What were the treatments for gonorrhea and chlamydia in 1997?

Treatment for Gonorrhea and Chlamydia in 1997

In 1997, the standard treatment for gonorrhea was a single dose of ceftriaxone 125 mg IM, cefixime 400 mg orally, ciprofloxacin 500 mg orally, or ofloxacin 400 mg orally, PLUS either azithromycin 1 g orally in a single dose OR doxycycline 100 mg orally twice daily for 7 days to cover concurrent chlamydial infection. 1

Rationale for Dual Therapy

The CDC established dual therapy as the standard approach by 1997 because patients with gonorrhea were frequently coinfected with Chlamydia trachomatis. 1 This strategy was cost-effective in populations where 20-40% of gonococcal infections were accompanied by chlamydial infection, since the cost of doxycycline therapy ($0.50-$1.50) was less than the cost of testing. 1

Specific Treatment Regimens for Gonorrhea

Recommended Options (1998 CDC Guidelines)

The following regimens were equally acceptable first-line choices: 1

• Ceftriaxone 125 mg IM - Provided sustained, high bactericidal blood levels and cured 99.1% of uncomplicated urogenital and anorectal infections 1
• Cefixime 400 mg orally - Cured 97.1% of uncomplicated urogenital and anorectal infections, with the advantage of oral administration 1
• Ciprofloxacin 500 mg orally - Cured 99.8% of uncomplicated urogenital and anorectal infections 1
• Ofloxacin 400 mg orally - Equally effective alternative fluoroquinolone 1

Alternative Regimens

For patients unable to take first-line agents: 1

• Spectinomycin 2 g IM - Effective but expensive, cured 98.2% of urogenital and anorectal infections 1
• Ceftizoxime 500 mg IM - Most effective of the alternative injectable cephalosporins 1
• Other oral cephalosporins (cefuroxime axetil 1 g, cefpodoxime proxetil 200 mg) had less favorable activity and limited clinical experience 1

Treatment for Chlamydia Component

The chlamydial coverage portion of dual therapy consisted of: 1

• Azithromycin 1 g orally in a single dose (preferred for compliance)
• Doxycycline 100 mg orally twice daily for 7 days (less expensive alternative)

Important Clinical Considerations

Quinolone Resistance Status in 1997

Fluoroquinolones were still widely recommended in 1997, as quinolone-resistant N. gonorrhoeae (QRNG) comprised less than 0.05% of isolates in the United States according to 1996 surveillance data. 1 However, the guidelines noted that QRNG was becoming widespread in parts of Asia and importation would likely continue. 1

Pharyngeal Infections

Pharyngeal gonorrhea was recognized as more difficult to eradicate, with many regimens unable to reliably cure >90% of infections. 1 Oral cephalosporins other than cefixime had poor efficacy against pharyngeal infections. 1

Special Populations

Pregnant women: 1

• Could NOT receive quinolones or tetracyclines
• Should be treated with a recommended cephalosporin (ceftriaxone preferred)

Patients with cephalosporin allergies: 1

• Should generally be treated with quinolones
• If unable to tolerate both cephalosporins and quinolones, spectinomycin was recommended (except for pharyngeal infections)

Follow-Up

Patients treated with recommended regimens did not require test-of-cure unless symptoms persisted. 1 Persistent infections after treatment were more commonly due to reinfection rather than treatment failure. 1

Partner Management

All sex partners within 30 days of symptom onset (or 60 days for asymptomatic patients) required evaluation and treatment for both gonorrhea and chlamydia. 1 Patients were instructed to avoid sexual intercourse until both they and their partners completed therapy and were asymptomatic. 1