Penicillin resistant Neisseria gonorrhoeae in low prevalence areas: implications for cost-effective management
The incidence of gonorrhea in which Neisseria gonorrhoeae, the bacteria causing the infection, has become penicillin-resistant has increased on the coasts of the US and in large cities. Rural regions are apparently less affected by this problem. Two measures to deal with this have been recommended. One, all isolated gonorrhea samples should be tested for penicillin resistance, and two, penicillin should be given only to sexual contacts of patients infected with penicillin-sensitive gonorrheal strains. However, the effectiveness and cost of these policies in rural, low prevalence areas is not established. The cost-effectiveness of bacterial screening and penicillin alternatives was studied in a rural Iowa county following an outbreak of penicillin-resistant gonorrhea. Assumptions about medical outcomes were derived from the literature. The outbreak was abrupt and infection extended rapidly, factors that supported the need to identify best strategies for antibiotic choice and use of bacterial testing. Five strategies, which differed in bacterial screening and antibiotic usage for cases of varying risks and presumed or known infections, were identified. Without bacterial screening, ciprofloxacin, an alternative to penicillin, as the only therapy for presumed and known infections (unless medically inappropriate), was the most cost-effective strategy. Ciprofloxacin should not be used by patients 16 years old or younger or by pregnant women, and the most cost-effective alternative for these patients is to treat them initially with penicillin-like antibiotics, test isolated bacteria for penicillin resistance, and then recall those patients with resistant infections for alternative treatment. The study suggests that patients with known or presumed gonorrhea infections should be routinely treated with an inexpensive drug which is effective against penicillin-resistant gonorrhea, such as ciprofloxacin. In addition, bacterial screening should also be performed routinely. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Sexually Transmitted Diseases
Longitudinal evaluation of serovar-specific immunity to Neisseria gonorrhoeae
A study of 2,838 subjects has been carried out in North Carolina in 1992-94 to evaluate epidemiologic evidence for serovar-specific immunity to Neisseria gonorrhoeae. All clients at a sexually transmitted disease (STD) clinic underwent genital culture for the organism. Gonococcal isolates were serotyped, and 427 males and 181 females were found to be infected at the time of the first visit, while 90 patients had 112 repeat gonococcal infections. Repeat infection with the same serovar was slightly more prevalent than would be expected on the basis of prevalent serovars in the community at the time of reinfection. Infection did not bring on immunity to same-serovar reinfection. The serovars of N. gonorrhoeae predominant in a community change in time, perhaps because of development of immunity to repeat infection with the same serovar.
Publication Name: American Journal of Epidemiology
Time required for elimination of Neisseria gonorrhoeae from the urogenital tract in men with symptomatic urethritis: comparison of oral and intramuscular single-dose therapy
Both oral and injected antibiotics appear to rapidly cure gonorrhea. Researchers cultured urethral, throat, semen and urine specimens from 16 men with gonorrhea before and after antibiotic treatment. Of these, six were injected with 250 milligrams (mg) of ceftriaxone, five received 500 mg of oral ciprofloxacin, and five took 400 mg of oral cefixime. Compared with pre-treatment levels, the number of gonococcal microorganisms in urine samples decreased in all men two hours after treatment. Four hours after therapy, urine cultures were negative for gonococcal microorganisms except in two men treated with cefixime. One day after therapy, no gonococcal microorganisms were identified in urine, urethral, throat, or semen cultures. Rapid gonorrhea cures are important to reduce the spread of the disease.
Publication Name: Sexually Transmitted Diseases
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