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Spectinomycin as initial treatment for gonorrhoea
Abstract:
The prevalence of penicillinase producing Neisseria gonorrhoeae at this hospital increased exponentially from less than 0.5% in 1978 to 6.5% of all isolates in 1982. In January 1983 first line treatment for uncomplicated heterosexual anogenital gonorrhoea was therefore changed from ampicillin and probenecid to spectinomycin. This subsequently cured 95% of cases seen at the Praed Street Clinic. Although there was an initial fall in the monthly isolation rate of penicillinase producing N gonorrhoeae after the introduction of spectinomycin, this was not maintained. The exponential increase in the prevalence of the strain did slow in 1983, rising to only 8.7%. This, however, may have reflected a general decline in the rate of increase of penicillinase producing N gonorrhoeae throughout Britain. The failure to influence the prevalence of penicillinase producing N gonorrhoeae to any great degree may have been due in part to spectinomycin resistance in both penicillinase producing and non-penicillinase-producing N gonorrhoeae. All of the isolates appeared identical, apart from the presence of the 4.4 megadalton plasmid in penicillinase producing N gonorrhoeae, but they could not be linked epidemiologically. Changing treatment in only one of the many venereal diseases clinics in London, where patients have open access to all such clinics, is unlikely to affect the prevalence of penicillinase producing N gonorrhoeae. This has probably been more important than spectinomycin resistance in limiting the effectiveness of spectinomycin in reducing the prevalence of the strain.
Insights
The rise of penicillinase-producing Neisseria gonorrhoeae led to spectinomycin treatment, which initially cured most cases. However, widespread clinic access and emerging resistance limited its long-term impact on controlling this gonorrhea strain.
Area of Science:
- Microbiology
- Infectious Diseases
- Public Health
Background:
- Penicillinase-producing Neisseria gonorrhoeae (PPNG) prevalence increased significantly between 1978 and 1982.
- This rise necessitated a change in treatment protocols for gonorrhea.
Purpose of the Study:
- To evaluate the effectiveness of switching treatment from ampicillin and probenecid to spectinomycin for uncomplicated anogenital gonorrhea.
- To assess the impact of this change on the prevalence of PPNG.
Main Methods:
- Treatment protocols were changed in January 1983, with ampicillin and probenecid replaced by spectinomycin.
- Monthly isolation rates of PPNG were monitored before and after the treatment change.
- Gonorrhea isolates were characterized, including plasmid presence and epidemiological linkage.
Main Results:
- Spectinomycin achieved a 95% cure rate for uncomplicated gonorrhea cases at the Praed Street Clinic.
- An initial decrease in PPNG isolation rates was observed post-spectinomycin introduction, but this trend was not sustained.
- The overall prevalence of PPNG continued to rise, albeit at a slower rate, reaching 8.7% in 1983.
- Spectinomycin resistance was identified in both PPNG and non-PPNG strains.
- Limited epidemiological linkage between isolates and the open access nature of London clinics were noted.
Conclusions:
- While spectinomycin was effective for individual cures, it failed to significantly reduce the overall prevalence of PPNG.
- Factors limiting spectinomycin's population-level effectiveness include emerging resistance and the challenges of controlling STI spread in a network of open-access clinics.
- The open access nature of venereal disease clinics in London likely played a more significant role in limiting the impact of spectinomycin than resistance alone.