In the UK, diagnosis rates for gonorrhoea in 2008 were 152/100,000 for men aged 20 to 24 years and 135/100,000 for women aged 16 to 19 years. Resistance to one or more antimicrobial agent is reported in more than one quarter of isolates. Co-infection with Chlamydia trachomatis is reported in 10% to 40% of people with gonorrhoea in the US and UK.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for uncomplicated infections in men and non-pregnant women; and in pregnant women? What are the effects of treatments for disseminated gonococcal infection? What are the effects of dual treatment for gonorrhoea and chlamydia infection? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 24 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotic regimens (dual treatment, multiple dose, single dose).
Gonorrhoea is caused by infection with Neisseria gonorrhoeae. In men, uncomplicated urethritis is the most common manifestation, while in women less than half of cases produce symptoms (such as vaginal discharge and dyspareunia).
Rates of diagnosed gonorrhoea infection in the UK fell by more than 30% between 2002 and 2009.In the UK in 2008, diagnosis rates for gonorrhoea were 152/100,000 for men aged 20 to 24 years, and 135/100,000 for women aged 16 to 19 years.Rates are highest in men aged 20 to 24 years and women aged 16 to 19 years.In the UK, some studies have shown that 28% of isolates are resistant to ciprofloxacin and 8% to penicillin. There is evidence of reduced susceptibility to cephalosporins.Co-infection with Chlamydia trachomatis is reported in 10% to 40% of people with gonorrhoea in the US and UK.
Single-dose antibiotic regimens have achieved cure rates of 95% and higher in men and non-pregnant women with urogenital or rectal gonorrhoea, although we don't know how different single-dose antibiotic regimens compare with each other.
Single-dose antibiotics are also effective for curing gonorrhoea in pregnant women.
In people with disseminated gonococcal infection, there is consensus that multiple-dose regimens using cephalosporins or fluoroquinolones (when the infecting organism is known to be susceptible) are the most effective treatments, although evidence supporting this is somewhat sparse.
We found insufficient evidence to judge the best treatment for people with both gonorrhoea and chlamydia, although theory, expert opinion, and clinical experience suggest that a combination of antimicrobials active against both N gonorrhoeae and C trachomatis is effective.