trimethoprim--sulfamethoxazole-drug-combination and Urethritis

Vaginitis, cystitis, urethritis, and cervicitis are common diagnoses made in women attending family physicians' offices. Recent research has fundamentally altered available information on the diagnosis and management of these common genitourinary infections. This clinical review discusses presenting symptoms, physical findings, laboratory diagnostic aids, treatment, and follow-up for each lower genitourinary syndrome in women concluding with a summary flow chart illustrating an overall recommended approach.

Topics: Amoxicillin; Anti-Infective Agents, Urinary; Cystitis; Diagnosis, Differential; Drug Combinations; Family Practice; Female; Humans; Metronidazole; Pregnancy; Pregnancy Complications, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis; Urinary Tract Infections; Uterine Cervicitis; Vaginitis

Gonorrhea continues to maintain its position as the most common reportable infectious disease in the United States. Penicillin is still the antibiotic of choice for the treatment of uncomplicated gonococcal urethritis in most of the United States, but the increasing incidence of penicillinase-producing Neisseria gonorrhoeae (PPNG) in many areas of the world necessitates a reconsideration of standard therapy. In addition to penicillin resistance, the gonococcus is also developing resistance to spectinomycin and tetracycline, which further complicates the choice of therapy.

Topics: Amoxicillin; Ampicillin; Bacteriological Techniques; Cephalosporins; Culture Media; Drug Combinations; Erythromycin; Female; Follow-Up Studies; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Penicillin G; Penicillin Resistance; Penicillinase; Spectinomycin; Sulfamethoxazole; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis

Topics: Anti-Infective Agents, Urinary; Drug Combinations; Humans; Male; Oxytetracycline; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis

Topics: Doxycycline; Drug Combinations; Humans; Minocycline; Random Allocation; Sulfamethoxazole; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis

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

Each of 201 men with symptoms and signs of acute urethritis was randomly assigned to one of two treatment regimens: ampicillin (2g) plus probenecid (1g), or sulphamethoxazole-trimethoprim (SMX-TMP) (sulphamethoxazole 1600 mg plus trimethoprim 320 mg) four tablets twice daily for two days. Before treatment Neisseria gonorrhoeae was isolated from 162 patients, while coexistent Chlamydia trachomatis was recovered from 42 (26%) men. After treatment N gonorrhoeae persisted in 11 (14.3%) of the 77 patients treated with ampicillin and probenecid and in three (3.5%) of the 85 treated with SMX-TMP (p less than 0.05), while C trachomatis persisted in four (16%) of the 25 men treated with SMX-TMP and in all 17 patients treated with ampicillin and probenecid. SMX-TMP was thus more effective than ampicillin in treating acute gonorrhoea in men and in eradicating concurrent C trachomatis infection.

Topics: Acute Disease; Ampicillin; Anti-Infective Agents, Urinary; Chlamydia Infections; Chlamydia trachomatis; Clinical Trials as Topic; Drug Combinations; Drug Therapy, Combination; Gonorrhea; Humans; Male; Probenecid; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis

To recommend a cost-effective approach for the management of acute male urethritis in the developing world, based on the findings of a theoretical study.. A model was developed to assess the cost-effectiveness of three urethritis management strategies in a theoretical cohort of 1000 men with urethral syndrome. (1) All patients were treated with cefixime and doxycycline for gonococcal urethritis (GU) and nongonococcal urethritis (NGU), respectively, as recommended by WHO. (2) All patients were treated with doxycycline for NGU; treatment with cefixime was based on the result of direct microscopy of a urethral smear. (3) All patients were treated with cotrimoxazole or kanamycin for GU and doxycycline for NGU. Cefixime was kept for patients not responding to the first GU treatment. Strategy costs included consultations, laboratory diagnosis (where applicable) and drugs. The outcome was the rate of patients cured of urethritis. Cost-effectiveness was measured in terms of cost per cured urethritis.. Strategy costs in our model depended largely on drug costs. The first strategy was confirmed as the most effective but also the most expensive approach. Cefixime should cost no more than US$ 1.5 for the strategy to be the most cost-effective. The second strategy saved money and drugs but proved a valuable alternative only when laboratory performance was optimal. The third strategy with cotrimoxazole was the least expensive but a low follow-up visit rate, poor treatment compliance or lower drug efficacy limited effectiveness. Maximizing compliance by replacing cotrimoxazole with single-dose kanamycin had the single greatest impact on the effectiveness of the third strategy.. Our model suggested that a cost-effective approach would be to treat gonorrhoea with a single-dose antibiotic selected from locally available products that cost no more than US$ 1.5.

Topics: Acute Disease; Anti-Bacterial Agents; Anti-Infective Agents; Cefixime; Cost-Benefit Analysis; Decision Trees; Developing Countries; Doxycycline; Drug Costs; Drug Therapy, Combination; Follow-Up Studies; Gonorrhea; Humans; Kanamycin; Male; Sensitivity and Specificity; Syndrome; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis

Mycoplasma have been suggested as co-factors in the pathogenesis of acquired immune deficiency syndrome (AIDS). The prevalence of urethral infection by Mycoplasma genitalium was determined by polymerase chain reaction (PCR) with urethral swabs from 35 HIV-infected patients at different stages of the disease (all of them were heterosexual men). M genitalium was detected in 2 out of 19 non-AIDS (stage A and B) patients and in a similar proportion (1 out of 14; 7.1%) of samples from healthy individuals. A dramatic increase in the frequency of M. genitalium detection was observed in samples of AIDS (stage C) patients. In fact, 9 out of 16 (56.2%) specimens tested positive by PCR. We found no association in AIDS patients between M. genitalium infection and CD4 count, Human Immunodeficiency Virus (HIV) p24 antigenemia or opportunistic infection.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Anti-Infective Agents, Urinary; DNA, Bacterial; HIV Infections; HIV Seronegativity; Humans; Male; Mucous Membrane; Mycoplasma; Mycoplasma Infections; Polymerase Chain Reaction; Trimethoprim, Sulfamethoxazole Drug Combination; Urethra; Urethritis; Zidovudine

Topics: Aged; Amoxicillin; Cystitis; Drug Combinations; Enterobacteriaceae Infections; Female; Humans; Injections, Intramuscular; Kanamycin; Middle Aged; Nitrofurantoin; Recurrence; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis

Chronic non-bacterial prostatitis is a difficult condition to diagnose accurately either by symptoms and signs or by investigations. Four groups of patients were assessed for the number of leucocytes and the presence of pathogens in expressed prostatic secretions before and after treatment with co-trimoxazole two tablets twice daily for three months. The pretreatment findings suggest that the upper limit of normal for the number of leucocytes in expressed prostatic secretions is about five per microscope field (X 40 magnification) and that for the cell count about 0.5 X 10(9)/l using the method described. Increased microscopical cell estimations and cell counts in the expressed prostatic secretions of patients with symptoms of prostatitis and those with recurrent non-specific urethritis seem to indicate the presence of prostatitis.

Topics: Adult; Bacteria; Cell Aggregation; Chronic Disease; Drug Combinations; Humans; Leukocyte Count; Leukocytes; Male; Middle Aged; Prostate; Prostatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis

Topics: Drug Combinations; Gentamicins; Gonorrhea; Humans; Male; Sulfamethoxazole; Sulfanilamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis