Evaluation of treatment with single-dose ampicillin/sulbactam with probenecid or ceftriaxone in patients with uncomplicated gonorrhea.

This study compared ampicillin/sulbactam plus probenecid with ceftriaxone for treatment of uncomplicated gonorrhea. Of the 297 men and women who were enrolled and randomized to receive either ampicillin/sulbactam (1.0 g/0.5 g) with probenecid (1 g) or ceftriaxone (0.25 g), 274 patients were evaluable. Both ampicillin/sulbactam and ceftriaxone were administered by intramuscular injections. Patients were gonococcal contacts, had positive culture results for Neisseria gonorrhoeae, or had clinical evidence of gonorrhea. Specimens for gonococcal cultures were collected from the cervix (female patients), urethra, rectum, and pharynx at pretreatment and test-of-cure visits. The presence of N. gonorrhoeae and a test-of-cure visit were required for drug efficacy analysis. Of the 274 evaluable patients, 195 (71.2%) had positive culture results for N. gonorrhoeae. Cure was achieved in 93 (94.9%) of 98 patients receiving ampicillin/sulbactam with probenecid and in 96 (99.0%) of 97 patients receiving ceftriaxone. Penicillinase-producing N. gonorrhoeae strains were found in 21 (10.8%) patients; these were eradicated by either ampicillin/sulbactam with probenecid (N = 9) or ceftriaxone (N = 12). Overall, the two drug regimens were very well tolerated and no serious adverse effects were noted. Ampicillin/sulbactam with probenecid may be useful as single-dose therapy in patients with uncomplicated genitorectal gonorrhea.

The impact of urban community hospital surveillance for gonorrhoea on the infection rate and complications in the female. A progress report.

This study substantiates a previous report concerning the importance of the urban community hospital, particularly its emergency room, in the detection of gonorrhoea in women. Pelvic inflammatory disease (PID), a major complication of gonorrhoea in women, significantly declined during a nine-year surveillance and control programme in the Memphis-Shelby County area. This suggests that the programme may have prevented PID developing in women through the early detection and treatment of asymptomatic infections.

PIP: The experience of a community surveillance program aimed at detecting gonorrhea in women in Memphis-Shelby County, Tennessee, is reported. This report, presenting data from 1975-76, updates an earlier report from the 1973-74 period. Data from both periods are compared in an attempt to determine the program's impact on the rate of women with gonorrhea and on the number of hospital admissions for pelvic inflammatory disease (PID), the most serious complication of gonorrhea. The total number of tests performed in the community increased from 113,063 in 1973-74 to 140,201 in 1975-76. The percentage of women with positive cultures was 5.1 in the earlier period and 5.0 in the latter period. The total number of positive cultures at the City of Memphis Hospital declined by 7.4% from 3097 in 1973-74 and 2868 in 1975-76. This decline is largely due to a reduction in the number of positive cultures identified in the emergency room. Despite this decline, the emergency room continued to provide the highest number of positive cultures (16.5% in 1975-76) and the highest ratio of positive cultures to number of tests. City of Memphis Hospital as a whole provided 40.6% of the positive cultures in only 31.5% of total tests. The number of cultures obtained from other community health services increased by 54.5% from 2709 to 4185 in the 2 study periods. This increase is largely attributed to the establishment of new family planning clinics in poor areas and increased participation in the surveillance program among private physicians in these areas. The 3 year moving average incidence of PID recorded in the City of Memphis Hospital discharge at diagnosis showed a dramatic decline between 1968 (the year the surveillance program was initiated) and 1976, suggesting that the program has effectively prevented much infection from progressing to PID. Moreover, the unchanged incidence of gonorrhea observed in the 2 study periods indicates that the infection rate has stabilized. This is in contrast to the continuous upward trend observed on a national level.

The role of the urban community hospital in gonorrhoea surveillance.

In a progressive surveillance programme designed to detect gonococcal infection in females, 113,063 women were screened for gonorrhoea in Memphis-Shelby County, Tennessee, during a 2-year period. The importance of including the urban community hospital in the surveillance programme is emphasized by the contribution of the City of Memphis Hospital where 53-3 per cent. of all positive cases of gonorrhoea were detected in only 34-2 per cent. of all tests done. The City of Memphis Hospital emergency room was an especially productive surveillance area, giving 29-0 per cent. of all positives with only 6-1 per cent. of all tests performed. The importance of taking routine cultures for gonococci from women presenting for prenatal care, delivery, or for genitourinary complaints in an urban hospital is stressed.