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Spectinomycin as initial treatment for gonorrhoea
British Medical Journal (Clinical Research Ed.)
|October 20, 1984
Summary
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.