Disclosures: Mizushima reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
June 08, 2021
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High-dose ceftriaxone noninferior to dual therapy for extragenital gonorrhea in MSM

Disclosures: Mizushima reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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High-dose ceftriaxone monotherapy is as effective as dual therapy for the treatment of extragenital Neisseria gonorrhoeae among men who have sex with men, study results from Japan showed.

The study compared the efficacy of a single 1 g dose of ceftriaxone — double the dose now recommended by the CDC for uncomplicated gonorrhea — with 1 g of ceftriaxone plus a single oral dose of 1 g azithromycin or 100 mg doxycycline administered orally twice a day for 7 days.

Source: Aoki T, et al. Clin Infect Dis. 2021;doi:10.1093/cid/ciab455.

“Men who have sex with men (MSM) are more likely to be infected with N. gonorrhoeae-carrying antimicrobial resistance,” Daisuke Mizushima, MD, PhD, of the AIDS Clinical Center at the National Center for Global Health and Medicine in Tokyo, and colleagues wrote.

“Incidence of N. gonorrhoeae infection was reported to be approximately 39% per year among MSM in a pre-exposure prophylaxis program in Australia,” they wrote. “Hence, greater understanding of antimicrobial resistance in these populations is necessary for devising effective treatment strategies.”

Aoki and colleagues conducted a single-center observational study of MSM aged 19 years or older in Tokyo who received one of the three treatment regimens. They tested participants every 3 months for N. gonorrhoeae and Chlamydia trachomatis.

The researchers identified 320 patients with extragenital gonorrhea — 208 received monotherapy and 112 received dual therapy. For patients in the monotherapy arm, the efficacy against total, pharyngeal and rectal infections was 98.1% (95% CI, 95.2%-99.3%), 97.8% (95% CI, 93.8%-99.4%) and 98.6% (95% CI, 92.3%-99.9%), respectively. Among patients who received dual therapy, efficacy against total, pharyngeal and rectal infections was 95.5% (95% CI, 90%-98.1%), 96.1% (95% CI, 86.8%-99.3%) and 95.1% (95% CI, 86.5%-98.7%).

No significant differences were observed between either group (P = 0.29, 0.61 and 0.34, respectively), the researchers noted.

“Randomized controlled trials could clarify the efficacy of these treatment options in other settings where resistance to ceftriaxone may be a major concern,” they wrote.