Treating Uncomplicated Neisseria gonorrhoeae Infections

Moran, John S.

doi:10.1097/00007435-199501000-00007

Cited by 96 publications

(63 citation statements)

References 89 publications

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“…However, spectinomycin is currently not available and used in many countries, and it is feared that resistance will be selected rapidly if spectinomycin is introduced for first-line treatment. Furthermore, spectinomycin is suboptimal for treatment of pharyngeal gonorrhea, i.e., its efficacy rate is around 80% (115)(116)(117).…”

Section: The Antimicrobial Eramentioning

confidence: 99%

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

2014

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SUMMARY Neisseria gonorrhoeae is evolving into a superbug with resistance to previously and currently recommended antimicrobials for treatment of gonorrhea, which is a major public health concern globally. Given the global nature of gonorrhea, the high rate of usage of antimicrobials, suboptimal control and monitoring of antimicrobial resistance (AMR) and treatment failures, slow update of treatment guidelines in most geographical settings, and the extraordinary capacity of the gonococci to develop and retain AMR, it is likely that the global problem of gonococcal AMR will worsen in the foreseeable future and that the severe complications of gonorrhea will emerge as a silent epidemic. By understanding the evolution, emergence, and spread of AMR in N. gonorrhoeae , including its molecular and phenotypic mechanisms, resistance to antimicrobials used clinically can be anticipated, future methods for genetic testing for AMR might permit region-specific and tailor-made antimicrobial therapy, and the design of novel antimicrobials to circumvent the resistance problems can be undertaken more rationally. This review focuses on the history and evolution of gonorrhea treatment regimens and emerging resistance to them, on genetic and phenotypic determinants of gonococcal resistance to previously and currently recommended antimicrobials, including biological costs or benefits; and on crucial actions and future advances necessary to detect and treat resistant gonococcal strains and, ultimately, retain gonorrhea as a treatable infection.

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Section: The Antimicrobial Eramentioning

confidence: 99%

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

2014

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“…[56][57][58][59][60]71,72 This correlates with the pharmacokinetic properties of the individual antimicrobials. Treatment with spectinomycin has poor efficacy at eradicating pharyngeal gonorrhoea.…”

Section: Therapy For Uncomplicated Gonococcal Infection Of the Pharynxmentioning

confidence: 99%

“…16 Test of cure is particularly important to perform to ensure effective eradication of pharyngeal infection, which is substantially harder to treat than genital and anorectal infections. [56][57][58][59][60]71,72 When symptoms persist after treatment, culture is recommended to identify persisting infection and for antimicrobial sensitivity testing and may be performed 3-7 days after completion of therapy, possibly supplemented a week later with a NAAT for increased sensitivity if culture is negative. Tests of cure in asymptomatic patients can be performed with a NAAT 2 weeks after completion of treatment and ideally, all positives should be cultured and antibiotic susceptibility testing performed before further treatment is given [IV; C].…”

Section: Follow Up and Test Of Curementioning

confidence: 99%

2012 European guideline on the diagnosis and treatment of gonorrhoea in adults

2013

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Gonorrhoea is a major public health concern globally. Of particularly grave concern is that resistance to the extended-spectrum cephalosporins has emerged during the most recent years. This guideline provides recommendations regarding the diagnosis and treatment of gonorrhoea in Europe. Compared to the outdated 2009 European gonorrhoea guideline, this 2012 European gonorrhoea guideline provides up-to-date guidance on, broader indications for testing and treatment of gonorrhoea; the introduction of dual antimicrobial therapy (ceftriaxone 500 mg and azithromycin 2 g) for uncomplicated gonorrhoea when the antimicrobial sensitivity is unknown; recommendation of test of cure in all gonorrhoea cases to ensure eradication of infection and identify emerging resistance; and recommendations to identify, verify and report failures with recommended treatment regimens. Optimisations of the testing, diagnostics, antimicrobial treatment and follow-up of gonorrhoea patients are crucial in controlling the emergent spread of cephalosporin-resistant and multidrug-resistant gonorrhoea.

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“…Recently, the first three extensively drug-resistant (XDR) (4) gonococcal strains with high-level ceftriaxone resistance were reported, and all those strains were susceptible to spectinomycin (8,11,53). Based on this fact and because spectinomycin resistance is exceedingly rare globally, it would be very valuable to have spectinomycin available worldwide for treatment of ceftriaxone-resistant anogenital gonorrhea and for the rare patients who cannot tolerate cephalosporins (4,(21)(22)(23)25). Spectinomycin might also be appropriate in a dual antimicrobial treatment regimen, effectively treating also pharyngeal gonorrhea and inhibiting resistance development.…”

Section: Figmentioning

confidence: 99%

“…Nevertheless, spectinomycin remains an effective option for treatment, with the exception of pharyngeal gonorrhea (4,(21)(22)(23)(24)(25). Verified resistance to spectinomycin is exceedingly rare worldwide, e.g., in the U.S. Gonococcal Isolate Surveillance Project (GISP), established in 1986 (http://www.cdc.gov/std/gisp), and the European Gonococcal Antimicrobial Surveillance Programme (EURO-GASP), initiated in 2004 (26,27), only five spectinomycin-resistant isolates (all between 1988 and 1990) and no isolates, respectively, have been identified.…”

mentioning

confidence: 99%

Neisseria gonorrhoeae Strain with High-Level Resistance to Spectinomycin Due to a Novel Resistance Mechanism (Mutated Ribosomal Protein S5) Verified in Norway

Unemo

Golparian

Skogen

et al. 2013

Antimicrob Agents Chemother

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Gonorrhea may become untreatable, and new treatment options are essential. Verified resistance to spectinomycin is exceedingly rare. However, we describe a high-level spectinomycin-resistant (MIC, >1,024 g/ml) Neisseria gonorrhoeae strain from Norway with a novel resistance mechanism. The resistance determinant was a deletion of codon 27 (valine) and a K28E alteration in the ribosomal protein 5S. The traditional spectinomycin resistance gene (16S rRNA) was wild type. Despite this exceedingly rare finding, spectinomycin available for treatment of ceftriaxone-resistant urogenital gonorrhea would be very valuable.

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Treating Uncomplicated Neisseria gonorrhoeae Infections

Cited by 96 publications

References 89 publications

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

2012 European guideline on the diagnosis and treatment of gonorrhoea in adults

Neisseria gonorrhoeae Strain with High-Level Resistance to Spectinomycin Due to a Novel Resistance Mechanism (Mutated Ribosomal Protein S5) Verified in Norway

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