Update Gonorrhea Treatment

HTML: H124-22/2005E-HTML
0-662-40785-7

Gonorrhea Treatment (Cefixime, Spectinomycin)
Community Acquired Infections Division,
Centre for Infectious Diseases Prevention and Control
Public Health Agency of Canada
March 2005

Disease Profile

Gonorrhea is caused by the organism Neisseria gonorrhoeae and is a sexually transmitted infection (STI) that affects both men and women. If left untreated, gonorrhea can cause serious complications including pelvic inflammatory disease (PID) in women and infertility for both sexes.¹ Gonorrhea can be passed on to a newborn during birth and cause eye infections or blindness. Gonorrhea can be transmitted through oral, vaginal and anal sex. Many men and women infected with gonorrhea will not have symptoms, and therefore may not know they are infected. If symptoms do appear, they usually appear within 2 -7 days after sexual contact, but it can take up to 30 days. For women who do experience symptoms, these may include: new or different discharge from the vagina, burning sensation during urination, pain in the lower abdomen, fever, chills, pain during sex, vaginal bleeding between periods or after intercourse, rectal pain and/or discharge. Males who have symptoms may experience: yellow-green discharge from the penis, burning feeling when urinating, pain or swelling of the testicles, rectal pain and/or discharge.²

Over time, some strains of the bacteria have become resistant to certain antibiotics. Treating patients with resistant gonorrhea will become more challenging as the number of resistant strains continues to increase. Risk factors for gonorrhea include contact with a person with a proven infection; travelers to endemic countries who have unprotected sex with local population (higher risk of resistance); unprotected sex with a partner from an endemic area (or area with high rates of antimicrobial resistance); commercial sex workers, sexually active youth (<25 years) with multiple partners, street-involved youth and men who have sex with men (MSM)³.

Epi Update⁴

1997 reported cases = 4,917 cases (14.9/100,000 population)
2004 estimated case reports (projected) = 9,207 cases (27.9/100,000 population)⁵

This represents an estimated increase of 87% for 2004 over 1997; the national goal for gonorrhea, set in 1996, was elimination by 2010⁶. These goals are currently under review by the Agency.

In 1997, the rates of reportable STI in Canada, which previously had been decreasing, began to rise. This trend continues today. This rise may be associated with factors such as safe-sex fatigue; the introduction of highly active anti-retroviral treatment (HAART) for HIV; a new generation of sexually active youth who did not witness the effects of the original HIV epidemic; the internet facilitating high-risk partnering; and, a general lack of awareness of STI, their associated risk factors and potential sequelae such as cancer and infertility.

Treatment Issues

Cefixime (SUPRAX) remains one of the recommended treatments for gonorrhea in Canada (Interim Statement) and is still a licensed product with an active drug identification number (DIN). It is distributed in Canada by Aventis Pharma Inc. as a 400 mg tablet or 100 mg / 5 ml powder for solution (oral).

• Despite earlier concerns that availability might be limited in North America, Aventis confirmed (November 1, 2004) that there are no short or long term plans to change the supply of this product in Canada.

Spectinomycin (TROBICIN) is an alternative treatment for gonorrhea and a discontinued drug distributed by Pfizer in Canada as 400 mg / ml reconstituted solution (intramuscular injectable). Use of this medication should be followed with a test for cure. Spectinomycin should not be used for treating pharyngeal infections.

• This product is available through the Special Access Program. There is no supply/stock issue, however, there is a two week delay in product being shipped as it is being imported from the US.

For more information:

• Gonorrhea
• Interim Statement on Treatment
• Publications

____________________________
¹ Sexual Health & Sexually Transmitted Diseases PHAC 2003
² What You Need to Know About STI, Health Canada 2002
³ Canadian STD Guidelines, 1998 Edition, Health Canada
⁴ Reported Cases and rates of notifiable STI, Health Canada, 1998/1999 Volume 26S6, October 2000 & Public Health Agency of Canada, September 23, 2004
⁵ Estimated total cases (projected) for 2004 based on preliminary reported number of cases/rate Jan-Mar 2004
⁶ National Goals for the Prevention and Control of Sexually Transmitted Diseases in Canada, CCDR, November 1997, Vol 23S6, Health Canada