Could tolerance explain an individual's eight episodes of gonococcal treatment failure with ceftriaxone? A case
Izumo Kanesaka1,2, Thibaut Vanbaelen2, Irith De Baetselier2
1Department of Infection Control and Prevention, Faculty of Nursing, Toho University Faculty of Medicine Graduate School of Medicine, Ota, Tokyo, Japan.
Objectives:
Describe the clinical evolution of a person with recurrent gonococcal cervicitis despite appropriate treatment and lack of reinfection.
Methods:
We used the tolerance detection test to confirm that all three culture-positive gonococcal isolates were tolerant to ceftriaxone.
Results:
Over a period of 6 months, a transgender man with gonococcal cervicitis experienced eight episodes of treatment failure despite receiving ceftriaxone 1 g intramuscularly on each occasion. The isolate remained susceptible to ceftriaxone throughout this period. His Neisseria gonorrhoeae infection was then successfully eradicated with a prolonged course of ceftriaxone.
Conclusions:
We propose that bacterial tolerance be considered a possible cause of treatment failure in N. gonorrhoeae. A tolerance detection test can be used to diagnose tolerance.
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