Antibiotics for treating gonorrhoea in pregnancy

Area of Science:

• Infectious Diseases
• Obstetrics and Gynecology
• Pharmacology

Background:

• Gonorrhoea, caused by Neisseria gonorrhoeae, is a significant public health concern and a major sexually transmitted infection.
• Maternal gonorrhoea can lead to neonatal infections like ophthalmia neonatorum and systemic infections, as well as maternal complications such as endometritis and pelvic sepsis.
• This review updates previous research on antibiotic treatments for gonorrhoea, specifically focusing on pregnant women.

Purpose of the Study:

• To evaluate the clinical effectiveness of various antibiotic treatments for gonorrhoea in pregnant women.
• To assess the potential harms associated with antibiotic use for gonorrhoea during pregnancy.

Main Methods:

• A systematic search of multiple databases including Cochrane Pregnancy and Childbirth Group's Trials Register, LILACS, and WHO ICTRP was conducted.
• Included were randomized controlled trials (RCTs) comparing antibiotics for gonorrhoea treatment in pregnant women, regardless of publication status, language, or country.
• Two RCTs involving 514 pregnant women were included, comparing ceftriaxone with cefixime or amoxicillin plus probenecid. Meta-analysis was not possible due to differing medications.

Main Results:

• Evidence for the cure rate of gonococcal infections was inconclusive, with no clear superiority of intramuscular ceftriaxone over oral amoxicillin/probenecid or oral cefixime.
• The quality of evidence was very low, downgraded due to poor trial design and imprecision, with both included trials assessed as having a high risk of bias.
• Key maternal outcomes like obstetric complications and neonatal outcomes such as ophthalmia neonatorum were not adequately reported. Some adverse events included vomiting and injection site pain; hyperbilirubinemia was more frequent in neonates exposed to ceftriaxone.

Conclusions:

• While current antibiotic regimens demonstrate high cure rates for gonorrhoea in pregnancy, the evidence is insufficient to recommend one regimen over another.
• The safety profiles and potential harms of these antibiotic treatments in pregnant women remain largely unknown.
• High-quality RCTs adhering to SPIRIT and CONSORT guidelines are urgently needed to definitively assess the clinical effectiveness and safety of antibiotics for treating gonorrhoea in pregnant populations.