Evaluation of Tetracycline Phosphate Complex and Other Antibiotics in Treatment of Gonorrhea in Males

Tiedemann, John H.; Hackney, J F; Simpson, William G.; Price, Eleanor V.

doi:10.2307/4591528

Cited by 11 publications

(3 citation statements)

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“…Some workers (Tiedemann, Hackney, Simpson, and Price, 1962;Lentz, MacVicar, and Beilstein, 1962) have demonstrated by administering placebos that approximately 90 per cent. of patients with treatment failure return within 2 weeks for retreatment.…”

Section: Discussionmentioning

confidence: 99%

Treatment of gonorrhoea with a single oral dose of minocycline.

Duncan¹,

Glicksman²,

Knox³

et al. 1971

Sexually Transmitted Infections

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The gradual decrease in susceptibility of the gonococcus to penicillin has led authorities to recommend ever larger doses for the therapy of gonorrhoea. The current recommendation of the U.S. Public Health Service for the treatment of infections in women is the administration of 4-8 m.u. aqueous procaine penicillin; one half that amount is advised for cases in men.In seeking alternative antibiotics for the treatment of gonorrhoea, we have recently completed a trial of minocycline (7 dimethylamino-6-deoxy-6-dimethyltetracycine), a new semisynthetic derivative of tetracycline. The preparation and some biological properties of minocycline were described by Martell and Boothe (1967).Subsequent investigations (Fedorko, Katz, and Allnoch, 1968;Frisk and Tunevall, 1969; Washington, Yu, and Martin, 1970) have shown minocycline to have a broad spectrum much like tetracycline, with apparently more activity against the staphylococcus than tetracycline. Martin, Lester, Kellogg, and Thayer (1969) found that gonococcal strains isolated from patients after failure of treatment with penicillin were inhibited in vitro by minocycline at lower concentrations than was the case with tetracycline or doxycycline. The minimum inhibitory concentration (MIC) of minocycline ranged from 0125 to 1 0 ,Lg./ml. (mean 0 52); for tetracycline the MIC ranged from 0-125-20 ,±g./ml. (mean 075). Steigbigel, Reed, and Finland (1968a) Because these studies indicated that minocycline might fit the need for an oral antigonococcal agent effective in the form of a single dose, a clinical trial was felt to be worth while. MaterialDuring an 8-month period, 170 men presenting at the Houston Social Hygiene Clinic for treatment of a urethral discharge were selected for the study. Criteria for acceptance of these males into the study included a Gramstained urethral smear showing typical intracellular Gram-negative diplococci and a positive culture for N. gonorrhoeae. Eleven non-pregnant females with genital secretions culturally positive for N. gonorrhoeae were also included in the study. MethodUsing sterile cotton-tipped applicator sticks, urethral or cervical exudate from each subject was cultured on Thayer-Martin selective medium. The cultures were incubated in a candle jar at 37°C. and examined at 24 hours. Identification of N. gonorrhoeae was confirmed by finding Gram-negative diplococci with typical colony characteristics giving a positive oxidase reaction.Patients were treated with a single dose of minocycline and observed for 30 minutes for side-effects. The men were instructed to return within one week and the women within 2 weeks for follow-up examination and re-culture as is the routine in this clinic. On return each individual was questioned regarding sexual contact and the occurrence of any side-effects. Patients with a post-treatment positive culture result were considered to indicate therapeutic failure regardless of clinical findings. The majority of men returning did so within one week and those who did not return within 14 days were exclud...

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Section: Discussionmentioning

confidence: 99%

Treatment of gonorrhoea with a single oral dose of minocycline.

Duncan¹,

Glicksman²,

Knox³

et al. 1971

Sexually Transmitted Infections

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“…The important bias that continuing or recurring urethral symptoms may have on the interpretation of compliance behavior is evident from a 1%2 Fulton County Health Department (Atlanta) study: which noted that only 53 per cent of men treated with antibiotics for gonococcal urethritis returned within two weeks for a TOC compared to 91 per cent of those given a placebo. 4 All RS programs have been frustrated by compliance rates that fall precipitously over time. Patient characteristics significantly associated with low compliance rates existed in our population, but the differences were not large (e.g., blacks are 83 per cent as likely to comply as whites).…”

Section: Discussionmentioning

confidence: 99%

Rescreening for gonorrhea: an evaluation of compliance methods and results.

Judson¹,

Wolf²

1979

Am J Public Health

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To evaluate the cost-effectiveness of a routine rescreening (RS) culture several weeks after treatment for gonorrhea, as well as the specific efforts to ensure return visits, we followed 438 consecutive patiehts, 347 men and 91 women. Return visit compliance rates were 70 per cent for a test-of-cure culture, 27 per cent for a six-week RS, and 15 per cent at 12 weeks. The program detected seven cases of gonorrhea at $796 per case. In our clinic, RS is not a costeffective way to control gonorrhea. (Am J Public Health 69:1178-1180, 1979.)The Venereal Disease Control Division of the Center for Disease Control (CDC) in Atlanta, GA, has recommended that additional efforts be made to follow-up patients treated for gonorrhea.* It is reasoned that patients who acquire gonorrhea at least once are those most likely to acquire gonorrhea again. To systematically evaluate the costs and benefits from intensified follow-up efforts, the Denver (Colorado) Metro Health Clinic (DMHC) conducted a prospective study of a sequence of methods for motivating patients to return for test-of-cure (TOC) and rescreening (RS) cultures. We also sought to better define patient characteristics associated with compliance behavior. MethodsFrom January 15 to April 7, 1976, 347 16, 1979. complicated anogenital gonorrhea were instructed to return for a TOC in three to five days and RS in six and 12 weeks.To obtain patient compliance, four motivational methods were used in a sequence determined by anticipated costeffectiveness (Figure 1). The clinician informed the patient about the complications of gonorrhea, initiated a contactcard system,' and explained the rationale for a TOC. When the patient returned for a TOC, the clinician explained the rationale for RS. At each visit, the patient was given an appointment card with the date entered for the next follow-up culture.We attributed any non-contact case detected duning a designated follow-up period to the most recently used motivational method. We did not attribute a gonorrhea case to RS efforts if the patient returned with symptoms before a scheduled appointment or at any time as a result of contact investigation.We compared the cost-effectiveness of each method based upon the unit cost of bringing a new case of previously undetected gonorrhea to treatment. Costs included clinician labor related to follow-up visits; secretarial labor in telephoning and filling out and posting letters; field investigator's labor and supervision; and the additional clinic visits generated at a 1976 average of $12.75 per visit. Indirect costs were not included.Gonorrhea was diagnosed by CDC recommended culture techniques.2 Patients were assigned by a random card system to receive the CDC recommended treatment schedule3 of procaine penicillin G, tetracycline hydrochloride, or spectinomycin. Women were not offered tetracycline and patients with a history of penicillin allergy received tetracycline (men) or spectinomycin (women).tCorrelations were made between TOC compliance behavior and sex, race, sexual ...

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“…Nevertheless, even with 1 -2 mega units procaine penicillin, failure rates of 8 to 12 per cent. have been reported (Tiedemann, Hackney, Simpson, and Price, 1962;Willcox, 1964) and further dosage increases to 1 -8-2-4 mega units have been recommended by the International Union against the Venereal Diseases (Brit. J. vener.…”

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confidence: 99%