ro13-9904 and Urethritis

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

By culturing for N gonorrhoeae in cases of neonates and children with conjunctivitis, vaginitis, urethritis, proctitis, sepsis, and arthritis, gonococcal infections can be identified easily. They are then treated with ceftriaxone. In neonates, the mother and her sexual contacts also should be treated. In children, a full evaluation for sexual contacts, with the assistance of other professionals, if necessary, will almost always identify a sexual contact. Appropriate action then can be taken to protect the child from further sexual contact. .

Topics: Abscess; Ceftriaxone; Child; Child, Preschool; Conjunctivitis; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Male; Mouth Diseases; Ophthalmia Neonatorum; Pelvic Inflammatory Disease; Pharyngeal Diseases; Proctitis; Scalp Dermatoses; Urethritis; Vaginitis

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 assessed the efficacy of fosfomycin trometamol in treating uncomplicated gonococcal urethritis in men. We conducted an open randomized controlled trial in 152 consecutive men with any main complaints suggestive of uncomplicated gonococcal urethritis in Dujiangyan Medical Center between 1 September 2013 and 31 August 2015. In total, 126 patients completed all aspects of this study. Sixty were provided therapy with fosfomycin trometamol 3 g orally on days 1, 3 and 5 in the intervention group; the other 61 were provided ceftriaxone 250 mg intramuscularly plus azithromycin 1 g orally simultaneously as a single dose in the control group. The primary outcomes involved clinical and microbiologic cure on days 7 and 14 after receipt of all the study medications. At the day 7 follow-up visit, all the 121 participants had complete resolution of clinical symptoms and signs. In addition, five patients (two in the intervention group and three in the control group) discontinued intervention because of unsuccessful treatment. After receipt of all the study medications, these five patients still had urethral purulent discharge and were switched to other unknown treatment regimens by other doctors. The bacterial smears and cultures of urethral or urine specimens in the 121 patients who completed all aspects of the study were negative on a test-of-cure visit. In the per-protocol analysis, both clinical and microbiologic cure were experienced by 96.8% (60/62 patients) in the intervention group and 95.3% (61/64 patients) in the control group. There were no recurrences at the day 14 test-of-cure visit. This trial indicates that fosfomycin trometamol exhibits excellent efficacy for treatment of uncomplicated gonococcal urethritis in men. Serious adverse effects are rare.

Topics: Administration, Oral; Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Fosfomycin; Gonorrhea; Humans; Injections, Intramuscular; Male; Middle Aged; Treatment Outcome; Urethritis; Young Adult

This prospective study was carried out to determine the antimicrobial susceptibility of Neisseria gonorrhoeae isolates by disc diffusion method and minimum inhibitory concentration (MIC) by E -test with special reference to azithromycin. Also, the correlation between in vitro susceptibility and treatment outcome with single 2 g oral dose azithromycin was assessed.. The study included 75 gonococcal isolates from males with urethritis, females with endocervicitis and their sexual contacts. All isolates were subjected to susceptibility testing for penicillin, ciprofloxacin, tetracycline, ceftriaxone, spectinomycin, cefixime and azithromycin. Males with gonococcal urethritis were randomised to receive a single dose of either azithromycin or ceftriaxone. Forty-two men with urethritis received 2 g single oral dose azithromycin, while all other patients were given 250 mg parentral ceftriaxone. All patients were called for follow-up to assess clinical and microbiological cure rates.. While all the isolates were susceptible to ceftriaxone, spectinomycin, cefixime and azithromycin; 74 (98.7%), 24 (32%) and 23 (30.7%) strains were resistant to ciprofloxacin, penicillin and tetracycline respectively, by both disc diffusion method and E -test. The MIC range, MIC50 and MIC90 of N. gonorrhoeae strains, to azithromycin were 0.016-0.25, 0.064 and 0.19 microg/mL, respectively. Follow-up attendance of the patients was 52.4 with 100% clinical and microbiological cure rates.. Results of our study indicate that 2 g single oral dose azithromycin is safe and effective in the treatment of uncomplicated gonorrhoea.

Topics: Administration, Oral; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Drug Resistance, Bacterial; Endometritis; Female; Gonorrhea; Humans; Injections, Intravenous; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Prospective Studies; Treatment Outcome; Urethritis

Sexually transmitted diseases (STDs) have a significant adverse effect on reproductive and child health worldwide. The control of STDs such as gonorrhea is therefore an absolute priority. Cefixime, an oral third-generation cephalosporin with in vitro activity similar to that of ceftriaxone, may be an effective candidate for the treatment of gonorrhea. The efficacy of a single oral 400-mg dose of cefixime was compared with that of a single intramuscular 250-mg dose of ceftriaxone for the treatment of Neisseria gonorrhoeae urethritis in 190 men and cervicitis in 46 women in Nairobi, Kenya. A bacteriologic cure was recorded in 100% of 63 evaluatable patients treated with ceftriaxone and 118 (98%) of 121 evaluatable patients treated with cefixime. Cefixime, as a single oral dose, is an effective alternative for the treatment of uncomplicated gonococcal urethritis in men and cervicitis in women.

Topics: Administration, Oral; Adult; Aged; Anti-Bacterial Agents; Cefixime; Cefotaxime; Ceftriaxone; Drug Evaluation; Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Urethritis; Uterine Cervicitis

Temafloxacin is an oral fluoroquinolone with potent in vitro activity against Neisseria gonorrhoeae. The efficacy and safety of a single dose of temafloxacin were compared with ceftriaxone, the current treatment of choice for gonorrhea, in a randomized, multicenter study. A total of 421 patients with uncomplicated gonococcal urethritis or cervicitis were randomly assigned to receive a single oral dose of temafloxacin 200 mg (n = 63) or 400 mg (n = 175), or a single intramuscular injection of ceftriaxone 250 mg (n = 183). In evaluable patients, bacteriologic cure rates were greater than 99% for both temafloxacin and ceftriaxone recipients. Corresponding clinical cure rates were 93.6% and 94.6%, respectively. Both regimens were well tolerated. A single oral dose of temafloxacin appears to be as safe and effective as injectable ceftriaxone in the treatment of uncomplicated gonococcal urethritis or cervicitis.

Topics: Administration, Oral; Adolescent; Adult; Aged; Anti-Infective Agents; Ceftriaxone; Female; Fluoroquinolones; Gonorrhea; Humans; Injections, Intramuscular; Male; Middle Aged; Quinolones; Urethritis; Uterine Cervicitis

Neisseria gonorrhoeae strains resistant to treatment with penicillin, tetracycline, and/or spectinomycin are increasing in prevalence in many parts of the world. In Zambia, 52% of N. gonorrhoeae isolates produced beta-lactamase in 1986. Few oral regimens have proven effective for treatment of resistant N. gonorrhoeae. We conducted a prospective, double-blind, randomized clinical trial of 250 mg of ciprofloxacin given orally versus 250 mg of ceftriaxone given intramuscularly for treatment of uncomplicated gonococcal urethritis in adult males. Two hundred men were enrolled and treated. The two groups were comparable in age (27.5 years), prevalence of latent syphilis (14 and 10%), and human immunodeficiency virus infection (32 and 38%). Of 165 patients with cultures positive for N. gonorrhoeae who returned for follow-up, ciprofloxacin cured 83 of 83 (100%), including 26 with penicillinase-producing N. gonorrhoeae (PPNG) and 21 with N. gonorrhoeae with chromosomally mediated resistance to multiple antibiotics (CMRNG), and ceftriaxone cured 81 of 82 (98.7%), including 30 with PPNG and 19 with CMRNG. Both treatment regimens were well tolerated. Chlamydia trachomatis in urethral exudate was found by direct fluorescent-antibody microscopic examination or by culture in 10 (5%) participants. All N. gonorrhoeae isolates were inhibited by ceftriaxone at 0.06 micrograms/ml, except one which was inhibited at 0.125 micrograms/ml, while ciprofloxacin inhibited all isolates at 0.03 micrograms/ml. Ciprofloxacin is a safe and effective therapy for uncomplicated gonococcal urethritis, including that caused by PPNG and CMRNG in human immunodeficiency virus-infected men.

Topics: Adult; Ceftriaxone; Chlamydia trachomatis; Ciprofloxacin; Double-Blind Method; Drug Resistance, Microbial; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Randomized Controlled Trials as Topic; Urethritis; Zambia

From 26 April to 30 June 1983 a total of 200 men with uncomplicated gonococcal urethritis were randomly treated with either 2 g spectinomycin or 250 mg ceftriaxone, both administered intramuscularly. Of 197 isolates tested for the presence of the enzyme beta lactamase, 91 (46.2%) were positive (PPNG) and 106 (53.8%) were non-PPNG strains. All 93 patients treated with spectinomycin and followed up and 97 treated with ceftriaxone and followed up were cured. Ceftriaxone 250 mg administered by intramuscular injection is highly effective in treating gonococcal infections caused by both PPNG and non-PPNG strains and is an appropriate alternative to spectinomycin.

Topics: Cefotaxime; Ceftriaxone; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillinase; Spectinomycin; Urethritis

Since cefoxitin has been shown to be an effective alternative to spectinomycin for the treatment of infections due to penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) its efficacy was compared with that of a new cephalosporin, ceftriaxone (R013-9904). One hundred and twenty eight men with culture-confirmed gonococcal urethritis were treated with either 250 mg of ceftriaxone intramuscularly or 2 g of cefoxitin intramuscularly with oral probenecid 1 g. The incidence of penicillin-resistant strains in each group was about 60%. Ceftriaxone was completely effective in treating both penicillin-sensitive and penicillin-resistant gonococcal urethritis. No side effects were noted. Ceftriaxone thus seems to be an effective and safe alternative to either spectinomycin or cefoxitin in the treatment of penicillin-resistant gonococcal urethritis.

Topics: Cefotaxime; Cefoxitin; Ceftriaxone; Gonorrhea; Humans; Male; Penicillin Resistance; Random Allocation; Urethritis

Ceftriaxone, a third generation cephalosporin, was used in a single intramuscular dose with oral probenecid to treat 124 men with infections due to non-penicillinase-producing Neisseria gonorrhoeae (non-PPNG) and 64 men with infections due to PPNG. Three different doses of ceftriaxone were used--125 mg, 62.5 mg, ad 32.5 mg, and 32.5. The cure rate for all PPNG infections with the different doses was 100%. The cure rate for the non-PPNG infections with ceftriaxone 125 mg was 100%; those for non-PPNG infections treated with ceftriaxone 62.5 mg and 32.5 mg were 96.2% and 97.3% respectively. The 160 strains of non-PPNG and 60 strains of PPNG isolated were all susceptible to ceftriaxone with minimum inhibitory concentrations of 0.008 microgram/ml. These results are compared with those using kanamycin 2 g. Ceftriaxone is a safe and effective treatment for PPNG and non-PPNG infections.

Topics: Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Gonorrhea; Humans; Kanamycin; Male; Neisseria gonorrhoeae; Penicillinase; Probenecid; Urethritis

54 adult male patients suffering from acute uncomplicated gonococcal urethritis entered a dose-range trial with a new parenteral cephalosporin, ceftriaxone Ro 13-9904. In order to evaluate the lowest effective dose of a single intramuscular injection of Ro 13-9904, the patients received different doses in descending order: 500 mg for the first group of 10 patients, 250 mg for the second group of 13 patients, 125 mg for the third group of 11 patients and 50 mg for the fourth group of 20 patients. All 34 patients of the first three trial groups were cured clinically and bacteriologically. In the group receiving 50 mg of the cephalosporin, 1 patient was bacteriologically a failure and a second was considered to be a reinfection. 7 further patients of this trial group showed clinical symptoms of urethritis after therapy, but gonococci were eradicated. The systemic and local tolerance of the drug was satisfactory. On the basis of this trial, the lowest effective dose for the eradication of Neisseria gonorrhoeae in male patients with uncomplicated gonorrhoea seems to be a single injection of between 50 and 125 mg of Ro 13-9904.

Topics: Adult; Ceftriaxone; Cephalosporins; Dose-Response Relationship, Drug; Drug Tolerance; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Pilot Projects; Urethritis

Neisseria gonorrhoeae is one of the important pathogens of sexually transmitted infections. N. gonorrhoeae is rapidly becoming antimicrobial resistant, and there are few drugs that are effective in the initial treatment of gonorrhea. To understand the trends of antimicrobial susceptibility of N. gonorrhoeae, the Surveillance Committee of the Japanese Society of Infectious Diseases, the Japanese Society for Chemotherapy, and the Japanese Society of Clinical Microbiology conducted the third nationwide antimicrobial susceptibility surveillance of N. gonorrhoeae isolated from male urethritis. The specimens were collected from male patients with urethritis at 30 facilities from May 2016 to July 2017. From the 159 specimens collected, 87 N. gonorrhoeae strains were isolated, and 85 were tested for susceptibility to 21 antimicrobial agents. All strains were non-susceptible to penicillin G. Seven strains (8.2%) were β-lactamase-producing strains. The rates of susceptibility to cefixime and cefpodoxime were 96.5% and 52.9%, respectively. Three strains were non-susceptible with a minimum inhibitory concentration (MIC) of 0.5 mg/L for cefixime. None of the strains were resistant to ceftriaxone or spectinomycin. The susceptibility rate for ciprofloxacin was 23.5% (20 strains), and no strains showed intermediate susceptibility. The susceptibility rate against azithromycin was 81.2%, with one strain isolated with a MIC of 8 mg/L against azithromycin. The results of this surveillance indicate that ceftriaxone and spectinomycin, which are currently recommended for gonococcal infections in Japan, appear to be effective. It will be necessary to further expand the scale of the next surveillance to understand the current status of drug-resistant N. gonorrhoeae in Japan.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Cefixime; Ceftriaxone; Gonorrhea; Humans; Japan; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Spectinomycin; Urethritis

To investigate the incidence, clinical manifestations, and treatments of gonococcal tysonitis in men. We enrolled men with gonococcal tysonitis and men with gonococcal urethritis from January 2000 to December 2020. Demographic data, interval from non-marital sexual contact to the onset of symptoms of gonococcal tysonitis, occurrence sites, and manifestations were recorded for all patients. Ceftriaxone (1 g) was injected intramuscularly once daily for 5 days in patients with lesions comprising abscesses or nodules. A single dose of ceftriaxone (1 g) was injected intramuscularly in patients with sinus-like lesions. Incision and drainage were performed in patients with non-ruptured abscesses. Fifteen patients with gonococcal tysonitis (0.29%; 95% confidence interval: 0.15-0.44%) were observed among 5087 patients with gonococcal urethritis. The mean age was 38.64 years (range, 17-74 years). The mean gonococcal tysonitis incubation period was 6.02 ± 1.37 days (range, 2-11 days). Lesions were present in the right side of the preputial frenulum in seven patients (46.67%), in the left side of the preputial frenulum in six patients (40%), and in both sides of preputial frenulum in two patients (13.33%). The lesions manifested as abscesses in 7 patients (46.67%), nodules in six patients (40%), and sinus-like lesions in two patients (13.33%); all lesions exhibited tenderness. All 15 patients were cured after treatment. Gonococcal tysonitis is a rare local complication of gonorrhea. Gonococcal urethritis with concurrent gonococcal tysonitis was less common than gonococcal urethritis with concurrent paraurethral gonococcal infection or gonococcal urethritis with concurrent gonococcal epididymitis. Gonococcal tysonitis lesions manifest as abscesses, nodules, and sinus-like lesions. Treatment with ceftriaxone is effective for gonococcal tysonitis.

Topics: Abscess; Adult; Ceftriaxone; Female; Gonorrhea; Humans; Male; Urethritis

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

Test of cure (TOC) for. The Sexually Transmitted Bacteria Reference Unit at Public Health England undertook testing of gonococcal and chlamydial nucleic acids within neat urine stored in different conditions over 25 days to provide evidence of the stability of the nucleic acid prior to recruitment. Individuals diagnosed with uncomplicated NG or CT infection were recruited from three sexual health clinics. Individuals were asked to return nine self-taken samples from the site of infection over a course of 35 days. Survival analyses of time to first negative NAAT result for NG and CT infection and univariate regression analysis of factors that affect time to clearance were undertaken.. At room temperature, chlamydial DNA in urine is stable for up to 3 weeks and gonococcal DNA for up to 11 days. We analysed data for 147 infections (81 NG and 66 CT). The median time to clearance of infection was 4 days (IQR 2-10 days) for NG infection and 10 days (IQR 7-14 days) for CT infection. Vaginal CT infections took longer to clear (p=0.031). NG infection in men who have sex with men took longer to clear (p=0.052).. Chlamydial and gonococcal nucleic acids are stable in urine before addition of preservatives, longer than recommended by the manufacturer. The TOC results suggest that it may be possible to undertake TOC for NG and CT infections earlier than current guidelines suggest and that anatomical site of infection may affect time to clearance of infection.

Topics: Adult; Aged; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Feasibility Studies; Female; Gonorrhea; Humans; Male; Middle Aged; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Pharyngitis; Proctitis; Real-Time Polymerase Chain Reaction; Time Factors; Treatment Outcome; Urethritis; Vulvovaginitis; Young Adult

Topics: Anti-Bacterial Agents; Aztreonam; Ceftriaxone; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Urethritis

Topics: Adult; Alleles; Anti-Bacterial Agents; Ceftriaxone; China; Cystitis; Drug Resistance, Bacterial; Gonorrhea; Humans; Internationality; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Polymorphism, Genetic; Urethritis

We report two cases of multidrug-resistant

Topics: Anti-Bacterial Agents; Azithromycin; Back Pain; Cambodia; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Dysuria; France; Gonorrhea; Heterosexuality; Humans; Male; Microbial Sensitivity Tests; Multilocus Sequence Typing; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Travel; Treatment Outcome; Urethritis; Whole Genome Sequencing

Male urethritis is primary sexually transmitted. Northern Territory (NT) has the highest rates of gonococcal infection in Australia and local guidelines recommend empiric treatment with azithromycin and ceftriaxone for all men presenting with urethritis. As gonococcal drug resistance is a growing concern, this study aims to improve empiric use of ceftriaxone through examining local patterns of male urethritis, comparing cases of gonococcal urethritis (GU) to controls with non-gonococcal urethritis (NGU).. A retrospective study was undertaken of all men with symptomatic urethritis presenting to Darwin sexual health clinic from July 2015 to July 2016 and aetiology of urethritis in this population was described. Demographic, risk profile, and clinical features of GU cases were compared to NGU controls.. Among n = 145 men, the most common organisms identified were Chlamydia trachomatis (23.4%, SE 3.5%) and Neisseria gonorrhoeae (17.2%, SE 3.1%). The main predictors of GU were any abnormalities on genital examination (aOR 10.4, 95% CI 2.1 to 50.8) and a history of urethral discharge (aOR 5.7, 95% CI 1.4 to 22.6). Aboriginal patients (aOR 3.0, 95% CI 0.9 to 9.6) and those over 30 years of age (aOR 1.4, 95% CI 0.3 to 7.0) were more likely to have GU in the unadjusted analysis, but not in the adjusted model.. This is the first study looking at patterns of male urethritis in urban NT and the results support a move towards adopting national guidelines to use ceftriaxone for empiric management of syndromic urethritis only in high-risk patients. In addition to traditional demographic risk factors, clinical features remain an important component of risk stratification.

Topics: Adult; Ambulatory Care Facilities; Azithromycin; Case-Control Studies; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Northern Territory; Retrospective Studies; Urethritis

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: Anti-Bacterial Agents; Benin; Ceftriaxone; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Urethritis; Uterine Cervicitis

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

We report a case of Neisseria gonorrhoeae with a non-mosaic penA allele that exhibited decreased susceptibility to extended-spectrum cephalosporins, including a ceftriaxone minimum inhibitory concentration of 0.5 μg/mL. An analysis of resistance determinants suggested that the observed phenotype might have resulted from the combined effects of mutations in multiple genes.

Topics: Adult; Alleles; Anti-Bacterial Agents; Carrier Proteins; Ceftriaxone; Drug Resistance, Bacterial; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Mutation; Neisseria gonorrhoeae; Phenotype; Serine-Type D-Ala-D-Ala Carboxypeptidase; Urethra; Urethritis

We describe a multidrug-resistant

Topics: Administration, Oral; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Denmark; Gonorrhea; Humans; Injections, Intramuscular; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Treatment Outcome; Urethritis; Young Adult

There have been few comprehensive studies on Haemophilus influenza-positive urethritis.. In this retrospective study, we enrolled 68 men with H. influenzae-positive urethritis, including coinfections with Neisseria gonorrhoeae, Chlamydia trachomatis, and/or genital mycoplasmas: 2, 3, 20, and 43 treated with ceftriaxone, levofloxacin, sitafloxacin, and extended-release azithromycin (azithromycin-SR), respectively. We assessed microbiological outcomes in 54 men and clinical outcomes in 46 with H. influenzae-positive monomicrobial nongonococcal urethritis. We determined minimum inhibitory concentrations (MICs) of 6 antimicrobial agents for 59 pretreatment isolates.. H. influenzae was eradicated from the men treated with ceftriaxone, levofloxacin, or sitafloxacin. The eradication rate with azithromycin-SR was 85.3%. The disappearance or alleviation of urethritis symptoms and the decreases in leukocyte counts in first-voided urine were significantly associated with the eradication of H. influenzae after treatment. For the isolates, ceftriaxone, levofloxacin, sitafloxacin, azithromycin, tetracycline, and doxycycline MICs were ≤0.008-0.25, 0.008-0.5, 0.001-0.008, 0.12-1, 0.25-16, and 0.25-2 μg/mL, respectively. The azithromycin MICs for 3 of 4 strains persisting after azithromycin-SR administration were 1 μg/mL. H. influenzae with an azithromycin MIC of 1 μg/mL increased chronologically.. H. influenzae showed good responses to the chemotherapies for urethritis. The significant associations of the clinical outcomes of the chemotherapies with their microbiological outcomes suggested that H. influenzae could play pathogenic roles in urethritis. All isolates, except for one with decreased susceptibility to tetracyclines, were susceptible to the examined agents. However, the increase in H. influenzae with an azithromycin MIC of 1 μg/mL might threaten efficacies of azithromycin regimens on H. influenzae-positive urethritis.

Topics: Acute Disease; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Coinfection; Doxycycline; Drug Resistance, Bacterial; Fluoroquinolones; Gonorrhea; Haemophilus influenzae; Humans; Leukocyte Count; Levofloxacin; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Retrospective Studies; Urethritis

We tested the activity of ETX0914 against 187 Neisseria gonorrhoeae isolates from men with urethritis in Nanjing, China, in 2013. The MIC50, MIC90, and MIC range for ETX0914 were 0.03 μg/ml, 0.06 μg/ml, and ≤0.002 to 0.125 μg/ml, respectively. All isolates were resistant to ciprofloxacin, and 36.9% (69/187) were resistant to azithromycin. Of the isolates, 46.5% were penicillinase-producing N. gonorrhoeae (PPNG), 36% were tetracycline-resistant N. gonorrhoeae (TRNG), and 13% (24 isolates) had an MIC of 0.125 μg/ml for ceftriaxone. ETX0914 may be an effective treatment option for gonorrhea.

Topics: Anti-Bacterial Agents; Azithromycin; Barbiturates; Ceftriaxone; Ciprofloxacin; DNA Gyrase; Drug Resistance, Multiple, Bacterial; Gene Expression; Gonorrhea; Humans; Isoxazoles; Male; Microbial Sensitivity Tests; Morpholines; Neisseria gonorrhoeae; Oxazolidinones; Spiro Compounds; Tetracycline; Topoisomerase II Inhibitors; Urethritis

Topics: Administration, Oral; Adolescent; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Clinical Decision-Making; Diagnostic Errors; Disease Progression; Drug Costs; Drug Prescriptions; Drug Resistance, Bacterial; Ethical Analysis; Female; Gonorrhea; Humans; Injections, Intramuscular; Insurance, Health; Male; Physician's Role; Public Health; Risk; Risk-Taking; Rural Population; Sexual Partners; Social Justice; Urethritis

We treated men with gonococcal urethritis with a single-dose regimen of 1 g of ceftriaxone, which is recommended as the first-line treatment for gonorrhoea in Japan, to determine its microbiological outcomes and tolerability.. We enrolled 255 men with gonococcal urethritis and treated them with a single-dose regimen of 1 g of ceftriaxone. We evaluated its microbiological outcomes and tolerability. We also determined ceftriaxone MICs for pretreatment isolates of Neisseria gonorrhoeae collected from the patients.. The microbiological efficacy of the ceftriaxone regimen, which was determined between 5 and 9 days after treatment in 111 men based on the Japanese guideline for clinical research on antimicrobial agents in urogenital infections, was 100%. In the 194 men who returned to the clinic between 2 and 41 days after treatment, 191 (98.5%; 95% CI 96.8%-100%) were negative for N. gonorrhoeae after treatment. Ceftriaxone MICs determined for 136 pretreatment isolates obtained from these 194 men ranged from 0.001 to 0.25 mg/L. One isolate persisting after treatment exhibited a ceftriaxone MIC of 0.008 mg/L. For two isolates persisting after treatment, ceftriaxone MICs were not determined. Seven adverse events were observed in 7 (3.2%) of the 220 men treated with the ceftriaxone regimen. Four men had diarrhoea classified as grade 1. Three had urticaria during ceftriaxone administration, with one event classified as grade 1 and two events classified as grade 3.. A single-dose regimen of 1 g of ceftriaxone was microbiologically effective against gonococcal urethritis and was safe and tolerable.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Drug-Related Side Effects and Adverse Reactions; Gonorrhea; Humans; Japan; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Treatment Outcome; Urethritis

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Urethritis

Worldwide, the most important concern in the treatment of sexually transmitted infections is the increase in antimicrobial resistant Neisseria gonorrhoeae strains including resistance to cephalosporins, penicillins, fluoroquinolones or macrolides. To investigate the trends of antimicrobial susceptibility among N. gonorrhoeae strains isolated from male patients with urethritis, a Japanese surveillance committee conducted the second nationwide surveillance study. Urethral discharge was collected from male patients with urethritis at 26 medical facilities from March 2012 to January 2013. Of the 151 specimens, 103 N. gonorrhoeae strains were tested for susceptibility to 20 antimicrobial agents. None of the strains was resistant to ceftriaxone, but the minimum inhibitory concentration (MIC) 90% of ceftriaxone increased to 0.125 μg/ml, and 11 (10.7%) strains were considered less susceptible with an MIC of 0.125 μg/ml. There were 11 strains resistant to cefixime, and the MICs of these strains were 0.5 μg/ml. The distributions of the MICs of fluoroquinolones, such as ciprofloxacin, levofloxacin and tosufloxacin, were bimodal. Sitafloxacin, a fluoroquinolone, showed strong activity against all strains, including strains resistant to other three fluoroquinolones, such as ciprofloxacin, levofloxacin and tosufloxacin. The azithromycin MICs in 2 strains were 1 μg/ml.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Cefixime; Ceftriaxone; Drug Resistance, Bacterial; Fluoroquinolones; Humans; Japan; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Penicillins; Population Surveillance; Urethritis; Young Adult

We report a treatment failure to azithromycin 2.0 g caused by a urethral Neisseria gonorrhoeae isolate with high-level azithromycin resistance in California. This report describes the epidemiological case investigation and phenotypic and genetic characterization of the treatment failure isolate.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; California; Ceftriaxone; Contact Tracing; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Population Surveillance; Treatment Failure; United States; Urethritis

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Bacteremia; Ceftriaxone; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Gardnerella vaginalis; Gram-Positive Bacterial Infections; Humans; Immunocompetence; Male; Metronidazole; Recurrence; Sex Distribution; Urethritis

To approach the method of sequential therapy in gonococcal inflammation of the paraurethral glands around the external urethral orifice in males.. Step one: ceftriaxone sodium (1 g intramuscularly (IM) once daily for 5 days) was used for all patients. Step two: refractory patients from step one were treated with incision and drainage, followed by administration of IM ceftriaxone sodium. Step three: patients' sinus tracts were cauterized with a monopulse CO(2) laser.. After step one, 34 patients recovered (recovery rate 70.83%). However, 14 patients were unaffected, and sinus tracts appeared in two patients. After step two, 11 of 14 patients recovered and three patients developed sinus tracts, two of whom had sinus tracts in step one that did not heal in step two. After step three, all patients with sinus tracts that had been treated with monopulse CO(2) laser therapy recovered in 2 weeks.. This sequential therapy can be used to successfully treat gonococcal inflammation of the paraurethral glands around the external urethral orifice in males.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Drainage; Drug Administration Schedule; Exocrine Glands; Gonorrhea; Humans; Injections, Intramuscular; Laser Therapy; Lasers, Gas; Male; Middle Aged; Neisseria gonorrhoeae; Time Factors; Treatment Outcome; Urethra; Urethritis; Young Adult

Topics: Anti-Bacterial Agents; Azithromycin; Carrier State; Ceftriaxone; Cephalosporin Resistance; Contact Tracing; Doxycycline; Drug Resistance, Multiple, Bacterial; Gonorrhea; Homosexuality, Male; Humans; Male; Neisseria gonorrhoeae; Pharynx; Rectum; Sexual Behavior; Sexual Partners; Spain; Urethra; Urethritis; Young Adult

Detection of Neisseria gonorrhoeae (NG) or Chlamydia trachomatis (CT) from the pharynx of women or men is not uncommon. However, there is no recommendation how urologists should care for the pharyngeal infection of men with urethritis in Japan. The aim of this study is to clarify the prevalence of NG or CT infection in the pharynx of men and to show a recommendation for urologists. The Japanese reports about the detection of NG or CT from the pharynx or the oral cavity of men in Japan are reviewed in the literature from 1990 to 2011. The prevalence of NG or CT in the pharynx was 4% or 6% in men who attended clinics, and 20% or 6% in men who were positive for NG or CT from genital specimens, respectively. Single 1-g dose ceftriaxone was recommended to treat pharyngeal NG, but no evidence was found for pharyngeal CT. There was not enough evidence for recommendation. However, when men with urethritis only caused by NG or CT are treated through the guideline of the Japanese Society of Sexually Transmitted Infection, we do not think additional tests or treatment for the pharynx are needed when a single 1-g dose ceftriaxone for gonococcal urethritis or a single 1- or 2- g dose azithromycin is prescribed for chlamydial urethritis in Japan.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Pharyngeal Diseases; Urethritis; Urology

Topics: Adult; Azithromycin; Ceftriaxone; HIV Infections; Humans; Male; Meningococcal Infections; Neisseria meningitidis; Unsafe Sex; Urethritis

The aim of the study was to estimate the diagnostic and treatment patterns in the management of acute nongonococcal urethritis (NGU) in males in some cities of Russia. Retrospective cross-sectional study was conducted in 2009 in 5 centers of 4 cities in the Central Part of Russia (Kaluga, Pskov, Smolensk - 2 centres and Tula). The data on the diagnostic and treatment approaches to the management of NGU in male subjects >16 years old were collected and analyzed with the use of specially designed case report forms. 556 cases of acute urethritis were analyzed during the study. The diagnosis of NGU was confirmed in 401 cases. The average age of the patients was 29.8 years (16-68 years). The following diagnostic methods were used in 95% of the cases: urethral smear microscopy (314/82.4%), C. trachomatis - PCR (113/29.7%), ELISA (155/40.7%); T. vaginalis - PCR (106/27.8%); U. urealyricum and M. hominis, respectively - bacteriology (140/36.7% and 126/33.1%), PCR (110/28.9% and 108/28.3%); M. genitalium - PCR (110/28.9%). The treatment patterns included antimicrobials AMs alone in 60.3, and AMs + non-AMs in 37.8% of the cases. The most frequently prescribed AMs were azithromycin (27.5%), fluconazole (16.4%), doxycycline (13.6%), metronidazole (11.2%), ofloxacine (7.3%), ceftriaxone (4.4%), josamycin (4.2). According to the results use of the standard methods for NGU diagnosis was rather rare. The use of PCR for atypical pathogens was the following: C. trachomatis 29.7%, U. urealyticum 36.7%, M. hominis 28.9%, M. genitalium 28.3%. Doubtful culture methods were used for detection of U. urealyticum and M. hominis (36.7% and 33.1%). The AMs treatment in some cases was not in compliance with the up-to-date practical guidelines for STD and NGU.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antiprotozoal Agents; Azithromycin; Ceftriaxone; Chlamydia trachomatis; Cross-Sectional Studies; Doxycycline; Fluconazole; Guideline Adherence; Humans; Josamycin; Male; Metronidazole; Middle Aged; Mycoplasma genitalium; Mycoplasma hominis; Ofloxacin; Polymerase Chain Reaction; Practice Guidelines as Topic; Retrospective Studies; Russia; Trichomonas vaginalis; Ureaplasma urealyticum; Urethra; Urethritis

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Ceftriaxone; Drainage; Ethacridine; Exocrine Glands; Gonorrhea; Humans; Injections, Intramuscular; Male; Neisseria gonorrhoeae; Urethra; Urethritis

Symptoms of urethritis in men typically include urethral discharge, penile itching or tingling, and dysuria. A diagnosis can be made if at least one of the following is present: discharge, a positive result on a leukocyte esterase test in first-void urine, or at least 10 white blood cells per high-power field in urine sediment. The primary pathogens associated with urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae. Racial disparities in the prevalence of sexually transmitted infections persist in the United States, with rates of gonorrhea 40 times higher in black adolescent males than in white adolescent males. Recent studies have focused on identifying causes of nongonococcal urethritis and developing testing for atypical organisms, such as Mycoplasma genitalium and Ureaplasma species. Less common pathogens identified in patients with urethritis include Trichomonas species, adenovirus, and herpes simplex virus. History and examination findings can help distinguish urethritis from other urogenital syndromes, such as epididymitis, orchitis, and prostatitis. The goals of treatment include alleviating symptoms; preventing complications in the patient and his sexual partners; reducing the transmission of coinfections (particularly human immunodeficiency virus); identifying and treating the patient's contacts; and encouraging behavioral changes that will reduce the risk of recurrence. The combination of azithromycin or doxycycline plus ceftriaxone or cefixime is considered first-line empiric therapy in patients with urethritis. Expedited partner treatment, which involves giving patients prescriptions for partners who have not been examined by the physician, is advocated by the Centers for Disease Control and Prevention and has been approved in many states. There is an association between urethritis and an increased human immunodeficiency virus concentration in semen.

Topics: Adolescent; Adult; Azithromycin; Black or African American; Cefixime; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Contact Tracing; Doxycycline; Drug Therapy, Combination; Gonorrhea; HIV Infections; Humans; Male; Mycoplasma Infections; Ureaplasma Infections; Urethritis; White People; Young Adult

Neisseria gonorrhoeae strains with reduced susceptibility to cefixime and ceftriaxone, with minimum inhibitory concentrations (MICs) of cefixime of 0.125-0.25 microg/ml and ceftriaxone of 0.031-0.125 microg/ml, were isolated from male urethritis patients in Tokyo, Japan, in 2006. The amino acid sequences of PenA, penicillin-binding protein 2, in these strains were of two types: PenA mosaic and nonmosaic strains. In the PenA mosaic strain, some regions in the transpeptidase-encoding domain in PenA were similar to those of Neisseria perflava/sicca, Neisseria cinerea, Neisseria flavescens, Neisseria polysaccharea, and Neisseria meningitidis. In the PenA nonmosaic strain, there was a mutation of Ala-501 to Val in PenA. In addition, we performed homology modeling of PenA wild-type and mosaic strains and compared them. The results of the modeling studies suggested that reduced susceptibility to cephems such as cefixime and ceftriaxone is due to a conformational alteration of the beta-lactam-binding pocket. These results also indicated that the mosaic structures and the above point mutation in PenA make a major contribution to the reduced susceptibility to cephem antibiotics.

Topics: Amino Acid Sequence; Anti-Bacterial Agents; beta-Lactamases; Cefixime; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Humans; Male; Microbial Sensitivity Tests; Mutation; Neisseria gonorrhoeae; Penicillin-Binding Proteins; Sequence Analysis, Protein; Urethritis

The objectives of this study were to assess the prevalence of ciprofloxacin-resistant gonorrhoea in two South African cities and to investigate the association between the isolation of ciprofloxacin-resistant Neisseria gonorrhoeae and the HIV serostatus of patients.. Gonococci were cultured from endourethral swabs taken from consecutive men with urethritis attending clinics in Johannesburg and Cape Town. Minimum inhibitory concentrations (MIC) for ciprofloxacin and ceftriaxone were determined with E-tests. Isolates with a ciprofloxacin MIC of 1 mg/l or greater were defined as resistant and isolates with a ceftriaxone MIC of 0.25 mg/l or less were defined as susceptible. Rapid tests were used to screen and confirm the presence of HIV antibodies. Survey data from 2004 were used as a baseline to assess trends in gonococcal resistance to ciprofloxacin.. In 2004, the prevalence of ciprofloxacin resistance was 7% in Cape Town and 11% in Johannesburg. In 2007, 37/139 (27%) Cape Town isolates and 47/149 (32%) Johannesburg isolates were resistant to ciprofloxacin; in comparison with 2004 data, this represents 2.9-fold and 1.9-fold increases, respectively. All isolates were fully susceptible to ceftriaxone. There was a significant association between HIV seropositivity and the presence of ciprofloxacin-resistant gonorrhoea among patients (p = 0.034).. Johannesburg and Cape Town have witnessed significant rises in the prevalence of ciprofloxacin-resistant gonorrhoea among men with urethritis. The resistant phenotype is linked to HIV seropositivity. There is now an urgent need to change national first-line therapy for presumptive gonococcal infections within South Africa.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Gonorrhea; HIV Seropositivity; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Prevalence; South Africa; Urethritis

To evaluate the efficacy of 1 g ceftriaxone in the treatment of urethritis, cervicitis and pharyngeal infection caused by Neisseria gonorrhoeae (N. gonorrhoeae) including the oral cephem-resistant strain with chimera penicillin-binding protein 2 (PBP-2) (cefozopran-resistant N. gonorrhoeae, CZRNG).. From September 2004 to November 2006, 67 patients (27 male and 40 female) who had genital infection and/or pharyngeal infection caused by N. gonorrhoeae were enrolled in this study at five participating centers in Japan. To detect the chimera PBP-2 gene, polymerase chain reaction (PCR) was performed using established primers against the altered penA of CZRNG isolates. All patients received a single 1 g dose of ceftriaxone. Efficacy was evaluated only in those who returned for examination and culture for N. gonorrhoeae between 3 and 14 days after the treatment.. CZRNG isolates detected by PCR accounted for 41.7% (20/48) of urogenital infections and 60.0% (15/25) of pharyngeal infections in the treatment efficacy evaluable cases. 37 of 39 CZRNG isolates (94.9%) were multi-drug resistant isolates that had simultaneous resistance to penicillin, tetracycline, and ciprofloxacin. Nineteen patients had N. gonorrhoeae isolates in the urogenital area and pharynx simultaneously. Ceftriaxone treatment eradicated all N. gonorrhoeae isolates from 48 patients with genitourinary infection and 25 patients with pharyngeal infection.. We report for the first time that ceftriaxone is effective in patients with gonococcal urethritis, cervicitis, and pharyngeal infection caused by CZRNG that has chimera PBP-2.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Female; Gonorrhea; Humans; Male; Middle Aged; Pharyngeal Diseases; Urethritis; Uterine Cervicitis; Young Adult

To determine the prevalence of urethritis pathogens amongst male symptomatic urethritis (MUS) patients, genital ulcer (GUS) patients without urethritis symptoms and men requesting HIV testing at a voluntary counselling and testing (VCT) clinic.. A prospective study was conducted in Johannesburg, South Africa. Men from the three groups were screened for urethritis pathogens using molecular tests. Culture for Neisseria gonorrhoeae and, initially, trichomoniasis was performed. Antimicrobial susceptibility testing was undertaken for ciprofloxacin on all gonococcal isolates; ciprofloxacin resistant isolates were screened for ceftriaxone resistance.. 664 participants were recruited (438 MUS, 76 GUS and 158 VCT) over 2 years. Gonorrhoea was detected in 62.3% MUS, 15.8% GUS and 3.2% VCT participants. Chlamydial infection was detected in 19.3% MUS, 13.2% GUS and 8.2% VCT participants. Trichomoniasis was detected in 4.9% MUS, 19.7% GUS and 3.8% VCT participants. Mycoplasma genitalium infection was detected in 14.4% MUS, 13.2% GUS and 7.0% VCT participants. Ciprofloxacin resistance increased from 13.0% in the first year to 26.3% in the second year; all resistant isolates were susceptible to ceftriaxone.. Urethritis pathogens, including Trichomonas vaginalis, should be covered in syndromic management treatment of genital ulcers in the absence of clinical urethritis. Consideration should be given to adding metronidazole to existing MUS treatment. Ciprofloxacin can no longer be relied upon to treat presumptive gonococcal infections in South Africa.

Topics: Ceftriaxone; Ciprofloxacin; Counseling; Drug Resistance, Microbial; Gonorrhea; HIV Infections; Humans; Male; Mycoplasma Infections; Patient Acceptance of Health Care; Prospective Studies; South Africa; Syndrome; Trichomonas Infections; Urethritis

Topics: Administration, Oral; Anti-Bacterial Agents; Azithromycin; Bangladesh; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Diagnosis, Differential; Gonorrhea; Humans; Injections, Intramuscular; Male; Travel; Urethritis; Urination Disorders

In this retrospective study of the outcome of treatment of 245 patients (87 females and 158 males) with a diagnosis of Neisseria gonorrhoeae infection seen between 1996 and 2002, 81% (95% confidence interval (CI) 74%-86.8%) of the males and 88.5% (95% CI 79.9%-94.3%) of the females attended for a test of cure. At initial presentation, 93% (95% CI 87.9%-96.5%) and 94.3% (95% CI 89.5%-97.4%) of males respectively, had symptoms and signs of gonococcal infection compared with 48.3% (95% CI 37.4%-59.2%) and 44.8% (95% CI 34.1%-55.9%) of females, and this difference was statistically significant (P = 0.005). Initial diagnosis at first visit was made by Gram-stained smear in 88.6% (95% CI 82.6%-93.1%) of males and 32.2% (95% CI 22.6%-43.1%) of females, a statistically significant difference P = 0.001. There were 12 (4.9%) cases of reinfection that rebooked to attend after failing to attend for their test of cure in two females and 10 males. There were two (0.8%) treatment failures amongst the 245 episodes in two males who still had symptoms when they returned for their test of cure. One male had a ciprofloxacin-resistant strain (CRNG) acquired locally and the other one had a betalactamase-producing CRNG/penicillinase-producing N. gonorrhoeae (PPNG) isolate acquired abroad in South America. These patients would have sought to return, as they still had signs and symptoms of gonococcal infection, and they would have been recalled following receipt of the antimicrobial susceptibility report. Post-gonococcal urethritis occurred in 36.3% (95% CI 27.8%-45.4%) of the males who attended for their test of cure, 74.8% (95% CI 67.2%-81.5%) received anti-chlamydial therapy with their standard treatment. In men who received anti-chlamydial therapy the odds ratio of having post-gonococcal urethritis was 0.42 (95% CI 0.17-1.06), P = 0.04. Co-infection with Chlamydia trachomatis was more likely to occur amongst females (43.9%), odds ratio 3.97 (95% CI 2.07-7.67), P < 0.001 than males (16.5%). We have now discontinued routine attendance for a test of cure and encourage our patients to telephone for their results with recall only of patients whose antimicrobial susceptibility indicate inappropriate first line therapy or who are still symptomatic.

Topics: Adolescent; Adult; Ambulatory Care Facilities; Anti-Bacterial Agents; Candidiasis; Ceftriaxone; Chlamydia Infections; Cohort Studies; Contact Tracing; Drug Resistance, Microbial; Female; Gonorrhea; Herpes Simplex; Humans; Male; Middle Aged; Neisseria gonorrhoeae; Recurrence; Retrospective Studies; Sex Factors; Sexually Transmitted Diseases, Viral; United Kingdom; Urethritis; Vaginitis

In the modern era of broad spectrum antibiotics, urethral fistulae (watering can perineum) is one of the forgotten sequelae of chronic gonococcal infection. We report a 20-year-old unmarried male with gonococcal urethritis and two sinuses in the scrotum (watering can perineum). The micturating and retrograde urethrogram revealed mucosal irregularity and extravasation of contrast medium at the junction of bulbous and membranous urethra. Recent worldwide emergence of multidrug resistant strains of gonococci give rise to alarm. In the present scenario of HIV pandemic, ineffective treatment of patient or partner with gonorrhoea may result in development of these complications.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cutaneous Fistula; Gonorrhea; Humans; Male; Perineum; Scrotum; Urethral Stricture; Urethritis

Regarding Neisseria gonorrhoeae, the National Committee for Clinical Laboratory Standards (NCCLS) has not defined the breakpoint minimum inhibitory concentration (MIC) for expanded spectrum cephems such as cefpodoxime and ceftizoxime, because of the absence of resistant strains to these antibiotics. To date, in gonococcal urethritis, after treatment with third generation cephems and aztreonam, clinical failures caused by resistant N. gonorrhoeae strains have not been reported. However, we experienced two clinical failures in patients with gonococcal urethritis treated with cefdinir and aztreonam. N. gonorrhoeae isolates from these two patients showed high-level MICs to these agents. The MIC of cefdinir was 1 microg/ml for both strains and that of aztreonam was 8 microg/ml for both strains, while the MICs of other beta-lactams were also higher than the NCCLS value, except for ceftriaxone, for which the MIC was 0.125 microg/ml for both strains. Moreover, the MICs of fluoroquinolones, tetracyclines, and erythromycin against these two isolates were higher than the NCCLS susceptibility value. These isolates were susceptible to spectinomycin. In N. gonorrhoeae, the emergence of these beta-lactam-resistant isolates is of serious concern. However, a more serious problem is that these isolates were already resistant to non-beta-lactam antimicrobials. In Japan, ceftriaxone has not been permitted for clinical use against gonococcal infections. Therefore, in Japan, patients with gonococcal urethritis caused by these resistant N. gonorrhoeae strains should be treated with cefodizime or spectinomycin.

Topics: Adult; Anti-Infective Agents; Aztreonam; Cefdinir; Ceftriaxone; Cephalosporins; Drug Resistance, Microbial; Drug Resistance, Multiple; Drug Therapy, Combination; Fluoroquinolones; Gonorrhea; Humans; Japan; Male; Microbial Sensitivity Tests; Minocycline; Naphthyridines; Neisseria gonorrhoeae; Roxithromycin; Spectinomycin; Urethritis

The therapeutic efficacy of single intramuscular doses of ceftriaxone (Rocephin; Roche) (62.5, 125 and 250 mg), administered without probenecid, was evaluated in 167 adult males with uncomplicated acute gonococcal urethritis. Cure rates of 100% were achieved at 62.5 mg and 250 mg. In the 125 mg dose group, Neisseria gonorrhoeae was isolated from 1 patient at follow-up after therapy. Reinfection was suspected, since this patient returned on day 10 and admitted to sexual contact 2 days previously. Side-effects were minimal, and patient acceptance was better for ceftriaxone dissolved in lignocaine than in sterile water. Chlamydia trachomatis was detected at follow-up in 14.4% patients, confirming that ceftriaxone has no significant effect on chlamydial infection and additional treatment is necessary for patients with coexistent infection.

Topics: Acute Disease; Adolescent; Adult; Ceftriaxone; Chlamydia trachomatis; Evaluation Studies as Topic; Gonorrhea; Humans; Injections, Intramuscular; Male; Neisseria gonorrhoeae; Ureaplasma; Urethritis

Ceftriaxone was used in single intravenously dose of 1 g to treat 20 men with gonorrhoea caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) and non-PPNG. Of 14 patients followed up, 13 (92.9%) were cured. Cure rates for PPNG infections and non-PPNG infections were 100% and 90.9% respectively. No side effect was observed except 1 case of vomiting out of 20 cases. It is concluded that this drug is safe and effective in treating both PPNG and non-PPNG infections.

Topics: Adult; Cefotaxime; Ceftriaxone; Drug Evaluation; Drug Resistance, Microbial; Gonorrhea; Humans; Injections, Intravenous; Male; Neisseria gonorrhoeae; Urethritis