its manifestation varies from a classic arthritis-dermatitis syndrome to uncommon pyogenic infections of several organs. Herein, we reported atypical presentation of DGI with subcutaneous abscess of right knee, pyomyositis of right lower extremity, and subsequently complicated by Escherichia coli pyomyositis. This infection responded to appropriate antimicrobial therapy and prompt surgical management with good clinical outcome.
    Full-text · Article · Aug 2012
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    • "[21] Cefixime for GC 0.975 0.955–0.995 [21] Probability of developing PID if patients with uncured CT or GC infections 0.20 0.1–0.4 [22] [23] Test cost ( "
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    ABSTRACT: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are two common sexually transmitted diseases (STDs) in the United States. Annual screening for CT for all sexually active women aged 25 years and younger, all pregnant women, women with history of STDs, or women older than 25 years who are at increased risk of infection (e.g., women who have a new or more than one sex partner) is recommended by several medical professional organizations. Publicly-funded programs usually do not have enough funding to screen and treat all patients. Therefore, we propose a resource allocation model to assist clinic decisionmakers under a given budget in selecting a CT and GC screening and treatment strategy for clinic patients. This model is designed to maximize the number of cured cases. Our study demonstrates that a resource allocation model can be used to identify an optimal strategy among many potential strategies to guide decisions about effective use of limited resources for CT and GC control and prevention. The results of the model also helped to identify key variables in the model and to understand how each key variable affects the determination of the optimal strategy.
    Preview · Article · Jun 2012 · Operations Research for Health Care
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