tetracycline and Gonorrhea

Topics: 4-Quinolones; Anti-Infective Agents; Cephalosporins; Conjunctivitis, Bacterial; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G; Tetracycline; Urethritis; Uterine Cervicitis

Topics: Canada; Chlamydia Infections; Chlamydia trachomatis; Erythromycin; Gonorrhea; Humans; Infant, Newborn; Ophthalmia Neonatorum; Preventive Medicine; Silver Nitrate; Tetracycline

Tetracyclines have an unusually broad spectrum of antimicrobial activity. They are generally well tolerated, with relatively few side effects compared with alternative antibiotic choices. Tetracyclines also compare favorably with newer antimicrobials, i.e., oral quinolones, with respect to cost and microbial resistance. Doxycycline's and minocycline's spectrum of antibacterial activity, pharmacokinetic profile, and safety profile make them preferred drugs when tetracyclines are indicated in urologic infections.

Topics: Bacteria; Female; Gonorrhea; Humans; Intestinal Absorption; Lymphogranuloma Venereum; Male; Prostate; Prostatitis; Pyelonephritis; Tetracycline; Tetracycline Resistance; Tissue Distribution; Urethritis; Urinary Tract Infections

The first two known cases of Neisseria gonorrhoeae infection of a penile implant are reported. The literature regarding periprosthetic infections is reviewed, and the mode of transmission of the gonococcal organism to the corpora is discussed.

Topics: Adult; Cefoxitin; Erectile Dysfunction; Gonorrhea; Humans; Male; Middle Aged; Postoperative Complications; Prostheses and Implants; Prosthesis Failure; Tetracycline

Topics: Cephalosporins; Chlamydia Infections; Clavulanic Acid; Clavulanic Acids; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillanic Acid; Penicillin Resistance; Penicillins; Pharyngeal Diseases; Quinolines; Spectinomycin; Sulbactam; Syphilis; Tetracycline

Topics: Anti-Bacterial Agents; Cephalosporins; Chlamydia Infections; Erythromycin; Gonorrhea; Humans; Male; Spectinomycin; Tetracycline; Urethritis

In many countries the statutory use of silver nitrate prophylaxis as soon as possible after birth has recently been reviewed from both a human rights and a medical standpoint. It has been argued that silver nitrate does not prevent all cases of gonococcal ophthalmia neonatorum (GON) and that it causes chemical conjunctivitis, pain and visual impairment, which may interfere with parent-infant bonding. Furthermore, the low incidence of GON, better methods of prenatal diagnosis, and the availability of suitable alternative prophylactic medication and of effective methods of treatment of GON have prompted recommendations that alternative prophylaxis be legally allowed or that mandatory prophylaxis be eliminated altogether. This paper reviews the situation and provides updated recommendations.

Topics: Conjunctivitis; Erythromycin; Gonorrhea; History, 20th Century; Humans; Infant, Newborn; Legislation, Medical; Ophthalmia Neonatorum; Silver Nitrate; Sweden; Tetracycline; Therapeutic Equivalency; Wisconsin

Administration of silver nitrate 1% solution into the eyes of the newborn has proven effective in the prophylaxis of gonococcal neonatal conjunctivitis. Silver nitrate, however, is not active against Chlamydia trachomatis, the most common cause of neonatal conjunctivitis. Also, silver nitrate commonly is associated with substantial chemical irritation. For these reasons, alternative agents are receiving increasing attention. Recently, erythromycin 0.5% and tetracycline 1% ophthalmic ointments were recommended by the Centers for Disease Control Venereal Disease Control Division for prophylaxis of neonatal conjunctivitis. Erythromycin has proven at least as effective as silver nitrate for gonococcal prophylaxis, can prevent chlamydial conjunctivitis in infants born to Chlamydia-positive mothers, and is associated with minimal complications. Clinical studies, however, demonstrating significant differences between erythromycin and tetracycline ophthalmic ointments are lacking. Well-controlled clinical studies comparing silver nitrate, erythromycin, and tetracycline prophylaxis are needed to determine the relative effectiveness of these agents.

Topics: Chlamydia Infections; Erythromycin; Female; Gonorrhea; Humans; Infant, Newborn; Ophthalmia Neonatorum; Pregnancy; Pregnancy Complications, Infectious; Silver Nitrate; Tetracycline

Topics: Bacitracin; Chlamydia Infections; Erythromycin; Gonorrhea; Humans; Infant, Newborn; Ophthalmia Neonatorum; Penicillins; Silver Nitrate; Sulfonamides; Tetracycline

Topics: Anti-Infective Agents; Arthritis, Infectious; Cephalosporins; Child; Doxycycline; Erythromycin; Female; Gonorrhea; Humans; Kanamycin; Leucomycins; Male; Ophthalmia Neonatorum; Penicillins; Proctitis; Salpingitis; Sexually Transmitted Diseases; Spectinomycin; Sulfonamides; Tetracycline; Thiamphenicol; Trimethoprim

Topics: Acute Disease; Adult; Age Factors; Analgesics; Epididymitis; Genital Diseases, Male; Gonorrhea; Humans; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Technetium; Testicular Neoplasms; Testis; Tetracycline; Trachoma; Ultrasonography

Nongonococcal urethritis is a venereal disease whose incidence is almost double that of gonorrhea. Despite this, the diagnosis, origin, treatment, and complications of nongonococcal urethritis remain unclear. Although some cases are undoubtedly caused by infection with Chlamydia trachomatis, the origin of many cases is uncertain. Treatment is recommended to shorten symptoms and prevent complications. This review presents the current status of this confusing disease.

Topics: Adolescent; Adult; Epididymitis; Female; Gonorrhea; Humans; Infant; Male; Mycoplasma Infections; Neisseria gonorrhoeae; Pelvic Inflammatory Disease; Pneumonia; Sexually Transmitted Diseases; Tetracycline; Trachoma; Urethritis

Topics: Anti-Bacterial Agents; Chancroid; Female; Gonorrhea; Granuloma Inguinale; Humans; Infant; Infant, Newborn; Lymphogranuloma Venereum; Male; Penicillins; Pregnancy; Sexually Transmitted Diseases; Syphilis; Syphilis, Congenital; Tetracycline

Topics: Anus Diseases; Cervix Uteri; Culture Techniques; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G Procaine; Spectinomycin; Tetracycline; Urethra; Vagina; Vaginal Smears

Topics: Adolescent; Adult; Ampicillin; Arthritis, Infectious; Dermatitis; Endocarditis, Bacterial; Female; Gonorrhea; Humans; Male; Meningitis; Neisseria gonorrhoeae; Penicillin G; Pregnancy; Pregnancy Complications, Infectious; Sepsis; Skin Diseases, Infectious; Tetracycline

Topics: Ampicillin; Culture Techniques; Female; Gonorrhea; Humans; Metronidazole; Neisseria gonorrhoeae; Penicillin G Procaine; Sexually Transmitted Diseases; Sulfisoxazole; Syphilis; Syphilis Serodiagnosis; Tetracycline; Treponema pallidum

Topics: Bacteriological Techniques; Coitus; Drug Therapy, Combination; Female; Gonorrhea; Homosexuality; Humans; Male; Penicillin G Procaine; Pharyngeal Diseases; Sexual Behavior; Sulfamethoxazole; Tetracycline; Trimethoprim

The role of prophylactic techniques in controlling venereal disease (VD) continues to be disputed despite the fact that prophylactic techniques have been used for centuries. Focus in this discussion is on the effectiveness of available prophylactic methods and some factors influencing the impact of effective prophylaxis on disease control. For practical purposes there are 3 categories of personal prophylaxis: mechanical (of which the condom is most important), locally acting measures, and systemic chemotherapy. Fallopio reported in the 16th century the 1st use of the condom to protect 1100 men from syphilis. Since then the condom has been an important element of many control programs. Condoms should be undamaged, of good quality, and used at the right time in the correct manner. Frequently the condom fails to prevent VD because of deficiencies in these conditions. Several studies have suggested that the condom may be of prophylactic value: venereal infection was detected in 9.5% of those using a condom or early treatment, but in 22% of those using inadequate prophylaxis and in 68.5% of those using none. There is inadequate evidence to support the effectiveness of available local acting prophylactic agents. Systemic antibiotics offer an effective form of prophylaxis. In addition, due to their potent specific antimicrobial properties, systemic antibiotics offer the unique advantage of aborting infection when administered a considerable time after exposure. A recent study demonstrated that 200 mgm minocycline, given as a postexposure prophylactic, decreased the attack rate of gonococcal urethritis by 55%, but those patients developed infection experienced a prolonged incubation period and tended to be infected with relatively resistant strains. These findings suggest the possibility of a more serious sequel: production of a chronic asymptomatic carrier state. Abortive VD therapy in managing a rape victim requires special consideration. Assessment of management should be based on the following: the likelihood of infection, the risks of treatment, the efficacy of treatment, and patient follow-up. Even when safe and effective techniques are available, their impact on VD control may be minimal if they are only rarely used. In many environments condom use ranges 3-20% among VD clinic patients and rarely exceeds 25% in the general male population. Condoms are used least by those who need them most. If utilization is to be increased, the motiv

Topics: Chloramphenicol; Contraceptive Devices, Male; Female; Follow-Up Studies; Gonorrhea; Humans; Iodobenzoates; Male; Methods; Penicillin G; Rape; Sex Work; Sexually Transmitted Diseases; Silver Nitrate; Soaps; Syphilis; Tetracycline; Time Factors; Urination

Topics: Administration, Oral; Arthritis, Reactive; Candida; Chlamydia; Coitus; Culture Media; Epididymitis; Female; Gonorrhea; Humans; Male; Mycoplasma; Neisseria gonorrhoeae; Prostatitis; Recurrence; Tetracycline; Urethral Stricture; Urethritis; Urine

Topics: Adolescent; Age Factors; Ampicillin; Child; Diagnosis, Differential; Female; Gonorrhea; Humans; Injections, Intravenous; Male; Neisseria gonorrhoeae; Penicillin G; Penicillin G Procaine; Penicillin Resistance; Sex Factors; Skin Manifestations; Tetracycline; United States

Topics: Adolescent; Adult; California; Gonorrhea; Humans; Male; Middle Aged; Penicillin G Procaine; Syphilis; Tetracycline

Topics: Anti-Bacterial Agents; Gonorrhea; Greenland; History, 20th Century; Humans; Penicillins; Syphilis; Tetracycline

Topics: Anti-Bacterial Agents; Chloramphenicol; Drug Resistance, Microbial; Erythromycin; Gonorrhea; Humans; Penicillin Resistance; Spectinomycin; Streptomycin; Tetracycline

Topics: Acetamides; Bacteria; Cyclohexanes; Drug Interactions; Gonorrhea; Half-Life; Humans; Kinetics; Meningococcal Infections; Methylamines; Microbial Sensitivity Tests; Penicillin Resistance; Penicillins; Spectinomycin; Tetracycline

Topics: Ampicillin; Anti-Bacterial Agents; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G; Spectinomycin; Sulfonamides; Tetracycline; Urethritis

Topics: Adolescent; Adult; Age Factors; Chloramphenicol; Female; Gonorrhea; Humans; Immunization; Male; Penicillins; Prognosis; Sex Factors; Sex Work; Sexual Behavior; Sexually Transmitted Diseases; Social Medicine; Syphilis; Tetracycline

Topics: Anti-Bacterial Agents; Asia, Southeastern; Chloramphenicol; Erythromycin; Female; Gonorrhea; Humans; Injections; Male; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Probenecid; Spectinomycin; Sulfathiazoles; Sulfonamides; Tetracycline

Topics: Acne Vulgaris; Adult; Aged; Child, Preschool; Female; Gonorrhea; Hirsutism; Humans; Ichthyosis; Infant; Male; Melphalan; Middle Aged; Psoriasis; Sarcoidosis; Skin Diseases; Skin Neoplasms; Syphilis; Tetracycline; United States

Topics: Antifungal Agents; Candidiasis, Vulvovaginal; Female; Glucocorticoids; Gonorrhea; Haemophilus Infections; Herpes Simplex; Humans; Infant, Newborn; Infant, Newborn, Diseases; Metronidazole; Mycoplasma Infections; Ophthalmia Neonatorum; Penicillin G Procaine; Pregnancy; Pregnancy Complications, Infectious; Pregnancy in Diabetics; Syphilis; Syphilis Serodiagnosis; Syphilis, Congenital; Tetracycline; Trichomonas Vaginitis; Vaginal Diseases

Topics: Ampicillin; Cephaloridine; Culture Media; Female; Fluorescent Antibody Technique; Gonorrhea; Humans; Kanamycin; Male; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Tetracycline

Topics: Anti-Bacterial Agents; Cephaloridine; Gonorrhea; Humans; Kanamycin; Male; Neisseria gonorrhoeae; Oxytetracycline; Penicillins; Sulfonamides; Tetracycline; Urethritis

Topics: Anti-Bacterial Agents; Cephalosporins; Chloramphenicol; Colistin; Drug Hypersensitivity; Enterobacteriaceae Infections; Erythromycin; Female; Gonorrhea; Humans; Kidney Diseases; Mycoplasma Infections; Pelvic Inflammatory Disease; Salpingitis; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Tetracycline; Thrombophlebitis; Tuberculosis, Female Genital; Wound Infection

Difloxacin is a new quinolone antimicrobial agent with in vitro activity against both Neisseria gonorrhoeae and Chlamydia trachomatis and a long (26-h) half-life. A single oral dose of 200 mg of difloxacin was used to treat 30 men with uncomplicated urethral gonorrhea in an open trial. Of the isolates of N. gonorrhoeae, three produced penicillinase and two were resistant to tetracycline. N. gonorrhoeae was eradicated from all 29 evaluable patients. The geometric mean MIC of difloxacin for 30 pretreatment N. gonorrhoeae isolates was 0.014 (range, less than or equal to 0.0039 to 0.03) microgram/ml. Four (13.3%) of the 30 subjects with gonococcal urethritis also had C. trachomatis recovered from their pretreatment cultures. Treatment with difloxacin was associated with the eradication of C. trachomatis from all four men. In addition, C. trachomatis was isolated from the posttreatment culture of only one man who had a negative culture before treatment. Nineteen patients (65.5%) reported adverse experiences, and 17 of them (58.6%) developed symptoms suggestive of central nervous system dysfunction. An oral dose of 200 mg of difloxacin is effective treatment for uncomplicated urethral gonorrhea and may also eliminate a coexisting infection with C. trachomatis. Side effects may limit the utility of this agent.

Topics: Adult; Anti-Bacterial Agents; Chlamydia Infections; Ciprofloxacin; Clinical Trials as Topic; Fluoroquinolones; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin G; Tetracycline

Opinions differ concerning the efficacy of prophylaxis against neonatal chlamydial and gonococcal conjunctivitis. From January 1986 through June 1988, we gave all infants born at Kings County Hospital Medical Center one of three prophylactic agents -- silver nitrate drops, erythromycin ophthalmic ointment, or tetracycline ophthalmic ointment. The treatments were rotated monthly. Gonococcal ophthalmia occurred in 8 of the 12,431 infants born during the study (0.06 percent), 1 in the silver nitrate group, 4 in the erythromycin group, and 3 in the tetracycline group (P not significant). Seven of these infants were born to women who had received no prenatal care. From September 1985 through December 1987, we screened 4357 pregnant women for cervical chlamydial infection, of whom 341 (8 percent) had positive cultures. Of their offspring, 230 were evaluated for neonatal chlamydial conjunctivitis; the incidence was 20 percent in the silver nitrate group, 14 percent in the erythromycin group, and 11 percent in the tetracycline group (P not significant). We conclude that neonatal ocular prophylaxis with either erythromycin or tetracycline ophthalmic ointment does not significantly reduce the incidence of chlamydial conjunctivitis in the offspring of mothers with chlamydial infection as compared with silver nitrate, and that better management of maternal chlamydial infection is therefore required. We also conclude that there is a small but appreciable incidence of neonatal gonococcal ophthalmia that could be prevented by better prenatal screening and treatment of maternal gonococcal infection.

Topics: Chlamydia Infections; Erythromycin; Female; Gonorrhea; Humans; Infant, Newborn; Ointments; Ophthalmia Neonatorum; Ophthalmic Solutions; Pregnancy; Pregnancy Complications, Infectious; Silver Nitrate; Tetracycline

The first penicillinase producing isolates of Neisseria gonorrhoeae (PPNG) identified in Chile were discovered during a clinical and microbiological study to compare the efficacy of penicillin (4.8 MIU aqueous procaine penicillin G plus 1 g oral probenecid) and tetracycline (1.5 g followed by 500 mg four times daily for four days) treatment regimens for acute uncomplicated gonorrhoea. Penicillin treatment was effective in 93.1% (282) of 303 patients, whereas tetracycline was effective in 98.3% (233) of 237 patients. Six of the penicillin treatment failures were attributable to PPNG strains. In all, 21 PPNG strains were identified during the study. They were genetically identical, having a wild type auxotype, a WII/III serotype (serovar Bajk), and carrying cryptic and transfer plasmids and an Asian type penicillinase producing plasmid. In addition, 674 non-PPNG isolates were tested for their susceptibility to eight antimicrobials. Over 95% were sensitivie to 1 mg/l of penicillin, ampicillin, cefotaxime, cefuroxime, and erythromycin, over 90% were sensitive to 1 mg/l of tetracycline and 2 mg/l of thiamphenicol, and all were sensitive to spectinomycin. Of 226 non-PPNG isolates characterised for plasmid content and auxotype, 90% (205) were either wild type or proline requiring, 67% (153) carried only the cryptic plasmid, and a further 31% (71) carried both cryptic and transfer plasmids. Unusually, three of four isolates lacking the cryptic plasmid carried only the transfer plasmid.

Topics: Chile; Clinical Trials as Topic; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillinase; Penicillins; Plasmids; Random Allocation; Tetracycline

Of the currently recommended regimens for treatment of uncomplicated gonorrhea, only aqueous penicillin G procaine is effective against infections at all sites. However, procaine penicillin is not effective against penicillinase-producing Neisseria gonorrhoeae and suffers from poor patient acceptability owing to the 10-mL volume of injection and allergic and toxic procaine reactions. Ceftriaxone is a new extended-spectrum cephalosporin with a long serum half-life and is many times more active than penicillin G against both beta-lactamase-positive or -negative strains of N gonorrhoeae. Ceftriaxone was compared as a single, 125-mg, 0.5-mL injection with a single 2-g injection of spectinomycin in difficult to treat pharyngeal gonorrhea in men and women and anorectal gonorrhea of men. Ceftriaxone cured 30/32 (94%) pharyngeal and 52/52 anorectal infections, compared with 6/14 (43%) and 9/9, respectively, for spectinomycin. Both regimens were well tolerated. Ceftriaxone may prove to be a drug of choice for uncomplicated gonorrhea, particularly where homosexual men are treated and/or penicillinase-producing N gonorrhoeae is prevalent.

Topics: Adult; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Drug Eruptions; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Penicillin G; Pharyngitis; Proctitis; Spectinomycin; Tetracycline

Eight hundred twenty-five ambulatory women with a clinical diagnosis of salpingitis were randomized to a 10-day course of either penicillin/ampicillin or tetracycline. Forty-four percent of women had gonococcal salpingitis and 56% nongonococcal salpingitis. Overall, both regimens cured equal proportions of women: At 30 days, 81% were cured by penicillin/ampicillin and 82% by tetracycline. However, the proportion of women with gonococcal salpingitis cured by 30 days was significantly greater than that of women with nongonococcal salpingitis. By 30 days, 14% of women with gonococcal salpingitis and 21% of women with nongonococcal salpingitis were not cured by either regimen. These data suggest that both regimens were only marginally acceptable for women with gonococcal salpingitis and that neither regimen was acceptable for nongonococcal salpingitis.

Topics: Adolescent; Adult; Ambulatory Care; Ampicillin; Child; Clinical Trials as Topic; Drug Administration Schedule; Drug Therapy, Combination; Female; Gonorrhea; Humans; Middle Aged; Penicillin G; Penicillin G Procaine; Random Allocation; Salpingitis; Tetracycline; Time Factors; United States

We evaluated the effect of treatment of gonorrhea on simultaneous Chlamydia trachomatis infection by randomly assigning 293 heterosexual men and 246 heterosexual women with gonorrhea to receive one of the following treatment regimens: (1) 4.8 million units of aqueous procaine penicillin plus 1 g of probenecid, (2) nine tablets of trimethoprim-sulfamethoxazole daily for three days, or (3) 500 mg of tetracycline four times a day for five days. Among the men, gonococcal infection was cured in 99 per cent given penicillin plus probenecid, 96 per cent given trimethoprim-sulfamethoxazole, and 98 per cent given tetracycline. Among the women, only 90 per cent given tetracycline were cured, in contrast to 97 per cent given penicillin plus probenecid and 99 per cent given trimethoprim-sulfamethoxazole. Chlamydial infection, present in 15 per cent of the men and 26 per cent of the women, was cured in 30 of 32 patients given trimethoprim-sulfamethoxazole and 27 of 29 given tetracycline, but in only 10 of 23 given penicillin plus probenecid. Among chlamydia-positive patients, postgonococcal urethritis in men and cervicitis in women occurred more often in patients given penicillin plus probenecid. Salpingitis developed in 6 of 20 women given penicillin plus probenecid, but in only 1 of 26 given trimethoprim-sulfamethoxazole and in none of 24 given tetracycline. We conclude that the use of penicillin plus probenecid alone for gonorrhea in heterosexual patients carries an unacceptably high risk of postgonococcal chlamydial morbidity. Trimethoprim-sulfamethoxazole and tetracycline were highly effective against both pathogens and were well tolerated in men, but both drugs caused frequent side effects in women. The failure of tetracycline to cure gonorrhea in 10 per cent of women argues against its use alone; treatment with penicillin followed by tetracycline has been recommended for further trial.

Topics: Adolescent; Clinical Trials as Topic; Drug Administration Schedule; Drug Combinations; Female; Gonorrhea; Humans; Lymphogranuloma Venereum; Male; Pelvic Inflammatory Disease; Penicillin G Procaine; Probenecid; Random Allocation; Sex Factors; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis; Uterine Cervicitis

Topics: Acute Disease; Anti-Bacterial Agents; Chile; Clinical Trials as Topic; Drug Therapy, Combination; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G; Penicillin G Procaine; Probenecid; Tetracycline

In a prospective evaluation of antibiotic prophylaxis against gonorrhea, 1080 men were given 200 mg of oral minocycline or placebo after sexual intercourse with prostitutes in a Far Eastern port. Later, at sea, gonococcal infection was detected in 57 of 565 men given placebo and 24 of 515 men given minocycline (P less than 0.001). Minocycline prophylaxis completely prevented infection by gonococci susceptible to 0.75 microgram or less of tetracycline per milliliter, reduced the risk of infection or prolonged the incubation period in men exposed to gonococci susceptible to 1.0 to 2.0 micrograms per milliliter, but did not prevent infection or prolong incubation in men exposed to gonococci resistant to 2.0 micrograms. Minocycline did not increase the proportion of asymptomatic infections. Minocycline prophylaxis would probably have limited effectiveness as a public-health measure because of the tendency to select resistant gonococci.

Topics: Administration, Oral; Asia, Eastern; Coitus; Drug Evaluation; Drug Resistance, Microbial; Gonorrhea; Humans; Male; Minocycline; Naval Medicine; Neisseria gonorrhoeae; Sex Work; Tetracycline; Tetracyclines; Time Factors; United States; Urethritis

There were 50 patients with acute epididymitis who were evaluated prospectively by history, examination and microbiologic studies, including cultures for aerobes, anaerobes, Neisseria gonorrhoeae, Chlamydia trachomatis and Ureaplasma urealyticum. Escherichia coli was the predominant pathogen isolated from the urine of men more than 35 years old, while Chlamydia trachomatis and Neisseria gonorrhoeae were the predominant pathogens isolated from the urethra of men less than 35 years old. The etiologic role of Escherichia coli and Chlamydia trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine or urethral cultures for these agents. Chlamydia trachomatis epididymitis accounted for two-thirds of idiopathic epididymitis in young men and often was associated with oligospermia. Of 9 female sexual partners of men with Chlamydia trachomatis infection 6 had antibody to Chlamydia trachomatis, of whom 2 had positive cervical cultures for this organism and 2 others had non-gonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with Chlamydia trachomatis epididymitis and should be offered to the female sex partners.

Topics: Adolescent; Adult; Aged; Ampicillin; Cell Count; Epididymitis; Escherichia coli Infections; Female; Gonorrhea; Humans; Lymphogranuloma Venereum; Male; Middle Aged; Physical Examination; Prospective Studies; Pseudomonas Infections; Semen; Sexual Behavior; Tetracycline

Spectinomycin and tetracycline are alternative drugs to penicillin in the treatment of gonorrhea. To compare the efficacy of these agents and their propensity to select resistant gonococci, we treated 4043 patients randomly with either 2 or 4 g of spectinomycin once or 9 g of oral tetracycline for four days. Minimum cure rate for anogenital gonorrhea was 94 per cent with either drug. Oropharyngeal infection responded poorly to spectinomycin in men, with failure of therapy in six of 11. Postgonococcal urethritis in men was less common after tetracycline than after spectinomycin (P less than 0.005). Spectinomycin failure was not related to drug resistance. Tetracycline failure correlated with resistance (P less than 0.0002); one fifth of the isolates resistant to 1.0 mug per milliter of tetracycline were not eradicated. For several reasons, including the appearance of beta-lactamase-producing gonococci, it is no longer clear that penicillin G is the "drug of choice" for gonorrhea. Spectinomycin and tetracycline are equally acceptable alternatives, each with distinct advantages and disadvantages.

Topics: Administration, Oral; Drug Evaluation; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Spectinomycin; Tetracycline; Urethritis

To monitor the efficacy of the 1972 United States Public Health Service recommended treatment regimens for uncomplicated gonorrhea, we studied 9008 patients who were randomly assigned either to aqueous procaine penicillin G, 4.8 million units intramuscularly plus 1 g of oral probenecid, or to one of the three other recommended regimens. Among the 3871 patients re-examined within three to seven days after therapy, the penicillin-probenecid regimen was successful in 96.8 per cent, whereas the cure rates of the ampicillin-probenecid, tetracycline, and spectinomycin regimens were 92.8, 96.2, and 94.8 per cent, respectively. In clinics comparing the regimens, penicillin G-probenecid was as effective as tetracycline, but more effective than ampicillin-probenecid (P less than 0.05) and spectinomycin (P less than 0.01). However, in patients re-examined three to 14 days after treatment, only the ampicillin-probenecid regimen was significantly less effective than penicillin probenecid (P less than 0.01). Despite these differences in results, all four regimens recommended by the Public Health Service provided effective therapy for uncomplicated gonorrhea.

Topics: Administration, Oral; Ampicillin; Drug Evaluation; Drug Therapy, Combination; Female; Follow-Up Studies; Gonorrhea; Humans; Injections, Intramuscular; Male; Penicillin G Procaine; Probenecid; Prospective Studies; Sex Factors; Spectinomycin; Tetracycline; Time Factors

A clinical trial was performed to test a loading dose regimen of tetracycline (1.5 gm po sTAT and 0.5 mg po quid for 4 days) against a no-loading dose (0.5 gm po quid for 4 1/2 days) in the treatment of 477 cases of uncomplicated male urogenital gonorrhea. The regimens were equivalent, with an overall cure rate of 96%. A crossover pharmacokinetic study in 10 healthy volunteers demonstrated higher blood levels during the first day on the loading regimen, but equivalence thereafter. Tetracycline, in a total dose of 9.5 gm, is highly effective treatment, and a loading dose is not necessary.

Topics: Adult; Clinical Trials as Topic; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Tetracycline

A trial of Sustamycin, a sustained-release preparation of tetracycline hydrochloride, in uncomplicated gonorrhoea in sixty males is described, Each patient was given an initial dose of 500 mg. followed by 250 mg. twice daily for 5 days. Of the 57 patients who attended for follow-up 47 (82-5 per cent.) were cured. There were no adverse reactions.

Topics: Adolescent; Adult; Clinical Trials as Topic; Delayed-Action Preparations; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Penicillins; Streptomycin; Tetracycline

In a collaborative prospective study 327 women with uncomplicated gonococcal cervicitis or proctitis were randomly assigned to one of four treatment groups: (1) aqueous procaine penicillin G, 4.8 million units IM in one session plus 1.0 g probenecide; (2) tetracycline HCI, 9 g over 4 days; (3) trimethoprim, 80 mg-sulfamethoxazole, 400 mg (TMP-SMX) six tablets once daily for 3 days; (4) TMP-SMX, six tablets wtice on 1 dat at a 6-hour interval. They were re-examined 4 to 8 days and 10 to 15 days after completion of therapy. There was no significant difference between the results of the four regimens in the 4- to 8-day period (P greater than 0.36). However, at the 2-week point the results of TMP-SMX given for 3 days were less effective (P smaller than 0.05) than those obtained by penicillin plus probenecid. There was no significant difference between the results of the other regimens at this latter period.

Topics: Administration, Oral; Adolescent; Adult; Clinical Trials as Topic; Drug Combinations; Drug Evaluation; Female; Follow-Up Studies; Gonorrhea; Humans; Injections, Intramuscular; Middle Aged; Neisseria gonorrhoeae; Penicillin G Procaine; Probenecid; Sulfamethoxazole; Tetracycline; Trimethoprim

One hundred and eighty-four male patients with uncomplicated gonorrhea were treated in a randomized double-blind trial using two drug regimens. The combinations used were co-trimoxazole (trimethoprim, 80 mg and sulfamethoxazole, 400 mg) and TMP-SDZ (sulfadiazine, 400 mg and trimethoprim, 80 mg). In 43 patients who received eight tablets of co-trimoxazole in a single dose the cure rate was 88%. In the 46 patients who received a second dose of eight tablets 24 hours later the cure rate was 100%. When TMP-SDZ was used according to the same schedule the respective cure rates were 85% (41 patients) and 86% (35 patients). It is suggested that the two-dose regimen with co-trimoxazole is very effective in the treatment of uncomplicated urethral gonorrhea in the male and that the single-dose regimen, although less effective, may well prove adequate in patients defaulting after the initial treatment. At the present time, and with our local conditions, this form of treatment should be reserved for patients sensitive to penicillin or whose infections are resistant to this agent. The attack rate for patients having an episode of gonorrhea in the 12-month period immediately preceding the trial bore a direct relation to the outcome of therapy. It was highest (26%) in the group with an unsatisfactory outcome and lowest(4.3%) in the group with the highest cure rate. No adverse toxic reactions to the drug were recorded.

Topics: Administration, Oral; Adolescent; Adult; Clinical Trials as Topic; Drug Combinations; Drug Evaluation; Drug Hypersensitivity; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Patient Dropouts; Penicillin Resistance; Penicillins; Sulfadiazine; Sulfamethoxazole; Tetracycline; Trimethoprim

Topics: Adult; Clinical Trials as Topic; Gonorrhea; Humans; Male; Minocycline; Tetracycline; Urethritis

Topics: Female; Follow-Up Studies; Gonorrhea; Humans; Kenya; Length of Stay; Male; Neisseria gonorrhoeae; Oxyphenbutazone; Pain; Pelvic Inflammatory Disease; Placebos; Tetracycline; Urethra; Uterine Cervical Diseases

Topics: Cephalosporins; Clinical Trials as Topic; Drug Combinations; Erythromycin; Female; Gonorrhea; Humans; Male; Penicillin G Procaine; Penicillins; Probenecid; Sexually Transmitted Diseases; Spectinomycin; Syphilis; Syphilis, Congenital; Tetracycline; Time Factors; Urethritis

Topics: Ampicillin; Costs and Cost Analysis; Drug Hypersensitivity; Drug Synergism; Female; Genetics, Microbial; Gonorrhea; Humans; Male; Molecular Biology; Neisseria gonorrhoeae; Penicillin G Benzathine; Penicillin G Procaine; Penicillin Resistance; Penicillins; Placebos; Probenecid; Spectinomycin; Syphilis; Tetracycline; United States

Topics: Adolescent; Adult; Chlorides; Clinical Trials as Topic; Female; Gonorrhea; Humans; Male; Middle Aged; Nausea; Pharyngitis; Sex Factors; Spectinomycin; Tetracycline

Topics: Anti-Infective Agents; Clinical Trials as Topic; Culture Media; Drug Combinations; Folic Acid Antagonists; Gonorrhea; Humans; Male; Penicillin Resistance; Penicillins; Pyrimidines; Streptomycin; Sulfamethoxazole; Sulfisoxazole; Tetracycline; Trimethoprim

Topics: Acute Disease; Chloramphenicol; Clinical Trials as Topic; Gonorrhea; Humans; Penicillin G Procaine; Tetracycline

Topics: Drug Combinations; Follow-Up Studies; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Penicillin G Procaine; Probenecid; Sulfamethoxazole; Tetracycline; Trimethoprim; United States; Urethritis

Topics: Adult; Ampicillin; Anti-Infective Agents; Black People; Clinical Trials as Topic; Drug Combinations; Folic Acid Antagonists; Gonorrhea; Humans; Male; Pyrimidines; Sulfamethoxazole; Tetracycline; Trimethoprim

Topics: Administration, Oral; Adolescent; Adult; Demeclocycline; Doxycycline; Drug Hypersensitivity; Gonorrhea; Humans; Injections, Intramuscular; Male; Middle Aged; Neisseria gonorrhoeae; Oxytetracycline; Penicillin G Procaine; Penicillin Resistance; Tetracycline

Topics: Administration, Oral; Adolescent; Adult; Age Factors; Clinical Trials as Topic; Doxycycline; Gonorrhea; Humans; Injections, Intramuscular; Male; Middle Aged; Neisseria gonorrhoeae; Oxytetracycline; Penicillin Resistance; Penicillins; Tetracycline; Time Factors

Topics: Aluminum; Chloramphenicol; Female; Gonorrhea; Humans; Male; Penicillin G Benzathine; Penicillin G Procaine; Stearic Acids; Syphilis; Tetracycline

Topics: Administration, Oral; Age Factors; Ampicillin; Gonorrhea; Humans; Hypersensitivity; Injections, Intramuscular; Male; Penicillins; Tetracycline; Time Factors; Urethritis

Topics: Acute Disease; Adolescent; Adult; Australia; Clinical Trials as Topic; Gonorrhea; Humans; Male; Marriage; Middle Aged; Penicillin G Procaine; Probenecid; Sexual Behavior; Single Person; Tetracycline; Urethritis

Topics: Bacteriological Techniques; Gonorrhea; Humans; Male; Military Medicine; Neisseria gonorrhoeae; Penicillin G Benzathine; Penicillin G Procaine; Penicillin Resistance; Probenecid; Staphylococcal Infections; Tetracycline; Urethritis; Vietnam

Topics: Adult; Gonorrhea; Humans; Kanamycin; Male; Penicillins; Tetracycline; Urethritis

Topics: Adult; Gonorrhea; Humans; Male; Naval Medicine; Neisseria gonorrhoeae; Penicillin G Procaine; Penicillin Resistance; Probenecid; Tetracycline

We found that tetracycline resistance-associated mutations and genes in Neisseria gonorrhoeae are linked to mutations causing resistance to other antimicrobials. Therefore, the use of doxycycline postexposure prophylaxis may select for resistance to other antimicrobials.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Doxycycline; Drug Resistance, Bacterial; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Tetracycline

Pre-existing tetracycline resistance in Neisseria gonorrhoeae limits the effectiveness of post-exposure prophylaxis (PEP) with doxycycline against gonorrhea, and selection for tetracycline resistance may influence prevalence of multi-drug resistant strains. Using genomic and antimicrobial susceptibility data from N. gonorrhoeae, we assessed the near-term impact of doxycycline PEP on N. gonorrhoeae resistance.

Topics: Anti-Bacterial Agents; Doxycycline; Drug Resistance, Bacterial; Genomics; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Post-Exposure Prophylaxis; Tetracycline

Global antimicrobial resistance (AMR) surveillance in Neisseria gonorrhoeae is essential. In 2017-18, only five (10.6%) countries in the WHO African Region reported to the WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO GASP). Genomics enhances our understanding of gonococcal populations nationally and internationally, including AMR strain transmission; however, genomic studies from Africa are extremely scarce. We describe the gonococcal genomic lineages/sublineages, including AMR determinants, and baseline genomic diversity among strains in Uganda, Malawi and South Africa, 2015-20, and compare with sequences from Kenya and Burkina Faso.. Gonococcal isolates cultured in Uganda (n = 433), Malawi (n = 154) and South Africa (n = 99) in 2015-20 were genome-sequenced. MICs were determined using ETEST. Sequences of isolates from Kenya (n = 159), Burkina Faso (n = 52) and the 2016 WHO reference strains (n = 14) were included in the analysis.. Resistance to ciprofloxacin was high in all countries (57.1%-100%). All isolates were susceptible to ceftriaxone, cefixime and spectinomycin, and 99.9% were susceptible to azithromycin. AMR determinants for ciprofloxacin, benzylpenicillin and tetracycline were common, but rare for cephalosporins and azithromycin. Most isolates belonged to the more antimicrobial-susceptible lineage B (n = 780) compared with the AMR lineage A (n = 141), and limited geographical phylogenomic signal was observed.. We report the first multi-country gonococcal genomic comparison from Africa, which will support the WHO GASP and WHO enhanced GASP (EGASP). The high prevalence of resistance to ciprofloxacin (and empirical use continues), tetracycline and benzylpenicillin, and the emerging resistance determinants for azithromycin show it is imperative to strengthen the gonococcal AMR surveillance, ideally including genomics, in African countries.

Topics: Anti-Bacterial Agents; Azithromycin; Ciprofloxacin; Drug Resistance, Bacterial; Genomics; Gonorrhea; Humans; Malawi; Microbial Sensitivity Tests; Neisseria gonorrhoeae; South Africa; Tetracycline; Uganda

There is a paucity of Neisseria gonorrhoeae antimicrobial resistance data from resource-constrained settings because of the lack of diagnostic testing and limited scale of surveillance programs. This study aimed to determine the antimicrobial resistance profile of N. gonorrhoeae in the rural Eastern Cape province of South Africa.. Specimens for N. gonorrhoeae culture were obtained from men with urethral discharge and women with vaginal discharge attending primary health care facilities. Direct inoculation of the agar plates was performed followed by culture and drug susceptibility testing using the Etest at the laboratory. Whole-genome sequencing of the isolates was performed to identify resistance-determining variants.. One hundred N. gonorrhoeae isolates were obtained. Most strains were nonsusceptible to ciprofloxacin (76%), tetracycline (75%), and penicillin G (72%). The gyrA S91F mutation was present in 68 of 72 ciprofloxacin-resistant isolates (94%), with concurrent parC mutations in 47 of 68 (69%); gyrA I250M was the only mutation in 4 other resistant strains. One azithromycin-resistant isolate was identified with a minimal inhibitory concentration (MIC) of 8.0 mg/L and the 23S rDNA gene mutation C2597T. The median MIC of cefixime was 0.016 mg/L (range, 0.016-0.064 mg/L), and that of ceftriaxone was 0.016 mg/L (range, 0.016 mg/L). Whole-genome sequencing showed 58 sequence types as revealed in N. gonorrhoeae sequence typing for antimicrobial resistance and 70 sequence types in N. gonorrhoeae multiantigen sequence typing.. This study confirmed high rates of N. gonorrhoeae antimicrobial resistance to ciprofloxacin, penicillin G, and tetracycline in our setting. The MICs of cephalosporins are reassuring for ceftriaxone use in syndromic treatment regimens, but the identification of azithromycin resistance warrants further attention.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Molecular Typing; Mycobacterium tuberculosis; Neisseria gonorrhoeae; Penicillin G; South Africa; Tetracycline

Agar dilution is the gold standard method for phenotypic antimicrobial susceptibility testing (AST) for

Topics: Agar; Alberta; Anti-Bacterial Agents; Azithromycin; Cefixime; Ceftriaxone; Ciprofloxacin; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Retrospective Studies; Tetracycline

Gentamicin has been used for the treatment of gonorrhea in Malawi since 1993. However, declining clinical cure rates have been suspected. We evaluated current Neisseria gonorrhoeae susceptibility to gentamicin in vitro and clinically.. Men with acute urethritis were recruited at the Bwaila District Hospital STI Clinic in Lilongwe, Malawi, between January 2017 and August 2019. All men provided urethral swabs for etiological testing at enrollment and test of cure (TOC), 1 week later, using Gram-stained microscopy and culture. We used Etest to determine minimum inhibitory concentrations (MICs) of gentamicin, azithromycin, cefixime, ceftriaxone, ciprofloxacin, and spectinomycin; disc diffusion for tetracycline susceptibility; and whole-genome sequencing (WGS) to verify/refute treatment failure.. Among 183 N. gonorrhoeae culture-positive men enrolled, 151 (82.5%) had a swab taken for TOC. Of these 151 men, 16 (10.6%) had a positive culture at TOC. One hundred forty-one baseline isolates were tested for gentamicin susceptibility using Etest: 2 (1.4%), MIC = 2 μg/mL; 111 (78.7%), MIC = 4 μg/mL; and 28 (19.9%), MIC = 8 μg/mL. All isolates were susceptible to azithromycin, cefixime, ceftriaxone, and spectinomycin, whereas 63.1% had intermediate susceptibility or resistance to ciprofloxacin. Almost all (96.1%) isolates were resistant to tetracycline. All examined isolates cultured at TOC (n = 13) had gentamicin MICs ≤8 μg/mL. Ten men had pretreatment and posttreatment isolates examined by whole-genome sequencing; 2 (20%) were verified new infections (4119 and 1272 single-nucleotide polymorphisms), whereas 8 (80%) were confirmed treatment failures (0-1 single-nucleotide polymorphism).. Gentamicin MICs poorly predict gonorrhea treatment outcome with gentamicin, and treatment failures are verified with gonococcal strains with in vitro susceptibility to gentamicin. The first-line treatment of gonorrhea in Malawi should be reassessed.

Topics: Anti-Bacterial Agents; Azithromycin; Cefixime; Ceftriaxone; Ciprofloxacin; Female; Gentamicins; Gonorrhea; Humans; Malawi; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Polymorphism, Single Nucleotide; Spectinomycin; Tetracycline; Treatment Outcome

Limited data are available regarding antimicrobial resistance in Neisseria gonorrhoeae strains circulating in WHO Eastern Mediterranean Region (EMR). We investigated the antimicrobial susceptibility/resistance of N. gonorrhoeae isolates to five antimicrobials (ceftriaxone, azithromycin, ciprofloxacin, tetracycline, and benzylpenicillin) currently or previously used for gonorrhoea treatment in Qatar, 2017-2020. Minimum inhibitory concentrations (MICs; mg/L) of antimicrobials were determined using Etest on gonococcal isolates collected during January 1, 2017-August 30, 2020 at Hamad Medical Corporation, a national public healthcare provider. During 2017-2020, resistance in isolates from urogenital sites of 433 patients was 64.7% (95% CI: 59.5-69.6%; range: 43.9-78.7%) for ciprofloxacin, 50.7% (95% CI: 45.3-56.1%; range: 41.3-70.4%) for tetracycline, and 30.8% (95% CI: 26.3-35.6%; range: 26.7-35.8%) for benzylpenicillin. Percentage of isolates non-susceptible to azithromycin was 4.1% (95% CI: 2.0-7.4%; range: 2.7-4.8%) and all (100%) isolates were susceptible to ceftriaxone. Two (1.6%) isolates from 2019 and one (2.2%) isolate from 2020 had high-level resistance to azithromycin (MIC≥256 mg/L). Overall, 1.0% (4/418) of isolates had a ceftriaxone MIC of 0.25 mg/L, which is at the ceftriaxone susceptibility breakpoint (MIC≤0.25 mg/L). Treatment with ceftriaxone 250 mg plus azithromycin 1 g can continuously be recommended for gonorrhoea therapy in Qatar. Continued quality-assured gonococcal AMR surveillance is warranted in EMR.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Gonorrhea; Humans; Microbial Sensitivity Tests; Mitomycin; Neisseria gonorrhoeae; Qatar; Tetracycline

Neisseria gonorrhoeae poses an urgent public health threat because of increasing antimicrobial resistance; however, much of the circulating population remains susceptible to historical treatment regimens. Point-of-care diagnostics that report susceptibility could allow for reintroduction of these regimens, but development of such diagnostics has been restricted to ciprofloxacin, for which susceptibility can be predicted from a single locus. We aimed to define genetic variants associated with susceptibility to penicillin and tetracycline.. We collected publicly available global whole-genome sequencing data (n=12 045) from clinical N gonorrhoeae isolates, with phenotypic resistance data for penicillin (n=6935), and tetracycline (n=5727). Using conditional genome-wide association studies, we defined genetic variants associated with susceptibility to penicillin and tetracycline. We excluded isolates that could not be classified as either susceptible or resistant. To validate our results, we assembled 1479 genomes from the US Centers for Disease Control and Prevention (CDC)'s Gonococcal Isolate Surveillance Project, for which urethral specimens are collected at sentinel surveillance sites across the USA. We evaluated the sensitivity and specificity of susceptibility-associated alleles using Clinical & Laboratory Standards Institute breakpoints for susceptibility and non-resistance in both the global and validation datasets.. In our conditional penicillin genome-wide association study, the presence of a genetic variant defined by a non-mosaic penA allele without an insertion at codon 345 was associated with penicillin susceptibility and had the highest negative effect size (β) of significant variants (p=5·0x10. As few as two genetic loci can predict susceptibility to penicillin and tetracycline in N gonorrhoeae with high specificity. Molecular point-of-care diagnostics targeting these loci have the potential to increase available treatments for gonorrhoea.. National Institute of Allergy and Infectious Diseases, the National Science Foundation, and the Smith Family Foundation.

Topics: Anti-Bacterial Agents; Genome-Wide Association Study; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Tetracycline

The increasing rate of antimicrobial-resistant Neisseria gonorrhoeae poses a considerable public health threat due to the difficulty in treating gonococcal infections. This study examined antimicrobial resistance (AMR) to drugs recommended for gonorrhea treatment between 2015 and 2017, and the AMR determinants and genetic compositions of plasmids in 3 gonococcal strains with high-level penicillin resistance.. We collected 117 N. gonorrhoeae isolates from patients with gonococcal infections who attended Siriraj Hospital, Bangkok, Thailand, between 2015 and 2017. Minimum inhibitory concentrations (MICs) of penicillin, tetracycline, ciprofloxacin, azithromycin, spectinomycin, cefixime, and ceftriaxone were determined by the agar dilution method. PCR amplification and sequencing of 23S rRNA and mtrR (a negative regulator of MtrCDE efflux pump) were performed. Whole genomes of 3 PPNG strains with high-level penicillin resistance (MIC ≥ 128 μg/ml) were sequenced using Illumina and Nanopore sequencing platforms.. The proportions of N. gonorrhoeae isolates with resistance were 84.6% for penicillin, 91.5% for tetracycline, and 96.6% for ciprofloxacin. All isolates were susceptible to spectinomycin, azithromycin, cefixime, and ceftriaxone. An adenine deletion within a 13 bp inverted repeat sequence in the mtrR promoter and an H105Y mutation in the mtrR coding region were found in the N. gonorrhoeae isolate with the highest azithromycin MIC value (1 μg/ml). Three high-level penicillin-resistant isolates contained nonmosaic type II penA and had mutations in penB and the mtrR coding region. All isolates with high-level penicillin resistance carried the conjugative plasmids with or without the Dutch type tetM determinant, the beta-lactamase plasmid (Rio/Toronto), and the cryptic plasmid.. The gonococcal population in Thailand showed high susceptibility to ceftriaxone and azithromycin, current dual therapy recommended for gonorrhea treatment. As elevated MIC of azithromycin has been observed in 1 strain of N. gonorrhoeae, expanded and enhanced surveillance of antimicrobial susceptibility and study of genetic resistance determinants are essential to improve treatment guidelines.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Cefixime; Ceftriaxone; Ciprofloxacin; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Sequence Analysis; Spectinomycin; Tetracycline; Thailand

Neisseria gonorrhoeae, the causative agent for sexually transmitted infection (STI) gonorrhoea, has emerged with a significant public health impact on acquiring resistance to antimicrobials available for treatment. The resistance of N. gonorrhoeae limit treatment options and contributed to high morbidity associated with gonorrhoea. Data on antimicrobial resistance (AMR) profiles in N. gonorrhoeae is scares in Zambia. This study aimed to determine the antibiotic susceptibilities in N. gonorrhoeae isolates from Lusaka, Zambia.. A prospective cross-sectional study was conducted on 630 STI patients who presented with urethral or vaginal discharge from 2019 to 2020. Urethral and endocervical secretions were cultured on Modified Thayer Martin agar and incubated at 36 °C ± 1 °C in 5% CO. The N. gonorrhoeae resistance to penicillin, tetracycline and ciprofloxacin was high necessitating revision of the treatment guidelines. However, no resistance to ceftriaxone was detected. Therefore, monitoring of antibiotic resistance remains critical in Zambia.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Ciprofloxacin; Cross-Sectional Studies; Drug Resistance, Bacterial; Female; Gonorrhea; Hospitals, Urban; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Prospective Studies; Tetracycline; Zambia

We present a case of gonococcal septic arthritis of the right hip diagnosed via synovial fluid cultures. Antimicrobial susceptibility testing of the synovial fluid demonstrated susceptibility to tetracycline, ciprofloxacin, cefixime and ceftriaxone. Our patient was initially treated with ceftriaxone and was successfully de-escalated to oral levofloxacin to complete the treatment. This case is interesting given the rarity of disseminated gonococcal infections in the 21st century and that most clinical isolates of

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Cefixime; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Fluoroquinolones; Gonorrhea; Humans; Levofloxacin; Tetracycline

There is growing concern about the emergence and spread of multidrug-resistant

Topics: Amino Acid Substitution; Anti-Bacterial Agents; Azithromycin; Bacterial Outer Membrane Proteins; Drug Resistance, Multiple, Bacterial; Gonorrhea; Humans; Mutation; Neisseria gonorrhoeae; Penicillins; Proteomics; Tetracycline

Background Neisseria gonorrhoeae has developed resistance to various antimicrobials. At least 10 countries have reported treatment failures with extended-spectrum cephalosporins. Periodic surveillance is essential to determine local treatment guidelines. This study was conducted to determine the resistance of N. gonorrhoeae to penicillin, tetracycline, levofloxacin, cefixime and ceftriaxone among the high-risk population for acquiring STIs in Jakarta and to identify factors associated with resistance.. A cross-sectional study was conducted in Jakarta, Indonesia, from September to November 2018. In all, 98 high-risk males and females who fulfilled the study criteria were included. Specimens were collected from urethral or endocervical swabs, put into Amies transport medium and then transported to the Laboratory of Clinical Microbiology, Universitas Indonesia for culture and identification. Proven gonococcal isolates were examined for susceptibility to various antimicrobials using the disk diffusion method according to Clinical and Laboratory Standard Institute guidelines.. Of the 98 specimens, 35 were confirmed to be N. gonorrhoeae. The proportion of N. gonorrhoeae specimens resistant to penicillin, tetracycline, levofloxacin, cefixime and ceftriaxone among the high-risk population was 97.1%, 97.1%, 34.3%, 0% and 0% respectively. The possible factors associated with resistance could only be analysed for levofloxacin. Age, sexual orientation and a history of orogenital sexual activity during the past month were not associated with N. gonorrhoeae resistance to levofloxacin.. This study detected no resistance of N. gonorrhoeae to cefixime and ceftriaxone. Further studies with larger samples are needed to obtain more representative results of N. gonorrhoeae resistance and the possible factors associated with resistance.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefixime; Ceftriaxone; Cross-Sectional Studies; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; Indonesia; Levofloxacin; Male; Middle Aged; Neisseria gonorrhoeae; Penicillins; Tetracycline

We report on the first high-level azithromycin-resistant Neisseria gonorrhoeae isolate (minimum inhibitory concentration, ≥256 μg/mL) in North Carolina isolated from a pharyngeal swab of a 33-year-old HIV-negative man who has sex with men. In addition, the isolate was found to be susceptible to cefixime, ceftriaxone, and penicillin and resistant to tetracycline. By whole-genome sequencing, the strain was assigned as MLST ST9363, NG-MAST ST5035, and a novel NG-STAR sequence type, ST1993.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Cefixime; Ceftriaxone; Drug Resistance, Bacterial; Gonorrhea; HIV Seronegativity; Homosexuality, Male; Humans; Male; Microbial Sensitivity Tests; Multilocus Sequence Typing; Neisseria gonorrhoeae; North Carolina; Penicillins; Pharynx; Tetracycline; Whole Genome Sequencing

Neisseria gonorrhoeae (commonly known as gonorrhea) has developed resistance to all first-line therapy in Southeast Asia. East Africa has historically had absent or rudimentary gonorrhea surveillance programs and, while the existence of antimicrobial-resistant gonorrhea is recognized, the extent of its resistance is largely unknown. In 2016, the World Health Organization's Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP) was initiated in Uganda to monitor resistance trends.. This study characterizes gonorrhea and antibiotic resistance in a large surveillance program of men with urethral discharge syndrome from Kampala, Uganda.. Men attending sentinel clinics with urethritis provided demographic information, behavior data, and a urethral swab in line with the World Health Organization's EGASP protocols for culture, identification, and antibiotic-sensitivity testing using 2 methods-disk diffusion (Kirby-Bauer test) and Etest (BioMérieux Inc). A subset of samples underwent detailed antimicrobial resistance testing.. Of 639 samples collected from September 2016 to February 2018, 400 (62.6%) were culture-positive though 414 (64.8%) had microscopic evidence of gonorrhea. The mean age of the men from whom the samples were collected was 26.9 (SD 9.6) years and 7.2% (46/639) reported having HIV. There was high-level resistance to ciprofloxacin, tetracycline, and penicillin (greater than 90%) by Kirby-Bauer disk diffusion and 2.1% (4/188) had reduced azithromycin sensitivity by Etest. Of the early isolates that underwent detailed characterization, 60.3% (70/116) were culture-positive, 94% (66/69) isolates were either ciprofloxacin-resistant or ciprofloxacin-intermediate by Etest, 96% (65/68) were azithromycin-sensitive, and 96% (66/69) were gentamicin-sensitive. Resistance profiles were comparable between methods except for ceftriaxone (disk diffusion: 68/69, 99%; Etest: 67/69, 97%) and for gentamicin (disk diffusion: 2/8, 25%; Etest: 66/69, 96%) sensitivity.. This is the first report from a systematic gonorrhea surveillance program in Uganda. Findings demonstrated resistance or increased minimum inhibitory concentration to all key antigonococcal antibiotics. There was evidence of poor antibiotic stewardship, near-universal resistance to several antibiotics, and emerging resistance to others. Individuals in the population sampled were at exceptionally high risk of STI and HIV infection requiring intervention. Ongoing surveillance efforts to develop interventions to curtail antimicrobial-resistant gonorrhea are needed.

Topics: Adult; Anti-Bacterial Agents; Cefixime; Ceftriaxone; Ciprofloxacin; Demography; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G; Population Surveillance; Sentinel Surveillance; Spectinomycin; Tetracycline; Uganda

Treatment of gonorrhea is complicated by the development of antimicrobial resistance in Neisseria gonorrhoeae (GC) to the antibiotics recommended for treatment. Knowledge on types of plasmids and the antibiotic resistance genes they harbor is useful in monitoring the emergence and spread of bacterial antibiotic resistance. In Kenya, studies on gonococcal antimicrobial resistance are few and data on plasmid mediated drug resistance is limited. The present study characterizes plasmid mediated resistance in N. gonorrhoeae isolates recovered from Kenya between 2013 and 2018.. DNA was extracted from 36 sub-cultured GC isolates exhibiting varying drug resistance profiles. Whole genome sequencing was done on Illumina MiSeq platform and reads assembled de-novo using CLC Genomics Workbench. Genome annotation was performed using Rapid Annotation Subsystem Technology. Comparisons in identified antimicrobial resistance determinants were done using Bioedit sequence alignment editor.. Twenty-four (66.7%) isolates had both β-lactamase (TEM) and TetM encoding plasmids. 8.3% of the isolates lacked both TEM and TetM plasmids and had intermediate to susceptible penicillin and tetracycline MICs. Twenty-six (72%) isolates harbored TEM encoding plasmids. 25 of the TEM plasmids were of African type while one was an Asian type. Of the 36 isolates, 31 (86.1%) had TetM encoding plasmids, 30 of which harbored American TetM, whereas 1 carried a Dutch TetM. All analyzed isolates had non-mosaic penA alleles. All the isolates expressing TetM were tetracycline resistant (MIC> 1 mg/L) and had increased doxycycline MICs (up to 96 mg/L). All the isolates had S10 ribosomal protein V57M amino acid substitution associated with tetracycline resistance. No relation was observed between PenB and MtrR alterations and penicillin and tetracycline MICs.. High-level gonococcal penicillin and tetracycline resistance in the sampled Kenyan regions was found to be mediated by plasmid borne blaTEM and tetM genes. While the African TEM plasmid, TEM1 and American TetM are the dominant genotypes, Asian TEM plasmid, a new TEM239 and Dutch TetM have emerged in the regions.

Topics: Anti-Bacterial Agents; beta-Lactamases; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Female; Genotype; Gonorrhea; Humans; Kenya; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Plasmids; Tetracycline; Tetracycline Resistance; Whole Genome Sequencing

Antimicrobial resistance (AMR) to gonorrhoea is a threat to global health security. There have been concerns expressed that countries with high rates of disease have poor surveillance. The objectives of the study were to determine the AMR patterns of Neisseria gonorrhoeae clinical isolates to antimicrobial agents in patients with HIV or high risk of HIV acquisition, to compare the concordance of disk diffusion and agar dilution as methods for determining AMR to N. gonorrhoeae, and to describe methodological challenges to carrying out AMR testing. The study was conducted at an HIV outpatient service for at-risk populations and an outreach clinic for commercial sex workers in Kampala. Patients were offered a sexually transmitted infection screen using a polymerase chain reaction (PCR)-based assay. Samples positive for gonorrhoea were cultured. Antimicrobial susceptibility testing was performed using disk diffusion and isolates were sent to a reference laboratory for agar dilution direct susceptibility testing. Five hundred and seventy-five patients were screened. There were 33 (5.7%) patients with gonorrhoea detected by PCR. Of the 16 viable N. gonorrhoeae isolates, 100% were resistant to ciprofloxacin and tetracycline by disk diffusion and 31% exhibited reduced susceptibility to ceftriaxone and cefixime. By agar dilution, 100% of isolates were resistant to ciprofloxacin and all isolates were susceptible to ceftriaxone and cefixime. There was concordance between disk diffusion and agar dilution for ciprofloxacin and tetracycline resistance and a significant discordance for third-generation cephalosporins. More than half the women with gonorrhoea were asymptomatic and represent a potential reservoir for ongoing transmission. AMR testing of N. gonorrhoeae isolates is needed to ensure optimal treatment and prevention of antibiotic resistance progression.

Topics: Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gonorrhea; HIV Infections; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Tetracycline; Uganda

With increasing antibiotic resistance observed amongst clinical isolates of Neisseria gonorrhoeae, the second most prevalent sexually transmitted bacterial disease in the United States, there is still a need for antimicrobial susceptibility testing (AST). The current method recommended by the Clinical and Laboratory Standards Institute is agar dilution. In this study, we show that a commercially available version of Fastidious Broth is capable of supporting N. gonorrhoeae in the evaluation of minimum inhibitory concentrations of 4 antibiotics (ceftriaxone, azithromycin, ciprofloxacin, and tetracycline), when comparing the agar dilution (AD) versus microbroth dilution (MBD) method and the susceptibilities obtained for 32 N. gonorrhoeae isolates. Herein, 3 out of the 4 antibiotics tested showed 94% or greater essential agreement (EA) and 91% or greater categorical agreement (CA) respectively, when comparing the MBD versus AD methods.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Ciprofloxacin; Colony Count, Microbial; Culture Media; Drug Resistance, Bacterial; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Tetracycline

We report on the antimicrobial resistance profile of Neisseria gonorrhoeae isolates and the distribution of tetM genes in isolates with high-level tetracycline resistance in KwaZulu-Natal, South Africa.. Male and female patients presenting with urethral and/or vaginal discharge were recruited into the study. Urethral and cervical secretions were cultured on New York City agar. Confirmatory tests for N. gonorrhoeae included Gram stain, catalase, oxidase, and carbohydrate utilization tests. Beta-lactamase was tested by means of the chromogenic cephalosporin test. Minimum inhibitory concentrations were determined using agar dilution with multipoint inoculation. Polymerase chain reaction with gel electrophoresis was used to detect the presence and type of the tetM gene.. N. gonorrhoeae was isolated from the specimens of 319 (26%) of the 1220 recruited patients. Of these 319 isolates, 71% were resistant to 3 or more drugs. Resistance to azithromycin was found in 68% of the isolates. All isolates showed high-level tetracycline resistance with minimum inhibitory concentration values of 16 and 32 mg/mL. The tetM gene was present in 293 (92%). The American type was found in 264 (90%) and the Dutch type in 29 (10%). Twenty-six (8%) did not carry a tetM gene.. The current syndromic management with dual ceftriaxone and azithromycin is due to the high level of azithromycin resistance factually single-drug therapy. High-level tetracycline resistance based on a resistance mechanism other than ribosome protection by the tetM gene product is present in N. gonorrhoeae infecting South African patients.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Bacterial Proteins; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; South Africa; Tetracycline; Urethra; Vagina; Young Adult

Topics: Bacterial Proteins; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Tetracycline; Tetracycline Resistance

In this study, the trends of antimicrobial resistance in Neisseria gonorrhoeae were analysed in Shandong Province of China during 2007 to 2014. Furthermore, the ceftriaxone (CRO) genetic resistance determinants, including penA, mtrR, penB, ponA, and pilQ genes, were sequenced and the molecular mechanisms of decreased susceptibility or resistance to CRO in N. gonorrhoeae were elucidated. Overall, the increasing trends of resistance to penicillin (PEN), tetracycline (TET), and ciprofloxacin (CIP), and decreasing trends of susceptibility to CRO and azithromycin (AZM) were observed in Shandong Province between 2007 and 2014. The proportions of PPNG, TRNG, PP/TRNG, and MDR isolates increased sharply in this district. PenA mosaic structure, the substitution of A501V, and an insertion of aspartate in amino acid position 345 were identified in the N. gonorrhoeae isolates with decreased susceptibility or resistance to CRO. All the 28 N. gonorrhoeae isolates had substitutions at Gly-120 and Ala-121 of porin encoded by penB, substitution of L421P in PBP1, and a single nucleotide (A) deletion in the 13 bp inverted repeat located between the -10 and -35 sequences in the mtrR promoter. Additionally, 21 N.gonorrhoeae isolates had substitutions of A39T/G45D in MtrR, and three new substitutions of R44G, L47R, and/or H105F in MtrR were observed. Therefore, PenA mosaic structure in N. gonorrhoeae and the substitutions of Ala-501 in PBP2 may considerably increase CRO MICs. A close association between the genetic polymorphisms in mtrR, penB, and ponA and the development of decreased susceptibility to CRO might be confirmed.

Topics: Anti-Bacterial Agents; Azithromycin; Bacterial Proteins; Ceftriaxone; China; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Fimbriae Proteins; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Polymorphism, Single Nucleotide; Repressor Proteins; Tetracycline

The objective of this study was to estimate the tetracycline resistance level in the modern population of Neisseria gonorrhoeae in the Russian Federation, where this drug was removed from the treatment regimen for gonococcal infections in 2003. A total of 401 isolates collected between 2015 and 2017 were analyzed for genetic markers (chromosomal porB, rpsJ and mtrR gene mutations and the plasmid-located tetM gene) involved in tetracycline resistance. Antibiotic susceptibility testing revealed that 19% of the strains were tetracycline resistant (MIC > 1 mg/L) and that 10% of the strains had intermediate susceptibility (0.5 < MIC ≤ 1 mg/L). Various combinations of mutations identified in the rpsJ (Val57Met/Leu), porB (Gly120Lys/Asp/Asn/Thr and Ala121/Asp/Asn/Gly), and mtrR (-35 del A) genes resulted in MIC increases of up to 1.47 mg/L (geometric mean value). The presence of the tetM gene was detected in 29 strains, including 18 tetM genes of the American type and 11 of the Dutch type. The tetM gene was associated with a strong increase in resistance (MIC > 8 mg/L). One N. gonorrhoeae isolate was found to carry a defective tetM gene with an AG deletion at position 1239-1240, а new stop codon was introduced that caused a defect in TetM protein synthesis and decrease in the tetracycline resistance. Phylogenetic trees constructed using N. gonorrhoeae NG-MAST and tetM loci were compared. Complex relationship was observed between the N. gonorrhoeae sequence type and the tetM plasmid type. Partial recovery of N. gonorrhoeae tetracycline susceptibility was observed relative to the proportion of isolates with resistance detected ten years ago (75%). However, the current levels of tetracycline resistance still preclude the renewed use of these drugs for gonococcal infection therapy.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Gene Expression; Gonorrhea; Humans; Microbial Sensitivity Tests; Mutation; Neisseria gonorrhoeae; Phylogeny; Plasmids; Porins; Repressor Proteins; Ribosomal Proteins; Russia; Tetracycline; Tetracycline Resistance

A cross sectional study was conducted between April and August 2016 among STI clinic clients in Gondar town hospitals and health centers. Urethral swab and cervical swab specimens were inoculated to Thayer Martin media (OXOID, UK) plates. Observation of Gram-negative intracellular diplococcic was a presumptive diagnosis of gonococcal infection. Finally, antimicrobial susceptibility was assessed by using a modified Kirby-Bauer disk diffusion test, with results indicating susceptible, intermediate or resistant. Data were entered and analyzed using SPSS version 20.. The overall prevalence of laboratory confirmed N. Prevalence and drug resistance of

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Ethiopia; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Penicillins; Tetracycline; Urethra; Vagina; Young Adult

Tracking the spread of antimicrobial-resistant Neisseria gonorrhoeae is a major priority for national surveillance programmes.. We investigate whether WGS and simultaneous analysis of multiple resistance determinants can be used to predict antimicrobial susceptibilities to the level of MICs in N. gonorrhoeae.. WGS was used to identify previously reported potential resistance determinants in 681 N. gonorrhoeae isolates, from England, the USA and Canada, with phenotypes for cefixime, penicillin, azithromycin, ciprofloxacin and tetracycline determined as part of national surveillance programmes. Multivariate linear regression models were used to identify genetic predictors of MIC. Model performance was assessed using leave-one-out cross-validation.. Overall 1785/3380 (53%) MIC values were predicted to the nearest doubling dilution and 3147 (93%) within ±1 doubling dilution and 3314 (98%) within ±2 doubling dilutions. MIC prediction performance was similar across the five antimicrobials tested. Prediction models included the majority of previously reported resistance determinants. Applying EUCAST breakpoints to MIC predictions, the overall very major error (VME; phenotypically resistant, WGS-prediction susceptible) rate was 21/1577 (1.3%, 95% CI 0.8%-2.0%) and the major error (ME; phenotypically susceptible, WGS-prediction resistant) rate was 20/1186 (1.7%, 1.0%-2.6%). VME rates met regulatory thresholds for all antimicrobials except cefixime and ME rates for all antimicrobials except tetracycline. Country of testing was a strongly significant predictor of MIC for all five antimicrobials.. We demonstrate a WGS-based MIC prediction approach that allows reliable MIC prediction for five gonorrhoea antimicrobials. Our approach should allow reasonably precise prediction of MICs for a range of bacterial species.

Topics: Anti-Bacterial Agents; Azithromycin; Canada; Cefixime; Ciprofloxacin; Drug Resistance, Bacterial; England; Genome, Bacterial; Gonorrhea; High-Throughput Nucleotide Sequencing; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin G; Tetracycline; United States; Whole Genome Sequencing

Antimicrobial resistance (AMR) and genetic determinants of resistance of N. gonorrhoeae isolates from Hefei, China, were characterized adding a breadth of information to the molecular epidemiology of gonococcal resistance in China.. 126 N. gonorrhoeae isolates from a hospital clinic in Hefei, were collected between January, 2014, and November, 2015. The minimum inhibitory concentration (MIC) of N. gonorrhoeae isolates for seven antimicrobials were determined by the agar dilution method. Isolates were tested for mutations in penA and mtrR genes and 23S rRNA, and also genotyped using N. gonorrhoeae multi-antigen sequence typing (NG-MAST).. All N. gonorrhoeae isolates were resistant to ciprofloxacin; 81.7% (103/126) to tetracycline and 73.8% (93/126) to penicillin. 39.7% (50/126) of isolates were penicillinase producing N. gonorrhoeae (PPNG), 31.7% (40/126) were tetracycline resistant N. gonorrhoeae (TRNG) and 28.6% (36/126) were resistant to azithromycin. While not fully resistant to extended spectrum cephalosporins (ESCs), a total of 14 isolates (11.1%) displayed decreased susceptibility to ceftriaxone (MIC ≥ 0.125 mg/L, n = 10), cefixime (MIC ≥ 0. 25 mg/L, n = 1) or to both ESCs (n = 3). penA mosaic alleles XXXV were found in all isolates that harbored decreased susceptibility to cefixime, except for one. Four mutations were found in mtrR genes and mutations A2143G and C2599T were identified in 23S rRNA. No isolates were resistant to spectinomycin. Gonococcal isolates were distributed into diverse NG-MAST sequence types (STs); 86 separate STs were identified.. N. gonorrhoeae isolates from Hefei during 2014-2015, displayed high levels of resistance to antimicrobials that had been recommended previously for treatment of gonorrhea, e.g., penicillin, tetracycline and ciprofloxacin. The prevalence of resistance to azithromycin was also high (28.6%). No isolates were found to be fully resistant to spectinomycin, ceftriaxone or cefixime; however, 11.1% isolates, overall, had decreased susceptibility to ESCs.

Topics: Anti-Bacterial Agents; Azithromycin; Bacterial Proteins; beta-Lactamases; Cephalosporins; China; Ciprofloxacin; Drug Resistance, Bacterial; Genotype; Gonorrhea; Humans; Microbial Sensitivity Tests; Molecular Epidemiology; Mutation; Neisseria gonorrhoeae; Penicillins; Repressor Proteins; Spectinomycin; Tetracycline

The Centers for Disease Control and Prevention (CDC) currently recommends dual therapy with ceftriaxone and azithromycin for gonorrhea to ensure effective treatment and slow emergence of antimicrobial resistance. Since 2013, the prevalence of reduced azithromycin susceptibility increased in the United States; however, these strains were highly susceptible to cephalosporins. We identified a cluster of Neisseria gonorrhoeae isolates with high-level azithromycin resistance, several of which also demonstrated decreased ceftriaxone susceptibility.. Eight N. gonorrhoeae isolates collected from 7 patients on Oahu, Hawaii, seen 21 April 2016 through 10 May 2016 underwent routine Etest antimicrobial susceptibility testing by the Hawaii Department of Health. All demonstrated elevated azithromycin minimum inhibitory concentrations (MICs) >256 μg/mL and elevated ceftriaxone MICs (≥0.125 μg/mL). Isolates were sent to the University of Washington and CDC for confirmatory agar dilution testing; sequence data were sent to CDC for analysis. All patients were interviewed and treated, and when possible, partners were interviewed, tested, and treated.. All isolates had azithromycin MICs >16 µg/mL and 5 had ceftriaxone MICs = 0.125 µg/mL by agar dilution. All isolates were β-lactamase positive and were resistant to penicillin, tetracycline, and ciprofloxacin. Genomic analysis revealed genetic relatedness. No patients reported recent travel or antibiotic use, and no male patients reported male sex partners. All patients were successfully treated.. This cluster of genetically related gonococcal isolates with decreased ceftriaxone susceptibility and high-level azithromycin resistance may bring the threat of treatment failure in the United States with the current recommended dual therapy one step closer.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; beta-Lactamases; Ceftriaxone; Ciprofloxacin; Contact Tracing; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Gonorrhea; Hawaii; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Penicillins; Tetracycline; Young Adult

Seven countries in Latin America and the Caribbean report on (2010 and 2011) the susceptibility of 2235 isolates of Neisseria gonorrhoeae to 6 antibiotics. Thirteen isolates had ceftriaxone minimum inhibitory concentrations (MICs) of 0.125 to ≥ 0.25 mg/L. The percentage of resistant isolates to the following antibiotics was: azithromycin, 1.0% to 1.7%; ciprofloxacin, 42.1% to 36.2%; penicillin, 31% to 35%; tetracycline, 21.8% to 22.6%.

Topics: Anti-Bacterial Agents; Azithromycin; Caribbean Region; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; South America; Tetracycline

This study aimed to gain information on the antimicrobial susceptibility and molecular epidemiological typing of Neisseria gonorrhoeae (NG) isolates in China in 2012.. A total of 244 NG isolates were consecutively recovered from patients with uncomplicated gonorrhea attending sexually transmitted disease clinics in 3 Chinese cities-Guangzhou, Nanjing, and Tianjin-in 2012. Neisseria gonorrhoeae susceptibilities to penicillin and tetracycline were examined by detecting penicillinase-producing NG (PPNG) and high-level tetracycline-resistant NG, and NG susceptibilities to ciprofloxacin, spectinomycin, ceftriaxone, and cefixime were determined using an agar dilution method. Neisseria gonorrhoeae isolates were typed by multiple-locus variable number tandem repeat analysis. We conducted a χ analysis to compare clusters with Bonferroni correction and Kruskal-Wallis test.. Neisseria gonorrhoeae isolates gathered from the 3 cities differed significantly in the prevalence of tetracycline-resistant NG (P < 0.001) and NG treated with ceftriaxone with a minimum inhibitory concentration of 0.125 mg/L or higher (P < 0.001). The analysis of the combination of the 7 variable number of tandem repeats loci for all of the 244 isolates yielded 110 multiple-locus variable number tandem repeat analysis types falling into 5 clusters. Cluster III was associated with PPNG, whereas cluster II was associated with non-PPNG (P < 0.05) and NG treated with ceftriaxone with a minimum inhibitory concentration of 0.125 mg/L or higher (P < 0.05).. Antimicrobials that can be used with confidence to treat NG infection currently in China include ceftriaxone and spectinomycin, but not penicillin, tetracycline, ciprofloxacin, and cefixime. Moreover, some of the resulting clusters were associated with PPNG and NG with decreased ceftriaxone susceptibility.

Topics: Adult; Anti-Bacterial Agents; Cefixime; Ceftriaxone; Cervix Uteri; Chi-Square Distribution; China; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Minisatellite Repeats; Neisseria gonorrhoeae; Penicillins; Prevalence; Spectinomycin; Tetracycline; Urethra; Young Adult

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

The detection of high-level tetracycline-resistant strains of Neisseria gonorrhoeae (TRNG) can make important epidemiological contributions that are relevant to controlling infections from this pathogen. In this study, we aimed to determine the incidence of TRNG isolates over time and also to investigate the characteristics and genetic epidemiology of these TRNG isolates in Korea.. The antimicrobial susceptibilities of 601 isolates of N. gonorrhoeae from 2004 to 2011 were tested by standard Clinical and Laboratory Standards Institute methods. To determine the molecular epidemiological relatedness, N. gonorrhoeae multi-antigen sequence typing was performed.. The incidence of TRNG increased from 2% in 2004 to 21% in 2011. The minimum inhibitory concentration distributions of ceftriaxone and susceptibility of ciprofloxacin in TRNG were different from non-TRNG and varied according to the year of isolation. Most of the TRNG isolates collected from 2004 to 2007 exhibited genetic relatedness, with sequence type (ST) 1798 being the most common. From 2008 to 2011, the STs of the isolates became more variable and introduction of genetically unrelated TRNG were noted.. The increased incidence of TRNG strains until 2007 appears to be due, at least in part, to clonal spread. However, we propose that the emergence of various STs since 2008 could be associated with foreign import.

Topics: Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Gonorrhea; Humans; Incidence; Microbial Sensitivity Tests; Molecular Epidemiology; Neisseria gonorrhoeae; Republic of Korea; Sequence Analysis, DNA; Tetracycline; Tetracyclines

Gonorrhea is the second most commonly reported notifiable disease in the United States; 350,062 gonorrhea cases were reported in 2014. Sexually transmitted infections caused by Neisseria gonorrhoeae are a cause of pelvic inflammatory disease in women, which can lead to serious reproductive complications including tubal infertility, ectopic pregnancy, and chronic pelvic pain. Prevention of sequelae and of transmission to sexual partners relies largely on prompt detection and effective antimicrobial treatment. However, treatment has been compromised by the absence of routine antimicrobial susceptibility testing in clinical care and evolution of antimicrobial resistance to the antibiotics used to treat gonorrhea.. 2014.. The Gonococcal Isolate Surveillance Project (GISP) was established in 1986 as a sentinel surveillance system to monitor trends in antimicrobial susceptibilities of N. gonorrhoeae strains in the United States. Each month, N. gonorrhoeae isolates are collected from up to the first 25 men with gonococcal urethritis attending each of the participating sexually transmitted disease (STD) clinics at 27 sites. The number of participating sites has varied over time (21-30 per year). Selected demographic and clinical data are abstracted from medical records. Isolates are tested for antimicrobial susceptibility using agar dilution at one of five regional laboratories.. A total of 5,093 isolates were collected in 2014. Of these, 25.3% were resistant to tetracycline, 19.2% to ciprofloxacin, and 16.2% to penicillin (plasmid-based, chromosomal, or both). Reduced azithromycin susceptibility (Azi-RS) (defined as minimum inhibitory concentration [MIC] ≥2.0 µg/mL) increased from 0.6% in 2013 to 2.5% in 2014. The increase occurred in all geographic regions, but was greatest in the Midwest, and among all categories of sex of sex partners (men who have sex with men [MSM], men who have sex with men and women [MSMW], and men who have sex with women [MSW]). No Azi-RS isolates exhibited reduced cefixime or ceftriaxone susceptibility (Cfx-RS and Cro-RS, respectively). The prevalence of Cfx-RS (MIC ≥0.25 µg/mL) increased from 0.1% in 2006 to 1.4% in both 2010 and 2011, decreased to 0.4% in 2013, and increased to 0.8% in 2014. Cro-RS (MIC ≥0.125 µg/mL) increased following a similar pattern but at lesser percentages (increased from 0.1% in 2008 to 0.4% in 2011 and decreased to 0.1% in 2013 and 2014). The percentage of isolates resistant to tetracycline, ciprofloxacin, penicillin, or all three antimicrobials, was greater in isolates from MSM than from MSW.. This is the first report to present comprehensive surveillance data from GISP and summarize gonococcal susceptibility over time, as well as underscore the history and public health implications of emerging cephalosporin resistance. Antimicrobial susceptibility patterns vary by geographic region within the United States and by sex of sex partner. Because dual therapy with ceftriaxone plus azithromycin is the only recommended gonorrhea treatment, increases in azithromycin and cephalosporin MICs are cause for concern that resistance to these antimicrobial agents might be emerging. It is unclear whether increases in the percentage of isolates with Azi-RS mark the beginning of a trend. The percentage of isolates with elevated cefixime MICs increased during 2009-2010, then decreased during 2012-2013 after treatment recommendations were changed in 2010 to recommend dual therapy (with a cephalosporin and a second antibiotic) and a higher dosage of ceftriaxone. Subsequently, the treatment recommendations were changed again in 2012 to no longer recommend cefixime as part of first-line therapy (leaving ceftriaxone-based dual therapy as the only recommended therapy). Despite the MIC decrease (i.e., trend of improved cefixime susceptibility) during 2012-2013, the increase in the number of strains with Cfx-RS in 2014 underscores the potential threat of cephalosporin-resistant N. gonorrhoeae.. The National Strategy for Combating Antibiotic-Resistant Bacteria identifies prevention, rapid detection, and control of outbreaks of ceftriaxone-resistant N. gonorrhoeae infection as a priority for U.S.. Antimicrobial susceptibility surveillance is conducted to guide development of treatment recommendations for effective therapy and prevention of complications from and transmission of gonorrhea. Federal agencies can use GISP data to develop national treatment recommendations and set research and prevention priorities. Local and state health departments can use GISP data to determine allocation of STD prevention services and resources, guide prevention planning, and communicate best treatment practices to health care providers. Continued surveillance, appropriate treatment, development of new antibiotics, and prevention of transmission remain the best strategies to reduce gonorrhea incidence and morbidity.

Topics: Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Sentinel Surveillance; Tetracycline; United States

Molecular epidemiology of 100 consecutive gonococcal isolates collected between April 2010 and October 2013 from New Delhi was investigated using Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) along with its association with antimicrobial resistance profiles. Neisseria gonorrhoeae isolates were assigned into 60 different sequence types and 43 (71.6%) were novel. Sole representation was seen in 76.6% sequence types. There was significant association between ST6058 and resistance to penicillin (P = 0.00) and tetracycline (P = 0.002).

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacterial Typing Techniques; Female; Gonorrhea; Humans; India; Male; Middle Aged; Molecular Epidemiology; Multilocus Sequence Typing; Neisseria gonorrhoeae; Penicillins; Sequence Analysis, DNA; Tetracycline; Young Adult

The widespread distribution of Neisseria gonorrhoeae strains that are resistant to previously used and clinically implemented antibiotics is a significant global public health problem. In line with WHO standards, the national Gonococcal Antimicrobial Surveillance Programme (RU-GASP) has been in existence in Russia since 2004; herein, the current status (2015) is described, including associations between N. gonorrhoeae antimicrobial susceptibility, primary genetic resistance determinants and specific strain sequence types.. A total of 124 N. gonorrhoeae strains obtained from 9 regions in Russia in 2015 were examined using N. gonorrhoeae Multi-Antigen Sequence Typing (NG-MAST), an antimicrobial susceptibility test according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria and an oligonucleotide microarray for the identification of mutations in the penA, ponA, rpsJ, gyrA and parC genes responsible for penicillin G, tetracycline, and fluoroquinolone resistance. Genogroup (G) isolates were evaluated based on their porB and tbpB sequence types (STs).. NG-MAST analysis showed a diversified population of N. gonorrhoeae in Russia with 58 sequence types, 35 of which were described for the first time. The STs 807, 1544, 1993, 5714, 9476 and 12531, which were typical for some Russian Federation regions and several countries of the former Soviet Union, were represented by five or more isolates. The internationally widespread ST 1407 was represented by a single strain in the present study. Division into genogroups facilitated an exploration of the associations between N. gonorrhoeae sequence type, antimicrobial resistance spectra and genetic resistance determinant contents. Preliminarily susceptible (G-807, G-12531) and resistant (G-5714, G-9476) genogroups were revealed. The variability in the most frequently observed STs and genogroups in each participating region indicated geographically restricted antimicrobial susceptibility in N. gonorrhoeae populations.. Resistance or intermediate susceptibility to previously recommended antimicrobials, such as penicillin G (60.5 %), ciprofloxacin (41.1 %) and tetracycline (25 %), is common in the N. gonorrhoeae population. Based on previous reports and current data, ceftriaxone and spectinomycin should be recommended for first-line empiric antimicrobial monotherapy for gonorrhoea in Russia.

Topics: Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Genotype; Gonorrhea; Humans; Microbial Sensitivity Tests; Molecular Epidemiology; Neisseria gonorrhoeae; Oligonucleotide Array Sequence Analysis; Russia; Spectinomycin; Tetracycline

Increasing antimicrobial resistance of Neisseria gonorrhoeae, particularly to third-generation cephalosporins, has been reported in many countries. We examined the susceptibility (determined by Etest and evaluated using the breakpoints of the European Committee on Antimicrobial Susceptibility Testing) of 434 N. gonorrhoeae isolates collected from 107 female and 327 male patients in Stuttgart, south-west Germany, between 2004 and 2015. During the study period, high proportions of isolates were resistant to ciprofloxacin (70.3%), tetracycline (48.4%; increasing from 27.5% in 2004/2005 to 57.7% in 2014/2015; p = 0.0002) and penicillin (25.6%). The proportion of isolates resistant to azithromycin was low (5.5%) but tended to increase (p = 0.08). No resistance and stable minimum inhibitory concentrations were found for cefixime, ceftriaxone, and spectinomycin. High-level resistance was found for ciprofloxacin (39.6%) and tetracycline (20.0%) but not for azithromycin; 16.3% of the isolates produced betalactamase. Thus, cephalosporins can still be used for the treatment of gonorrhoea in the study area. To avoid further increasing resistance to azithromycin, its usage should be limited to patients allergic to cephalosporins, or (in combination with cephalosporins) to patients for whom no susceptibility testing could be performed or those co-infected with chlamydiae.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Cephalosporins; Ciprofloxacin; Drug Resistance, Bacterial; Female; Germany, West; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Penicillins; Tetracycline; Tetracyclines; Treatment Outcome

In the 1990s, azithromycin became the drug of choice for many infectious diseases but emerging resistance to the drug has only been reported in the last decade. In the last 5 years, the National Neisseria gonorrhoeae Reference Laboratory of Hungary (NNGRLH) has also observed an increased number of N. gonorrhoeae strains resistant to azithromycin. The aim of this study was to determine the most frequent sequence types (ST) of N. gonorrhoeae related to elevated levels of azithromycin MIC (minimal inhibitory concentration). Previously and currently isolated azithromycin-resistant strains have been investigated for the existence of molecular relationship.. Maldi-Tof technic was applied for the identification of the strains isolated from outpatients attending the reference laboratory. Testing antibiotic susceptibility of azithromycin, cefixime, ceftriaxone, tetracycline, spectinomycin and ciprofloxacin was carried out for all the identified strains, using MIC strip test Liofilchem(®). N. gonorrhoeae multiantigen sequence typing (NG-MAST) was performed exclusively on azithromycin-resistant isolates. A phylogenetic tree was drawn using MEGA6 (Molecular Evolutionary Genetics Analysis Version 6.0) Neighbour-Joining method.. Out of 192 N. gonorrhoeae isolates, 30.0 % (58/192) proved resistant to azithromycin (MIC > 0.5 mg/L). Of the azithromycin-resistant isolates, ST1407, ST4995 and ST11064 were the most prevalent. Based on the phylogenetic analysis, the latter two STs are closely related.. In contrast to West-European countries, in our region, resistance to azithromycin has increased up to 30 % in the last 5 years, so the recommendation of the European Guideline -500 mg of ceftriaxone combined with 2 g of azithromycin as first choice therapy against N. gonorrhoeae- should be seriously considered in case of Hungary.

Topics: Adult; Alleles; Anti-Bacterial Agents; Azithromycin; Bacterial Typing Techniques; Cefixime; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gene Expression; Gonorrhea; Humans; Hungary; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Phylogeny; Porins; Prevalence; Spectinomycin; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Tetracycline; Transferrin-Binding Protein B

Accurate detection of Neisseria gonorrhoeae antimicrobial resistance is essential for appropriate management and prevention of spread of infection in the community. In this study Calibrated Dichotomous Sensitivity (CDS) and Clinical Laboratory Standards Institute (CLSI) disc diffusion methods were compared with minimum inhibitory concentration (MIC) by Etest in Neisseria gonorrhoeae isolates from Karachi, Pakistan. CDS and CLSI disc diffusion techniques, and Etest for ceftriaxone, penicillin G, spectinomycin and ciprofloxacin against 100 isolates from years 2012-2014 were performed. Due to lack of CLSI breakpoints for azithromycin, it was interpreted using cut-offs from British Society of Antimicrobial Chemotherapy (BSAC). Due to lack of low concentration tetracycline discs, tetracycline was tested with CLSI disc diffusion and Etest only. Comparisons were based on the identified susceptibility, intermediate susceptibility and resistance (SIR) categories using the different methods. Complete percent agreement was percentage agreement achieved when test and reference method had identical SIR-category. Essential percent agreement was percentage agreement when minor discrepancies were disregarded.. There was 100 % and 99 % overall essential agreement and 50 % versus 23 % overall complete agreement by CDS and CLSI methods, respectively, with MICs for all tested antibiotics. Using either method, there was 100 % complete agreement for ceftriaxone and spectinomycin. There was 90 % versus 86 % complete agreement for ciprofloxacin, and 60 % and 75 % for penicillin using CDS and CLSI method, respectively. Essential agreement of 99 % and complete agreement of 62 % was found for tetracycline with CLSI method. There was 100 % essential and complete agreement by CDS, BSAC and Etest for azithromycin.. No major errors with regard to identified SIR-categories were found for penicillin, ciprofloxacin, ceftriaxone and spectinomycin using CLSI and CDS methods. All isolates were susceptible to ceftriaxone and spectinomycin, and 99 % to azithromycin. In low-resource settings, both the CLSI and CDS disc diffusion techniques might be used for susceptibility testing of gonococcal isolates. However, these methods require considerable standardization and quality controls for adequate levels of reproducibility and correct interpretation to reflect appropriately the MIC values of the different antimicrobials. New, emerging, or rare resistance should be confirmed by MIC determination.

Topics: Anti-Bacterial Agents; Cross-Sectional Studies; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Pakistan; Reproducibility of Results; Tetracycline

The US system for gonococcal antimicrobial susceptibility surveillance monitors trends exclusively among men with urethral infection, the population from whom the yield of gonococcal culture is highest. Little is known about the susceptibility of female urogenital isolates, and it is unclear whether gonococcal susceptibility among men who report sex exclusively with women (MSW) is representative of susceptibility among women.. Using isolates collected during a recent treatment trial in 5 US cities, we performed a secondary analysis to compare antimicrobial susceptibilities of Neisseria gonorrhoeae urogenital isolates obtained from women, MSW, and men who have sex with men (MSM). Pretreatment isolates were collected from trial participants; minimum inhibitory concentrations (MICs) were determined by agar dilution. Geometric mean MICs were adjusted for geographic location using general linear models.. Susceptibility data for urogenital isolates from 56 women, 252 MSW, and 170 MSM were studied. The adjusted geometric mean ceftriaxone MIC was similar among women (0.0067 μg/mL; 95% confidence interval [CI], 0.0049-0.0092 μg/mL) and MSW (0.0060 μg/mL; 95% CI, 0.0053-0.0066 μg/mL). In contrast, the adjusted geometric mean ceftriaxone MIC was higher among MSM (0.0098 μg/mL; 95% CI, 0.0082-0.0119 μg/mL) than among MSW. This same pattern was observed for other antimicrobials, including cefixime and azithromycin. Ceftriaxone, cefixime, and azithromycin MICs were higher among MSM than among MSW, but were similar among women and MSW. These findings suggest that gonococcal antimicrobial susceptibility surveillance based on urethral isolates from MSW may adequately represent susceptibility of urogenital N. gonorrhoeae in women.

Topics: Adult; Anti-Infective Agents; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gonorrhea; Heterosexuality; Homosexuality; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Sentinel Surveillance; Tetracycline; United States; Urban Population

To investigate the molecular epidemiology of isolates of Neisseria gonorrhoeae from Saskatchewan, Canada, using Neisseria gonorrhoeae multi antigen sequence typing (NG-MAST), and to assess associations between antimicrobial susceptibility (AMS) and specific strain types (STs).. 320 consecutive gonococcal isolates, collected between 2003 and 2008, were typed by NG-MAST. STs were grouped if one of their alleles was common and the other differed by ≤1% in DNA sequence. AMS was determined by agar dilution (CLSI) to seven antibiotics.. N gonorrhoeae isolates were resolved into 82 individual NG-MAST STs and 18 NG-MAST ST groups with groups 25, 3655, 921, 3654, 3657 and 3656 comprising 53.4% (171/320) of the isolates. N gonorrhoeae isolates susceptible to all the tested antimicrobials were significantly (p<0.05) associated with ST 25 (87%). Other significant associations between ST and AMS included: ST 3654 and isolates with minimum inhibitory concentrations of ≥0.03 mg/L to third generation cephalosporins; ST 3711 (100%) and TRNG; and ST/group 3654 (43%) and chromosomal resistance to penicillin and tetracycline. Several NG-MAST STs/groups were significantly associated with isolates with chromosomal resistance to tetracycline. Isolates resistant to ciprofloxacin (n=5) and azithromycin (n=2) appeared as individual STs. Significant associations were observed among individual STs, sex and age of the patient, and regional and temporal distributions.. Associations between N gonorrhoeae AMS and NG-MAST STs were identified and may be useful in predicting AMS regionally. Because STs in different countries vary considerably, the use of NG-MAST for the prediction of AMS globally requires further study.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Bacterial Typing Techniques; Cefixime; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; DNA, Bacterial; Female; Gonorrhea; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Typing; Neisseria gonorrhoeae; Penicillins; Saskatchewan; Sequence Analysis, DNA; Spectinomycin; Tetracycline; Young Adult

The spread of Neisseria gonorrhoeae (Ng) isolates resistant to the clinically implemented antibiotics is challenging the efficacy of treatments. Unfortunately, phenotypic and molecular data regarding Ng detected in Switzerland are scarce.. We compared the characteristics of Ng detected during 1998-2001 (n = 26) to those detected during 2009-2012 (n = 34). MICs were obtained with the Etest and interpreted as non-susceptible (non-S) according to EUCAST criteria. Sequence type (ST) was achieved implementing the NG-MAST. BlaTEM, ponA, penA, mtrR, penB, tet(M), gyrA, parC, mefA, ermA/B/C/F, rplD, rplV, and 23S rRNA genes were analyzed.. The following susceptibility results were obtained (period: % of non-S, MIC90 in mg/L): penicillin (1998-2001: 42.3%, 3; 2009-2012: 85.3%, 16), cefixime (1998-2001: 0%, ≤0.016; 2009-2012: 8.8%, 0.125), ceftriaxone (1998-2001: 0%, 0.004; 2009-2012: 0%, 0.047), ciprofloxacin (1998-2001: 7.7%, 0.006; 2009-2012: 73.5%, ≥32), azithromycin (1998-2001: 11.5%, 0.25; 2009-2012: 23.6%, 0.38), tetracycline (1998-2001: 65.4%, 12; 2009-2012: 88.2%, 24), spectinomycin (1998-2001: 0%, 12; 2009-2012: 0%, 8). The prevalence of multidrug-resistant (MDR) isolates increased from 7.7% in 1998-2001 to 70.6% in 2009-2012. International STs and genogroups (G) emerged during 2009-2012 (G1407, 29.4%; G2992, 11.7%; G225, 8.8%). These isolates possessed distinctive mechanisms of resistance (e.g., G1407: PBP1 with L421, PBP2 pattern XXXIV, GyrA with S91F and D95G, ParC with S87R, PorB with G120K and A121N, mtrR promoter with A deletion).. The prevalence of penicillin- ciprofloxacin- and tetracycline-resistant Ng has reached dramatic levels, whereas cefixime and ceftriaxone show MICs that tend to increase during time. International MDR clones less susceptible to cephalosporins are rapidly emerging indicating that the era of untreatable gonococcal infections is close.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Cefixime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Phenotype; Switzerland; Tetracycline; Young Adult

Globally, incidence of Neisseria gonorrhoeae infection is once again the highest of the bacterial sexually transmitted infections. The bacterium can produce serious complications in those infected, and emerging resistance to third generation cephalosporins could usher in an era of potentially untreatable gonorrhea. This research aimed to identify risk factors for antibiotic resistant gonorrhea infection among clients at a Shanghai sexually transmitted infection clinic over two time periods, 2004-2005 and 2008-2011. Demographic and risk factor behavior data, and biological samples for antimicrobial resistance analysis, were collected. Statistical models were built to identify risk factors associated with probable resistance to ceftriaxone and resistance to penicillin and tetracycline. High levels of ciprofloxacin resistance (98%) in our sample precluded examining its risk factors; all isolates were susceptible to spectinomycin. Overall (P<0.001), chromosomal (P<0.001), and plasmid-mediated (P = 0.01) penicillin resistance decreased from the first to second period of the study. For tetracycline, chromosomal resistance decreased (P = 0.01) and plasmid-mediated resistance increased (P<0.001) between the first and second periods of study. In multi-level multivariable regression models, male gender (P = 0.03) and older age (P = 0.01) were associated with increased minimum inhibitory concentrations to ceftriaxone. Male gender (P = 0.03) and alcohol use (P = 0.02) were associated with increased odds of overall tetracycline resistance. Male gender was associated with increased odds of chromosomally-mediated tetracycline resistance (P = 0.04), and alcohol use was associated with increased odds of plasmid-mediated tetracycline resistance (P = 0.02). Additionally, individuals in middle-salary categories were found to have lower odds of plasmid-mediated resistance to tetracycline compared with those in the lowest salary category (P≤0.02). This study is one of the first to use multilevel analysis to consider the association between risk factors for gonorrhea infections and mechanisms of resistance to individual antibiotics. Such information is urgently needed to combat the growing threat of untreatable gonorrhea.

Topics: Age Factors; Alcohol Drinking; Ceftriaxone; China; Cities; Drug Resistance, Bacterial; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillins; Regression Analysis; Risk Factors; Statistics, Nonparametric; Tetracycline

To monitor the frequency of antibiotic resistance of Neisseria gonorrhoeae (NG) in Nanning, China, between 2000 and 2012.. The production of β-lactamase by NG isolates was determined using the paper acidometric testing method. Antimicrobial susceptibility testing was performed for tetracycline, ciprofloxacin, spectinomycin, and ceftriaxone using the agar dilution method. The χ(2) test, t test, and univariate and multivariate analyses were used to analyze the statistical difference of the results.. A total of 923 NG isolates were collected in Nanning between 2000 and 2012. Among these, 131 (14.2%) were penicillinase-producing NG, 520 (56.3%) isolates were tetracycline-resistant NG, and 857 (92.9%) isolates were ciprofloxacin-resistant strains. One spectinomycin-resistant strain was identified in 2000. There were 304 (32.9%) isolates with decreased susceptibility to ceftriaxone; the proportion of such isolates increased from 22.8% in 2000 to 2002 to 48.9% in 2006 to 2008 (P < 0.001), followed by a fall to 32.2% in 2009 to 2012 (P = 0.001). Patients' age of 16 to 25 years and isolate collection period of 2008 to 2012 (except 2011) were demonstrated to be risk factors for infection with isolates with decreased susceptibility to ceftriaxone.. Antimicrobial susceptibility of NG isolates obtained from patients in Nanning from 2000 to 2012 was characterized by high occurrence of penicillinase-producing NG, tetracycline-resistant NG, and ciprofloxacin-resistant strains. Spectinomycin and ceftriaxone can be considered drugs of choice for empirical treatment of NG infection in Nanning. Moreover, we recommend a combination of 500 mg or higher dose of intramuscular ceftriaxone and 1 g oral azithromycin be used for the treatment of NG infection in Nanning and possibly in China.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents; Azithromycin; beta-Lactamases; Ceftriaxone; China; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Sentinel Surveillance; Spectinomycin; Tetracycline

The Hungarian national guidelines for the treatment of gonorrhoea were published in 2002 but are now widely considered to be outdated. Improved knowledge is needed with respect to the epidemiology and antimicrobial susceptibility of Neisseria gonorrhoeae strains currently circulating in Hungary not least for the construction of updated local recommendations for treating gonorrhoea. European guidelines are based mostly on western European data raising concerns locally that recommended treatments might not be optimised for the situation in Hungary. We report our recent study on the distribution of antibiotic resistance in various Hungarian (East European) Neisseria gonorrhoeae strains isolated from patients with gonorrhoea over the past four years.. Between January 2010 and December 2013, isolates of N. gonorrhoeae were obtained from sexually active individuals during medical examination at the STD Center of Semmelweis University in Budapest. The minimal inhibitory concentrations (MIC) of azithromycin, cefixime, ceftriaxone, ciprofloxacin, penicillin, tetracycline and spectinomycin were determined to establish the antimicrobial susceptibility of the strains currently circulating in patients that attend our clinic.. Among the 9097 patients tested, 582 had an N. gonorrhoeae infection as detected by culture. The isolates were all sensitive to ceftriaxone and spectinomycin and 581/582 strains were sensitive to cefixime. In contrast, the number of detected strains with elevated azithromycin MIC did increase over the time period examined to approximately 16% in 2013. There was a high percentage of detected resistance to penicillin (77%), tetracycline (86%), and ciprofloxacin (66%) in the isolates examined in this study.. Current European guidelines recommend 2 g azithromycin in addition to 500 mg ceftriaxone as first choice therapy for gonorrhoea. For the purposes of revising the Hungarian national treatment guidelines, apparent increasing resistance to azithromycin during the last four years should be accounted for. It is also clear that penicillin, tetracycline and ciprofloxacin are inappropriate treatment measures at least locally. We also recommend that culture should form part of the diagnostic pathway of gonorrhoea, followed by antibiotic susceptibility testing with MIC determination. This will provide valuable continued monitoring of antibiotic resistance development in strains of Neisseria gonorrhoeae circulating in Hungary.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; Hungary; Incidence; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Penicillins; Tetracycline; Time Factors; Young Adult

Antimicrobial resistance of Neisseria gonorrhoeae is a serious health problem in China. Gonococcal antimicrobial susceptibility has been monitored in Shanghai since 1988. In this study, we examined the changing pattern of gonococcal antimicrobial susceptibility based on data from N. gonorrhoeae isolates collected over the past 25 years.. Approximately 100-200 isolates each year (1988-2013) were tested for their susceptibility to penicillin (PEN), tetracycline (TET), ciprofloxacin (CIP), ceftriaxone (CRO) and spectinomycin (SPT), using the agar dilution method. Plasmid-mediated N. gonorrhoeae antimicrobial resistance, comprising penicillinase-producing N. gonorrhoeae (presumed PPNG) and high-level tetracycline resistance N. gonorrhoeae (presumed TRNG), were also determined. Breakpoints for susceptibilities followed those described by the Clinical and Laboratory Standard Institute and the European Committee on Antimicrobial Susceptibility Testing.. A high proportion of isolates were resistant to PEN, TET and CIP, ranging from less than 20% at the beginning of the survey, increasing in the late 1990s and reaching over 90% in recent years. The proportion of isolates exhibiting plasmid-mediated resistance exceeded 38% for presumed PPNG and 20% for presumed TRNG in recent years. The proportion of CRO nonsusceptible isolates (MIC ≥ 0.125 mg/L) ranged from 7% to 13% in most of the study years. Almost all isolates were susceptible to SPT. The SPT MIC90 was 16-32 mg/L for 2008-2013. The proportion of CRO nonsusceptible-associated multiple-drug-resistant (MDR) isolates was over 5% in most of the study years.. N. gonorrhoeae isolates in Shanghai were resistant to PEN, TET and CIP. Furthermore, CRO nonsusceptible and MDR isolates were prevalent. N. gonorrhoeae isolates were also found to be susceptible to SPT. It is recommended that the CRO dose be increased from currently recommended 250 mg to 500 mg and that SPT be an alternative in treating urogenital gonorrhea. Our findings highlight the importance of both regional and national surveillance programs for the prompt modification of treatment guidelines, vital in responding to the changing pattern of gonococcal antimicrobial susceptibility.

Topics: Anti-Bacterial Agents; Ceftriaxone; China; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Prevalence; Spectinomycin; Tetracycline; Tetracycline Resistance

Gonorrhea treatment has been complicated by antimicrobial resistance in Neisseria gonorrhoeae. Gonococcal fluoroquinolone resistance emerged more rapidly among men who have sex with men (MSM) than men who have sex exclusively with women (MSW).. To determine whether N. gonorrhoeae urethral isolates from MSM were more likely than isolates from MSW to exhibit resistance to or elevated minimum inhibitory concentrations (MICs) of antimicrobials used to treat gonorrhea.. 6 years of surveillance data from the Gonococcal Isolate Surveillance Project.. Publicly funded sexually transmitted disease clinics in 30 U.S. cities.. Men with a total of 34 600 episodes of symptomatic urethral gonorrhea.. Percentage of isolates exhibiting resistance or elevated MICs and adjusted odds ratios for resistance or elevated MICs among isolates from MSM compared with isolates from MSW.. In all U.S. regions except the West, isolates from MSM were significantly more likely to exhibit elevated MICs of ceftriaxone and azithromycin than isolates from MSW (P < 0.050). Isolates from MSM had a high prevalence of resistance to ciprofloxacin, penicillin, and tetracycline and were significantly more likely to exhibit antimicrobial resistance than isolates from MSW (P < 0.001).. Sentinel surveillance may not be representative of all patients with gonorrhea. HIV status, travel history, and antimicrobial use data were missing for some patients.. Men who have sex with men are vulnerable to the emerging threat of antimicrobial-resistant N. gonorrhoeae. Because antimicrobial susceptibility testing is not routinely done in clinical practice, clinicians should monitor for treatment failures among MSM diagnosed with gonorrhea. Strengthened prevention strategies for MSM and new antimicrobial treatment options are needed.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Ciprofloxacin; Doxycycline; Drug Resistance, Bacterial; Female; Gonorrhea; Heterosexuality; Homosexuality; Humans; Logistic Models; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Sensitivity and Specificity; Sentinel Surveillance; Tetracycline

Surveillance of gonococcal antimicrobial resistance and the molecular characterization of the mechanisms underlying these resistance phenotypes are essential in order to establish correct empirical therapies, as well as to describe the emergence of new mechanisms in local bacterial populations. To address these goals, 149 isolates were collected over a 1-month period (October-November 2008) at the Ontario Public Health Laboratory, Toronto, Canada, and susceptibility profiles (8 antibiotics) were examined. Mutations in previously identified targets or the presence of some enzymes related to resistance (r), nonsusceptibility (ns) (resistant plus intermediate categories), or reduced susceptibility (rs) to the antibiotics tested were also studied. A significant proportion of nonsusceptibility to penicillin (PEN) (89.2%), tetracycline (TET) (72.3%), ciprofloxacin (CIP) (29%), and macrolides (erythromycin [ERY] and azithromycin; 22.3%) was found in these strains. Multidrug resistance was observed in 18.8% of the collection. Although all the strains were susceptible to spectinomycin and extended-spectrum cephalosporins (ESC) (ceftriaxone and cefixime), 9.4% of them displayed reduced susceptibility to extended-spectrum cephalosporins. PBP 2 mosaic structures were found in all of these ESC(rs) isolates. Alterations in the mtrR promoter, MtrR repressor (TET(r), PEN(ns), ESC(rs), and ERY(ns)), porin PIB (TET(r) and PEN(ns)), and ribosomal protein S10 (TET(r)) and double mutations in gyrA and parC quinolone resistance-determining regions (QRDRs) (CIP(r)) were associated with and presumably responsible for the resistance phenotypes observed. This is the first description of ESC(rs) in Canada. The detection of this phenotype indicates a change in the epidemiology of this resistance and highlights the importance of continued surveillance to preserve the last antimicrobial options available.

Topics: Amino Acid Sequence; Anti-Bacterial Agents; Bacterial Proteins; Cefixime; Ceftriaxone; Cephalosporins; DNA, Bacterial; Drug Resistance, Bacterial; Gonorrhea; Humans; Microbial Sensitivity Tests; Molecular Sequence Data; Neisseria gonorrhoeae; Ontario; Penicillin-Binding Proteins; Polymerase Chain Reaction; Sequence Analysis, DNA

To detect and type plasmids responsible for penicillin and tetracycline resistance in Neisseria gonorrhoeae isolates using a novel duplex polymerase chain reaction (PCR) assay.. A duplex PCR assay, to detect and type penicillinase-producing N. gonorrhoeae (PPNG), and plasmid-mediated tetracycline resistant N. gonorrhoeae (TRNG), was developed on the basis of published single assays. Gonococcal Isolate Surveillance Project control strains were used in assay development and then 209 consecutive N. gonorrhoeae isolates, collected from men with urethral discharge in 2008, were tested. Controls included Asia, Africa, and Toronto β-lactamase plasmids, as well as American and Dutch TRNG plasmids. PCR amplicons were detected using an Agilent 2100 Bioanalyzer. Minimum inhibitory concentrations (MIC) were determined with E tests. Penicillinase production was detected using Nitrocefin solution.. Among 209 gonococcal isolates, 54 (25.8%) PPNG and 154 (73.3%) TRNG were detected. The MIC50 and MIC90 values were determined for penicillin (0.19 and 32 mg/L) and tetracycline (6 and 16 mg/L). The assay detected the Africa-type (35.2%), the Toronto-type (44.4%), and a new type (20.3%) of β-lactamase plasmid. The American-type TRNG plasmid was 3-fold more frequent as compared with the Dutch-type. Although there was no overall association between the detection of PPNG and TRNG plasmids, only American type TRNG contained β-lactamase-encoding plasmids (P < 0.0001).. The prevalence of plasmid-mediated resistance to tetracycline, and to a lesser extent penicillin, is high and neither drug is likely to have any future role in the treatment of gonorrhoea in South Africa. A novel β-lactamase plasmid was detected during the study and requires further characterization.

Topics: Anti-Bacterial Agents; beta-Lactamases; DNA, Bacterial; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Molecular Typing; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Polymerase Chain Reaction; Prevalence; R Factors; South Africa; Tetracycline; Tetracycline Resistance; Urethra

Antimicrobial resistance in Neisseria gonorrhoeae (NG) is a public health concern globally, and azithromycin-resistant NG isolates have been identified in many countries. This study aimed to investigate azithromycin susceptibility in NG and to genetically characterize the azithromycin-resistant isolates identified in 2 cities in China.. NG isolates (n = 318) were cultured from patients attending 2 sexually transmitted infection clinics in Nanjing and Chongqing, China, between 2008 and 2009. Minimum inhibitory concentration (MIC) of azithromycin, tetracycline, ciprofloxacin, spectinomycin and ceftriaxone was determined using the agar dilution method. NG strains ATCC 49226 and WHO G, J, L, and P were used for quality control. Azithromycin-resistant isolates were defined as having an MIC value equal to or greater than that of strain WHO P, which is internationally recognized as azithromycin-resistant (MIC = 2 mg/L), and genotyped using NG multiantigen sequence typing.. The MIC values of strain WHO P for azithromycin were 2 to 4 mg/L in all runs, which showed that the method provided consistent and reliable MIC values. Seventeen isolates (5.3%) showed resistance to azithromycin. Among these isolates (n = 17), 11 sequence types (STs) were identified by NG multiantigen sequence typing, of which 5 were novel. The most common ST was ST3356, represented by 6 isolates. ST1866 was represented by 2 isolates, which were isolated from patients with an unknown relationship, and both isolates were highly resistant to azithromycin, i.e., displayed an MIC of >64 mg/L.. A relatively high prevalence of azithromycin-resistant NG strains implies that azithromycin should not be recommended for the treatment of gonococcal urethritis or cervicitis in China.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; China; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; Microbial Sensitivity Tests; Molecular Epidemiology; Multilocus Sequence Typing; Neisseria gonorrhoeae; Spectinomycin; Tetracycline; Urban Population

The third-generation cephalosporins recommended in national guidelines are amongst the last remaining effective agents for treatment of gonorrhoea. This study characterizes gonococcal isolates with decreased cefixime susceptibility from England and Wales.. A total of 96 isolates of Neisseria gonorrhoeae exhibiting cefixime MICs of ≥0.125 mg/L, either collected as part of the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) between 2005 and 2008 (54 from a total of 4649 isolates) or referred to the national reference laboratory in 2008 and 2009 (42 isolates), were tested for susceptibility to a range of antimicrobial agents and were typed using N. gonorrhoeae multiantigen sequence typing (NG-MAST).. All 96 isolates were also resistant to tetracycline (MIC ≥2 mg/L) and ciprofloxacin (MIC ≥16 mg/L) and 56% showed low-level chromosomal resistance to penicillin. Where data were available, the mean patient age was 31 years, and 88% (83/94) of patients were men. Isolates referred through GRASP were predominantly from men who have sex with men (MSM; 29/44, 66%) and from patients of white British ethnicity (25/43, 58%). The majority of isolates belonged either to sequence type (ST) 1407 (71/96, 74%) or to a highly related ST that shares the tpbB allele (allele 110), but with a different por allele (20/96, 21%). ST1407 was found in both MSM (22/29, 76%) and heterosexual patients (12/15, 80%) and among all eight isolates from patients reporting sex abroad.. The emergence of a clonal group of gonococci showing decreased susceptibility to cefixime in England and Wales highlights the need for continued surveillance.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cefixime; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; England; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Epidemiology; Molecular Typing; Neisseria gonorrhoeae; Penicillins; Sexual Behavior; Tetracycline; Wales

Fluoroquinolone-resistant Neisseria gonorrhoeae strains originated in Eastern Asia in the 1980s; first appeared in United States during the early 1990 s in Hawaii, and subsequently spread to California and the continental US shortly after 2000. In 2007, the CDC recommended that fluoroquinolones should not be used as first-line therapy and recommended monitoring local resistance patterns to guide treatment recommendations. The Public Health-Dayton and Montgomery County STD Clinic tested N. gonorrhoeae isolates in 1996, 2001 and since 2006 to monitor susceptibility trends in the region.. Cultures for N. gonorrhoeae were collected from male and female patients presenting to the Public Health-Dayton and Montgomery County STD Clinic. In 1996 and 2001, consecutive isolate were collected. Since 2006, 10 isolates were randomly selected per month. Susceptibility testing was performed using Etest strips. Susceptibility results were interpreted following the Clinical Laboratory Standards Institute guidelines.. In 1996, 102 isolates were tested; 85% were susceptible to ciprofloxacin (15% intermediate, 0% resistant) and 52% susceptible to tetracycline (39% intermediate, 9% resistant). In 2001, 106 isolates were tested; 100% were susceptible to ciprofloxacin and 76% susceptible to tetracycline (22% intermediate, 2% resistant). From 2006-2008, 286 isolates were tested; 98% were susceptible to ciprofloxacin (2% resistant), 60% susceptible to tetracycline (36% intermediate, 4% resistant) and 99% were susceptible to azithromycin.. Rates of ciprofloxacin resistance remain low in Montgomery County. Azithromycin is another potentially useful treatment; tetracycline is not acceptable for empirical therapy.

Topics: Anti-Bacterial Agents; Azithromycin; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Ohio; Tetracycline

Quinolone-resistant Neisseria gonorrhoeae rates have increased worldwide since 1994. The objective of this study was to appraise: (i) the antimicrobial susceptibility of Neisseria gonorrhoeae in a venereology clinic in Paris, between 2005 and 2007; and (ii) the factors associated with quinolone-resistant N. gonorrhoeae. A prospective study of consecutive cases was performed for the period 2005 to 2007. Susceptibility of N. gonorrhoeae to five antibiotics (ciprofloxacin, ceftriaxone, spectinomycin, penicillin G and tetracycline) was tested systematically. Clinical and epidemiological data were collected using a standardized form. Male-to-female sex ratio was 22.0. Median age was 30.0 years. Of 115 cases, 84 occurred in men having sex with men (72.6%) and 22 involved the anorectal area (19.1%). The rate of quinolone-resistant N. gonorrhoeae was 37.4% (43/115), without significant association with gender, age, sexual behaviour, past history of sexually transmitted diseases and susceptibility to other antibiotics. All N. gonorrhoeae were susceptible to ceftriaxone and spectinomycin. The rate of quinolone-resistant N. gonorrhoeae in Paris has been increasing since 2004. Ceftriaxone remains the gold standard treatment.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Paris; Penicillin G; Practice Guidelines as Topic; Prospective Studies; Risk Factors; Sexual Behavior; Spectinomycin; Tetracycline; Time Factors; Young Adult

The main goal of this work is to clarify the predictive value of known genetic markers of Neisseria gonorrhoeae resistance to penicillin, tetracycline, and fluoroquinolones. The correlation between the presence of certain genetic markers and susceptibility of N. gonorrhoeae isolates to penicillin, tetracycline, and fluoroquinolones has been analyzed by means of statistical methods. Susceptibility testing with penicillin, tetracycline, and fluoroquinolones was performed by the agar dilution method. N. gonorrhoeae genomic DNA was isolated. The presence of bla(TEM-1) and tet(M) genes was analyzed by PCR. A novel method of polymorphism discovery based on a minisequencing reaction followed by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry was applied for the analysis of chromosomal N. gonorrhoeae genes involved in antimicrobial resistance development. Clinical N. gonorrhoeae isolates (n = 464) were collected. Susceptibility levels to penicillin, tetracycline, and fluoroquinolones were found to be 25.9%, 35.9%, and 54.1%, respectively. Among the 19 N. gonorrhoeae isolates with penicillin MICs of > or =4 microg/ml, the bla(TEM-1) gene was detected in 12. The Tet(M) determinant was found in 4 of 12 N. gonorrhoeae isolates with tetracycline MICs of > or =16 microg/ml. The chromosomal genetic markers of penicillin and tetracycline resistance were detected especially in isolates with penicillin MICs of 0.25 to 2.0 microg/ml and tetracycline MICs of 0.5 to 4 microg/ml. Mutations in GyrA and ParC were found in 208 of 211 quinolone-resistant N. gonorrhoeae isolates. This work is the first representative molecular research of the N. gonorrhoeae population in Russia. Information about the prevalence of antibiotic resistance mechanisms and the positive predictive value of certain genetic determinants is given. The positive predictive values of the analyzed genetic markers were found to be different for fluoroquinolones (90.3%), penicillin (91.1%), and tetracycline (81.9%).

Topics: Anti-Bacterial Agents; Bacterial Proteins; Base Sequence; Drug Resistance, Bacterial; Fluoroquinolones; Genetic Markers; Genotype; Gonorrhea; Humans; Microbial Sensitivity Tests; Molecular Sequence Data; Neisseria gonorrhoeae; Penicillins; Sequence Analysis, DNA; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Tetracycline

The aim of this study was to examine tetracycline-resistant gonococci and to set up a real-time PCR method to identify, in the same assay, both the chromosomally and the plasmid-mediated tetracycline-resistant genotypes. A retrospective analysis for tetracycline susceptibility was performed by the E-test and agar dilution methods on 289 gonococci isolated in Italy from 2003 to 2005. Molecular mechanisms of resistance were investigated by both sequence analyses of the three main genes associated with chromosomally mediated resistance (mtrR, penB and rpsJ genes) and by the identification of plasmids carrying the tetM determinant associated with plasmid-mediated resistance, by PCR (American- or Dutch-type plasmids). The genetic relatedness of nonsusceptible strains was evaluated by pulsed field gel electrophoresis (PFGE). The results showed the presence of 22.5% tetracycline-resistant and 49.5% tetracycline-intermediate gonococci. Coexistence of chromosomally and plasmid-mediated resistance to tetracycline was observed in the majority of resistant isolates. No clonal structure was highlighted by analysis of PFGE pattern profiles. Real-time PCR assay was able to identify all the tetracycline nonsusceptible gonococci correctly for the presence of both chromosomally and/or plasmid-mediated genotypes.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Genotype; Gonorrhea; Humans; Italy; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Polymerase Chain Reaction; Repressor Proteins; Sensitivity and Specificity; Tetracycline; Tetracycline Resistance

Topics: Adolescent; Anti-Bacterial Agents; Base Sequence; Ciprofloxacin; DNA Primers; Drug Resistance, Multiple, Bacterial; Female; Gonorrhea; Humans; Meningitis, Bacterial; Neisseria gonorrhoeae; Pregnancy; Pregnancy Complications, Infectious; RNA, Bacterial; RNA, Ribosomal, 16S; Tetracycline

Regular monitoring of antimicrobial resistance of Neisseria gonorrheae needs to be established in the country. The aim of the study was to determine the trend of resistance phenotypes of N. gonorrheae in India, and to assess the susceptibility profile of resistance phenotypes.. Antimicrobial susceptibilities of N. gonorrheae isolates to penicillin, tetracycline, ceftriaxone, ciprofloxacin, and spectinomycin were determined by in terms of minimum inhibitory concentrations using Etest. World Health Organization reference strains were used as control strains. Phenotypic characterization of N. gonorrheae isolates was carried out on the basis of plasmid and chromosomally mediated resistance to penicillin and tetracycline.. Of 382 isolates, 172 (45.0%) belonged to 6 resistance phenotype i.e., penicillinase-producing N. gonorrheae (PPNG) (16.5%), tetracycline resistant N. gonorrheae (TRNG) (8.9%), PPNG-TRNG (4.7%), chromosomally mediated tetracycline resistant N. gonorrheae (11.2%), and chromosomally mediated penicillin resistant N. gonorrheae (3.7%). Chromosomally mediated penicillin and tetracycline resistant N. gonorrheae isolates were not detected. Chromosomally mediated penicillin resistant N. gonorrheae and chromosomally mediated tetracycline resistant N. gonorrheae decreased from 2002 to 2006 whereas TRNG strains increased during the study period. Ciprofloxacin resistant and ceftriaxone less sensitive strains were more frequent among the resistance phenotypes.. The high rates of plasmid and chromosomally mediated resistance to penicillin, tetracycline along with high rates of resistance to ciprofloxacin among all the resistance phenotypes underlines the necessity for continuous surveillance of antimicrobial resistance to help in controlling the spread of gonorrhoea.

Topics: Anti-Bacterial Agents; Chromosomes, Bacterial; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; India; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Phenotype; Plasmids; Tetracycline

Resistant Neisseria gonorrhoeae has been evolving. This study assessed the antimicrobial susceptibility profile of isolates in the Pretoria region, South Africa. Isolates of N. gonorrhoeae from men with urethritis were tested for susceptibility to eight antimicrobial agents by disc diffusion, Etest and agar dilution methods. Chromosomal resistance to penicillin was found in 16% of isolates, 16% showed plasmid-mediated resistance and decreased susceptibility was seen in 73% of isolates. For the first time, there is evidence of high-level tetracycline resistance (36%). Ciprofloxacin resistance emerged at 7%. All isolates remained susceptible to ceftriaxone. In view of these findings of the emergence of quinolone-resistant N. gonorrhoeae, national treatment guidelines for syndromic management of sexually transmitted infections need to be urgently reviewed. The injectable preparation, ceftriaxone has to be considered as a first-line agent for the management of gonococcal infections. Overall, the gonococcal isolates in the Pretoria region remain susceptible to ceftriaxone, cefoxitin, cefpodoxime and spectinomycin.

Topics: Anti-Bacterial Agents; beta-Lactams; Cephalosporins; Drug Resistance, Bacterial; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin Resistance; Quinolones; South Africa; Spectinomycin; Tetracycline; Tetracycline Resistance; Urethritis

We applied complex genetic analysis for evaluation of tetracycline-resistance markers in 129 clinical strains of Neisseria gonorrhoeae from Central, Privolzhskii, and Siberian regions. For detection of mutations in rpsJ gene and MtrRCDE locus we first used minisequence reaction followed by identification of products by MALDI-TOF mass spectrometry. The incidence of detection of resistance markers among the analyzed strains were: tetM--3.1%, mutations in genes rpsJ--82.2%, penB--62.8%, and mtrR--54.3%. The analyzed genetic markers were not detected in 17.5% strains. tetM gene was detected in only 12.5% strains from the Central Region. No differences were revealed in regional distribution of other genotypes. Genotypes tetM(pres), rpsJ(mut), mtrR(mut), and rpsJ(mut), penB(mut), mtrR(mut) reliably predict tetracycline resistance. Microbiological and genetic testing of tetracycline resistance yielded similar results.

Topics: Anti-Bacterial Agents; Genetic Markers; Genotype; Gonorrhea; Humans; Mutation; Neisseria gonorrhoeae; Russia; Tetracycline; Tetracycline Resistance

In the mid-1990s, fluoroquinolones were introduced in Indonesia for the management of gonorrhea and are now part of the national recommended treatment guidelines. We recently documented introduction of ciprofloxacin-resistant Neisseria gonorrhoeae strains in female sex workers (FSWs) in Timika, Indonesia, 5 years after treating gonococcal cervicitis with ciprofloxacin and periodically monitoring antimicrobial susceptibility of isolates. To assess the importance of this observation, we determined antimicrobial susceptibilities and strain types of N. gonorrhoeae isolates from FSWs seen in a sexually transmitted infection (STI) clinic in Denpasar, Bali, Indonesia.. The goal of this study was to determine antimicrobial susceptibilities and strain types among N. gonorrhoeae isolated from FSWs in Denpasar, Bali.. FSWs in Denpasar were screened for N. gonorrhoeae by standard culture. Endocervical isolates were frozen in Microbank tubes and sent to the University of California at San Francisco on dry ice. Antimicrobial susceptibility testing using a Clinical Laboratory Standards Institute-recommended agar dilution method was performed at the Centers for Disease Control and Prevention. Isolates were characterized by beta-lactamase production, antimicrobial resistance phenotypes, and auxotype/serovar class.. One hundred forty-seven N. gonorrhoeae isolates were characterized. All isolates were highly resistant to tetracycline (minimum inhibitory concentration, >or=16.0 microg/mL): 117 (79.1%) were beta-lactamase-positive (PP-TR), 3 (2.0%) exhibited chromosomally mediated resistance to penicillin (PenR-TRNG), and 27 (18.2%) were susceptible to penicillin (TRNG). All isolates were susceptible to ceftriaxone, cefixime, and spectinomycin; lack of interpretive criteria do not allow interpretation of susceptibilities of cefoxitin, cefpodoxime, or azithromycin. Fifty-nine (40.1%) isolates were ciprofloxacin-resistant; 35 (59.3%) of the ciprofloxacin-resistant isolates exhibited high-level resistance to ciprofloxacin (Cip-HLR; minimum inhibitory concentration, >or=4.0 microg/mL of ciprofloxacin). Three (2.0%) isolates were intermediate to ciprofloxacin. Twenty-two strain types were identified among these isolates; small clusters were identified with 3 strain types.. N. gonorrhoeae isolates from FSWs in Denpasar were resistant to penicillin and tetracycline; 40.1% of the isolates were fluoroquinolone-resistant. With gonorrhea prevalence of 35% at this clinic (by nucleic acid amplified tests), ongoing surveillance for antimicrobial resistance will be needed to appropriately choose treatment for infections caused by these resistant organisms.

Topics: Anti-Bacterial Agents; Cervix Uteri; Drug Resistance, Bacterial; Female; Fluoroquinolones; Gonorrhea; Hospitals, Urban; Humans; Indonesia; Neisseria gonorrhoeae; Penicillins; Prevalence; Sex Work; Tetracycline

The aim of the present study was to determine prospectively the antimicrobial susceptibility of Neisseria gonorrhoeae strains collected in southern Germany (Heidelberg and Stuttgart areas). Sixty-five N. gonorrhoeae strains, isolated between July 2004 and June 2005 from patients with uncomplicated gonorrhoea, were tested. Minimum inhibitory concentrations of penicillin, tetracycline, ciprofloxacin, azithromycin, spectinomycin, ceftriaxone, and cefixime were determined by the E test. All isolates were fully susceptible to ceftriaxone, cefixime, and spectinomycin. However, 21.5% (14/65), 29.2% (19/65), and 47.7% (31/65) of isolates were resistant to penicillin (>2.0 mg/l), tetracycline (>2.0 mg/l), and ciprofloxacin (>1.0 mg/l), respectively. Critical MICs of azithromycin (>1.0 mg/l, as defined by the Neisseria Reference Laboratory at the Centers for Disease Control) were found for five (7.7%) N. gonorrhoeae isolates. These data indicate a high prevalence of N. gonorrhoeae strains resistant to the antimicrobial agents currently used to treat gonococcal infections in the Heidelberg and Stuttgart areas. Even though the findings may not be representative of the general population in Germany, they nevertheless illustrate the need to establish an antimicrobial resistance surveillance system in order to control gonorrhoea effectively.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Ciprofloxacin; Drug Resistance; Female; Germany; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Penicillins; Prospective Studies; Tetracycline

Topics: Ambulatory Care Facilities; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Ciprofloxacin; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Nepal; Penicillins; Pilot Projects; Spectinomycin; Tetracycline

The presence of a reserpine-affected mechanism of tetracycline resistance was investigated in 17 Neisseria gonorrhoeae clinical isolates. To establish this fact the MIC of tetracycline in the presence and absence of reserpine was determined, and, in addition, mechanisms of tetracycline resistance were analyzed by PCR. The results showed that reserpine affects the MIC of tetracycline at least 4-fold in all isolates, including those containing the tetM gene. An inhibitory effect of reserpine against the MtrCDE efflux system was ruled out by using strains either with an inactive or with an unrepressed MtrCDE system. The results suggest the presence of a constitutive system of resistance to tetracycline, by a possible efflux pump, which may be inhibited by reserpine. Further studies are required to determine the exact nature of the action of reserpine on the MIC of tetracycline.

Topics: Anti-Bacterial Agents; Gonorrhea; Humans; Neisseria gonorrhoeae; Reserpine; Tetracycline; Tetracycline Resistance

Topics: Anti-Bacterial Agents; Bacterial Proteins; Base Pairing; Base Sequence; Drug Resistance, Multiple; Erythromycin; Gonorrhea; Humans; Molecular Sequence Data; Mutation; Neisseria gonorrhoeae; Penicillins; Promoter Regions, Genetic; Repetitive Sequences, Nucleic Acid; Repressor Proteins; Tetracycline; Thymine

Emergence of multidrug-resistant Neisseria gonorrhoeae resulting from new genetic mutations is a serious threat to controlling gonorrhea.. To determine 1) antimicrobial susceptibilities and the corresponding genetic mutations and 2) the role of MtrRCDE efflux system in gonococcal resistance to fluoroquinolones.. Antimicrobial susceptibility testing and sequence analysis of gyrA, parC, and mtrR loci of 131 N. gonorrhoeae isolates from Japan.. The proportion of N. gonorrhoeae strains resistant and intermediate-resistant to antimicrobials was 25.2% and 48.9% for ciprofloxacin, 25.2% and 30.5% for ofloxacin, 12.2% and 53.4% for penicillin; and 17.6% and 51.1% for tetracycline, respectively. Strains were categorized into 22 mutation profiles, with GyrA-S91F/ParC-D86N/MtrR-G45D being the most predominant profile. The frequency of mutation in gyrA, parC, mtrR, and the mtrR promoter was 71%, 47.3%, 77.1%, and 23.7%, respectively. Seventy-one percent of strains carried mutations in both gyrA and mtrR.. This study reports simultaneous mutations in fluoroquinolone target enzymes and the MtrRCDE efflux system as a fluoroquinolone-resistant mechanism in N. gonorrhoeae.

Topics: Anti-Infective Agents; Bacterial Proteins; Ciprofloxacin; DNA Gyrase; DNA Topoisomerase IV; Drug Resistance, Bacterial; Ferredoxin-NADP Reductase; Fluoroquinolones; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Mutation; Neisseria gonorrhoeae; Ofloxacin; Penicillins; Repressor Proteins; Tetracycline

Antibiotic-resistant strains of Neisseria gonorrhoeae, especially those resistant to penicillin and tetracycline, have spread with remarkable rapidity in many Caribbean countries.. The goal of the study was to survey the antibiotic susceptibilities of N gonorrhoeae strains isolated from 1995 to 1999 in Cuba and to discuss the impact of antimicrobial resistance on the management of gonorrhea in the country.. Susceptibility of the strains to penicillin, tetracycline, cefuroxime, ceftriaxone, ciprofloxacin, spectinomycin, and azithromycin were determined by an agar dilution method.. Penicillin and tetracycline resistance was noted in 60.8% and 54.2%, respectively, of the N gonorrhoeae strains tested. A total of 63.35 (76/120) of the N gonorrhoeae strains exhibited plasmid-mediated resistance to penicillin, tetracycline, or both. Strains with chromosomally mediated resistance to these antibiotics accounted for 10% (12/120) of the strains. The strains were susceptible to ceftriaxone, cefuroxime, spectinomycin, and ciprofloxacin. One strain's ciprofloxacin MIC was 0.125 mircog/ml. Of the 52 strains tested, 23.1% displayed intermediate resistance to azithromycin.. N gonorrhoeae strains exhibited a high frequency of resistance and multiresistance to penicillin and tetracycline. Therefore, these antibiotics should no longer be used to treat gonococcal infections in Cuba and should be substituted with effective drugs such as third-generation cephalosporins, spectinomycin, and fluoroquinolones. The detection of intermediate resistance to azithromycin and ciprofloxacin underlines the importance of periodic surveillance for susceptibility of N gonorrhoeae strains to antimicrobials agents used as primary therapy for gonorrhea.

Topics: Anti-Bacterial Agents; Cuba; Drug Resistance, Multiple, Bacterial; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Tetracycline; Tetracycline Resistance

Despite the rapid spread of antibiotic resistance in gonococci all over Southeast Asia, there is only limited surveillance for antibiotic susceptibility in Indonesia.. This study was undertaken to determine the frequency and diversity of antimicrobial resistance in gonococcal isolates from cohorts of female commercial sex workers in Bandung and Jakarta, Indonesia, and to characterize the Tet M plasmid among the tetracycline-resistant strains N gonorrhoeae.. The antimicrobial susceptibility of 267 strains (85 strains from Bandung and 182 from Jakarta) to penicillin, spectinomycin, tetracycline, ciprofloxacin, cefotaxime, thiamphenicol, kanamycin, azithromycin, and trimethoprim-sulfamethoxazole (TMP-SMZ) was determined by agar dilution. Typing of the Tet M plasmid in tetracycline-resistant isolates was performed by PCR.. Prevalence of penicillin and tetracycline resistance was extremely high: 60.0% of the isolates from Bandung and 70.9% of the isolates from Jakarta were resistant to penicillin. Of these, 60.0% and 62.1%, respectively, were penicillinase-producing N gonorrhoeae (PPNG). All the isolates from Bandung and 98.4% from Jakarta were resistant to tetracycline. All tetracycline-resistant isolates from Bandung and 97.8% from Jakarta carried a PCR fragment characteristic of the "Dutch" type Tet M plasmid. One isolate from Jakarta showed chromosomal resistance to tetracycline (0.6%). Chromosomal resistance to thiamphenicol (MIC, >/=2.0 microg/ml) was significantly higher in Jakarta than in Bandung (P < 0.05). All gonococcal isolates were susceptible to kanamycin, spectinomycin, cefotaxime, ciprofloxacin, and azithromycin.. Spectinomycin, fluoroquinolones, and azithromycin are still useful primary drugs for treatment of gonococcal infections in Indonesia. Continued surveillance of antimicrobial susceptibility should be part of gonorrhea control in Indonesia.

Topics: Anti-Bacterial Agents; Cohort Studies; Drug Resistance, Multiple, Bacterial; Female; Gonorrhea; Humans; Indonesia; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Prevalence; Sex Work; Tetracycline; Tetracycline Resistance

The World Health Organization has proposed the syndromic approach for management of sexually transmissible diseases (STD) in countries where diagnostic laboratory tests are not consistently available. The purpose of this study was to evaluate the effectiveness of this approach for treatment of ureteral discharge in Senegal. Twenty seven men presenting ureteral discharge underwent two-week treatment using a combination of cotrimoxazole plus tetracycline for suspected gonococcal and a chlamydial infections. Ureteral samples were collected before and after treatment to detect Neisseria gonorrhoeae by culture and Chlamydia trachomatis by direct immunofluorescence and ELISA. Results demonstrated successful treatment of all patients presenting gonococcal and chlamydial infections i.e. 84.6% of cases. Neither germ was detected in 15.4% of cases. Before treatment, Neisseria gonorrhoeae, Chlamydia trachomatis or both were found respectively in 53.9%, 5.1% and 25.6% of samples respectively. Based on these findings we conclude that the syndromic approach was effective in 84.6% of cases but treatment was in adequation with STD biologically documented only with 25.6% of cases.

Topics: Anti-Bacterial Agents; Chlamydia Infections; Chlamydia trachomatis; Drug Therapy, Combination; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Senegal; Syndrome; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Urethral Diseases

In many regions the susceptibility of Neisseria gonorrhoeae isolates to antimicrobial agents is rarely tested. The Gonococcal Antimicrobial Surveillance Program (GASP) in Cuba was established as part of a larger regional GASP program to facilitate the collection and reporting of antimicrobial susceptibility data for N gonorrhoeae isolates.. The goal was to retrospectively determine the antimicrobial susceptibility and molecular epidemiology of 91 isolates of N gonorrhoeae isolated from 11 centers in Cuba.. Isolates of N gonorrhoeae were collected and presumptively identified from 11 Cuban provincial health centers. They were then forwarded to the National Laboratory of Pathogenic Neisseria Havana for confirmatory identification and were subsequently analyzed at the Center for GASP in Ottawa. Isolates were tested for susceptibility to penicillin, tetracycline, spectinomycin, ceftriaxone, ciprofloxacin, and azithromycin by the agar dilution method. To establish baseline data for molecular epidemiologic profiles, the auxotype (A), serovar (S), plasmid content (P), and TetM type of the isolates were determined. Certain A/S/P classes were further analyzed by pulsed field gel electrophoresis (PFGE).. High percentages of the 91 N gonorrhoeae isolates were resistant to penicillin (68%) and tetracycline (83.5%), with 56% being penicillinase-producing (PPNG) and 64% carrying plasmid-mediated tetracycline resistance (TRNG; 50% were PP/TRNG). An additional 14% of the isolates carried chromosomal resistance (CMRNG) to either tetracycline or penicillin or both antibiotics. All isolates were susceptible to spectinomycin, ceftriaxone, and ciprofloxacin. However, nine isolates were resistant to azithromycin (MIC, > or = 1.0 microgram/ml), and 43 other isolates displayed reduced susceptibility to this antibiotic (MIC, 0.25-0.5 microgram/ml). Although a total of 21 different A/S classes were identified, most of the isolates (61) belonged to three A/S classes: NR/IA-6 (35 isolates), NR/IB-1 (15 isolates), and P/IA-6 (11 isolates). Thirty-two of 45 PP/TRNG were A/S class NR/IA-6, and nine of the P/IA-6 isolates were TRNG. By contrast, most of A/S class NR/IB-1 (8) were CMRNG. PFGE analysis following digestion with NheI or SpeI further clustered the isolates into separate groups.. This study demonstrates high percentages of N gonorrhoeae isolates with penicillin and tetracycline resistance in Cuba. As has been noted in other studies in the Caribbean region and Latin America, resistance and reduced susceptibility to azithromycin are developing as emerging problems. Since penicillin and tetracycline continue to be widely used for the treatment of gonococcal infections in Cuba, this study indicates the importance of antimicrobial susceptibility surveillance so that effective antibiotics may be recommended for treatment of gonococcal infections.

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Ciprofloxacin; Cuba; Female; Genotype; Gonorrhea; Humans; Incidence; Male; Microbial Sensitivity Tests; Molecular Epidemiology; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Retrospective Studies; Serotyping; Spectinomycin; Tetracycline; Tetracycline Resistance; Urban Population

We monitored the trends of chromosomally mediated resistant Neisseria gonorrhoeae (CMRNG) in Canada. Chromosomally resistant N. gonorrhoeae (CMRNG) were defined as having resistance to 3 antibiotics: penicillin (minimum inhibitory concentration [MIC] > or =2.0 mg/L), tetracycline (MIC > or =2.0 mg/L and < or =8.0 mg/L), and erythromycin (MIC > or =2.0 mg/L).. The goal was to provide surveillance data for public health interventions for the control of gonococcal infections.. Antibiotic susceptibility tests were performed on N. gonorrhoeae isolates obtained from 1994 to 1999 in Canada. Strains were further characterized by auxotype (A), serovar (S), and plasmid profile (P).. Between 1994 and 1999, 19.2% of strains were CMRNG, 12.9% had a combined resistance to tetracycline and erythromycin, and 4.7% were resistant to tetracycline. The incidence of ciprofloxacin resistance and azithromycin resistance was 2.3% and 0.8%, respectively.. This survey of N. gonorrhoeae provides strain characterization data and temporal trends of strains in the Canadian population. CMRNG strains are on the rise, and the continual monitoring and characterization of these strains is important for the evaluation of current recommended antibiotic therapies used in Canada.

Topics: Anti-Infective Agents; Canada; Drug Resistance, Bacterial; Erythromycin; Gonorrhea; Humans; Incidence; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Plasmids; Tetracycline; Tetracycline Resistance

Determination of the diversity within the tet(M) sequence from N gonorrhoeae is a useful epidemiologic tool for monitoring the movement or importation of strains within a geographic region. Only two distinct tet(M) genes in clinical gonococcal isolates have been described up to now: the Dutch and the American types.. The study involved surveillance of the tet(M) gene types in high-level-tetracycline-resistant gonococcal isolates from Uruguay during the period 1996 to 1999.. Among 181 gonococcal isolates, those showing MICs >/=16 microg/ml to tetracycline were analyzed for detection and characterization of the tet(M) gene by a polymerase chain reaction (PCR) and further HpaII restriction fragment polymorphism methods, respectively. The plasmid content and antibiogram were determined.. Twenty-two of 181 isolates (12%) exhibited high levels of resistance to tetracycline (MICs >/=16 microg/ml) and harbored a putative 25.2-Mda plasmid that contained the tet(M) gene. A high percentage of isolates (95%; 21/22) presented the Dutch type tet(M) gene. One isolate from 1999 revealed a new restriction pattern. Such a pattern had been previously noted in 1991. This new restriction pattern has not been described previously as occurring in isolates of N gonorrhoeae. The tet(M) amplimer sequence showed 100% identity with a previously described tet(M)-carrying plasmid from N meningitidis.. A new HpaII restriction pattern of the tet(M) gene is present in low frequency. The tet(M) sequence was different from the gonococcal tet(M) sequences already known and not typable with the use of a differential PCR assay. Accordingly, with the genetic diversity already present within the tet(M) sequence of N gonorrhoeae isolates, we should be aware of the sensitivity of the PCR assays in use for tetracycline-resistant N gonorrhoeae detection.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Base Sequence; DNA-Cytosine Methylases; Drug Resistance, Bacterial; Gonorrhea; Humans; Microbial Sensitivity Tests; Molecular Sequence Data; Neisseria gonorrhoeae; Polymerase Chain Reaction; Population Surveillance; Tetracycline; Uruguay

A long-term program of surveillance of antimicrobial resistance in Neisseria gonorrhoeae isolated in the World Health Organization's Western Pacific Region (WHO WPR GASP) continued in 2001. Seventeen focal points contributed data on about 10,000 gonococci. Resistance to quinolone and penicillin antibiotics remained widely dispersed and at high levels. Gonococci with decreased susceptibility to third generation cephalosporins were again observed in four centres. Spectinomycin resistance was infrequently encountered. Control of gonorrhoea in the WHO WPR is compromised by the further reduction in options for cheap and effective treatment of gonorrhoea.

Topics: Anti-Bacterial Agents; Cephalosporins; Drug Resistance, Microbial; Female; Gonorrhea; Humans; Incidence; Male; Neisseria gonorrhoeae; Pacific Islands; Penicillins; Population Surveillance; Quinolones; Spectinomycin; Tetracycline; World Health Organization

The prevalence of sexually transmitted diseases (STDs) has been increasing in China since the 1980s. Because gonorrhea is the most frequently reported STD there, information on the antimicrobial susceptibility of Neisseria gonorrhoeae will aid in its control.. To investigate the antimicrobial susceptibility of N gonorrhoeae isolates in China and to provide data for formulation of treatment guidelines and control policies.. The agar dilution technique was used to determine antimicrobial susceptibility, and acidimetric method was used to test for penicillinase-producing N gonorrhoeae.. A total of 3186 gonococcal isolates were tested during the 6-year study period. The rate of resistance to penicillin was 66.70%; 8.14% of isolates were penicillinase-producing N gonorrhoeae. The percentage of tetracycline-resistant isolates was 92.03%, and that of highly tetracycline-resistant isolates was 4.65%. The rate of resistance to ciprofloxacin was also relatively high (34.25%). The rates of resistance to spectinomycin and ceftriaxone were 0.44% and 0.57%.. The gonococcal isolates in China are relatively highly resistant to penicillin, tetracycline, and ciprofloxacin, but most of them are still susceptible to spectinomycin and ceftriaxone. Standardized treatment of gonorrhea is needed to prevent further spread of resistant gonococcal strains.

Topics: Adult; Anti-Bacterial Agents; Cervix Uteri; China; Ciprofloxacin; Community Health Centers; Drug Resistance, Bacterial; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Tetracycline; Urethra

We tested the susceptibility patterns of 128 N. gonorrhoeae isolates to six antimicrobials; penicillin, tetracycline, spectinomycin, ceftriaxone, ciprofloxacin and azithromycin, and examined whether certain demographic or behavioral factors related to antibiotic use increased the likelihood of infection by a resistant strain. There was a low rate of resistance to penicillin; penicillinase-producing and chromosomal-mediated penicillin resistant gonorrhea were estimated to be 0.8%. A much higher proportion of isolates were resistant to tetracycline (up to 15%). All isolates were sensitive to spectinomycin, ciprofloxacin and ceftriaxone. However, less than 2% of isolates displayed intermediate resistance to both ciprofloxacin and ceftriaxone, and 9% exhibited intermediate resistance to spectinomycin. Patients who had obtained medication before attending the clinic and had taken all of the medication were more likely (p = 0.03) to be infected with a resistant strain of gonococcus. Also, patients who were asked by a clinic doctor to return for a test of cure during an earlier clinic visit, but who did not return were more likely to be infected with a resistant organism (p = 0.006) compared to those who returned at the doctor's request. These findings have important implications for antibiotic use and educational programs in Trinidad and Tobago.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Cephalosporins; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Gonorrhea; Health Behavior; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin Resistance; Penicillinase; Penicillins; Prevalence; Spectinomycin; Tetracycline; Tetracycline Resistance; Trinidad and Tobago

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Bangladesh; Ciprofloxacin; Drug Resistance, Microbial; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Sex Work; Tetracycline

We evaluated the ability of the Etest (AB Biodisk, Solna, Sweden) method to accurately and reproducibly determine the antimicrobial susceptibility of Neisseria gonorrhoeae. One hundred gonococcal isolates were used to evaluate the diagnostic performance of the Etest compared with the reference agar dilution method for penicillin, tetracycline, ciprofloxacin, and ceftriaxone. Between 92 and 99% of Etest MIC results for all drugs were within +/- 1 log2 dilution of the reference MIC. According to recommended interpretive criteria, ceftriaxone, cefotaxime, and ciprofloxacin had 100% categorical agreement, while penicillin (86%) and tetracycline (85%) categorical agreement percentages were lower because of the large number of strains that were within 0.5 to 1 log2 dilution of the susceptible or resistant breakpoints. Reproducibility data also demonstrated that the Etest was precise (99.1%) when subjected to replicate testing. On the basis of these data, the Etest method provides an effective, simple alternative to the reference agar dilution method for the direct quantification of N. gonorrhoeae susceptibility.

Topics: Cefotaxime; Ceftriaxone; Ciprofloxacin; Drug Resistance, Microbial; Evaluation Studies as Topic; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Sensitivity and Specificity; Tetracycline

To investigate penA and tetM resistance gene variation of Neisseria gonorrhoeae in order to define gene types for epidemiological monitoring and resistance development.. Isolates of N. gonorrhoeae which were susceptible and resistant to penicillin and/or tetracycline were selected. Strains comprised South African isolates (22 from Bloemfontein, 13 from Transvaal, 20 from the Cape) and 15 Botswana and 4 Namibia isolates. The penA genes (2 kb) of all strains and tetM genes (765 bp) of 11 high-level tetracycline-resistant strains were amplified and restricted with HpaII.. Twelve different HpaII fingerprint patterns were obtained from the 74 isolates analysed for penicillin-binding protein (PBP) 2 gene (penA) alterations. Focusing on the transpeptidase domain, 25 isolates (3 whole gene patterns, minimal inhibitory concentrations (MICs) < or = 0.03-0.125 micrograms/ml) had restriction sites equivalent to those previously described for a susceptible strain. Of the remaining 9 PBP 2 gene groups, 25 strains fell into a designated group E. Penicillin/ penicillin + clavulanic acid MICs determined on these group E isolates gave a range of 0.125-2.0 micrograms/ml, although MICs against 4 strains were < or = 0.03 micrograms/ml. MICs of penicillin/penicillin + clavulanic acid for the 24 isolates that contained altered PBP 2 transpeptidase gene regions not designated group E were only < or = 0.03-0.125 micrograms/ml. The lack of a HpaII restriction site at nucleotide 1934 in the PBP 2 gene of group E strains was indicative of a small terminal region of N. cinerea DNA. This gene block, which was found in all the southern African areas studied, appears to predispose isolates to increased penicillin resistance. The 25.2 MDa conjugative plasmid carrying the tetM resistance determinant was readily demonstrated in 11 Botswana/Namibia isolates exhibiting high-level resistance to tetracycline (MICs > or = 16 micrograms/ml). The tetM gene was shown to be of the American type.

Topics: Drug Resistance, Microbial; Genes, Bacterial; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillins; South Africa; Tetracycline

Topics: Base Sequence; Gene Amplification; Gonorrhea; Humans; Molecular Sequence Data; Neisseria gonorrhoeae; Netherlands; Plasmids; Polymorphism, Restriction Fragment Length; Tetracycline; Tetracycline Resistance; United States

Dade County sexually transmitted disease clinic records were reviewed to estimate the relative effectiveness of gonorrhea treatment regimens for eradicating incubating syphilis. Records were searched to see if persons treated for gonorrhea returned with primary syphilis 3-45 days after treatment or secondary syphilis 15-90 days after treatment. The number of persons treated was adjusted for the prevalence of syphilis in the year of treatment. Between 1985 and 1992, 98,441 persons were treated for gonorrhea. Syphilis was diagnosed in an interval that suggested it was incubating at the time of the treatment for 5.6/10(4) (adjusted number) persons treated with spectinomycin alone (a regimen not expected to eradicate syphilis); 2.9/10(4) persons treated with spectinomycin plus tetracycline, doxycycline, or erythromycin; and 2.1/10(4) persons treated with ceftriaxone plus tetracycline, doxycycline, or erythromycin (P > .1). Incubating syphilis was rare despite a syphilis epidemic. The effectiveness of a regimen for eradicating incubating syphilis should not be a major consideration when choosing gonorrhea therapy.

Topics: Ceftriaxone; Doxycycline; Drug Therapy, Combination; Erythromycin; Florida; Follow-Up Studies; Gonorrhea; Humans; Incidence; Medical Records; Prevalence; Risk Factors; Syphilis; Tetracycline

The genetic relatedness of 354 non-penicillinase-producing Neisseria gonorrhoeae strains was studied by multilocus enzyme electrophoresis. The strains, isolated over 9 years in Spain, had different levels of susceptibility to penicillin and tetracycline. On the basis of results obtained by analysis at 12 enzyme loci, the strains were separated into 46 electrophoretic types (ETs). The average number of alleles per enzyme locus was 2.07, and the mean genetic diversity per locus was 0.26 for ETs and 0.27 for individual isolates. The distribution of strains among ETs was not linked to any particular auxotype or serovar class. The index of discrimination of auxotyping combined with serovar determination was similar to multilocus enzyme analysis. Classification of strains by auxotype and serovar did not seem to be related to genotype. Clustering analysis revealed that moderate penicillin-resistant and chromosomally mediated tetracycline-resistant strains were largely shared, while penicillin-resistant strains appeared only in some clusters.

Topics: Alleles; Enzymes; Genes, Bacterial; Genetic Variation; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin Resistance; Penicillinase; Penicillins; Polymorphism, Genetic; Serotyping; Spain; Tetracycline

The prevalence of antimicrobial resistance in Neisseria gonorrhoeae in the United States has been increasing since the mid-1970s.. The Gonococcal Isolate Surveillance Project (GISP) was established in 1986 to monitor trends of antimicrobial resistance in N. gonorrhoeae. GISP is a sentinel surveillance system consisting of 26 publicly funded sexually transmitted disease clinics and five regional laboratories. At each clinic, urethral isolates are obtained from the first 20 men diagnosed with gonorrhea each month; these isolates are shipped to one of the regional laboratories, where the susceptibilities of the organisms to a panel of antibiotics are determined.. This report describes the results of surveillance for antimicrobial resistance in N. gonorrhoeae from January 1991 through December 1991. These results are compared with data obtained from January 1988 through December 1990.. In the 1991 GISP sample, 32.4% of isolates were resistant to penicillin or tetracycline. The proportions of isolates with high-level, plasmid-mediated resistance to penicillin, tetracycline, or both drugs have increased significantly (p < 0.001) in the GISP sample during 1988-1991. No documented clinical treatment failures have been related to decreased susceptibility of N. gonorrhoeae to either ceftriaxone or ciprofloxacin, which belong to the classes of antibiotics currently recommended for gonococcal therapy. ACTION TAKEN: Because of the demonstrated ability of N. gonorrhoeae to develop resistance to antimicrobial agents, surveillance to guide therapy recommendations will be continued.

Topics: Ceftriaxone; Ciprofloxacin; Drug Resistance, Microbial; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillins; Species Specificity; Spectinomycin; Tetracycline; United States

Topics: beta-Lactamases; Diagnosis, Differential; Gonorrhea; Humans; Infant, Newborn; Male; Moraxella catarrhalis; Neisseria; Neisseriaceae Infections; Ophthalmia Neonatorum; Penicillin G; Tetracycline

A case of an HIV positive man with multiple sexually acquired disease occurring concurrently is described. Risk behaviours that could have predisposed him to HIV infection are discussed. The factors which might have interacted to make the sexually acquired infections severe and difficult to treat are postulated.. The case of an HIV-seropositive man with gonorrhea, syphilis, genital warts, and chancroid is described. Multiple sexual partners, genital ulcer diseases, and lack of circumcision may have predisposed him to HIV infection. As indicated by his CD4/CD8 ratio of 0.5, his immunological status was not very compromised. Other factors were therefore probably behind these multiple sexually transmitted diseases (STD). This 30-year old man was inadequately treated for a long time for urethral discharge and genital ulcer disease, and ultimately collapsed on the job with a comprised central nervous system. Bacterial infection related to the multiple STDs could certainly have caused this collapse. The time demands of this man's work, the lack of medical facilities to diagnose and treat such conditions, his unprotected sexual behavior with multiple partners, and broader socioeconomic conditions which separate wage- earning males from their families in Africa conspire to produce multiply-afflicted cases such as these.

Topics: Adult; Anti-Infective Agents; Chancroid; Ciprofloxacin; Condylomata Acuminata; Gonorrhea; HIV Seropositivity; Humans; Injections, Intravenous; Kenya; Male; Risk Factors; Sexually Transmitted Diseases; Syphilis; Tetracycline

54 patients presented by history, physical examination and laboratory tests with suspected pelvic inflammatory disease (PID). The use of laparoscopy as a diagnostic tool proved in 13 cases (24%) that the presumptive diagnosis was incorrect. Bacteriological studies revealed chlamydial infection in 21 of 41 cases, in 6 cases only at laparoscopy in the pelvic cavity, gonococcal in 9 of 41 cases; mycoplasmas were identified in 15 cases, being the only pathogen in 7. In 9 cases, no recognized pathogens were isolated. Polymicrobism was frequent. Follow-up studies identified 5 cases of treatment failure; 2 of Gonococcus and 3 of Chlamydia, and detected 3 cases of Chlamydia which had not been identified initially. We discuss the use of laparoscopy in the diagnosis and for follow-up and treatment of PIDs.

Topics: Acute Disease; Adult; Ampicillin; Chlamydia Infections; Drug Therapy, Combination; Female; Gonorrhea; Humans; Laparoscopy; Metronidazole; Mycoplasma Infections; Netilmicin; Pelvic Inflammatory Disease; Penicillin G Procaine; Tetracycline; Tobramycin

Topics: Adolescent; Adult; Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Female; Gonorrhea; Humans; Male; Spectinomycin; Tetracycline

We studied the susceptibilities of 77 strains of Neisseria gonorrhoeae to four antibiotics: cefpodoxime, ceftriaxone, penicillin, and tetracycline. All strains were susceptible to ceftriaxone. Cefpodoxime MICs (range, 0.001 to 0.125 micrograms/ml) were parallel to and approximately four times those of ceftriaxone, and all strains will probably be considered susceptible to cefpodoxime. Disk diffusion zone diameters for cefpodoxime ranged from 35 to 57 mm. Of the strains, 32% were penicillin resistant and 51% were tetracycline resistant (MIC, greater than or equal to 2 micrograms/ml). Susceptibility measurements were consistent for disk diffusion zone diameter and MIC, with an overall agreement of 215 of 225 (96%) for ceftriaxone, penicillin, and tetracycline combined. On the basis of these in vitro data, cefpodoxime should be evaluated in the treatment of gonorrhea.

Topics: Cefpodoxime; Ceftizoxime; Ceftriaxone; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Tetracycline; Tetracycline Resistance

The relative frequency of penicillinase-producing Neisseria gonorrhoeae strains isolated from Munich STD patients nowadays clearly exceeds five percent. Penicillin resistance is either due to the 3.2 or 4.4 Megadalton plasmid. Similar trends are reported from other European countries. Therefore, treatment with third generation cephalosporins such as ceftriaxone, cefotaxime or others is now generally advisable not only in the Far East and Central Africa but also in Central Europe.

Topics: Enoxacin; Germany, West; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillin Resistance; Penicillinase; R Factors; Tetracycline

Topics: Canada; Conjugation, Genetic; Gonorrhea; Humans; Incidence; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Plasmids; Serotyping; Tetracycline; Tetracycline Resistance

Topics: Anti-Bacterial Agents; Erythromycin; Female; Gonorrhea; Humans; Male; Syphilis; Tetracycline

Topics: Drug Resistance, Microbial; Gonorrhea; Humans; Neisseria gonorrhoeae; Netherlands; Prevalence; Tetracycline

Topics: Conjunctivitis, Bacterial; Conjunctivitis, Inclusion; Erythromycin; Female; Gonorrhea; Humans; Infant, Newborn; Ophthalmic Solutions; Pregnancy; Silver Nitrate; Tetracycline

Topics: Gonorrhea; Humans; Neisseria gonorrhoeae; Tetracycline; Tetracycline Resistance

Susceptibilities to penicillin, cefotaxime, kanamycin, tetracycline, and spectinomycin were measured for 5 reference strains and 302 Neisseria gonorrhoeae isolates collected between 1980 and 1985. After an initial rise, the number of penicillinase-producing strains decreased. A gradual decrease in susceptibility to spectinomycin and the appearance of tetracycline-resistant strains were also documented.

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Gabon; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Spectinomycin; Tetracycline; Time Factors

The official records of uncomplicated gonorrhoea for Córdoba state show that between 1975 and 1985, about one in 1000 sexually active people acquired gonorrhoea each year. A study was therefore undertaken to obtain information about treatment of uncomplicated gonorrhoea, as well as the nutritional requirements, plasmid analyses, and susceptibility profiles of gonococci in this geographical area. From August 1983 to April 1984, 219 men with uncomplicated gonorrhoea were treated with one of four antibiotic schedules, all of which were over 95% efficient. All 98 strains isolated and purified were non-penicillinase-producing Neisseria gonorrhoeae (non-PPNG). The minimum inhibitory concentrations (MICs) of benzylpenicillin, tetracycline, thiamphenicol, spectinomycin, kanamycin, and cefoxitin were assessed. The MIC of benzylpenicillin showed that 88% (86) of the strains were inhibited by 0.5 mg/l of the drug, and also showed a bimodal sensitivity pattern to that antibiotic. The nutritional requirements of the 62 strains tested showed that 53% (33) were of the non-requiring (wild type) auxotype, 42% (26) required proline (pro-) and 5% (3) required proline and arginine (pro- arg-). Resistance to antibiotics was more notable in the pro- than in the wild type strains.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Argentina; Cefoxitin; Drug Resistance, Microbial; Gonorrhea; Humans; Kanamycin; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Penicillin G; Plasmids; Spectinomycin; Tetracycline; Thiamphenicol; Urethra

Between April 1983 and December 1985, 576 strains of Neisseria gonorrhoeae were isolated in our laboratory from patients attending Sexually Transmitted Diseases (STD) clinics. Of these, 61 (10.6%) were penicillinase-producing. Studies on these strains by plasmid analysis, auxotyping and serogrouping showed that the predominant type strains harboured the Asian resistance plasmid, were prototrophic, and were of serogroup W II/W III. About half of the strains, both of the African and Asian type, harboured the transfer plasmid. Strains of serogroup W II/W III were less sensitive to tetracycline and cefoxitin than serogroup W I strains.

Topics: Cefoxitin; Ceftazidime; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G; Penicillinase; Plasmids; Serotyping; Spain; Spectinomycin; Tetracycline

Topics: Drug Resistance, Microbial; Gonorrhea; Humans; Neisseria gonorrhoeae; Plasmids; Tetracycline; United States

Three treatment regimens are currently recommended for penicillin-susceptible Neisseria gonorrhoeae infection of the cervix: ampicillin, tetracycline, and a combination of ampicillin and tetracycline. To evaluate the cost-effectiveness of these options, we developed a decision analysis model and analyzed the efficacy of each treatment in curing gonorrhea, as well as coexisting Chlamydia trachomatis infection, and in preventing subsequent pelvic inflammatory disease, ectopic pregnancy, and infertility. We included direct costs of medication and expenditures for management of unresolved infections and associated complications. Combination treatment is more than twice as cost-effective as tetracycline and seven times as cost-effective as ampicillin when the medical cost of managing pelvic inflammatory disease is considered. When the costs of ectopic pregnancies and infertility are included, the cost-effectiveness of combination treatment increases further.

Topics: Ampicillin; Chlamydia Infections; Chlamydia trachomatis; Cost-Benefit Analysis; Drug Therapy, Combination; Female; Gonorrhea; Humans; Infertility, Female; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Tetracycline; Uterine Cervicitis

Topics: Drug Resistance, Microbial; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin Resistance; Tetracycline; Wisconsin

Topics: Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillin Resistance; Penicillinase; Penicillins; Prospective Studies; Tetracycline; United States

Topics: beta-Lactamases; Ceftriaxone; Doxycycline; Drug Resistance, Microbial; Endophthalmitis; Female; Gonorrhea; Humans; Infant, Newborn; Information Systems; Neisseria gonorrhoeae; Pelvic Inflammatory Disease; Population Surveillance; Tetracycline; United States

Topics: Gonorrhea; Humans; Tetracycline; Tetracycline Resistance

The natural history, transmissibility, and treatment of oropharyngeal gonorrhea have been incompletely examined in previous studies. We repeated cultures on 60 patients with untreated pharyngeal gonorrhea, before treatment. The probability that the culture would remain positive decreased progressively as the interval between cultures increased, suggesting self-limited colonization. Gonococci were easily grown from expectorated saliva in 34 of 51 cultures from patients with oropharyngeal gonorrhea, suggesting transmissibility and providing another reason for ensuring effective treatment. Five treatment regimens were evaluated in 292 cases of oropharyngeal gonorrhea. Compared with aqueous procaine penicillin G, single-dose ampicillin and spectinomycin had unacceptably higher failure rates, and oral tetracycline given for 5 or 7 days was shown to be effective. A simple oral regimen providing a second dose of ampicillin plus probenecid 8 to 14 hours after the first dose was also effective.

Topics: Ampicillin; Drug Administration Schedule; Drug Therapy, Combination; Female; Gonorrhea; Humans; Male; Penicillin G Procaine; Pharyngitis; Pharynx; Probenecid; Retrospective Studies; Saliva; Spectinomycin; Tetracycline

Gonococcal conjunctivitis in adults is rare; however, over the past two years there have been reports of cases from the military and an outbreak of ten cases in Miami, where urine was used as therapy for hemorrhagic conjunctivitis. Reported here is the case of a sixteen-year-old female who developed hemorrhagic conjunctivitis that grew Neisseria gonorrhoeae. With the increase in sexual activity at younger ages, gonococcal conjunctivitis may become more prevalent in this age group.

Topics: Adolescent; Conjunctivitis, Bacterial; Drug Therapy, Combination; Female; Gonorrhea; Hemorrhage; Humans; Neisseria gonorrhoeae; Penicillin G Procaine; Tetracycline

Between January 1983 and October 1984, 446 cases of infection due to chromosomally mediated resistance in Neisseria gonorrhoeae (CMRNG) were reported in 23 states. Eighty percent were detected as primary penicillin or ampicillin treatment failures. Gonococcal isolates were submitted from 175 (40%) for confirmation of resistance, susceptibility testing, gonococcal strain typing using monoclonal antibodies specific for outer membrane Protein I, and auxotyping. All were typed as Protein I serogroup IB (WII/WIII), and the majority were proline or prototrophic auxotypes. All were resistant in vitro to less than 1 microgram/ml of either penicillin or tetracycline. Comparing CMRNG with penicillinase-producing Neisseria gonorrhoeae (PPNG), we found that CMRNG were significantly more resistant to tetracycline and erythromycin, but PPNG were more resistant to penicillin (P less than .01). Because of increasing reports of gonococcal resistance in the United States, improved surveillance of clinical and laboratory resistance is needed in support of control and treatment recommendations for gonorrhea.

Topics: Amino Acids; Anti-Bacterial Agents; Chromosomes, Bacterial; Drug Resistance, Microbial; Female; Gonorrhea; Homosexuality; Humans; Male; Neisseria gonorrhoeae; Penicillin Resistance; Penicillinase; Plasmids; Serotyping; Tetracycline; United States

Topics: Adult; Arthritis, Infectious; Cephalosporins; Chromosomes, Bacterial; Gonorrhea; Humans; Male; Middle Aged; Neisseria gonorrhoeae; Penicillin Resistance; Synovial Fluid; Tetracycline

Topics: Anti-Bacterial Agents; Chloramphenicol; Czechoslovakia; Erythromycin; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin G; Tetracycline

Isolates of Neisseria gonorrhoeae from patients attending the sexually transmitted disease clinics of the Cape Town Municipal Health Department were examined for beta-lactamase (penicillinase) production by a chromogenic cephalosporin test. Of the 208 isolates, 4 (less than 2%) produced beta-lactamase. When grown on chocolate blood agar plates 3 isolates showed no inhibition of growth around a penicillin disc; the 4th had a markedly reduced zone of inhibition. The minimum inhibitory concentrations of penicillin for these 4 strains were from 1 to 4 micrograms/ml.

Topics: Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin Resistance; Penicillinase; South Africa; Tetracycline

The detection of the differentiated chemotherapeutic activity of tetracyclin and penicillin has been used as an example for demonstrating the possibility of using the experimental in ovo model of mixed chlamydial and gonococcal infection for the detection and primary selection of effective etiotropic preparations, simultaneously affecting Chlamydia trachomatis and Neisseria gonorrhoeae.

Topics: Animals; Chick Embryo; Chlamydia Infections; Chlamydia trachomatis; Disease Models, Animal; Drug Evaluation, Preclinical; Gonorrhea; Neisseria gonorrhoeae; Penicillin G; Tetracycline; Time Factors; Yolk Sac

Topics: Drug Resistance, Microbial; Gonorrhea; Humans; Neisseria gonorrhoeae; Tetracycline

Topics: Adult; Drug Resistance, Microbial; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; R Factors; Tetracycline

In the absence of a cure or vaccine for acquired immune deficiency syndrome (AIDS) educational and social marketing efforts to reduce the transmission of Human T-lymphotropic type III/lymphadenopathy-associated virus (HTLV-III/LAV) are currently our best hope for controlling the disease. Since 1983, the Centers for Disease Control (CDC) has funded a series of research studies to determine whether education efforts can successfully motivate the adoption of key behaviors relevant to the control of a variety of sexually transmitted diseases (STDs). Analysis of the first two studies which are now completed, and preliminary data from a third study, have documented dramatic changes in behavior, knowledge, and attitudes among clients in inner-city public health clinics. The authors describe the principles and underlying assumptions that have guided the design of their STD initiatives, drawing special attention to the implications for AIDS health education efforts.. The results of a series of 3 research studies to determine whether education efforts can successfully motivate the adoption of key behaviors relevant to the control of a variety of sexually transmitted diseases (STDs) are reported, and some of the similarities and differences are examined between prevention efforts such as those reported, which are aimed at the more traditional STDs, and possible acquired immune deficiency syndrome (AIDS) risk-reduction strategies. With the important exceptions of condom promotion and sex partner notification/referral, the behavioral objectives focused the the 3 studies are unrelated to objectives one would target in an AIDS risk-reduction program. The fact that AIDS is both incurable and fatal distinguishes it from the other STDs. The serious attention directed to AIDS which has resulted is in marked contrast to the often cavalier attitude that many segments of the public take toward gonorrhea, syphillis, and other STDs for which there are cures. Another difference between AIDS risk-reduction and other STD prevention efforts is their location, i.e., most STD prevention efforts have occurred in clinics. For AIDS prevention messageses, educators must reach high-risk groups in the general public who have not been exposed yet or who have been exposed but are asymptomatic. Yet, despite the problems, with creativity and the thoughtful use of multiple channels of communications, AIDS prevention messages will be heard. Recent social marketing campaigns illustrate the range of creativity that can be brought to a community effort. It is particularly well suited for promoting condoms, whose use is critical to reducing HTLV-III/LAV transmission among both homsexuals and heterosexuals. Drama-based methods are especially relevant to AIDS risk-reduction efforts. They offer an excellent means of modeling the communication and interpersonal skills that are fundamental to the behavior changes sought. Drama-based videotapes, for example, would be especially useful for seropositive men and women who face exceptional stress as a consequence of learning their diagnosis. Clinic-based videotapes would be good resources for counselors of seropositive men who face the prospect of telling their diagnosis to wives and women friends who may never have suspected they would be at risk. Drama-based videotapes are not the only ways to create identification or motivate behavior change. Peer education, individual counseling, and social marke

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Contraceptive Devices, Male; Female; Gonorrhea; Health Education; Homosexuality; Humans; Male; Risk; Sexually Transmitted Diseases; Tetracycline; Videotape Recording

A case of gonococcal urethritis with bilateral tysonitis is discussed. The patient was treated successfully with oral tetracycline 500 mg 6 hourly for 10 days, with a complete resolution.

Topics: Adult; Balanitis; Gonorrhea; Humans; Male; Tetracycline; Urethritis

One hundred and sixty strains of N. gonorrhoeae were studied for their in-vitro sensitivity to six different antimicrobial agents and tested for beta-lactamase production in Zaria, Northern Nigeria. While 82% of strains were sensitive to erythromycin, 70% to tetracycline and 61% to chloramphenicol, only 35%, 33% and 24% were sensitive to ampicillin, penicillin and streptomycin respectively. Penicillin is no more the drug of choice in the treatment of gonorrhoea in this environment since two thirds of strains are either partially resistant or completely resistant to penicillin and 44% of strains are beta-lactamase producers. Erythromycin/tetracycline are recommended as the drugs of choice.

Topics: Anti-Bacterial Agents; beta-Lactamases; Chloramphenicol; Drug Resistance, Microbial; Erythromycin; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Nigeria; Penicillin Resistance; Tetracycline

Between 1976 and 1984 204 infections by penicillinase-producing Neisseria gonorrhoeae (PPNG) were seen in the Whitechapel Clinic. In 1984 PPNG were isolated from 4.7% of all patients attending with gonorrhoea. Three infections were homosexually acquired; 140 infections (68%) were acquired in the U.K. Strains that were tested were fully sensitive to spectinomycin (190), cefuroxime (177), kanamycin (170), amoxycillin combined with clavulanic acid (24) and rosoxacin (18). Of 135 strains 61% were resistant to co-trimoxazole, 69% of 169 to tetracycline (MIC greater than or equal to I mg/l) and 32% of 75 to streptomycin. Of 109 strains subjected to plasmid typing, 72(66%) were Asian strains. Of these, 55 (50% of the total) were without and 17 (16% of the total) possessed the 24.5 Mdal transfer plasmid; 27 (25%) were African strains without and 10 (9%) with the transfer plasmid. Of the Asian strains 10 were acquired in Africa. All four plasmid-containing strains are now endemic in the U.K. On the basis of the sensitivity tests, spectinomycin, cefuroxime and kanamycin should be effective in treatment, but not co-trimoxazole and tetracycline.

Topics: Drug Combinations; Drug Resistance, Microbial; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillinase; Plasmids; Streptomycin; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Drug Resistance, Microbial; Female; Georgia; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; New Hampshire; Pennsylvania; Tetracycline

A young man who acquired gonococcal urethritis in the Far East was not cured by repeated i.v. treatment with a broad-spectrum penicillin. Cultures of pre- and post-treatment urethral specimens grew tetracycline-resistant penicillinase-producing Neisseria gonorrhoeae (PPNG) and tetracycline-resistant Ureaplasma urealyticum. The patient was successfully treated with erythromycin, to which both isolates were sensitive. The strain of N. gonorrhoeae carried a novel plasmid of 10.5 Md molecular mass in addition to plasmids previously observed in this organism. The strain of U. urealyticum carried two distinct plasmids, one with mass 4.9 Md and the other one with mass 8.1 Md. This report demonstrates that ureaplasmas can contain plasmids and raises the question if tetracycline resistance is controlled by plasmids or by the chromosome.

Topics: Adult; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Plasmids; Tetracycline; Ureaplasma; Urethritis

The antimicrobial susceptibility of gonococci isolated in Singapore has been studied over several years. In 1983, the prevalence of penicillinase producing Neisseria gonorrhoeae (PPNG) was 33.5% and 64% of non-PPNG isolates had minimum inhibitory concentrations (MICs) of penicillin of greater than or equal to 0.5 mg/l. After a control programme, the isolation of the gonococcus from prostitutes was reduced and there was improvement in its susceptibility to antimicrobials. The incidence of PPNG strains was stabilised with a change in the treatment regimen. An influx of foreign prostitutes, however, had an unfavourable impact on these variables. Countries in South East Asia have a high prevalence of PPNG and non-PPNG strains that have reduced susceptibility to antimicrobials. In view of increased air travel the problem should be seen from a global perspective. Better treatment regimens and control strategies are urgently needed.

Topics: Ampicillin; Anti-Bacterial Agents; Female; Gonorrhea; Humans; Kanamycin; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin Resistance; Penicillinase; Penicillins; Sex Work; Singapore; Spectinomycin; Tetracycline

Beta lactamase producing Neisseria gonorrhoea strains are only occasionally found in Curaçao; of the non beta lactamase producing strains isolated from civilians a high percentage was moderately to highly resistant to penicillin and moderately resistant to tetracyclin. These percentages were even high in the case of gonococcal strains isolated from prostitutes. Strains which are resistant to spectinomycin were not found. These findings may warrant considering the use of alternative antibiotics in the treatment of gonococcal infections in this community.

Topics: Anti-Bacterial Agents; Dose-Response Relationship, Drug; Gonorrhea; Humans; Neisseria gonorrhoeae; Netherlands Antilles; Penicillin Resistance; Penicillins; Sex Work; Spectinomycin; Tetracycline

Topics: Anti-Bacterial Agents; Cefoxitin; Drug Resistance, Microbial; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin Resistance; Tetracycline

Topics: Administration, Oral; Adolescent; Adult; Chlamydia Infections; Drug Therapy, Combination; Gonorrhea; Humans; Male; Military Medicine; Penicillin G Procaine; Probenecid; Tetracycline

A retrospective chart review was conducted of all patients with pelvic inflammatory disease (PID) during 1980 at an inner-city neighborhood health center. The presenting clinical features, laboratory results, management, and recurrences within a 6-18 month follow-up were analyzed. PID was diagnosed in 264 patients, 60 (23%) of whom were less than 21 years old. Pelvic organ tenderness was present in all patients. Three percent had an elevated white blood cell count and/or erythrocyte sedimentation rate. Four percent were hospitalized. Ten percent had positive endocervical cultures for N. gonorrhoeae. Six percent of the records included treatment plans for the male contact. Twenty-seven percent had a recurrence of PID. The lack of criteria for diagnosing PID and the inconsistencies in its management are discussed. Recommendations for the management of cervicitis and male contacts are presented.

Topics: Adolescent; Adult; Age Factors; Ambulatory Care; Ampicillin; Erythromycin; Female; Follow-Up Studies; Gonorrhea; Humans; Neisseria gonorrhoeae; New York; Pelvic Inflammatory Disease; Recurrence; Tetracycline

In Munich 169 isolates of Neisseria gonorrhoeae were investigated with respect to nutritional profiles (auxotypes) and antibiotic susceptibility. Of the 165 penicillin-susceptible strains 97 proved to be prototrophic (auxotype 1), 42 proline-dependent (auxotype 2). Only 3 arginine-, hypoxanthine- and uracil-dependent strains (auxotype 14) were found. A total of 10 different auxotypes were identified among the non-penicillinase-producing strains and one among the penicillinase producers. The minimal inhibitory concentrations of penicillin G ranged from 0.01 to 1 microgram/ml, those of cefuroxime from 0.001 to 4 mg/ml; tetracycline and kanamycin had a narrow spectrum of effective concentrations, from 0.25 to 8 micrograms/ml and from 4 to 64 micrograms/ml respectively. The type 14 strains showed the well-known high susceptibility to penicillin G.

Topics: Cefuroxime; Germany, West; Gonorrhea; Humans; Kanamycin; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin G; Tetracycline

We report a male patient with severe penicillin-resistant gonococcal urethritis, coinfected with a tetracycline resistant strain of ureaplasma urealyticum. Ureaplasmas are frequently involved in gonococcal urethritis and commonly this organism may persist after the penicillin therapy causing a "post-gonoccal-urethritis" (PGU). Additional treatment with tetracyclines prove to be successful in most of these patients except in cases of tetracycline resistance in ureaplasma urealyticum. In a case like this erythromycin may be useful, a drug to which these isolates are sensitive. The microbiological and genetic feature of a tetracycline resistant strain of ureaplasma urealyticum is presented in detail. The clinical and epidemiological importance of these results are discussed and compared with the literature.

Topics: Adult; Genital Diseases, Male; Gonorrhea; Humans; Male; Mycoplasma Infections; Neisseria gonorrhoeae; Penicillin Resistance; R Factors; Tetracycline; Ureaplasma

A four-year retrospective review of 55 patients with disseminated infections from Neisseria gonorrhoeae revealed that this complication occurs in young adults, with a predominance in women (80%). The most common manifestation of disseminated gonococcal infection was arthritis, which occurred in 47 patients (85.5%). The second most common manifestation of disseminated gonococcal infection was dermatitis, which occurred in 33 patients (60%). A thorough history, a careful physical examination, and a high index of suspicion are essential for the diagnosis. Disseminated gonococcal infection can be confirmed by isolation of gonococci from potential sites, including urethra, cervix, rectum, oropharynx, and blood. Early diagnosis and adequate therapy are necessary to prevent serious complications. The role of the gynecologist in preventing, diagnosing, and/or treating this disorder is emphasized.

Topics: Adolescent; Adult; Ampicillin; Arthritis, Infectious; Endocarditis, Bacterial; Female; Gonorrhea; Humans; Male; Menstruation; Middle Aged; Penicillin G; Pregnancy; Pregnancy Complications, Infectious; Skin Diseases, Infectious; Tetracycline

Without preventive measures, gonococcal ophthalmia will develop in approximately 28% of infants born to women with gonorrhea, a disease that is relatively frequent and largely asymptomatic in pregnant women. In addition, in some settings conjunctivitis caused by Chlamydia trachomatis may be more frequent than gonococcal conjunctivitis among neonates. The Canadian Paediatric Society therefore recommends that, as soon as possible after birth, all infants receive prophylaxis with silver nitrate, tetracycline or erythromycin, administered according to specific guidelines.

Topics: Conjunctivitis, Inclusion; Erythromycin; Female; Gonorrhea; Humans; Infant, Newborn; Ointments; Ophthalmia Neonatorum; Ophthalmic Solutions; Penicillin G; Pregnancy; Pregnancy Complications, Infectious; Silver Nitrate; Tetracycline

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Sulfamethoxazole; Tetracycline

The records of 1,381 patients with gonorrhea were examined by the Massachusetts Department of Public Health to determine the efficacy of their treatment schedules. Urethritis, cervicitis and pharyngitis were treated with 4.8 million u. of aqueous procaine penicillin G intramuscularly, without probenecid. Cure rates were 98 percent in urethritis, 97 percent in pharyngitis and 98 percent in cervicitis. Patients allergic to penicillin were treated with tetracycline orally or spectinomycin intramuscularly. In patients with proctitis, a 98 percent cure rate was achieved with one intramuscular injection of procaine penicillin G, followed by ampicillin orally for four days.

Topics: Adult; Ampicillin; Drug Administration Schedule; Female; Gonorrhea; Humans; Male; Pelvic Inflammatory Disease; Penicillin G Procaine; Penicillin Resistance; Pharyngitis; Proctitis; Spectinomycin; Tetracycline; Urethritis; Uterine Cervicitis

Four hundred three men with signs and symptoms of urethritis were examined by stained slide and culture of urethral exudate. Of these slides, 14.1% were interpreted as "borderline" for gonorrhea, ie, showing typical Gram-negative diplococci on microscopic examination located extracellularly only. Of these, only 10.5% were culture positive for Neisseria gonorrhoeae. Patients with urethritis whose slides are "borderline" should be treated as for nongonococcal urethritis with tetracycline hydrochloride and not with aqueous penicillin G procaine.

Topics: Diagnosis, Differential; Exudates and Transudates; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G Procaine; Staining and Labeling; Tetracycline; Urethra; Urethritis

In a prospective investigation of rectal gonorrhea in men, 1262 patients were studied on the basis of rectal symptoms, gonorrhea contact, or a previously positive rectal culture for Neisseria gonorrhoeae. Five hundred fifty-four patients (44%) had rectal gonorrhea, based on a positive culture; in these patients the symptom of mucus on the stool and the anoscopic finding of generalized exudate proved significant but of low specificity when compared with symptoms and findings in culture-negative patients. Patients were treated with either 4.8 million units of procaine penicillin with 1 g probenecid, 3.5 or 4.5 g of ampicillin with 1 g probenecid, or 9.5 g of tetracycline given over 4 days. Four hundred seven patients with rectal gonorrhea returned for test of cure. Failure rates were 5% with each of the first three regimens and 15% with tetracycline (P less than 3.31). Procaine penicillin with probenecid is recommended as the treatment of choice, with tetracycline being reserved for penicillin-allergic patients.

Topics: Ampicillin; Drug Therapy, Combination; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G Procaine; Probenecid; Proctitis; Proctoscopy; Prospective Studies; Tetracycline

Topics: Adult; Female; Gonorrhea; Humans; Male; Middle Aged; Neisseria gonorrhoeae; Penicillin Resistance; Penicillinase; Penicillins; Pharyngeal Diseases; Probenecid; Tetracycline; World Health Organization

Chlamydia trachomatis is being recognized as an important sexually transmitted disease in adolescents and young adults. This report reviews the recent literature regarding the many clinical entities encompassed by this organism; this includes urethritis and cervicitis as well as epididymitis, salpingitis, peritonitis, perihepatitis, urethral syndrome, Reiter syndrome, arthritis, endocarditis, and others. It is emphasized that many aspects of chlamydial infections parallel those of gonorrhea, including incidence, transmission, carrier state, reservoir, complications, (local and systemic), and others. A paragonococcal spectrum of sexual chlamydial disorders is discussed as well as effective antibiotic therapy. This microbiological agent must always be considered if venereal disease is suspected by the clinician in teenagers or adults. Mixed infections with Chlamydia trachomatis and Neisseria gonorrhoeae are common in both males and females. It may be preferable to treat gonorrhea with tetracycline to cover for this possibility.

Topics: Adolescent; Adult; Chlamydia Infections; Chlamydia trachomatis; Diagnosis, Differential; Female; Gonorrhea; Humans; Male; Sexually Transmitted Diseases; Tetracycline; Urethritis; Uterine Cervicitis

Topics: Adult; Ampicillin; Arthritis, Infectious; Diagnosis, Differential; Gonorrhea; Humans; Knee Joint; Male; Penicillin G; Tetracycline

Topics: Adult; Ankle Joint; Arthritis, Infectious; Female; Gonorrhea; Humans; Male; Penicillin G Procaine; Radiography; Tetracycline

In attempting to improve treatment of gonorrhea in men allergic to penicillin or in those who refused intramuscular (IM) treatment, a comparison of the test of cure rate of doxycycline vs tetracycline was done. Tests of cure were performed one week after treatment on culture positive patients only. Doxycycline proved to have a better test-of-cure rate, primarily because of patient compliance.

Topics: Doxycycline; Gonorrhea; Humans; Male; Patient Compliance; Tetracycline

The results of therapy in 916 men with anorectal gonorrhea treated with orally given antibiotic drugs were reviewed retrospectively. There was a 17.8 percent failure rate for tetracycline (total dose, 10 grams) and a 10.7 percent failure for 3.5 grams of ampicillin plus 1 gram of probenicid. Repeating the ampicillin plus probenicid dose once in 8 to 14 hours reduced the failure rate to 1.6 percent, an efficacy comparable to the regimen of 4.8 million units of aqueous procaine penicillin G given intramuscularly plus 1 gram of probenicid given orally for treatment of anorectal gonorrhea.

Topics: Administration, Oral; Ampicillin; Drug Combinations; Gonorrhea; Humans; Male; Probenecid; Rectal Diseases; Retrospective Studies; Tetracycline

Topics: Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Drug Administration Schedule; Epididymitis; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Neisseria gonorrhoeae; Ophthalmia Neonatorum; Penicillin G Procaine; Penicillinase; Pregnancy; Pregnancy Complications, Infectious; Tetracycline

Topics: Animals; Anti-Bacterial Agents; Asia, Eastern; Bacteria; Cholera; Diarrhea; Doxycycline; Drug Resistance, Microbial; Gonorrhea; Humans; Infection Control; Male; Minocycline; Mucous Membrane; R Factors; Tetracycline; United States

These recommendations specify appropriate treatment, including dosage of antibiotics for uncomplicated gonococcal infections in adults, infections with penicillinase-producing Neisseria gonorrhoeae, acute salpingitis, acute epididymitis, disseminated gonococcal infections, and gonococcal infections in pediatric patients (including neonatal infections). Special attention is given to important diagnostic considerations, relation of gonococcal infections to concomitant venereal infections, treatment of sexual partners, follow-up, treatment failures, treatments not recommended, allergic problems in treatment, needs for hospitalization, and prevention of gonococcal ophthalmia. Attention is called to the importance of using no less than the recommended dosages of antibiotics.

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; Child; Drug Administration Schedule; Endocarditis, Bacterial; Endophthalmitis; Epididymitis; Female; Gonorrhea; Hospitalization; Humans; Infant, Newborn; Male; Meningitis; Neisseria gonorrhoeae; Penicillin G Procaine; Penicillinase; Pregnancy; Pregnancy Complications, Infectious; Salpingitis; Spectinomycin; Tetracycline

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Child; Gonorrhea; Humans; Infant, Newborn; Ophthalmia Neonatorum; Ophthalmic Solutions; Penicillin G; Penicillins; Spectinomycin; Tetracycline; United States; United States Public Health Service

For men with urethral discharge, a simple gram stained smear is 98% sensitive and over 99% specific in detecting gonococcal infection when compared to a single Thayer-Martin culture. The smear is less than 50% sensitive in asymptomatic urethritis. Neither Fluorescent antibody nor various serologic tests offer any diagnostic advantages over smears and/or cultures and they are not cost-effective. Treatment of gonococcal urethritis may be successfully accomplished with a variety of antibiotic regimens. Tetracycline hydrochloride (500 mg four times a day for 5 days) is highly effective, inexpensive, and is active against Chlamydia trachomatis; post gonococcal urethritis (PGU) is therefore uncommon. Aqueous Procaine Penicillin G (4.8 million units IM with 1 g of probenecid) has become the standard in the United States but suffers from higher cost, the need for refrigeration, occasional alarming toxic procaine reactions, and a high incidence of PGU. Spectinomycin 2 g IM remains expensive but is the regimen of choice for treatment failures and for Neisseria gonorrhoeae that produce penicillinase (PPNG). Other antibiotics active against PPNG are cotrimoxozole, cefoxitin, and cefuroxime. PNNG have now been reported from 27 countries throughout the world, but have attained significant prevalence in only a few areas of East Asia and West Africa. Because gonococcal patterns of antibiotic resistance are constantly changing, each region of the world needs to monitor treatment results and maintain some surveillance over sensitivity to antibiotics.

Topics: Gonorrhea; Humans; Male; Penicillin G Procaine; Probenecid; Spectinomycin; Tetracycline; Urethritis

Topics: Adolescent; Adult; Doxycycline; Drug Evaluation; Gonorrhea; Humans; Male; Methacycline; Middle Aged; Tetracycline; Tetracyclines

Topics: Acute Disease; Adult; Amoxicillin; Ampicillin; Child; Drug Administration Schedule; Epididymitis; Female; Gonorrhea; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Ophthalmia Neonatorum; Penicillin G Procaine; Pregnancy; Pregnancy Complications, Infectious; Probenecid; Salpingitis; Tetracycline

Topics: Amoxicillin; Ampicillin; Drug Administration Schedule; Female; Gonorrhea; Humans; Male; Penicillin G Procaine; Pregnancy; Pregnancy Complications; Tetracycline

Topics: Adult; Gonorrhea; Humans; Male; Penicillin G Procaine; Pharyngitis; Retrospective Studies; Tetracycline

Topics: Age Factors; Ambulatory Care Facilities; Female; Georgia; Gonorrhea; Humans; Male; Ohio; Patient Dropouts; Penicillins; Racial Groups; Sex Factors; Tetracycline

Topics: Amoxicillin; Ampicillin; Female; Gonorrhea; Humans; Male; Penicillin G Procaine; Tetracycline

In many cases gonorrhea is overlooked and not treated due to an unusual course of the disease. The longer this infection exists the greater is the danger of dissemination of the gonococci. Gonorrhea, if not diagnosed, may cause a series of local and general clinical manifestations, such as: the dermatitis-arthritis syndrome whose pathogenesis is not yet completely clarified: the Fitz-Hugh-Curtis syndrome which is often seen in females with chronic gonococcal adnexitis;gonococcal pharyngitis which nowadays occurs more often due to less conventional sexual practices of contemporary society; gonococcal conjunctivitis which represents the best known extragenital gonococcosis. This paper deals with the clinical manifestations and their treatment.

Topics: Adult; Arthritis; Conjunctivitis; Dermatitis; Female; Gonorrhea; Humans; Infant, Newborn; Male; Meningitis; Neisseria gonorrhoeae; Ophthalmia Neonatorum; Penicillins; Pharyngitis; Prognosis; Sepsis; Spectinomycin; Tetracycline

We have briefly presented practical approaches to the management of the most common disorders caused by sexually transmitted pathogens, including pelvic inflammatory disease, urethritis in men, genital lesions, vaginal discharge, and syphilis. Guidelines for the management of gonorrhea may change if penicillin-resistant strains become more prevalent. Areas which require further research include the treatment of genital herpes and the prevention of recurrences, the treatment of nonspecific vaginitis, and definition of the importance of metronidazole toxicity.

Topics: Anti-Bacterial Agents; Candidiasis, Vulvovaginal; Female; Genital Diseases, Female; Genital Diseases, Male; Gonorrhea; Herpesviridae Infections; Humans; Male; Pelvic Inflammatory Disease; Penicillin G; Pharyngeal Diseases; Pregnancy; Sexually Transmitted Diseases; Syphilis; Tetracycline; Urethritis; Vaginitis

Topics: Cell Wall; Diffusion; Female; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillin G; Penicillin Resistance; Species Specificity; Temperature; Tetracycline

Topics: Adolescent; Adult; Age Factors; Gonorrhea; Humans; Male; Middle Aged; Recurrence; Retrospective Studies; Tetracycline; Urethritis

Topics: Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Spectinomycin; Tetracycline

Topics: Arizona; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin G; Spectinomycin; Tetracycline

Anorectal gonococcal infection is particularly prevalent in women and homosexual men. Although the currently recommended Public Health Service therapeutic regimens for uncomplicated gonorrhea appear to be effective also for anorectal gonorrhea in women, their efficacy for anorectal infection in men has not been adequately evaluated. We report a case of gonococcal proctitis in a homosexual man that did not respond to therapy with ampicillin plus probenecid and tetracycline, but subsequently responded to spectinomycin therapy. Currently available therapeutic regimens for anorectal gonococcal infection in males are reviewed.

Topics: Adult; Ampicillin; Anus Diseases; Gonorrhea; Humans; Kanamycin; Male; Penicillin G Procaine; Rectal Diseases; Spectinomycin; Sulfamethoxazole; Tetracycline; Trimethoprim

Asymptomatic gonorrhea is significantly common in both males and females. A patient with one sexually transmitted disease (STD) is more likely to have an asymptomatic gonorrheal infection. A physician seeing a patient with an STD should obtain a culture for Neisseria gonorrhoeae to check for a possible asymptomatic infection. Routine culturing of this sexually active population will help to control the increasing incidence of gonorrhea. Appropriate treatment should be initiated by the physician who makes the diagnosis of gonorrhea.

Topics: Aftercare; Ampicillin; Female; Genital Diseases, Female; Genital Diseases, Male; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G Procaine; Penicillin Resistance; Pharyngeal Diseases; Probenecid; Sexually Transmitted Diseases; Spectinomycin; Tetracycline

Topics: Chlamydia Infections; Dimethyl Sulfoxide; Drug Combinations; Female; Gonorrhea; Herpes Simplex; Humans; Idoxuridine; Lymphogranuloma Venereum; Male; Penicillins; Sexually Transmitted Diseases; Syphilis; Tetracycline

Routine testing of gonococci isolated from patients attending the Venereal Diseases Control Centre in Adelaide during the year July, 1974 to June, 1975, with a plate dilution method, showed that 93-8% of the 947 infecting strains were relatively sensitive to penicillin at a minimum inhibitory concentration (MIC) of 0-12 units/ml or less, and that 90% of the 648 strains tested were relatively sensitive to tetracycline at an MIC of 1-0 mug/ml or less. A small proportion only of isolates were relatively insensitive to penicillin and/or tetracycline. The routine treatment schedules which were used at the Centre proved adequate for infections over the whole range of sensitivities encountered. A significant proportion of the less sensitive strains were isolated from people infected in South-East Asia, most of whom had been inadequately treated there.

Topics: Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G; Penicillin Resistance; Tetracycline

The worldwide increase in the incidence of sexually transmitted diseases confronts the physician to an increasing extent with this group of infections. The high morbidity and the change in the clinical picture of gonorrhea, especially its asymptomatic form, give rise to extragenital complications which frequently lead the patient to the internal specialist in the first instance. Non-gonorrheal urethritis, in particular the infectious form, is undergoing intensive research. A number of organisms may be responsible, but a non-infectious origin must also be kept in mind. Syphilis is still important. The late stages of the disease have become rare thanks to highly effective therapy with antibiotics. The early stages of the infection, however, must always be considered in the differential diagnosis of any genital or anal affection, and also in generalized exanthemas of unknown origin. Homosexual transmission presents diagnostic problems of its own. Serological mass screening is essential. Interpretation of the results must take into account the different specificity of the various serological tests and their indication.

Topics: Erythromycin; Family Practice; Female; Gonorrhea; Hepatitis; Humans; Male; Neisseria gonorrhoeae; Penicillins; Proctitis; Sepsis; Sexually Transmitted Diseases; Syphilis; Tetracycline; Urethritis

Topics: Adult; Diagnosis, Differential; Drug Combinations; Epididymitis; Gonorrhea; Hernia; Humans; Infant, Newborn; Infrared Rays; Male; Orchitis; Penicillins; Phenylbutazone; Prognosis; Prostatitis; Spermatic Cord Torsion; Sulfamethoxazole; Testicular Neoplasms; Tetracycline; Trimethoprim; Tuberculosis

Topics: Erythromycin; Gonorrhea; Humans; Penicillin G; Syphilis; Tetracycline

To monitor temporal trends and regional differences in antibiotic susceptibility, we measured the minimum inhibitory concentrations for penicillin G, ampicillin, tetracycline, and spectinomycin of 4405 pre-treatment gonococcal isolates from patients with uncomplicated gonorrhea. As compared to isolates studied in 1970-1971, recent United States isolates appeared equally sensitive to penicillin G and more sensitive to tetracycline. Relatively resistant strains were found throughout the country. We also studied 1974 patients, treated for uncomplicated gonorrhea according to the 1972 regimens recommended by the United States Public Health Service, to determine the relation between pretreatment minimum inhibitory concentrations and treatment results. For patients receiving the procaine penicillin-probenecid and ampicillin-probenecid regimens, minimum inhibitory concentrations to the treatment drugs were significantly higher in patients not cured than in those cured (P less than 0.01 fr penicillin and P less than 0.05 for ampicillin). In contrast, spectinomycin-treatment results appeared to be independent of the isolate's susceptibility to spectinomycin and other antibiotics.

Topics: Ampicillin; Anti-Bacterial Agents; Drug Therapy, Combination; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin G; Penicillin G Procaine; Probenecid; Spectinomycin; Tetracycline

There has been a marked increase in the resistance of Neisseria gonorrhoeae isolated in Korea to penicillin, ampicillin, and tetracycline. In contrast, there has been no increased resistance to spectinomycin.

Topics: Ampicillin; Anti-Bacterial Agents; Culture Media; Gonorrhea; Humans; Korea; Neisseria gonorrhoeae; Penicillins; Spectinomycin; Tetracycline; Time Factors

The Center for Disease Control and cooperating clinics monitored adverse drug reactions in 6,969 patients who were treated for suspected uncomplicated gonorrhea with one of the four 1972 United States Public Health Service (USPHS) recommended regimens and returned for reexamination. Of those patients receiving the aqueous procaine penicillin G (APPG)-probenecid regimen, 2.0% had at least one adverse reaction and 0.18% experienced procaine reactions. No life-threatening reactions occurred. The overall reaction rates for the ampicillin-probenecid, tetracycline and spectinomycin regimens were 0.62%, 5.9%, and 0.61%, respectively. Our findings document the relative safety of the USPHS recommended regimens.

Topics: Drug Administration Schedule; Female; Gonorrhea; Humans; Male; Penicillin G Procaine; Probenecid; Spectinomycin; Tetracycline; United States; United States Public Health Service

One hundred emergency department charts on cases of suspected pelvic inflammatory disease (PID) were reviewed to determine method of diagnosis and treatment. Seventy-three gonococcus smears, 60 gonococcus cultures, and 53 VDRL tests for syphilis were done. Of these, 20 smears, 19 cultures, and 1 VDRL were positive. All 100 patients were treated for gonorrhea with either spectinomycin, tetracycline, ampicillin or penicillin. The author concludes there is no need to procure VDRL tests on all patients with suspected gonorrhea, nor do gonococcus cultures on all patients with suspected PID. Also, since only 39% of patients had a positive gonococcus smear or culture, penicillin may not always be the appropriate treatment.

Topics: Ampicillin; Emergency Service, Hospital; Female; Gonorrhea; Humans; Pelvic Inflammatory Disease; Penicillins; Spectinomycin; Tetracycline

The statistics relating to the incidence of sexually transmitted diseases in many developing countries are not available and where there are, they are unreliable. Nevertheless, the impression of many physicians is that they constitute serious public health problems as they are endemic in some developing countries. The facilities for diagnosis and treatment of the diseases have been briefly discussed. The merits and the demerits of various antimicrobial agents have been outlined with the causes of failure of treatment in the developing countries. The economic importance of the "traitment minute" in the tropical environment has been stressed because of its economic advantage in terms of time spent in overcrowded hospitals. The resultant effect of the widescale misuse of antibiotics in developing countries has been suggested as a cause of the increasing resistant strains encountered. A plea is made for stricter control of the antimicrobial agents in developing countries.

Topics: Ampicillin; Developing Countries; Gonorrhea; Humans; Penicillins; Sexually Transmitted Diseases; Spectinomycin; Substance-Related Disorders; Tetracycline

In a prospective controlled study of 290 men and women with uncomplicated gonorrhea, carbenicillin was shown to be less than 90% effective. Positive cultures were the basis for initial diagnosis and therapeutic failure in both sexes. Carbenicillin was evaluated in three different schedules: 5gm p.o., 10 gm p.o, and 2gm IM Plus 5GM p.o. The three schedules were equally effective. Eleven of 20 failures in women occurred in infection of the rectum. MICs of carbenicillin ranged from 0.025% to 1.0 mug/ml with a mean of 0.29 mug/ml.

Topics: Administration, Oral; Adult; Carbenicillin; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Rectal Diseases; Tetracycline

Topics: Anti-Bacterial Agents; Chlamydia Infections; Dimethyl Sulfoxide; Female; Gonorrhea; Herpes Simplex; Humans; Idoxuridine; Immunotherapy; Male; Penicillins; Sexually Transmitted Diseases; Syphilis; Tetracycline

Topics: Acute Disease; Adolescent; Adult; Drug Combinations; Gonorrhea; Humans; Male; Oleandomycin; Sex Factors; Tetracycline

Appropriate drugs and their proper use are described for the care of adult and pediatric patients with uncomplicated and complicated gonococcal infections in men and women. Special diagnostic considerations in some cases are indicated. These recommendations were established by the Venereal Disease Control Advisory Committee after deliberation with therapy consultants.

Topics: Acute Disease; Ampicillin; Anti-Bacterial Agents; Child; Female; Gonorrhea; Humans; Infant, Newborn; Male; Penicillin G; Pharyngeal Diseases; Pregnancy; Pregnancy Complications, Infectious; Probenecid; Salpingitis; Spectinomycin; Syphilis Serodiagnosis; Tetracycline; Urethra

Topics: Ampicillin; Anti-Bacterial Agents; Cephalosporins; Child, Preschool; Erythromycin; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Male; Ophthalmia Neonatorum; Penicillin G Procaine; Pregnancy; Pregnancy Complications, Infectious; Spectinomycin; Sulfides; Tetracycline; Tetrazoles; Thiadiazoles; Time Factors; United States; United States Public Health Service

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Arthritis; Child; Child, Preschool; Coitus; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Male; Penicillin G Procaine; Pharyngeal Diseases; Pregnancy; Pregnancy Complications, Infectious; Probenecid; Salpingitis; Spectinomycin; Syphilis Serodiagnosis; Tetracycline; Urethritis

Topics: Acute Disease; Ampicillin; Coitus; Female; Gonorrhea; Humans; Male; Penicillin G Procaine; Pharyngeal Diseases; Pregnancy; Pregnancy Complications, Infectious; Probenecid; Salpingitis; Spectinomycin; Syphilis Serodiagnosis; Tetracycline

Gonorrhea, the nation's second most frequently reported communicable disease, will affect more than a million persons this year. The following is the latest treatment schedule issued by the USPHS Center for Disease Control, Atlanta.

Topics: Adolescent; Ampicillin; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Erythromycin; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Penicillin G Procaine; Pharyngitis; Pregnancy; Pregnancy Complications, Infectious; Probenecid; Salpingitis; Spectinomycin; Sulfides; Tetracycline; Tetrazoles; Thiadiazoles; Urethritis

Topics: Adolescent; Adult; Age Factors; Ampicillin; Anti-Bacterial Agents; Cefazolin; Child; Child, Preschool; Endophthalmitis; Erythromycin; Female; Follow-Up Studies; Gonorrhea; Hospitalization; Humans; Infant; Infant, Newborn; Male; Penicillin G; Penicillin G Procaine; Pharyngeal Diseases; Pregnancy; Pregnancy Complications, Infectious; Probenecid; Salpingitis; Sex Factors; Spectinomycin; Tetracycline

Topics: Ampicillin; Child; Female; Gonorrhea; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Pelvic Inflammatory Disease; Penicillin G Procaine; Pharyngitis; Probenecid; Spectinomycin; Syphilis; Tetracycline; United States; United States Public Health Service; Urethritis

Topics: Ampicillin; Anti-Bacterial Agents; Female; Gonorrhea; Humans; Male; Penicillin G Procaine; Pregnancy; Public Health; Spectinomycin; Tetracycline

Several treatment regimens of trimethoprim-sulfamethoxazole (TMP-SMZ) were compared to the USPHS-recommended schedules for treatment of uncomplicated gonorrhea with ampicillin plus probenecid, tetracycline, or aqueous procaine penicillin G in both men and women. TMP-SMZ, six tablets as a single oral dose daily for 3 days, was as effective as the ampicillin or tetracycline schedules. The drug was well tolerated.

Topics: Ampicillin; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin G Procaine; Probenecid; Sulfamethoxazole; Tetracycline; Trimethoprim

108 male patients with non-gonococcal urethritis have been treated with minocycline given as two 100 mg. tablets initially, followed by one tablet twice a day over a period of 6 days (13 tablets). Of 96 patients followed, re-treatment for non-gonococcal urethritis within 3 months was undertaken in ten (10.4 per cent.). The findings are compared with those previously reported in seven series involving six other tetracyclines and with nine other treatment regimens. All of the tetracyclines proved superior to other agents and the best results combined with simplicity of administration were obtained with minocycline. Two patients complained of soreness of the mouth after 1 week but no other side-effects were reported. Minocycline thus gives excellent results in the treatment of non-gonococcal urethritis. In the dosage used it was also successful against gonorrhoea in seven patients treated. It is therefore particularly useful in cases in which gonorrhoea is suspected but not found in the smears or in which the smears cannot be read immediately.

Topics: Follow-Up Studies; Gonorrhea; Humans; Male; Minocycline; Tetracycline; Tetracyclines; Urethritis

Topics: Administration, Oral; Gonorrhea; Humans; Tetracycline

Topics: Ampicillin; Anti-Bacterial Agents; Child; Child Abuse; Erythromycin; Female; Gonorrhea; Hospitalization; Humans; Immobilization; Infant, Newborn; Infant, Newborn, Diseases; Ophthalmia Neonatorum; Penicillin G; Penicillin G Procaine; Pregnancy; Probenecid; Tetracycline

Topics: Administration, Oral; Female; Gonorrhea; Humans; Male; Penicillins; Sexually Transmitted Diseases; Syphilis; Tetracycline; Urethritis

Topics: Adolescent; Adult; Chronic Disease; Drug Evaluation; Drug Therapy, Combination; Gonorrhea; Humans; Immunotherapy; Male; Middle Aged; Oleandomycin; Pyrogens; Tetracycline; Trichomonas Infections

Topics: Adolescent; Adult; Age Factors; Female; Gonorrhea; Greenland; Humans; Male; Metronidazole; Middle Aged; Penicillins; Sex Factors; Syphilis; Syphilis Serodiagnosis; Tetracycline; Treponema Immobilization Test

Topics: Adolescent; Adult; Bacteriological Techniques; Carrier State; Coitus; Female; Fluorescent Antibody Technique; Gonorrhea; Humans; Male; Middle Aged; Military Medicine; Neisseria gonorrhoeae; Penicillin G; Prostate; Tetracycline; United States; Urethra

Topics: Adolescent; Adult; Ampicillin; Cervix Uteri; Female; Gonorrhea; Humans; Male; Middle Aged; Military Personnel; Neisseria gonorrhoeae; Netherlands; Penicillin G; Penicillin G Procaine; Pharyngitis; Prostate; Rectum; Tetracycline; Tonsillitis; Urethra

Topics: Acute Disease; Administration, Oral; Ampicillin; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Tetracycline; Urethritis; Valerates

Of 53 patients with acute uncomplicated gonorrhea treated with amoxicillin 2 g and probenecid 1 g orally as a single administration, six failed to return for follow-up examination, 10 developed postgonococcal urethritis and one was a treatment failure. The remainder achieved symptomatic cure in an average of 2.3 days. Adverse drug effects were infrequent, mild and transient. We conclude that this dose of amoxicillin and probenecid is a safe and effective treatment regimen.

Topics: Acute Disease; Administration, Oral; Adolescent; Adult; Amines; Drug Evaluation; Female; Follow-Up Studies; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillins; Probenecid; Tetracycline; Urethritis

Topics: Ampicillin; Cervix Uteri; Coitus; Female; Fingers; Gonorrhea; Humans; Male; Maternal Health Services; Neisseria gonorrhoeae; Penicillin G Procaine; Pharyngeal Diseases; Pharynx; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Rectum; Sexual Behavior; Sucking Behavior; Tetracycline; Urethra; Vagina

Topics: Administration, Oral; Adult; Doxycycline; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Penicillin G; Penicillin Resistance; Streptomycin; Tetracycline; Urethritis

The antibiotic sensitivity pattern of 3872 isolates of N. gonorrhoeae tested in Toronto from 1969 to 1973 is reviewed. An increase in resistance to both penicillin and tetracycline was noted up to 1971, but no further increase has occurred since then. Ninety-seven percent of 135 patients with "sensitive" strains (inhibited by 0.3 U/ml of penicillin and/or 0.5 mug/ml of tetracycline) were cured by either 8 g of tetracycline or 5,000,000 U of penicillin, whereas only 59% of 58 patients with "resistant" strains (requiring 1.0 U/ml of penicillin and/or 2.0 mug/ml of tetracycline for inhibition) were cured by the same dosage. Spectinomycin appears to be an acceptable alternative therapy. Maximum doses of the chosen drug are recommended in the hope of retarding further spread of more resistant organisms.

Topics: Anti-Bacterial Agents; Cephaloridine; Erythromycin; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Ontario; Penicillin G Procaine; Penicillin Resistance; Spectinomycin; Tetracycline

One hundred and thirty-five gonococcal isolates collected from Los Angeles in 1972 were studied for antibiotic susceptibility to penicillin, ampicillin, carbenicillin, tetracycline, minocycline, doxycycline and spectinomycin. Only 12 percent of the isolates were sensitive to 0.05 mug per ml of penicillin while 35 percent required at least 0.5 mug per ml for inhibition of growth. The results were slightly better with ampicillin and nearly the same with carbenicillin. Nineteen percent of the isolates required at least 1.0 mug per ml of tetracycline for inhibition of growth and the results were similar with either minocycline or doxycycline. Forty-nine percent were sensitive to 2.0 mug per ml spectinomycin, but 37 percent required at least 8.0 mug per ml for inhibition of growth. In this study nine of eleven isolates resistant to 1.0 mug per ml of tetracycline were also resistant to both penicillin and spectinomycin. Six came from endocervical sites of female patients who contributed only 37 percent of the total number of isolates studied. Correlation between the agar dilution and disc diffusion methods was satisfactory with penicillin but not with ether tetracycline or spectinomycin.

Topics: Adolescent; Adult; Ampicillin; Anti-Bacterial Agents; California; Carbenicillin; Child; Doxycycline; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Minocycline; Neisseria gonorrhoeae; Penicillin G; Penicillin Resistance; Spectinomycin; Tetracycline

Topics: Adolescent; Adult; Ampicillin; Biopsy; Coitus; Female; Genital Diseases, Female; Gonorrhea; Humans; Hydrocortisone; Lip; Lip Diseases; Lymphangitis; Male; Penile Diseases; Penis; Tetracycline; Urethritis; Vulva

Topics: Adolescent; Adult; Chronic Disease; Drug Combinations; Drug Therapy, Combination; Female; Gonorrhea; Humans; Immunotherapy; Middle Aged; Oleandomycin; Pelvic Inflammatory Disease; Prodigiosin; Tetracycline; Trichomonas Infections; Urethritis; Uterine Cervicitis

Topics: Adolescent; Adult; Family Characteristics; Follow-Up Studies; Gonorrhea; Humans; Male; Marriage; Middle Aged; Minocycline; Tetracycline; Urethritis

Topics: Female; Gonorrhea; Humans; Penicillins; Tetracycline

Topics: Administration, Oral; Anemia, Hemolytic; Blood-Brain Barrier; Chlortetracycline; Demeclocycline; Doxycycline; Drug Hypersensitivity; Female; Glucosephosphate Dehydrogenase Deficiency; Gonorrhea; Humans; Injections, Intramuscular; Intestinal Absorption; Male; Methacycline; Minocycline; Oxytetracycline; Penicillins; Tetracycline; Urethritis

Topics: Gonorrhea; Humans; Kanamycin; Male; Microbial Sensitivity Tests; Military Medicine; Neisseria gonorrhoeae; Penicillin G Procaine; Penicillin Resistance; Probenecid; Tetracycline; Vietnam

Topics: Ampicillin; Female; Fluorescent Antibody Technique; Gonorrhea; Humans; Male; Microscopy, Fluorescence; Middle Aged; Neisseria gonorrhoeae; Tetracycline

Topics: Administration, Oral; Adolescent; Adult; Chlortetracycline; Demeclocycline; Diarrhea; Drug Combinations; Gonorrhea; Humans; Male; Metoclopramide; Microbial Sensitivity Tests; Nausea; Promazine; Recurrence; Tetracycline; Urethritis; Vomiting

Topics: Adult; Child, Preschool; Chronic Disease; Complement Fixation Tests; Female; Gingivitis; Gonorrhea; Homosexuality; Humans; Male; Neisseria; Neisseria gonorrhoeae; Neisseria meningitidis; Paraphilic Disorders; Penicillin G Procaine; Pharyngeal Diseases; Pharyngitis; Pharynx; Prospective Studies; Recurrence; Spectinomycin; Tetracycline; Tonsillitis

Topics: Ampicillin; Anti-Bacterial Agents; Gonorrhea; Humans; Penicillin G; Penicillin G Benzathine; Penicillin Resistance; Penicillins; Probenecid; Spectinomycin; Tetracycline

Topics: Adult; Cervix Uteri; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G Procaine; Pharyngitis; Pharynx; Probenecid; Rectum; Sexual Behavior; Spectinomycin; Tetracycline

Topics: Female; Gonorrhea; Humans; Indicator Dilution Techniques; Male; Neisseria gonorrhoeae; Penicillin G; Penicillin Resistance; Spectinomycin; Streptomycin; Tetracycline

Topics: Administration, Oral; Ampicillin; Doxycycline; Female; Gonorrhea; Humans; Injections; Kanamycin; Male; Mycoplasma Infections; Neisseria gonorrhoeae; Penicillin G Procaine; Penicillin Resistance; Probenecid; Pyuria; Recurrence; Sex Factors; Spectinomycin; Tetracycline; United States; Urethritis

Topics: Anti-Infective Agents; Female; Folic Acid Antagonists; Gonorrhea; Humans; Male; Penicillin Resistance; Penicillins; Pyrimidines; Sulfamethoxazole; Syphilis; Tetracycline; Trimethoprim

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Denmark; Economics, Medical; Epidemiology; Gonorrhea; Greenland; History, 20th Century; Humans; Infant; Infant, Newborn; Penicillins; Statistics as Topic; Syphilis; Tetracycline

Topics: Bacteriological Techniques; Benzoates; Female; Gonorrhea; Humans; Iodobenzoates; Jurisprudence; Nevada; Sex Work; Sexually Transmitted Diseases; Syphilis; Tetracycline; Vaginal Smears

Topics: Adolescent; Age Factors; California; Child; Child, Preschool; Chloramphenicol; Disease Outbreaks; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Male; Neisseria gonorrhoeae; Ophthalmia Neonatorum; Pediatrics; Penicillin G; Sexual Behavior; Surveys and Questionnaires; Tetracycline; Vaginal Smears

Topics: Anti-Bacterial Agents; Gonorrhea; Greenland; History, 20th Century; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Streptomycin; Tetracycline

Topics: Administration, Oral; Anal Canal; Cervix Uteri; Doxycycline; Female; Follow-Up Studies; Gonorrhea; Humans; Male; Methacycline; Neisseria gonorrhoeae; Penicillin G; Penicillin G Procaine; Penicillin Resistance; Tetracycline; Urethra

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Cervix Uteri; Dermatitis; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin G; Penicillin Resistance; Skin Diseases, Infectious; Streptomycin; Syndrome; Tetracycline; Urethra; Virulence

Topics: Ampicillin; Anti-Bacterial Agents; Chloramphenicol; Costs and Cost Analysis; Doxycycline; Gonorrhea; Humans; Kanamycin; Tetracycline

Topics: Acute Disease; Ampicillin; Anti-Bacterial Agents; Doxycycline; Gonorrhea; Humans; Penicillins; Probenecid; Syphilis; Tetracycline

Topics: Adolescent; Adult; Aged; Culture Media; Doxycycline; Female; Gonorrhea; Humans; Male; Middle Aged; Nausea; Penicillins; Streptomycin; Tetracycline; Vomiting

Topics: Chancroid; Drug Combinations; Erythromycin; Female; Gonorrhea; Granuloma Inguinale; Humans; Injections, Intramuscular; Kanamycin; Lymphogranuloma Venereum; Male; Metronidazole; Penicillin Resistance; Penicillins; Rifampin; Sexually Transmitted Diseases; Streptomycin; Sulfamethoxazole; Sulfonamides; Syphilis; Tetracycline; Trimethoprim; Urethritis

Topics: Administration, Oral; Ampicillin; Anti-Bacterial Agents; Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Penicillin G Procaine; Penicillin Resistance; Probenecid; Spectinomycin; Syphilis; Tetracycline

Topics: Amino Sugars; Anti-Bacterial Agents; Bacteria; Candidiasis; Carbenicillin; Cephalosporins; Cryptococcosis; Drug Synergism; Flucytosine; Glycosides; Gonorrhea; Humans; Meningococcal Infections; Minocycline; Pseudomonas Infections; Spectinomycin; Sulfonamides; Tetracycline; Trimethoprim

Topics: Cervix Uteri; Culture Media; Female; Gonorrhea; Humans; Magnesium; Male; Methods; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Nystatin; Penicillins; Polymyxins; Rectum; Streptomycin; Tetracycline; Urethra; Vancomycin

Topics: Ampicillin; Female; Gonorrhea; Humans; Kanamycin; Male; Penicillin G Procaine; Sulfonamides; Tetracycline; Treponema pallidum; Trimethoprim

A 2 1/2 year gonorrhea screening program in Chicago showed 7.5% of women tested to be positive for Neisseria gonorrhoeae organisms with a single cervical culture. Young patients, unmarried patients, and black patients had the highest attack rates. Over 98% of those with positive cultures were treated, and this program has probably contributed to a decline in reported gonorrhea morbidity in the first 6 months of 1971. In another group 4816 women seen at a venereal disease clinic, 24.4% were positive at the cerivx, rectum, or both. The addition of rectal tests to cervical tests is productive of many cases that would otherwise be missed. 3 million units of procaine penicillin G with 2% aluminum monostearate intramuscularly is an inadequate treatment for women with gonorrhea.

Topics: Adolescent; Adult; Aluminum; Cervix Uteri; Chicago; Child; Child, Preschool; Disease Reservoirs; Evaluation Studies as Topic; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Injections, Intramuscular; Mass Screening; Middle Aged; Neisseria gonorrhoeae; Penicillin G Procaine; Rectum; Stearic Acids; Tetracycline

Topics: Adult; Blood; Culture Media; Doxycycline; Female; Fever; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillins; Sepsis; Skin Manifestations; Tetracycline; Uterus

Topics: Administration, Oral; Gonorrhea; Homosexuality; Humans; Injections, Intramuscular; Male; Neisseria gonorrhoeae; Penicillin G Procaine; Pharyngeal Diseases; Pharynx; Prospective Studies; Rectal Diseases; Rectum; Surveys and Questionnaires; Tetracycline; Urethral Diseases

Topics: Anti-Bacterial Agents; Cervix Uteri; Doxycycline; Female; Gonorrhea; Humans; Neisseria gonorrhoeae; Rectum; Remission, Spontaneous; Tetracycline

Topics: Adolescent; Cervix Uteri; Female; Gonorrhea; Humans; Mass Screening; Neisseria gonorrhoeae; Penicillin G; Penicillin G Procaine; Penicillins; Socioeconomic Factors; Tetracycline; Vagina; Vaginal Smears

Topics: Adolescent; Adult; Candidiasis, Vulvovaginal; Drug Resistance, Microbial; Female; Gonorrhea; Humans; Intrauterine Devices; Metronidazole; Neisseria gonorrhoeae; Nigeria; Nystatin; Penicillin Resistance; Sexually Transmitted Diseases; Tetracycline; Trichomonas Vaginitis

Topics: Adult; Contraceptives, Oral; Female; Gonorrhea; Humans; Marriage; Metronidazole; Tetracycline; Time Factors; Trichomonas Vaginitis; Urethritis

Topics: Acute Disease; Amines; Ampicillin; Benzyl Compounds; Cephalosporins; Gonorrhea; Humans; Male; Penicillins; Phenols; Probenecid; Recurrence; Tetracycline

Topics: Acute Disease; Administration, Oral; Adult; Gonorrhea; Humans; Male; Tetracycline

Topics: Adolescent; Adult; Emigration and Immigration; Female; Gonorrhea; Humans; Italy; Male; Penicillins; Sex Factors; Sex Ratio; Tetracycline

Topics: Administration, Oral; Ampicillin; Anti-Bacterial Agents; Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Penicillin G; Serologic Tests; Syphilis; Tetracycline

Topics: Adolescent; Adult; Gonorrhea; Humans; Male; Middle Aged; Oleandomycin; Tetracycline; Trichomonas Infections; Urethritis

Topics: Candidiasis, Vulvovaginal; Female; Gonorrhea; Humans; Male; Pelvic Inflammatory Disease; Penicillin G Procaine; Pharyngitis; Proctitis; Syphilis; Tetracycline; Urogenital System; Vulvovaginitis

Topics: Female; Gonorrhea; Humans; Male; Penicillins; Tetracycline

Topics: Gonorrhea; Humans; Penicillins; Tetracycline

Topics: Adolescent; Adult; Age Factors; Carrier State; Female; Gonorrhea; Humans; Male; Mycoplasma; Mycoplasma Infections; Sex Factors; Tetracycline; Urethritis

Topics: Ampicillin; Anti-Bacterial Agents; Gonorrhea; Humans; Male; Penicillins; Rifampin; Tetracycline; Time Factors

Topics: Cervix Uteri; Culture Media; Education, Medical, Continuing; Education, Medical, Graduate; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G Benzathine; Penicillin G Procaine; Programmed Instructions as Topic; Rectum; Staining and Labeling; Syphilis; Tetracycline; Urethritis

Topics: Adolescent; Adult; Drug Hypersensitivity; Female; Follow-Up Studies; Gonorrhea; Humans; Injections, Intramuscular; Male; Middle Aged; Neisseria gonorrhoeae; Penicillin G; Penicillin G Procaine; Penicillin Resistance; Probenecid; Rectum; Streptomycin; Syphilis; Syphilis Serodiagnosis; Tetracycline

Topics: Acne Vulgaris; Adolescent; Diagnosis, Differential; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Tetracycline

Topics: Adolescent; Adult; Ampicillin; Anti-Bacterial Agents; Erythromycin; False Positive Reactions; Female; Fluorescent Antibody Technique; Gonorrhea; Humans; Male; Neurosyphilis; Penicillin G Benzathine; Penicillin G Procaine; Probenecid; Syphilis; Syphilis Serodiagnosis; Syphilis, Cardiovascular; Syphilis, Latent; Tetracycline; United States

Topics: Ampicillin; Cephalosporins; Demeclocycline; Gonorrhea; Humans; Male; Tablets; Tetracycline

Topics: Adolescent; Adult; Ampicillin; Anemia; Arthritis, Infectious; Arthritis, Reactive; Endocarditis, Bacterial; Female; Gonorrhea; Hepatitis; Humans; Male; Meningitis; Menstruation; Myocarditis; Neisseria gonorrhoeae; Penicillin G Procaine; Penicillin V; Pericarditis; Pregnancy; Pregnancy Complications, Infectious; Pyuria; Sepsis; Skin Diseases; Tetracycline

Topics: Ampicillin; Anti-Bacterial Agents; Chloramphenicol; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Naval Medicine; Neisseria gonorrhoeae; Penicillin Resistance; Species Specificity; Streptomycin; Tetracycline

Topics: Ampicillin; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Tetracycline; United States

Topics: Acute Disease; Anti-Bacterial Agents; Chloramphenicol; Erythromycin; Gonorrhea; Humans; India; Leucomycins; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Tetracycline; Urethritis

Topics: Ampicillin; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Prostate; Prostatitis; Semen; Tetracycline; Urethra; Urethritis

Topics: Acute Disease; Administration, Oral; Female; Gonorrhea; Humans; Male; Methylamines; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Sex Factors; Tetracycline; Urethra

Topics: Adolescent; Adult; Age Factors; Emigration and Immigration; England; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Recurrence; Sex Factors; Tetracycline

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Arthritis; Cervix Mucus; Female; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Probenecid; Recurrence; Statistics as Topic; Syphilis; Tetracycline; United States

Topics: Doxycycline; Erythromycin; Female; Gonorrhea; Humans; Leucomycins; Lincomycin; Male; Neisseria gonorrhoeae; Penicillin G; Penicillin Resistance; Penicillins; Probenecid; Rifampin; Tetracycline

Topics: Anti-Bacterial Agents; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G; Penicillin Resistance; Procaine; Rifampin; Streptomycin; Syphilis; Tetracycline

Neisseria gonorrhoeae were cultured from tonsillar swabs in six men and six women out of 161 consecutive, unselected, Danish patients (95 men and 66 women) suffering from urogenital or rectal gonorrhoea. Gonococci were found in the tonsils in only one out of 49 foreign men with gonorrhoea. Eleven of the Danish patients admitted orogenital contact at their most recent intercourse. The gonococcal complement fixation test was negative in all except two cases. Standard singledose treatment cured the urogenital and rectal infections promptly but failed to cure the tonsillar infection in five cases, and in recalcitrant cases the organisms were demonstrable for some months.

Topics: Ampicillin; Complement Fixation Tests; Denmark; Ethnicity; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Palatine Tonsil; Penicillin G; Probenecid; Sexual Behavior; Tetracycline; Tonsillitis

Topics: Anti-Bacterial Agents; Chloramphenicol; Chronic Disease; Depression, Chemical; Erythromycin; Female; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Oleandomycin; Penicillin Resistance; Penicillins; Sulfanilamides; Tetracycline

Topics: Erythromycin; Female; Gonorrhea; Humans; Pregnancy; Pregnancy Complications, Infectious; Sepsis; Tetracycline

Topics: Administration, Oral; Adolescent; Adult; Child; Evaluation Studies as Topic; Gonorrhea; Humans; Male; Methylamines; Naphthacenes; Tetracycline; Time Factors

Topics: Administration, Oral; Drug Resistance, Microbial; Female; Gonorrhea; Humans; Male; Tetracycline

Topics: Administration, Oral; Age Factors; Ampicillin; Female; Gonorrhea; Humans; Hypersensitivity; Injections, Intramuscular; Penicillins; Tetracycline

Topics: Acute Disease; Adult; Arthritis, Reactive; Gonorrhea; Humans; Injections, Intramuscular; Male; Rolitetracycline; Tetracycline

Topics: Ampicillin; Australia; Culture Media; Drug Eruptions; Erythromycin; Gonorrhea; Humans; Kanamycin; Kidney; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Oxytetracycline; Penicillin G Benzathine; Penicillin G Procaine; Penicillin Resistance; Probenecid; Streptomycin; Tetracycline; Urethritis

Topics: Adolescent; Adult; Female; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Tetracycline

Topics: Administration, Oral; Ampicillin; Anti-Bacterial Agents; Female; Gonorrhea; Hospitalization; Humans; Injections, Intramuscular; Neisseria gonorrhoeae; Oxytetracycline; Penicillin G; Penicillin G Procaine; Penicillin Resistance; Penicillins; Probenecid; Tetracycline

Topics: Anti-Bacterial Agents; Cephalothin; Colistin; Female; Germany, West; Gonorrhea; Humans; Male; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Novobiocin; Penicillin G; Penicillin Resistance; Penicillins; Tetracycline

Topics: Delayed-Action Preparations; Follow-Up Studies; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Sexual Behavior; Tetracycline

Topics: Female; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Sex Work; Streptomycin; Tetracycline

Topics: Folic Acid Antagonists; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G Procaine; Penicillin Resistance; Pyrimidines; Sulfamethoxazole; Tetracycline

Topics: Adolescent; Adult; Age Factors; Aged; Bacteriological Techniques; Chicago; Child; Child, Preschool; Disease Reservoirs; Family Planning Services; Female; Gonorrhea; Humans; Infant; Infant, Newborn; Mass Screening; Maternal Health Services; Middle Aged; Neisseria gonorrhoeae; Penicillin G Procaine; Pregnancy; Streptomycin; Tetracycline

Topics: Acute Disease; Adult; Chloramphenicol; Chlortetracycline; Chronic Disease; Depression, Chemical; Female; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Oxytetracycline; Penicillin Resistance; Penicillins; Streptomycin; Tetracycline

Topics: Ampicillin; Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Military Medicine; Penicillin G; Penicillin G Procaine; Penicillins; Probenecid; Tetracycline

Topics: Anti-Bacterial Agents; Female; Gonorrhea; Humans; Male; Naphthacenes; Penicillin G Procaine; Syphilis; Tetracycline

Topics: Female; Gonorrhea; Humans; Injections, Intramuscular; Male; Penicillin G Procaine; Tetracycline

Topics: Administration, Oral; Diarrhea; Gonorrhea; Humans; Male; Nausea; New York City; Tetracycline; United States; Urethritis; Vomiting

Topics: Animals; Gonorrhea; Humans; Immunotherapy; Oleandomycin; Pyrogens; Rabbits; Tetracycline

Topics: Administration, Oral; Adolescent; Adult; Follow-Up Studies; Gonorrhea; Humans; Male; Tetracycline

Topics: Australia; Female; Fluorescent Antibody Technique; Gonorrhea; Humans; Male; Penicillins; Sex Factors; Sexually Transmitted Diseases; Syphilis; Syphilis Serodiagnosis; Syphilis, Congenital; Syphilis, Latent; Tetracycline; Urethritis

Topics: Drug Resistance, Microbial; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Oleandomycin; Tetracycline

Topics: Biological Assay; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G Procaine; Penicillin Resistance; Species Specificity; Tetracycline

The in vitro action of nine antibiotics was tested by the agar streak method against 45 gonococcal strains isolated from penicillin-therapy failures. The penicillin susceptibility range of these strains was 0.003 to 1.32 mug/ml, and the tetracycline susceptibility range was 0.125 to 2.0 mug/ml. Minimal inhibitory concentrations of minocycline and doxycycline paralleled the activity of tetracycline and ranged from 0.125 to 1.0 mug/ml and 0.125 to 2.0 mug/ml, respectively. Rifampicin, with a narrow range of 0.5 to 1.0 mug/ml, inhibited 75% of the strains at 0.5 mug/ml. The range for cephaloridine and cephaloglycine was 0.5 to 20.0 mug/ml, but another cephalosporium derivative, cephalexin, exhibited greater activity in its range of 0.25 to 20.0 mug/ml. A semisynthetic penicillin, carbenicillin, with a range of 0.025 to 0.75 mug/ml, displayed more activity against the lower susceptible penicillin G gonococcal strains.

Topics: Anti-Bacterial Agents; Cephaloridine; Cephalosporins; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillin G; Penicillin Resistance; Penicillins; Rifampin; Tetracycline

Topics: Adolescent; Adult; Cervix Uteri; Epithelium; Female; Fever; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillins; Salpingitis; Tetracycline

Topics: Ampicillin; Anti-Bacterial Agents; Cephaloridine; Chloramphenicol; Erythromycin; Gonorrhea; Kanamycin; Leucomycins; Neisseria gonorrhoeae; Penicillin G; Penicillin Resistance; Sulfadiazine; Tetracycline

Topics: Ampicillin; Erythromycin; Gonorrhea; Humans; Penicillin Resistance; Penicillins; Tetracycline; Urethritis

Topics: Anti-Bacterial Agents; Antifungal Agents; Cephaloridine; Cephalosporins; Child; Gonorrhea; Hexachlorophene; Humans; Lincomycin; Penicillin Resistance; Penicillins; Salmonella Infections; Staphylococcal Infections; Tetracycline

Topics: Female; Gonorrhea; Humans; Male; Mycoplasma; Species Specificity; Tetracycline; Trichomonas Vaginitis; Urethritis

Topics: Adolescent; Adult; Gonorrhea; Humans; Male; Middle Aged; Oleandomycin; Tetracycline

Topics: Adolescent; Adult; Gonorrhea; Humans; Male; Middle Aged; Phosphates; Tetracycline; Urethritis

Topics: Chloramphenicol; Erythromycin; Gonorrhea; Humans; Oxytetracycline; Penicillins; Streptomycin; Sulfamoxole; Sulfanilamides; Tetracycline

Topics: Adult; Cervix Uteri; Culture Media; Female; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Sulfanilamides; Tetracycline

Topics: Adolescent; Adult; Gonorrhea; Humans; Kanamycin; Male; Middle Aged; Neisseria gonorrhoeae; Penicillin G; Penicillin Resistance; Streptomycin; Tetracycline; Washington

Topics: Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Tetracycline; Urethritis

Topics: Adolescent; Adult; Arthritis; Arthritis, Infectious; Arthritis, Reactive; Female; Gonorrhea; Humans; Male; Middle Aged; Neisseria gonorrhoeae; Penicillins; Pregnancy; Synovial Fluid; Tenosynovitis; Tetracycline

Topics: Adult; Gonorrhea; Humans; Male; Penicillin V; Tetracycline

Topics: Asia, Southeastern; Gonorrhea; Humans; Male; Military Medicine; Penicillin G Procaine; Penicillin Resistance; Probenecid; Tetracycline

Topics: Ampicillin; Anti-Bacterial Agents; Antineoplastic Agents; Cephaloridine; Czechoslovakia; Erythromycin; Gonorrhea; Humans; Leucomycins; Lincomycin; Male; Neisseria gonorrhoeae; Oleandomycin; Penicillin G; Penicillin Resistance; Penicillins; Streptomycin; Tetracycline

Topics: Drug Hypersensitivity; Gonorrhea; Humans; Kanamycin; Penicillin G Benzathine; Penicillin Resistance; Penicillinase; Penicillins; Streptomycin; Tetracycline

Topics: Cervix Uteri; Female; Follow-Up Studies; Gonorrhea; Humans; Penicillins; Tetracycline

Topics: Female; Gonorrhea; Humans; Male; Oleandomycin; Tetracycline

Topics: Acne Vulgaris; Gonorrhea; Humans; Oleandomycin; Pyoderma; Skin Diseases; Steroids; Syphilis; Tetracycline; Urethritis

During the last eight years, 5700 strains of Neisseria gonorrhoeae have been isolated and tested for sensitivity to penicillin and sulfadiazine in the Public Health Laboratory (Toronto). At the beginning of the study 63% of the strains tested were sensitive to a concentration of 0.01 unit of penicillin per ml. of diluent. Since then the gonococcus has gradually developed resistance to this antibiotic until 27% of the strains isolated are now resistant to a concentration of 0.3 unit/ml., and 8% are resistant to 1.0 unit/ml. To overcome this degree of resistance it is necessary to give a soluble penicillin preparation intramuscularly in very high dosage (2-8 million units). At the present time there is an urgent need for a satisfactory substitute for penicillin in the treatment of gonorrhea. None has yet been found.

Topics: Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Sulfadiazine; Tetracycline

Topics: Erythromycin; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Tetracycline

Topics: Diagnosis, Differential; Evaluation Studies as Topic; Gonorrhea; Humans; Male; Penicillins; Tetracycline; Urethritis

Topics: Adult; Female; Gonorrhea; Humans; Male; Mycoplasma; Naval Medicine; Neisseria gonorrhoeae; Penicillin G Procaine; Penicillin Resistance; Probenecid; Tetracycline; Urethritis

Topics: Ampicillin; Anti-Bacterial Agents; Bacteriological Techniques; Gonorrhea; Humans; Leucomycins; Neisseria gonorrhoeae; Penicillin G; Penicillin Resistance; Penicillins; Streptomycin; Tetracycline

Topics: Adult; Culture Media; Gonorrhea; History, 16th Century; History, 19th Century; History, Ancient; Homosexuality; Humans; Male; Penicillin G Procaine; Penicillins; Pharyngitis; Tetracycline

Topics: Adolescent; Adult; Gonorrhea; Humans; Inositol; Male; Middle Aged; Novobiocin; Tetracycline; Urethritis

Topics: Adolescent; Adult; Female; Gonorrhea; Humans; Male; Middle Aged; Oleandomycin; Tetracycline

Topics: Adult; Bacteriological Techniques; Female; Gonorrhea; Humans; Male; Penicillins; Sulfonamides; Sweden; Tetracycline

Topics: Female; Gonorrhea; Homosexuality; Humans; Male; Neisseria gonorrhoeae; Penicillin Resistance; Penicillinase; Penicillins; Probenecid; Streptomycin; Sulfamethoxypyridazine; Tetracycline

Topics: Chloramphenicol; Chlortetracycline; Dosage Forms; Female; Gonorrhea; Humans; Male; Oxytetracycline; Penicillin Resistance; Penicillins; Poland; Tetracycline

Topics: Gonorrhea; Humans; Oleandomycin; Tetracycline

Topics: Anti-Bacterial Agents; Biomedical Research; Chloramphenicol; Drug Therapy; Gonorrhea; Humans; Male; Penicillin G; Penicillin G Procaine; Procaine; Spectinomycin; Sulfates; Tetracycline; Urethritis

Topics: Anti-Bacterial Agents; Chloramphenicol; Drug Therapy; Epidemiology; Gonorrhea; Humans; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; South Africa; Streptomycin; Sulfanilamide; Sulfanilamides; Sulfonamides; Tetracycline; Urethritis

Topics: Adolescent; Anti-Bacterial Agents; Child; Denmark; Drug Therapy; Gonorrhea; Penicillins; Protein Synthesis Inhibitors; Spiramycin; Streptomycin; Tetracycline

Topics: Female; Gonorrhea; Humans; Male; Penicillins; Streptomycin; Sulfonamides; Tetracycline

Topics: Gonorrhea; Greenland; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins; Streptomycin; Tetracycline

Topics: Adult; Female; Gonorrhea; Humans; Male; Penicillin G; Penicillin G Procaine; Penicillin Resistance; Penicillins; Streptomycin; Tetracycline

Topics: Anti-Bacterial Agents; Clinical Laboratory Techniques; Female; Gonorrhea; Humans; Male; Oxytetracycline; Penicillin G Procaine; Streptomycin; Tetracycline

Topics: Gonorrhea; Humans; Lymecycline; Penicillin Resistance; Tetracycline

Topics: Chloramphenicol; Gonorrhea; Humans; Penicillins; Tetracycline

Topics: Gonorrhea; Humans; Male; Oleandomycin; Tetracycline

Topics: Anti-Bacterial Agents; Chloramphenicol; Gonorrhea; Humans; Leucomycins; Male; Tetracycline; Urethritis

Topics: Anti-Bacterial Agents; Communicable Disease Control; Diagnosis, Differential; Drug Resistance; Drug Resistance, Microbial; Ethylenediamines; Gonorrhea; Humans; Mycoplasma; Penicillin G; Penicillin G Benzathine; Philippines; Sexually Transmitted Diseases; Tetracycline; Urethritis

Topics: Anti-Bacterial Agents; Chloramphenicol; Drug Hypersensitivity; Drug Therapy; Gonorrhea; Humans; Penicillin Resistance; Tetracycline

Topics: Adolescent; Anti-Bacterial Agents; Drug Therapy; England; Gonorrhea; Naval Medicine; Penicillins; Statistics as Topic; Streptomycin; Sulfanilamide; Sulfanilamides; Sulfonamides; Tetracycline; Urethritis

Topics: Anti-Bacterial Agents; Gonorrhea; Humans; Penicillin G; Penicillin G Procaine; Procaine; Tetracycline

Topics: Anti-Bacterial Agents; Bacteriological Techniques; Drug Resistance; Drug Resistance, Microbial; Gonorrhea; Penicillins; Streptomycin; Sulfathiazoles; Tetracycline

Topics: Anti-Bacterial Agents; Bacteriological Techniques; Dihydrostreptomycin Sulfate; Drug Resistance; Drug Resistance, Microbial; Fluorescent Antibody Technique; Gonorrhea; Humans; Microscopy; Penicillins; Streptomycin; Tetracycline

Topics: Anti-Bacterial Agents; Dermatologic Agents; Drug Resistance; Drug Resistance, Microbial; Gonorrhea; Humans; Penicillins; Spectinomycin; Streptomycin; Tetracycline

Topics: Anti-Bacterial Agents; Bartholin's Glands; Candidiasis; Chloramphenicol; Conjunctivitis; Ethylenediamines; Female; France; Gonorrhea; Humans; Imidazoles; Penicillin G; Penicillin G Benzathine; Penicillin G Procaine; Procaine; Spiramycin; Streptomycin; Tetracycline; Trichomonas Infections; Urethritis; Vulvovaginitis

Topics: Anti-Bacterial Agents; Gonorrhea; Humans; Oxytetracycline; Penicillins; Protein Synthesis Inhibitors; Tetracycline

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Chloramphenicol; Erythromycin; Gonorrhea; Novobiocin; Nystatin; Oleandomycin; Penicillins; Protein Synthesis Inhibitors; Spiramycin; Streptomycin; Sulfonamides; Syphilis; Tetracycline; United Kingdom; Venereology

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Dermatologic Agents; Gonorrhea; Phosphates; Protein Synthesis Inhibitors; Tetracycline

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Gonorrhea; Humans; Male; Tetracycline; Urethritis

Topics: Anti-Bacterial Agents; Chloramphenicol; Dermatologic Agents; Gonorrhea; Humans; In Vitro Techniques; Neisseria gonorrhoeae; Penicillins; Streptomycin; Tetracycline

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Fungicides, Industrial; Gonorrhea; Protein Synthesis Inhibitors; Tetracycline

Topics: Anti-Bacterial Agents; Gonorrhea; Protein Synthesis Inhibitors; Tetracycline

As increasing numbers of gonococcal strains obtained in routine isolations from patients show reduced sensitivity to penicillin and as more and more patients report that they are allergic to penicillin, other antibiotics are being increasingly frequently resorted to in the treatment of gonorrhoea. It is therefore of importance to determine the susceptibility of both penicillin-sensitive and relatively "resistant" strains to these other chemotherapeutic agents.The authors report on a study of the in vitro action of the following antibiotics against routine gonococcal isolates and strains from gonorrhoea cases in which penicillin had failed to effect a cure: kanamycin, leucomycin, chloramphenicol, dextrosulphenidol, oxytetracycline, chlortetracycline, tetracycline, demethylchlortetracycline and synnematin B. It was found that strains of low penicillin susceptibility were as sensitive to these antibiotics-with the exception of synnematin B-as were those of high penicillin sensitivity.Emphasis is placed on the need for establishing an international standard procedure for gonococcal sensitivity testing which would make it possible-as it is often not at present-to compare results obtained in different laboratories. The relation between response to treatment and the degree to which patients develop blood and tissue concentrations of penicillin is also discussed.

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Gonorrhea; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Penicillins; Tetracycline

Topics: Anti-Bacterial Agents; Gonorrhea; Leadership; Methylprednisolone; Prednisolone; Protein Synthesis Inhibitors; Tetracycline

Topics: Acute Disease; Anti-Bacterial Agents; Gonorrhea; Phosphates; Protein Synthesis Inhibitors; Tetracycline; Urethritis

Topics: Anti-Bacterial Agents; Glucosamine; Gonorrhea; Humans; Male; Protein Synthesis Inhibitors; Tetracycline

Topics: Anti-Bacterial Agents; Gonorrhea; Penicillins; Streptomycin; Tetracycline

Topics: Anti-Bacterial Agents; Gonorrhea; Humans; Penicillins; Protein Synthesis Inhibitors; Tetracycline

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Dermatologic Agents; Gonorrhea; Humans; Oleandomycin; Protein Synthesis Inhibitors; Tetracycline

After briefly reviewing the history of penicillin therapy in gonorrhoea, the author shows that the number of cures effected with the repository penicillins, although originally very high, has diminished considerably in recent years, despite a general tendency to increase the dosage. The reduced efficacy of PAM and benzathine penicillin is demonstrated by an exposition of the current results obtained with these two preparations in the treatment of gonorrhoea patients in London. Some of the difficulties involved in distinguishing between treatment failures and reinfections are discussed.The paper continues with an examination of the possible alternatives to repository penicillin in the treatment of gonorrhoea. Data are given on the comparative efficacy of a number of prepations, including mixed penicillins, phenoxymethyl penicillin and various other antibiotics, such as streptomycin and the tetracycline group.The problem of re-examination of treated gonorrhoea cases is also dealt with, practical reasons being given for restricting the period of follow-up to three weeks.Finally, in a discussion of possible future developments, the author suggests a number of measures designed to prevent a further loss of sensitivity to penicillin in the gonococcus.

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Gonorrhea; Humans; Penicillin G Benzathine; Penicillins; Tetracycline

Topics: Drug Combinations; Gonorrhea; Sulfadiazine; Sulfamerazine; Sulfamethazine; Sulfonamides; Tetracycline

Topics: Anti-Bacterial Agents; Gonorrhea; Humans; Injections, Intramuscular; Protein Synthesis Inhibitors; Tetracycline

Topics: Anti-Bacterial Agents; Gonorrhea; Humans; Injections, Intramuscular; Male; Protein Synthesis Inhibitors; Tetracycline

Topics: Anti-Bacterial Agents; Chancroid; Gonorrhea; Humans; Lymphogranuloma Venereum; Sexually Transmitted Diseases; Tetracycline

Topics: Anti-Bacterial Agents; Gonorrhea; Protein Synthesis Inhibitors; Tetracycline