[Question #11168] Gonorrhea clarification

16 months ago

First let me thank you for operating this website, it is a priceless source of information.

I have a few questions about gonorrhea caused by simple curiosity.

1) I know that symptoms of gonorrhea can clear after a few weeks, does that mean the infection is gone? Or are these now asymptomatic carriers? If the latter, how much longer would they be able to spread before full clearance of the infection? (I appreciate this will not be based on hard data)

If cephalosporin resistance is increasing - especially for cefixime - would a multi-dose regimen overcome the MIC needed to cure the infection?

Do you think combination therapy is more helpful for AMR stewardship or mono therapy?

The CDC does not require ToC for the recommended or alternative treatments, so, if symptoms are cured by treatment is this proof of cure? How does this work in asymptomatic infections?

Thanks for your answers.

Edward W. Hook M.D.

16 months ago

Welcome to the Forum. Thanks for your questions. I'll be glad to comment. let me start by pointing out that in treating gonorrhea, the expectation is that over 97-98% of infections will be treated when treatment is a recommended regimen. This sort of success is higher than is anticipated for most other infections like pneumonia, skin infections, etc. The the "bar" for what gets recommended is high.

In response to your specific questions:

"Asymptomatic" gonorrhea comes in many forms. Years ago Dr. Handsfield led a classic study in which he performed examination of a large number of at risk men who denied any symptoms of infection. A little over 1% of them were found to have gonorrhea. Some had small amounts of discharge that were detected when examined by a trained clinician, others were truly asymptomatic without signs of infection. When persons have symptomatic gonorrhea which is ignored for a long period of time, in some the signs and symptoms of infection gradually go away. It is reasonable to think that in such persons there is a time infected persons are asymptomatic but infectious. Over time most of these people will probably completely resolve their infections and become non-infectious. There are no reliable data to provide more precise estimates of how often or how long the phenomena I describe above last

If cephalosporin resistance is increasing - especially for cefixime - would a multi-dose regimen overcome the MIC needed to cure the infection?

"Resistance" is not a "light switch" phenomenon in which all persons with bacteria classified as resistant fail therapy. Rather it is the MIC level at which treatment failure rates increase somewhat; the higher the MIC, the more likely failure is to occur. Many persons with "resistant" gonorrhea are successfully treated with recommended therapy. Multiple doses are likely to increase the therapeutic success rate.

Do you think combination therapy is more helpful for AMR stewardship or mono therapy?

There are no data to suggest that treatment with two antibiotics work better than one

The CDC does not require ToC for the recommended or alternative treatments, so, if symptoms are cured by treatment is this proof of cure? How does this work in asymptomatic infections?

If symptoms resolve, experience and many studies show that the infection has been cured. For this reason, ToC testing has not been recommended as being resource inefficient and unneeded.

I hope this information and reflections are helpful. Please understand that there will be limited follow-up available for these questions as there are few data, the situations you are asking about are uncommon, and we do not wish to mislead other clients by going into rare and/or hypothetical events. EWH

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16 months ago

Thank you for your answers. I find infectious diseases - and in particular sexually transmitted ones - fascinating (though obviously terrifying).

If two people are given the same treatment, and one was infected by the other, if that treatment worked for one, could it fail for the other?

I know resistance to cephalosporins has been rising in gonorrhea world wide, and I also know that ceftriaxone is not always available in certain circumstances, how confident are we that other cephalosporins are capable of curing these infections? I have read the meta study by K. Yang from last year, but much of the data he used is 20 years old. Have we not done studies on cefixime and other cephalosporins since?

How often are the recommended treatment regimens examined? Is this a yearly process?

Again, thank you for any insight you can provide.

Edward W. Hook M.D.

16 months ago

If two people are given the same treatment, and one was infected by the other, if that treatment worked for one, could it fail for the other?

Yes it is possible for one person to fail therapy while the sex partner is treated successfully

Comparative studies are done when new treatments are under consideration. They are expensive and arduous to carry out and for that reason, following approval are rarely repeated. All drugs, even within the same class are not created equal. They have different activities against gonorrhea and different pharmacology

How often are the recommended treatment regimens examined? Is this a yearly process?

See above. Treatment guidelines are review periodically, often after a period of years

EWH

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16 months ago

I know that this is my final response, so I will ask a few questions about treatment success.

If symptoms resolve after treatment, was it successful? Or could symptoms return a week or weeks later?

How likely are each of the three CDC approved treatments to result in cure?

I know that post gonococcal urethritis can occur and is often caused by co-infection. But are there cases that don't involve other infections? If so, are they caused by damage from the infection or are they psychosomatic?

Finally, is there any hope for a gonorrhea vaccine?

Edward W. Hook M.D.

16 months ago

Final response.

1. If your symptoms have Yeol following therapy, it is most unlikely they will recur.

2. Very likely

3. I think you are worrying unnecessarily. Please put these “what if” questions aside and move on.

4. There is a promising vaccine for gonorrhea prevention that is being studied at the present time. It will take several years until the results of these studies are available. In the meantime, I encourage you to practice safe, kind of protected sex.

This completes thread. Take care. Please don’t worry. EWH.

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