ro13-9904 and Sexually-Transmitted-Diseases

To provide a summary of the economic and methodological evidence on capturing antimicrobial resistance (AMR) associated costs for curable sexually transmitted infections (STIs). To explore approaches for incorporating the cost of AMR within an economic model evaluating different treatment strategies for gonorrhoea, as a case study.. A systematic review protocol was registered on PROSPERO (CRD42022298232). MEDLINE, EMBASE, CINAHL, Cochrane Library, International Health Technology Assessment Database, National Health Service Economic Evaluation Database, and EconLit databases were searched up to August 2022. Included studies were analysed, quality assessed and findings synthesised narratively. Additionally, an economic evaluation which incorporated AMR was undertaken using a decision tree model and primary data from a randomised clinical trial comparing gentamicin therapy with standard treatment (ceftriaxone). AMR was incorporated into the evaluation using three approaches-integrating the additional costs of treating resistant infections, conducting a threshold analysis, and accounting for the societal cost of resistance for the antibiotic consumed.. Twelve studies were included in the systematic review with the majority focussed on AMR in gonorrhoea. The cost of ceftriaxone resistant gonorrhoea and the cost of ceftriaxone sparing strategies were significant and related to the direct medical costs from persistent gonorrhoea infections, sequelae of untreated infections, gonorrhoea attributable-HIV transmission and AMR testing. However, AMR definition, the collection and incorporation of AMR associated costs, and the perspectives adopted were inconsistent or limited. Using the review findings, different approaches were explored for incorporating AMR into an economic evaluation comparing gentamicin to ceftriaxone for gonorrhoea treatment. Although the initial analysis showed that ceftriaxone was the cheaper treatment, gentamicin became cost-neutral if the clinical efficacy of ceftriaxone reduced from 98% to 92%. By incorporating societal costs of antibiotic use, gentamicin became cost-neutral if the cost of ceftriaxone treatment increased from £4.60 to £8.44 per patient.. Inclusion of AMR into economic evaluations may substantially influence estimates of cost-effectiveness and affect subsequent treatment recommendations for gonorrhoea and other STIs. However, robust data on the cost of AMR and a standardised approach for conducting economic evaluations for STI treatment which incorporate AMR are lacking, and requires further developmental research.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cost-Benefit Analysis; Drug Resistance, Bacterial; Gentamicins; Gonorrhea; Humans; Sexually Transmitted Diseases; State Medicine

Pelvic inflammatory diseases (PID) must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is necessary to rule out tubo-ovarian abscess (TOA) (grade C). Microbiological diagnosis requires endocervical and TOA sampling for molecular and bacteriological analysis (grade B). First-line treatment for uncomplicated PID combines ceftriaxone 1 g, once, IM or IV, doxycycline 100 mg ×2/day, and metronidazole 500 mg ×2/day PO for 10 days (grade A). First-line treatment for complicated PID combines IV ceftriaxone 1-2 g/day until clinical improvement, doxycycline 100 mg ×2/day, IV or PO, and metronidazole 500 mg ×3/day, IV or PO for 14 days (grade B). Drainage of TOA is indicated if the pelvic fluid collection measures more than 3 cm (grade B). Follow-up is required in women with sexually transmitted infections (STIs) (grade C). The use of condoms is recommended (grade B). Vaginal sampling for microbiological diagnosis is recommended 3-6 months after PID (grade C), before the insertion of an intrauterine device (grade B), and before elective termination of pregnancy or hysterosalpingography. When specific bacteria are identified, antibiotics targeted at them are preferable to systematic antibiotic prophylaxis.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Ceftriaxone; Doxycycline; Female; France; Genitalia, Female; Humans; Metronidazole; Pelvic Inflammatory Disease; Pelvic Pain; Practice Guidelines as Topic; Sexually Transmitted Diseases; Ultrasonography

Urethritis prevalence in Europe changed in the last years due to both the increase of migratory streams from North Africa and the more frequent exposition of males to relevant risk factors. Owing to these reasons, urethritis treatment should be optimized by accurate microbiological investigations to avoid the risk of persistence, recurrence, or reinfection.. The aim of this systematic review is to optimize the treatments for urethritis and investigate the applicability of nucleic acid amplification test (NAAT) as the primary microbiological investigation.. A literature search in Medline, Cochrane, and Google Scholar databases was conducted up to June 2018. Subject headings were selected as follows: Urethritis OR gonococcal urethritis OR non-gonococcal urethritis AND Antibiotics OR Recurrence. A total of 528 abstracts were identified and selected. Finally, 12 full-text articles were selected for a qualitative synthesis. The Preferred Reported Items for Systematic Reviews and Meta-Analyses statement was used to perform an accurate research checklist and report.. Empirical treatments are no more recommended, although a broad spectrum of antibiotic therapy may be initiated while awaiting the results from pathogens' microbiological characterization. First-line treatment for gonococcal urethritis consists of a single dose of ceftriaxone/azithromycin combined therapy. Specific therapies should be initiated for nongonococcal urethritis according to each single pathogen involved in the infection process. Owing to this reason, NAAT is mandatory in the clinical approach to the disease, although the Gram stain of urethral discharge or smear remains applicable for some less frequent nongonococcal urethritis. Moreover, the urethritis "modern view" also includes noninfectious etiologies that occurred after traumas or injection of irritating compounds. Sexual abstinence of at least 7 d should be observed from the start of treatment to avoid reinfection, while sexual partners should evenly be treated.. The treatment of urethritis implies accurate determination of pathogens involved in the infection process by NAAT with subsequent appropriate antibiotic therapy, thus avoiding the risk of antibiotic resistance and overuse of antibiotics indicated for empirical treatments. The population exposed to relevant risk factors should be adequately informed about the increased risk of developing infections and motivated toward the intensive use of condoms during sexual intercourses.. Urethritis is a sexually transmitted disease generally characterized by urethral discharge or other symptoms such as itching, tingling, and apparent difficulties in having a regular urinary flow. Microbiological investigations are mandatory to obtain satisfactory results from the treatment. Multiple antibiotic treatments are often necessary due to the high risk of multiple pathogens responsible for the disease. Similarly, sexual partners should be investigated and treated in the same way. Several risk factors such as immunodeficiency, multiple sexual partners, homo- and bisexuality, and alcohol abuse may be related to the disease. In these cases, the use of condom is strongly recommended.

Topics: Africa, Northern; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Condoms; Drug Therapy, Combination; Europe; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Prevalence; Risk Factors; Sexually Transmitted Diseases; Urethritis

Topics: Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Humans; Meningitis, Bacterial; Otitis; Pyelonephritis; Sexually Transmitted Diseases

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Female; Gonorrhea; Humans; Japan; Male; Neisseria gonorrhoeae; Pharyngitis; Sexual Behavior; Sexually Transmitted Diseases

The most recent CDC guidelines for treatment of STDs list a number of syndromes for which ceftriaxone is the recommended therapy, including those caused by N. gonorrhoeae and H. ducreyi. The drug has successfully eradicated incubating syphilis. Its use in primary, secondary, and latent syphilis is promising, although adequate data regarding optimal dose and duration of therapy are not yet available. It remains to be seen whether ceftriaxone represents the sun rising on a new era of successful STD treatment or the sun setting on the old penicillin era.

Topics: Ceftriaxone; Female; Gonorrhea; Humans; Male; Sexually Transmitted Diseases; Syphilis

A review is given of the selection and rational of optimal treatment regimens for patients with sexually transmitted pathogens, e.g. in cases of gonorrhea, chlamydial infections, chancroid, syphilis, pelvic inflammatory diseases and ophthalmia neonatorum. The scientific basis for the selection of a beta-lactam agent is discussed, including dose, MIC, the critical serum level and maintenance interval, and the duration of therapy. Except in the case of penicillinase-producing Neiserria gonorrhoeae, penicillin remained until recently the most effective agent available against many sexually transmitted diseases. However, ceftriaxone, a new third-generation cephalosporin, has been shown to have a long half-life (8 h) and excellent in vitro efficacy against Neiserria gonorrhoeae (including penicillinase-producing strains) and Haemophilis ducreyi. In view of its exceptional clinical efficacy against both gonorrhea and chancroid, clinical studies of its efficacy against other sexually transmitted diseases appear warranted.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cephalosporins; Chancroid; Chlamydia Infections; Female; Gonorrhea; Humans; Infant, Newborn; Male; Ophthalmia Neonatorum; Pelvic Inflammatory Disease; Penicillins; Sexually Transmitted Diseases; Syphilis; Time Factors; Urethritis

We prospectively analysed a total of 21 baby-mother pairs with culture-proven Neisseria gonorrhoeae treated with a single low dose of ceftriaxone, namely 62.5 mg for babies and 125 mg for mothers respectively. N. gonorrhoeae was eradicated from all babies' eyes with no residual damage, as well as from the mothers' cervixes. A single low dose of 62.5 mg ceftriaxone has emerged as the treatment of choice for gonococcal ophthalmia neonatorum because of its excellent activity against N. gonorrhocae, including penicillinase-producing strains.

Topics: Adult; Ceftriaxone; Cephalosporins; Cervix Uteri; Endophthalmitis; Eye; Female; Gonorrhea; Humans; Infant, Newborn; National Health Programs; Neisseria gonorrhoeae; Prospective Studies; Rectum; Sexually Transmitted Diseases; South Africa; Urethra

Sexually transmitted diseases (STDs) are highly prevalent in pregnant women in many developing countries and have been associated with poor obstetric outcomes. Case detection and treatment of STDs in women is problematic and expensive, underscoring the need for other strategies. To explore the potential benefits of routine antimicrobial therapy on pregnancy outcome, we carried out a randomized, double-blind, clinical trial in one of the antenatal clinics in Nairobi, Kenya. Four hundred pregnant women between 28 and 32 weeks' gestation were given a single dose of 250 mg ceftriaxone intramuscularly or a placebo. There was a significant difference between ceftriaxone and placebo-treated women in infant birth weight (3,209 versus 3,056 g, P = .01). In addition, there was a trend toward lower rates of birth weight < 2,500 g (4.0% versus 9.2%, P = .08) and postpartum endometritis (3.8% versus 10.4%, P = .05) in the intervention than in the placebo group. Neisseria gonorrhoeae was isolated from the cervixes of postpartum women in 1.8% of the intervention group as compared to 4.2% of the control group. These data suggest a beneficial effect of antimicrobial prophylaxis on pregnancy outcome. Larger studies should be carried out to examine the public health impact of this intervention.

Topics: Adult; Birth Weight; Ceftriaxone; Developing Countries; Double-Blind Method; Female; Humans; Kenya; Mass Screening; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnancy Trimester, Third; Sexually Transmitted Diseases

In South Africa, male urethritis syndrome (MUS) is the most common sexually transmitted infection (STI) syndrome in men. We determined the distribution of STI etiologies and the susceptibility profiles of Neisseria gonorrhoeae isolates from men presenting with MUS to 3 sentinel surveillance health care facilities. Secondary objectives were to determine the seroprevalence of coinfections (HIV, syphilis, herpes simplex virus 2).. Consecutive, consenting men with symptomatic urethral discharge were enrolled between January 1, 2019, and December 31, 2020. Genital discharge swab and blood specimens were collected and transported to a central STI reference laboratory in Johannesburg, South Africa.. Among 769 men enrolled, N. gonorrhoeae was the commonest cause of MUS (674 [87.8%]; 95% confidence interval [CI], 85.2%-89.9%), followed by Chlamydia trachomatis (161 [21.0%]; 95% CI, 18.2%-24.0%). Of 542 cultivable N. gonorrhoeae isolates, all were susceptible to ceftriaxone (modal minimum inhibitory concentration, 0.004 mg/L) and azithromycin (modal minimum inhibitory concentration, 0.128 mg/L). Seroprevalence rates of HIV, syphilis, and HSV-2 were 21.4% (95% CI, 18.5%-24.5%), 2.3%, and 50.1%, respectively. Condom use at last sexual encounter was reported by only 7%, less than 50% had been medically circumcised, and only 66.7% (58 of 87) who self-reported an HIV-positive status were adherent on antiretroviral drugs.. Neisseria gonorrhoeae and C. trachomatis were the predominant causes of MUS. Currently recommended dual ceftriaxone and azithromycin therapy are appropriate for MUS syndromic management; however, surveillance must be maintained to timeously detect emerging and increasing gonococcal resistance. Clinic-based interventions must be intensified in men seeing sexual health care to reduce the community transmission and burden of STI and HIV.

Topics: Azithromycin; Ceftriaxone; Chlamydia trachomatis; Gonorrhea; Herpesvirus 2, Human; HIV Infections; Humans; Male; Neisseria gonorrhoeae; Seroepidemiologic Studies; Sexually Transmitted Diseases; South Africa; Syphilis; Urethritis

Sexually transmitted infection (STI) rates are increasing for most nationally notifiable disease categories in the United States. The 2021 Centers for Disease Control and Prevention STI guidelines provide several updated, evidence-based testing and treatment recommendations. The recommended treatment for gonorrhea is ceftriaxone monotherapy given intramuscularly, with dosing based on the patient's body weight. For chlamydia, doxycycline is the preferred treatment. A test-of-cure is recommended for all cases of pharyngeal gonorrhea and for rectal chlamydia if treated with azithromycin. Vaginal trichomoniasis should be treated with a seven-day regimen of metronidazole. Treatment of pelvic inflammatory disease routinely includes metronidazole with doxycycline and an increased dosage of ceftriaxone. Syphilis of less than one year's duration should be treated with a single dose of intramuscular penicillin G benzathine, 2.4 million units. Syphilis of more than one year's or unknown duration should be treated with three consecutive weekly doses of intramuscular penicillin G benzathine, 2.4 million units each. A thorough evaluation for otic, ophthalmic, and neurologic symptoms is essential for anyone with syphilis because these complications can occur at any stage and require 10 to 14 days of treatment with intravenous aqueous crystalline penicillin G. Family physicians can reduce STI rates by taking a thorough sexual history, especially in teens and young adults, ordering screening tests and treatment based on the updated Centers for Disease Control and Prevention STI guidelines, and collaborating with public health departments for disease reporting and partner services.

Topics: Adolescent; Ceftriaxone; Centers for Disease Control and Prevention, U.S.; Chlamydia Infections; Doxycycline; Female; Gonorrhea; Humans; Metronidazole; Penicillin G Benzathine; Sexually Transmitted Diseases; Syphilis; United States; Young Adult

A higher dose of ceftriaxone is now recommended for gonorrhea. Doxycycline, not azithromycin, is first-line therapy for chlamydia.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Centers for Disease Control and Prevention, U.S.; Chlamydia Infections; Gonorrhea; Humans; Sexually Transmitted Diseases; United States

Topics: Acquired Immunodeficiency Syndrome; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Chlamydia trachomatis; Coinfection; Colonoscopy; Cytomegalovirus; DNA, Bacterial; Doxycycline; Drug Therapy, Combination; Granuloma; Humans; Intestinal Mucosa; Male; Middle Aged; Neisseria gonorrhoeae; Proctitis; Rectum; Sexually Transmitted Diseases; Treatment Outcome; Valganciclovir

Neisseria meningitidis sequence type 11 is an emerging cause of urethritis. We demonstrate by using whole-genome sequencing orogenital transmission of a N. meningitidis sequence type 11 isolate causing urethritis in a monogamous couple of men who have sex with men. These results suggest dissemination of this clonal complex among low-risk patients.

Topics: Acute Disease; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Communicable Diseases, Emerging; Humans; Injections, Intramuscular; Male; Meningococcal Infections; Neisseria meningitidis; Sexual and Gender Minorities; Sexually Transmitted Diseases; Treatment Outcome; Urethritis; Whole Genome Sequencing; Young Adult

Topics: Azithromycin; Ceftriaxone; Gonorrhea; Humans; Neisseria gonorrhoeae; Sexually Transmitted Diseases; United Kingdom

Sexually transmitted infections (STIs) are managed syndromically in most developing countries. In Zimbabwe, men presenting with urethral discharge are treated with a single intramuscular dose of kanamycin or ceftriaxone in combination with a week's course of oral doxycycline. This study was designed to assess the current etiology of urethral discharge and other STIs to inform current syndromic management regimens.. We conducted a study among 200 men with urethral discharge presenting at 6 regionally diverse STI clinics in Zimbabwe. Urethral specimens were tested by multiplex polymerase chain reaction testing for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis. In addition, serologic testing for syphilis and HIV was performed.. Among the 200 studied men, one or more pathogens were identified in 163 (81.5%) men, including N. gonorrhoeae in 147 (73.5%), C. trachomatis in 45 (22.5%), T. vaginalis in 8 (4.0%), and M. genitalium in 7 (3.5%). Among all men, 121 (60%) had a single infection, 40 (20%) had dual infections, and 2 (1%) had 3 infections. Among the 45 men with C. trachomatis, 36 (80%) were coinfected with N. gonorrhoeae. Overall, 156 (78%) men had either N. gonorrhoeae or C. trachomatis identified. Of 151 men who consented to HIV testing, 43 (28.5%) tested positive. There were no differences in HIV status by study site or by urethral pathogen detected.. Among men presenting at Zimbabwe STI clinics with urethral discharge, N. gonorrhoeae and C. trachomatis are the most commonly associated pathogens. Current syndromic management guidelines seem to be adequate for the treatment for symptomatic men, but future guidelines must be informed by ongoing monitoring of gonococcal resistance.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Health Surveys; Humans; Kanamycin; Male; Multiplex Polymerase Chain Reaction; Nucleic Acid Amplification Techniques; Sexual Behavior; Sexually Transmitted Diseases; Suppuration; Urethritis; Zimbabwe

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Neisseria gonorrhoeae; Sexual Partners; Sexually Transmitted Diseases; Young Adult

An HIV-negative man with pharyngeal gonorrhea had a positive test-of-cure (nucleic acid amplification test) result 7 days after treatment with ceftriaxone/azithromycin. Neisseria gonorrhoeae Multi-Antigen Sequencing Type 1407 and mosaic pen A (XXXIV) gene were identified in the test-of-cure specimen, and culture was negative. Retreatment with ceftriaxone 500 mg intramuscularly plus azithromycin 2 g orally yielded a negative test-of-cure result.

Topics: Anti-Bacterial Agents; Asymptomatic Diseases; Azithromycin; Ceftriaxone; Gonorrhea; Humans; Injections, Intramuscular; Male; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Pharynx; Sexually Transmitted Diseases; Treatment Outcome; Young Adult

Topics: Administration, Intravenous; Azithromycin; Ceftriaxone; Drug Resistance, Bacterial; Europe; Gonorrhea; Humans; Practice Guidelines as Topic; Sexually Transmitted Diseases; United States

Pelvic inflammatory disease (PID) is a common clinical syndrome with highest rates in adolescents, but no studies have singularly focused on this population in relationship to established guidelines for diagnosis and treatment. The study objective was to assess knowledge of diagnosis and treatment criteria for PID within an adolescent population and to compare factors associated with adherence to Centers for Disease Control and Prevention guidelines in outpatient settings.. Data were collected as part of a retrospective chart review of evaluation, diagnosis, and treatment of sexually transmitted infections in adolescent women in an outpatient setting. Participant charts were eligible for review if they were 12 to 21 years of age and were given an International Classification of Diseases, Ninth Revision/chart diagnosis of PID. Two primary outcome variables were utilized: meeting PID diagnosis guidelines (no/yes) and correct treatment for subject meeting criteria with guidelines (no/yes). The study controlled for race, age, medical venue, and current/past infection with gonorrhea/chlamydia.. Subjects (n = 150) were examined for the primary outcome variables; 78% (117/150) met at least 1 criterion for PID diagnosis. Nearly 75% (111/150) had cervical motion tenderness, 34% (51/150) adnexal tenderness, and 5% (7/150) had uterine tenderness; nearly 11% (16/150) were positive for all 3 criteria. Symptoms associated with PID were compared for subjects meeting diagnosis criteria versus subjects not meeting diagnosis criteria: abdominal pain and vomiting were significantly associated with PID diagnosis at P < 0.05.. Our findings show that PID diagnosis/treatment often does not follow guidelines in the adolescent population. Pelvic inflammatory disease and cervicitis appear to be confused by providers in the diagnosis process, and educational tools may be necessary to increase the knowledge base of practitioners in regard to PID.

Topics: Adolescent; Anti-Bacterial Agents; Arkansas; Ceftriaxone; Centers for Disease Control and Prevention, U.S.; Child; Diagnosis, Differential; Diagnostic Errors; Doxycycline; Ethnicity; Female; Guideline Adherence; Humans; International Classification of Diseases; Levofloxacin; Metronidazole; Ofloxacin; Outpatient Clinics, Hospital; Pain; Pelvic Inflammatory Disease; Practice Guidelines as Topic; Recurrence; Retrospective Studies; Sexually Transmitted Diseases; Symptom Assessment; United States; Uterine Cervicitis; Young Adult

Topics: Abscess; Adult; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Gonorrhea; Humans; Male; Penile Diseases; Sebaceous Gland Diseases; Sexual Behavior; Sexually Transmitted Diseases; Travel; United States; Vietnam

The British Association for Sexual Health and HIV (BASHH) UK gonorrhoea guideline has been updated in 2011. It offers advice on diagnosis, treatment and health promotion for anogenital and pharyngeal gonorrhoea. Nucleic acid amplification tests (NAATs) are now being used more for diagnosis and are increasing detection rates in the pharynx and rectum. First line treatment using ceftriaxone with azithromycin is now advised, along with routine test of cure (TOC). The aim is to slow the spread of resistant gonorrhoea now that fewer antibiotics remain effective. A patient information leaflet has been developed.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Disease Management; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Sexually Transmitted Diseases

Most important news are the reimbursement of post-exposure prophylaxis for HIV, change in treatment of gonococcal infections, increase of syphilis and sexually transmitted hepatitis C infections among HIV-infected men who have sex with men. Vaccination against papillomavirus (HPV) is not discussed here. Animal and human studies have shown that 28 days post-exposure prophylaxis for HIV initiated within 72 hours after the contact at risk could reduce the risk of HIV acquisition. This prophylaxis is now reimbursed in Belgium if it is prescribed by a HIV reference center, based on the Belgian consensus for HIV post-exposure prophylaxis. A single intramuscular dose of ceftriaxone 125 mg is now the best choice for the treatment of gonococcal infection, due to the resistance more and more frequent to penicillin, tetracycline and fluoroquinolone. If a concomitant infection with Chlamydia trachomatis has not been ruled out, a single dose of azithromycin 1 g or doxycycline for 7 days will be added. Syphilis is shortly reviewed and addresses of few very useful Internet sites are given.

Topics: Anti-Bacterial Agents; Anti-HIV Agents; Belgium; Ceftriaxone; Environmental Exposure; Female; Gonorrhea; HIV Infections; Humans; Male; Reimbursement Mechanisms; Sexually Transmitted Diseases; Zidovudine

Sexually transmitted diseases (STDs), especially HIV infection, gonococcal infection and genital chlamydial infections are increasing all over the world. UNAIDS recently reported that the number of HIV/AIDS patients had been increasing and the highest prevalence was found in African countries, followed by Caribbean, Asian and Eastern European countries. HIV infection has also been gradually increasing in Japan. In non-HIV STDs, genital chlamydial infections are increasing worldwide also. On the contrary, gonococcal infections have been decreasing in many countries except Asian countries. N. gonorrhoeae has been changing in its infecting sites. The pharynx is the most important infecting site, because gonococcal infection in the pharynx may be one of the causes of the wide spread of N. gonorrhoeae. Antimicrobial-resistant N. gonorrhoeae has wide distribution throughout the world. For example, penicillin-resistant N. gonorrhoeae is prevalent in various part of the world, and fluoroquinolone-resistant N. gonorrhoeae is prevalent mainly in Asia. In addition to penicillin, tetracycline and fluoroquinolone resistance, N. gonorrhoeae acquired resistance to almost all of the cephalosporins except for ceftriaxone and cefodizime in Japan. Although there is no resistant strain to ceftriaxone, cefodizime and spectinomycin, 1.0 g single dose of ceftriaxone is considered to be the most suitable regimen for the treatment of gonococcal infection including the pharyngeal infection, because of the 100% elimination rate of N. gonorrhoeae from the urethra, cervix and pharynx obtained in a recent study.

Topics: Anti-Bacterial Agents; Ceftriaxone; Chlamydia Infections; Drug Resistance, Bacterial; Gonorrhea; HIV Infections; Humans; Japan; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Pharynx; Sexually Transmitted Diseases

In the United Kingdom many genitourinary medicine clinics use oral doxycycline and metronidazole to treat pelvic inflammatory disease (PID). A retrospective case note review of PID treatment at our department in 2000 showed that the clinical cure rate (CCR) was only 55% with oral doxycycline and metronidazole for 2 weeks. We therefore added ceftriaxone 250 mg intramuscularly to the doxycycline and metronidazole for treating PID. We have repeated the review and compared the results with those from 2000.. All patients diagnosed as having PID between 1 July 2002 and 31 December 2002 were identified. These episodes were diagnosed on clinical presentations of pelvic pain, vaginal discharge or bleeding, and cervical motion tenderness on physical examination. The CCR was defined as patients who fully resolved their symptoms and signs during 2 week and 4 week follow up. The results were compared with those from 2000.. Women receiving ceftriaxone, doxycycline, and metronidazole had a CCR of 72%. In 2000 the CCR for women receiving only doxycycline and metronidazole was 55%. There were only 8% non-responders in 2002 compared with 18% in 2000. Comparing CCR and non-response rate, in 2002 there was a significant improvement in cure rate, OR 3.01 (95% CI 1.28 to 7.47) p = 0.009. Using an intent to treat analysis and including the defaulters as treatment failures there was still a significant improvement in cure rate, OR 2.03 (95% CI 1.18 to 3.50) p = 0.009.. The treatment of PID with ceftriaxone, doxycycline, and metronidazole gave a significantly higher CCR than doxycycline and metronidazole. Our experience would suggest that doxycycline and metronidazole alone is not a suitable regimen for treatment of PID in the United Kingdom.

Topics: Ambulatory Care; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Female; Humans; Injections, Intramuscular; Metronidazole; Pelvic Inflammatory Disease; Sexually Transmitted Diseases; Treatment Outcome

Topics: Bisexuality; California; Cefixime; Ceftriaxone; Centers for Disease Control and Prevention, U.S.; Drug Resistance, Bacterial; Female; Fluoroquinolones; Homosexuality, Male; Humans; Infertility; Male; Mass Screening; Pelvic Inflammatory Disease; Practice Guidelines as Topic; Risk Factors; Sexually Transmitted Diseases; United States

Topics: Anti-Bacterial Agents; Ceftriaxone; Chlamydia trachomatis; Ciprofloxacin; Doxycycline; Epididymitis; Humans; Male; Neisseria gonorrhoeae; Ofloxacin; Orchitis; Sexually Transmitted Diseases

Topics: Anti-Bacterial Agents; Cefoxitin; Ceftriaxone; Ciprofloxacin; Clindamycin; Contact Tracing; Female; Genital Diseases, Male; Humans; Male; Ofloxacin; Pelvic Inflammatory Disease; Peritonitis; Pregnancy; Pregnancy Complications, Infectious; Sexually Transmitted Diseases

We report the sensitivity and specificity of physical examination findings for diagnosing primary syphilis, chancroid, and genital herpes. The physical features of genital ulcers in 446 men were measured in accordance with a quantitative scale. Two hundred-twenty of these men had an established, single microbiological diagnosis. Forty-five (20%) had primary syphilis, 118 (54%) had chancroid, and 57 (26%) had genital herpes. There was considerable overlap in the clinical presentation of these three diseases. The classic clinical sign complex attributed to primary syphilis (painless, indurated, clean-based ulcers) was only 31% sensitive but 98% specific. The classic presentation of a chancroid ulcer (a deep, undermined, purulent ulcer) was only 34% sensitive but 94% specific. The classic description of genital herpes ulcers (multiple, shallow, tender ulcers) was only 35% sensitive but 94% specific. Inguinal lymph node findings did not contribute significantly to clinical diagnostic accuracy. These data indicate that the clinical diagnosis of genital ulcer disease can be made with reasonable certainty only for a minority of patients. Rapid, sensitive, and specific diagnostic tests for syphilis, chancroid, and genital herpes are needed.

Topics: Adolescent; Adult; Aged; Ceftriaxone; Cephalosporins; Chancre; Chancroid; Genitalia, Male; Herpes Genitalis; Humans; Male; Middle Aged; Penicillin G; Penicillins; Predictive Value of Tests; Sensitivity and Specificity; Sexually Transmitted Diseases; Syphilis; Ulcer

Topics: Cefixime; Cefotaxime; Ceftriaxone; Gonorrhea; HIV Infections; Humans; Sexually Transmitted Diseases

Following a brief review of the main bacteriological and pharmacokinetic properties of ceftriaxone, the authors present a therapeutic evaluation of this new cephalosporin antibiotic. The effects of ceftriaxone in severe infections, such as septicaemia, bacterial meningitis, urinary tract infections, typhoid, bone infections and sexually transmitted diseases, are described on the basis of recent publications. Mention is also made of the adverse reactions to, and benign side-effects of the drug. Finally, the advantages of ceftriaxone in the treatment of some infections are envisaged: the single daily dose and short therapeutic courses may modify therapeutic habits and exert a beneficial effect on costs in some cases.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Humans; Meningitis; Respiratory Tract Infections; Sepsis; Sexually Transmitted Diseases; Typhoid Fever; Urinary Tract Infections