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Spectinomycin as initial treatment for gonorrhea

, : Spectinomycin as initial treatment for gonorrhea. British Medical Journal 289(6455): 1383-1383

The prevalence of penicillinase producing Neisseria gonorrheae increased exponentially from < 0.5%, in 1978 to 6.5% of all isolates in 1982. In Jan. 1983, 1st line treatment for uncomplicated heterosexual anogenital gonorrhea was therefore changed from ampicillin and probenecid to spectinomycin. This subsequently cured 95% of cases seen. Although there was an initial fall in the monthly isolation rate of penicillinase producing N. gonorrhoeae after the introduction of spectinomycin, this was not maintained. The exponential increase in the prevalence of the strain did slow in 1983, rising to only 8.7%. This, however, may have reflected a general decline in the rate of increase of penicillinase producing N. gonorrheae throughout Britain. The failure to influence the prevalence of penicillinase producing N. gonorrheae to any great degree may have been due in part to spectinomycin resistance in both penicillinase producing and non-penicillinase-producing N. gonorrheae. All of the isolates appeared identical, apart from the presence of the 4.4 megadalton plasmid in penicillinase producing N. gonorrheae, but they could not be linked epidemiologically. Changing treatment in only 1 of the many venereal diseases clinics in London [UK], where patients have open access to all such clinics, is unlikely to affect the prevalence of penicillinase producing N. gonorrheae. This has probably been more important than spectinomycin resistance in limiting the effectiveness of spectinomycin in reducing the prevalence of the strain.

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