FDA approves new oral antibiotics effective against resistant strains of gonorrhea
Two new oral antibiotics, zoliflodacin and gepotidacin, have been approved by the Food and Drug Administration (FDA) for treating patients with uncomplicated urogenital gonorrhea in patients age 12 years and older. The gepotidacin approval is restricted to patients with few or no other treatment choices because of limited safety data.
Zoliflodacin and gepotidacin have novel mechanisms of action, which means they are effective against strains of Neisseria gonorrhoeae that are resistant to currently recommended antibiotics. Gepotidacin and zoliflodacin act by inhibiting bacterial DNA replication.
The new antibiotics provide oral treatment options and alternative treatments for resistant strains of N gonorrhoeae.
Summary
Definition
Urethritis is usually a sexually transmitted infection that typically presents with dysuria, urethral discharge, and/or pruritus at the end of the urethra. Urethral discharge is the classic physical finding. If the urinalysis is positive for leukocyte esterase, the Gram stain of the discharge (≥2 white blood cells per oil immersion field) or sediment of the first-voided urine (≥10 white blood cells per high power field) reveals abnormal numbers of polymorphonuclear leukocytes, the diagnosis of urethritis is confirmed.[1] Urethritis is divided into 2 main categories: gonococcal, if Neisseria gonorrhoeae is isolated; nongonococcal (NGU), if N gonorrhoeae is not isolated. The most common causes of NGU include Chlamydia trachomatis and Mycoplasma genitalium. Urethritis may also result from trauma but this topic focuses on infectious causes.[Figure caption and citation for the preceding image starts]: Gonorrhea with penile meatal dischargeCDC Image Library; Susan Lindsley [Citation ends].
Анамнез и осмотр
Ключевые диагностические факторы
- urethral discharge
- urethral irritation or itching
- dysuria
Другие диагностические факторы
- orchialgia
- absence of epididymal tenderness and/or swelling
- absence of pelvic pain (women)
- absence of pustular or petechial rash
- absence of arthritis
- absence of eye inflammation
Факторы риска
- ages 15 to 24 years
- female sex
- men who have sex with men
- new or multiple sex partners
- prior or current STI
- inconsistent condom use
- circumcision
Диагностические исследования
Исследования, которые показаны в первую очередь
- Gram stain of urethral discharge and/or urine sediment
- nucleic acid amplification tests (NAAT)
- culture of urethral discharge
- potassium hydroxide prep of urethral discharge
- HIV test
- syphilis test
Исследования, проведение которых нужно рассмотреть
- urinalysis and culture
- wet mount of urethral discharge (women)
- NAAT and culture of urine or urethral/vaginal swab for Trichomonas vaginalis
- NAAT for other organisms
Алгоритм лечения
initial Gram stain suggestive of gonorrhea: nonpregnant
initial Gram stain suggestive of gonorrhea: pregnant
initial Gram stain not suggestive of gonorrhea: nonpregnant
initial Gram stain not suggestive of gonorrhea: pregnant
recurrent or resistant urethritis
Составители
Авторы
Sheldon Morris, MD, MPH
Assistant Professor
Division of Infectious Diseases
Department of Medicine
UCSD Antiviral Research Center
Division of Family Medicine
Department of Family and Preventive Medicine
UCSD La Jolla Family and Sports Medicine
San Diego, CA
Раскрытие информации
SM has received funding from NIH, CHRP, CIRM, NASA, and Visby Medical. SM owns stock in Bristol Myers Squib and is the founder of Aspera Biomedicines. SM is an author of a number of references cited in this topic.
Выражение благодарностей
Dr Sheldon Morris would like to gratefully acknowledge Dr Christina Bailey, a previous contributor to this topic.
Раскрытие информации
CB declares that she has no competing interests.
Рецензенты
Vani Dandolu, MD, MPH
Associate Professor
Ob/Gyn and Urology
Director
Division of Urogynecology
Associate Residency Program Director
Temple University Hospital
Philadelphia, PA
Раскрытие информации
VD declares that he has no competing interests.
Khalil Ghanem, MD, PhD
Assistant Professor of Medicine
Associate Fellowship Program Director
Division of Infectious Diseases
Johns Hopkins University School of Medicine
Baltimore, MD
Раскрытие информации
KG declares that he has no competing interests.
Christopher Fairley, PhD
Professor of Sexual Health
University of Melbourne
Director
Melbourne Sexual Health Centre
Carlton
Victoria
Australia
Раскрытие информации
CF is an author of a number of references cited in this topic. CF has received program grants of 6 figures US$.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Список литературы
Основные статьи
Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Jul 2021 [internet publication].Полный текст
Centers for Disease Control and Prevention. National overview of STIs in 2023. Nov 2024 [internet publication].Полный текст
European Association of Urology. Guidelines on urological infections. 2023 [internet publication].Полный текст
Horner PJ, Blee K, Falk L, et al; International Union against Sexually Transmitted Infections. 2016 European guideline on the management of non-gonococcal urethritis. Int J STD AIDS. 2016 Oct;27(11):928-37.Полный текст
British Association for Sexual Health and HIV. Urethritis and cervicitis. May 2023 [internet publication].Полный текст
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Urinary tract infection
- Candida balanitis or vaginitis
- Noninfectious urethritis
Больше ОтличияРекомендации
- Guidelines on urological infections
- 2021 European guideline on Mycoplasma genitalium infections
Больше РекомендацииЛифлеты для пациента
Chlamydia
Gonorrhea
Больше Лифлеты для пациента
Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice
Использование этого контента попадает под действие нашего заявления об отказе от ответственности