A topic in Clinical Evidence 1 summarizes the results of one systematic review (search date 1993, updated 2004, total n=24383). The review included both RCTs and clinical trials on drugs other than beta-lactamase sensitive penicillins or a tetracycline (ceftriaxone, ciprofloxacin, gatifloxacin, spectinomycin, azithromycin, ofloxacin, cefixime). Cure rates averaged 97%, and were over 95% for all sites except the pharynx, for which they were about 80% (cephalosporins other than ceftriaxone and spectinomycin may be less effective for pharyngeal infection than quinolones or azithromycin). Ciprofloxacin 500 mg cured 99.8% (95% CI 98.7% to 100%) and azithromycin 2 g cured 99.2% (95% CI 97.2% to 99.9%) of urogenital and rectal infections.
Treatment has been compromised by the absence of routine antimicrobial susceptibility testing in clinical care and evolution of antimicrobial resistance to the antibiotics used to treat gonorrhea 2. A total of 5 093 isolates were collected in 2014 in the USA. Of these, 25% were resistant to tetracycline, 19% to ciprofloxacin, and 16% to penicillin. Reduced azithromycin susceptibility (Azi-RS) (defined as minimum inhibitory concentration [MIC] ≥2.0 µg/mL) increased from 0.6% in 2013 to 2.5% in 2014, and the increase occurred among all categories of sex of sex partners. The prevalence of reduced cefixime susceptibility, Cfx-RS (MIC ≥0.25 µg/mL) increased to 0.8% in 2014. Reduced ceftriaxone susceptibility, Cro-RS (MIC ≥0.125 µg/mL) increased following a similar pattern but at lesser percentages.
Azithromycin resistance and ceftriaxone resistance are growing globally3 5 6, and even combined high-level azithromycin resistance and ceftriaxone resistance has been diagnosed4.
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