[May the choice of antibiotics against gonorrhea be guided by anamnesis?]

Aminopenicillin with probenecid is the standard treatment for gonorrhoea in Norway. Nowadays, one fourth of the cases are caused by gonococci that produce betalactamase. Clinicians who have to treat gonorrhoea at the time of first presentation, while awaiting sensitivity testing in the laboratory, are reluctant to use non-standard treatment except when indicated. Is it possible to predict, on the basis of the patient history, which cases need non-standard treatment? A logistic model was fitted to data on a random half of cases of gonorrhoea reported in 1993 and 1994, and validated in the other half of the cases. Infection with betalactamase-producing strains was associated with patients born in Africa or Asia, with patients who had acquired the infection in these areas, and with residence in the Oslo area. Presence of at least one of these factors predicted 87% of the resistant cases, but 54% of patients would have received non-standard treatment. Thus, all patients might as well receive treatment that cures betalactamase-producing strains.