Untreated or inadequately treated gonorrhoea can lead to infection of the upper genital tract, with the potential complications of pain, infertility, and ectopic pregnancy. The incidence of gonorrhoea increased by 15% in the UK between 2012 and 2013. There is increasing awareness of the danger of gonorrhoea becoming an untreatable infection due the emergence of antimicrobial resistance.
Focus of the review
This review looks at the evidence for the effectiveness of single dose and antimicrobial treatment in the treatment of simple and disseminated infection with Neisseria gonorrhoeae. It also examines the evidence for simultaneous treatment of Chlamydia trachomatis and Neisseria gonorroheae. It does not comment on the effectiveness of individual antimicrobial regimens, as this decision is informed by local surveillance reports.
Comments on evidence
There is little published data in the form of RCTs, as much of the data relies on demonstration of microbial cure as proof of effectiveness and placebo controlled RCTs would be unethical given the clear demonstration of microbial cure. Furthermore, although there is considerable evidence of resistance patterns from national surveillance programs, these data are ineligible for inclusion in the benefits and harms sections of this review as they are not RCT data.
Search and appraisal summary
The update literature search for this review was carried out from the date of the last search, March 2010, to July 2013. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the review, please see the Methods section. Searching of electronic databases retrieved 79 studies. After deduplication and removal of conference abstracts, 47 records were screened for inclusion in the review. Appraisal of titles and abstracts led to the exclusion of 40 studies and the further review of seven full publications. Of the seven full articles evaluated, one systematic review and one RCT were added at this update.
Chlamydia trachomatis infection co-exists in 10% to 41% of adults with gonorrhoea. Treatment with antimicrobial agents effective against potential co-existent chlamydia may additionally exert a synergistic effect and is advised whenever treating gonorrhoea. Choice of antimicrobials should be guided by local and individual isolate resistance data.
Substantive changes at this update
Single-dose antibiotic regimens in men and non-pregnant women New evidence added. Categorised as likely to be beneficial.
Single-dose antibiotic regimens in pregnant women One existing systematic review updated. Categorised as likely to be beneficial.
Dual antibiotic treatment for gonorrhoea and chlamydia: Evidence re-evaluated. Categorisation changed from unknown effectiveness to likely to be beneficial by consensus.
INTRODUCTION: In 2012, the diagnosis rates for gonorrhoea among adults aged 20 to 24 years in the UK were 249 per 100,000 for men and 140 per 100,000 for women. Resistance to one or more antimicrobial agent is reported in more than one quarter of isolates. Co-infection with Chlamydia trachomatis is reported in 10% to 40% of people with gonorrhoea in the US and UK. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for uncomplicated infections in men and non-pregnant women, and in pregnant women? What are the effects of treatments for disseminated gonococcal infection? What are the effects of dual treatment for gonorrhoea and chlamydia infection? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2013 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found seven studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotic regimens (dual treatment, multiple dose, single dose).
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