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Gonorrhea in preschool- and school-aged children. Report of the prepubertal gonorrhea cooperative study group.

Single-dose antibiotic therapy was evaluated in 108 episodes of culture-confirmed, uncomplicated gonorrhea in 100 prepubertal children. There were 15 boys and 85 girls between 14 months and 14 years of age. Penicillin G procaine, 100,000 units/kg intramuscularly, was compared with amoxicillin trihydrate, 50 mg/kg orally. Probenecid, 25 mg/kg, was given simultaneously. Both drugs provided prompt bacteriological and clinical response. Multiple episodes of gonorrhea, presumably caused by reexposure, occurred in six girls. Oral and anal cultures were negative in all of 47 Costa Rican cases but were commonly positive in US children. Anal cultures yielded gonococci in 52% of girls and 25% of boys, and oral cultures were positive in 18% and 13%, respectively. In three instances, rectal cultures confirmed the diagnosis when vaginal cultures were negative. Gonorrhea should be considered in every child with vaginal or urethral discharge. Single-dose penicillin-probenecid or amoxicillin-probenecid treatment is curative.

Administration, Oral↗

A comparison of single-dose cefixime with ceftriaxone as treatment for uncomplicated gonorrhea. The Gonorrhea Treatment Study Group.

BACKGROUND: Because of the widespread existence of Neisseria gonorrhoeae resistant to penicillin or tetracycline, ceftriaxone is now recommended for the treatment of gonorrhea. There is, however, a need for effective antibiotics that can be administered orally as an alternative to ceftriaxone, which requires intramuscular administration. Cefixime is an orally absorbed cephalosporin that is active against resistant gonococci and has pharmacokinetic activity suitable for single-dose administration. METHODS AND RESULTS: In a randomized, unblinded multicenter study of 209 men and 124 women with uncomplicated gonorrhea, we compared three single-dose treatment regimens: 400 mg or 800 mg of cefixime, administered orally, and 250 mg of ceftriaxone administered intramuscularly. The overall cure rates were 96 percent for the 400-mg dose of cefixime (89 of 93 patients) (95 percent confidence interval, 93.5 percent to 97.8 percent); 98 percent for the 800-mg dose of cefixime (86 of 88 patients) (95 percent confidence interval, 94.6 percent to 100 percent); and 98 percent for ceftriaxone (92 of 94 patients) (95 percent confidence interval, 94.9 to 100 percent). The cure rates were similar in men and women, and pharyngeal infection was eradicated in 20 of 22 patients (91 percent). Thirty-nine percent of 303 pretreatment gonococcal isolates had one or more types of antimicrobial resistance; the efficacy of all three regimens was independent of the resistance pattern. Chlamydia trachomatis infection persisted in at least half the patients infected in each treatment group. All three regimens were well tolerated. CONCLUSIONS: In the treatment of uncomplicated gonorrhea, a single dose of cefixime (400 or 800 mg) given orally appears to be as effective as the currently recommended regimen of ceftriaxone (250 mg given intramuscularly).

Administration, Oral↗

Multicenter trial of single-dose azithromycin vs. ceftriaxone in the treatment of uncomplicated gonorrhea. Azithromycin Gonorrhea Study Group.

BACKGROUND AND OBJECTIVES: Azithromycin is a new, long-acting azalide antibiotic that is active against Neisseria gonorrhoeae. A single oral dose of 1.0 g is effective against uncomplicated genital infection with Chlamydia trachomatis. GOAL OF THIS STUDY: To compare the efficacy and tolerance of single-dose treatment of uncomplicated gonorrhea with azithromycin, 2.0 g orally, and ceftriaxone, 250 mg intramuscularly. STUDY DESIGN: Seven hundred twenty-four men and women with presumptive, uncomplicated gonorrhea were treated with azithromycin 2.0 g orally or ceftriaxone 250 mg intramuscularly in a 2:1 ratio in a multicenter, open, randomized control trial in 10 public sexually transmitted disease clinics in the United States. Patients were followed up in 5 to 9 days and, for a subset of patients, 12 to 18 days after treatment. The main outcome measures were the isolation of N. gonorrhoeae and C. trachomatis and patient-reported side effects. RESULTS: Among infected patients who returned for follow-up, N. gonorrhoeae was eradicated from all anatomic sites in 370 of 374 (98.9%; 95% confidence interval [95%CI] 97.9%-100%) treated with azithromycin and 171 of 175 (97.7%; 95%CI 95.5%-99.9%) given ceftriaxone. Treatment with either drug was effective in all 73 patients infected with beta-lactamase-producing N. gonorrhoeae. Chlamydial infection was eradicated in all 17 patients given azithromycin who returned and were recultured at follow-up and in two of seven patients given ceftriaxone (P < 0.001). Gastrointestinal side effects occurred in 35.3% (95%CI 30.7%-39.8%) of patients given azithromycin; of those with symptoms, these were moderate in 10.1% and severe in 2.9%. CONCLUSIONS: Azithromycin 2.0 g and ceftriaxone 250 mg are equally effective in the treatment of uncomplicated gonorrhea. Azithromycin was associated with a relatively high frequency of gastrointestinal side effects and is expensive, but it has the advantages of oral administration and efficacy against concomitant chlamydial infection.

Administration, Oral↗

[The sex hormone content of the peripheral blood in women with gonorrhea and gonorrhea-trichomoniasis infections].

Peripheral blood estradiol, progesterone, testosterone were measured in 100 women with gonorrhea and Gonococcus-Trichomonas infection. Estradiol levels were found reduced in both phases, progesterone level elevated in the follicular and lowered in the lutein phases of the menstrual cycle as against the norm. Elevated testosterone levels were revealed in the peripheral blood of women with gonorrhea, particularly so in chronic gonorrhea and mixed Gonococcus-Trichomonas infection. Therapy did not result in normalization of blood hormone concentrations, this pointing to advisability of including the drugs correcting hormonal disorders into a complex of treatment of such patients.

Adolescent↗

Trends for gonorrhea and pelvic inflammatory disease in England and Wales and for gonorrhea in a defined population.

Recent trends for gonorrhea and pelvic inflammatory disease in England and Wales are presented using routinely available data. The drawbacks of these data are examined, and a study is described which has attempted to rectify some of these inadequacies. The study attempted to identify patients with and without symptoms of gonorrhea, trichomoniasis, and candidiasis, living in a defined population. In addition, a calculation has been made of the number of cases of PID treated on an ambulatory basis in clinics for sexually transmitted disease in England and Wales.

Adolescent↗

Norfloxacin in the treatment of gonorrhea due to penicillinase and non-penicillinase producing Neisseria gonorrheae: a review.

In 12 recent clinical studies, norfloxacin given in various dosage regimens was shown to be highly effective in treating 1,588 gonococcal infections in 1,486 patients. A single oral dose of norfloxacin 800 mg cured 99.2% of 783 patients with penicillinase producing strains of Neisseria gonorrheae (PPNG) and non-penicillinase producing N. gonorrheae (NPPNG) causing urethritis, cervicitis and anorectal infections. A single oral dose of 800 mg of norfloxacin was found to be an effective alternative to a 2 g intramuscular dose of spectinomycin and superior to a 2.5 g oral dose of thiamphenicol for the treatment of PPNG urethritis or cervicitis. Its efficacy in treatment of NPPNG infections was shown to be similar to that of a single oral dose of 3.5 g of ampicillin plus 1 g of probenecid. Mild and transient gastrointestinal and neurological adverse events occurred in 3.3% of patients treated with norfloxacin 800 mg. Norfloxacin 800 mg as a single dose is recommended as an effective and safe single-dose treatment of urethritis, cervicitis and anorectal infections caused by PPNG or NPPNG.

Adolescent↗

Randomized trial of trovafloxacin and ofloxacin for single-dose therapy of gonorrhea. Trovafloxacin Gonorrhea Study Group.

PURPOSE: To compare trovafloxacin, a new quinolone antibiotic with enhanced activity against Neisseria gonorrhoeae, with ofloxacin as single-dose oral therapy for uncomplicated gonococcal urethritis or cervicitis. PATIENTS AND METHODS: In this multicenter, double-blind trial, 625 patients (270 men, 355 women) with uncomplicated gonococcal urethritis or cervicitis received one 100-mg tablet of trovafloxacin or two 200-mg capsules of ofloxacin as a single dose under direct supervision. RESULTS: Single-dose oral therapy with trovafloxacin was equivalent both bacteriologically and clinically to ofloxacin. Among evaluable patients, N gonorrhoeae was eradicated in 99% of trovafloxacin recipients and in 98% of ofloxacin recipients. Each treatment was well tolerated; vaginitis was the most frequently observed side effect (4% trovafloxacin, 7% ofloxacin). CONCLUSION: Based on the results presented here, trovafloxacin is a promising agent for single-dose therapy of uncomplicated gonorrhea.

Adolescent↗