Treatment of gonorrhea in the male with
using a trimethoprim-sulfamethoxazole one- or two-dose
regimen
A.R.
Brathwaite,* mb, ch b, dph
Summary: One hundred and eighty-four male patients with uncomplicated gonorrhea were treated in a randomized double-blind trial using two drug regimens. The combinations used were co-trimoxazole (trimethoprim, 80 mg and sulfamethoxazole, 400 mg) and TMP-SDZ (sulfadiazine, 400 mg and trimethoprim, 80 mg). In 43 patients who received eight tablets of co-trimoxazole in a single dose the cure rate was 88 % In the 46 patients who received a second dose of eight tablets 24 hours later the cure rate was 100 % When TMP-SDZ was used according to the same schedule the respective cure rates were 85 % (41 patients) and 86 % (35 patients). It is suggested that the two-dose regimen with .
.
co-trimoxazole is very effective in the treatment of uncomplicated urethral gonorrhea in the male and that the single-dose regimen, although less effective, may well prove adequate in patients defaulting after the initial treatment. At the present time, and with our local conditions, this form of treatment should be reserved for patients sensitive to penicillin or whose infections are resistant to this agent. The attack rate for patients having an episode of gonorrhea in the 12-month period immediately preceding the trial bore a direct relation to the outcome of therapy. It was highest (26 % ) in the group with an unsatisfactory outcome and lowest (4.3 % ) in the group with the highest cure rate. No adverse toxic reactions to the drug were recorded. Resume: Le traitement de la blennorragie chez I'homme avec le trimethoprime-sulfamethoxazole, aux posologies d'une dose et de deux doses Nous avons traite 184 malades de sexe masculin souffrant de blennorragie noncompliquee, par deux associations medicamenteuses differentes. II s'agissait d'essais a double anonymat, les malades etant repartis au hasard entre les deux groupes. Les associations utilisees etaient: 1) le trimethoprime-sulfamethoxazole (TMP-SMX) (80 mg de trimethoprime et 400 mg de sulfamethoxazole) et le trimethoprime-sulfadiazine (TMP-SDZ) (80 mg de trimethoprime et 400 mg de sulfadiazine). Chez les 43 malades qui ont recu huit comprimes de TMP-SMX en une seule dose, le taux de guerison a ete de 88 % Chez les 46 malades qui ont recu une seconde dose de huit comprimes 24 heures plus tard, la proportion de guerison a ete de 100 % .
.
*Senior medical officer of health,
Jamaica, West Indies
Ministry of Health and Environmental Control,
requests to: Dr. A.R. Brathwaite, Comprchensive Health Centre, 55 Slipc Reprint Pcn Rd., Kingston 5, Jamaica, West Indies 40S CMA JOURNAL/JUNE 14, 1975/VOL. 112
Chez les malades qui ont recu le TMP-SDZ suivant la meme posologie, les taux de guerison ont ete de 85 % (41 malades) et 86 % (35 malades). II est permis de conclure que la posologie double avec le TMP-SMX est tres efficace pour traiter I'uretrite blennorragique noncompliquee chez I'homme et que la posologie simple, bien que moins efficace, peut s'averer adequate chez des malades qui ne se sont pas representes apres le premier traitement. Actuellement, et compte tenu de nos conditions locales, il faudrait reserver cette form© de traitement aux malades allergiques a la penicilline ou a ceux dont I'infection ne reagit pas a cet antibiotique. La frequence des episodes de blennorragie qui sont survenus durant la periode de 12 mois precedant I'essai de traitement etait en relation directe avec Tissue de ce traitement. Elle etait maximale (26 % ) parmi le groupe dont les resultats therapeutiques avaient ete defavorables et etait minimale (4.3 % ) parmi le groupe de malades dont le taux de guerison etait le plus eleve. Nous n'avons registre aucune reaction toxique au medicament.
In the past few years the results of several trials of single-dose "one-shot" treatment of gonorrhea have been reported in the literature.1 The advantages of this type of treatment include: 1. Convenience for both patient and physician. 2. Administration under supervision, thereby avoiding the problems arising from giving the patient oral medication to take home, viz. failure to take the drug as prescribed, drug-sharing with sexual partners, selling or giving the medication to friends, and hoarding of drugs for the next attack (which may occur after the expiry date for the particular supply). 3. In the case of oral medication, simplicity of treatment for those patients who are afraid of injections. The disadvantage of this form of treatment compared with one of several days is a somewhat increased failure rate, Moreover, the amount depending on the type of antibiotic used. of penicillin required to produce cure has increased and in some areas, notably South-East Asia and the west coast of the United States, the volume of solution required per injection has reached critical amounts, being as large as 16 to 22 ml. The dangers of fatal reactions to penicillin in particular, and to injectable antibiotics in general, are other factors to be considered. At the Comprehensive Clinic, Kingston, Jamaica we have noted a decreasing response in gonococcal infections to our standard "one-shot" penicillin treatment using a mixture of penicillin, 1.2 crystalline penicillin, 1.2 million units, procaine million units and benzathine penicillin, 2.4 million units.a total of 4.8 million units contained in 8 ml.
or
study carried out at this clinic2 showed a relatively high degree of resistance* to penicillin among local gonococcal strains. Twenty-six percent of isolates were sensitive to a minimum inhibitory concentration (MIC) of 0.1 unit/ml or less;
51%toan MIC of 0.1 to 0.5 unit/ml and 23% to an MIC of 0.5 unit/ml and over. A similar degree of resistance was noted to tetracycline, 64% of strains being sensitive to MIC 1.0 Mg/ml and over and 21% sensitive to one of 4.0 iig/m\ and over. In view of these findings a double-blind trial was undertaken using trimethoprim-sulfamethoxazole (co-trimoxazole) and a second drug combination consisting of trimethoprim, 80 mg and sulfadiazine, 400 mg per tablet. The study was carried out from September to November 1972.
patients' numbers, e.g. patient 1 received box 77001, patient 2 received box 77002, and so on to 77240. As an added precaution the patient's name was placed on the box in the case of those receiving 16 tablets. The boxes of all patients were retained and affixed to their record sheets. The drug contained in a particular box was unknown to the supervisor or the physician until after the completion of the trial. All patients were told to return at 3 and 7 days following treatment when urethral smears and cultures were repeated. Follow-up was not extended beyond 7 days owing to the high rate of default (initially 33%) and reinfection (30%) among our clinic patients. The criteria for cure were absence of clinical signs and symptoms as well as a negative smear and culture for gonococci.
Objectives
Results
Our purpose was to determine the efficacy of co-trimoxazole in the treatment of uncomplicated gonorrhea in the male, using one of two dosage regimens, namely eight tablets given as a single dose or eight tablets given at the same time on 2 consecutive days. A second purpose was to determine the efficacy of trimethoprim-sulfadiazine (TMP/SDZ) in the treat¬ ment of uncomplicated gonorrhea in the male using the same
Patients who defaulted from follow-up or were reinfected excluded from the trial. Of the 120 patients treated with co-trimoxazole, 60 were given eight tablets each; 9 of these defaulted, 2 were reinfected after re-exposure and 43 (87.8%) were cured. Of the 60 given 16 tablets each, 12 defaulted, 2 were reinfected after reexposure and 46 (76.7%) were cured. Of the 120 patients treated with TMP-SDZ, 60 were given 8 of these defaulted, 2 were reinfected after tablets each; re-exposure anq 41 (85.4%) were cured. Of the 60 receiving 16 tablets, 19 defaulted and 35 (85.5%) were cured. These results are summarized in Table I. Of the total of 50 defaulters, 26 were later seen by an investigator outside the clinic and after 1 week had elapsed. All claimed that they were clinically cured within 2 to 3 days after treatment. The last two columns of Table I provide a break¬ down of these cases by treatment regimen and show an "apparent" cure rate based on the assumption that all default¬ ers were cured. The age distribution of the 184 patients completing the trial is given in Table II. The mode age was 21 (range, 15 to 59) with 20.1% under 20 years. The distribution in this sample is similar to that for male patients with gonorrhea attending our clinic. Nineteen of the 184 patients had one episode each of gonorrhea in the preceding 12-month period, an attack rate of 10.3%. The distribution of this rate throughout the sample is shown in Table III and its relation to the cure rate is of interest. The increasing difficulty of curing gonorrhea experienced with each successive eoisode is well known, and this is no doubt due to the resultant residual pathology in the male urethral tract.
A
dosage regimens. Subjects
1J0
A total of 240 male patients with urethral discharge attend¬ ing voluntarily for treatment at the Comprehensive Clinic were included in the trial. Patients whose attendance for regular follow-up was thought likely to be unreliable were excluded.
Methods
Diagnosis was established on the basis of a positive Gram's stain and culture on Thayer-Martin (VCN) medium.3 Material was inoculated directly and incubated immediately in 5% CO2 at 37°C for 2 days. Gonococci were identified by Gram's stain and the oxidase reaction. A blood test for syphilis was taken on each patient. Once the diagnosis was established, patients were treated drug. The randomly with either an 8- or 16-tablet box of the Those on a tablets were taken in the presence of the supervisor. 16-tablet regimen were given half the contents of the box, and the box with the remaining tablets was then attached to the patient's record sheet. The patients returned 24 hours later and took the second dose in the supervisor's presence. Each patient was assigned a number for treatment purposes, from 1 to 240. The boxes of tablets in foil wrapping were distributed in the order of the *MIC of 0.1 unit/ml of resistance.
were
penicillin or
1.0 ng/m\
tetracycline is taken as the beginning
Discussion The cure rate obtained in this series by treating gonorrhea in the male with co-trimoxazole was 88% on a single-dose and
Table I.Results of treatment with co-trimoxazole and TMP-SDZ
CMA JOURNAL/JUNE
14, 1975/VOL. 112 41S
100% on a two-dose regimen. Uliman, Niordson and Zachariae achieved a 98% cure rate in 104 patients (67 men and 37 women) using a two-dose regimen of five tablets repeated 8
Table Il-Age distribution of 184 patients completing trial Age group
No.
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Total
37 66 38 19 10 9 2 2 1 184
20.1 35.9 20.7 10.3 5.4 4.9 1.1 1.1 0.5
hours later.4 Previous reports on the efficacy of this drug were of multidose regimens extending over 2 to 6 days with cure rates of 90% and over.5-1 Wright and Grimble obtained cure rates of only 52% and 67% on a 5-day regimen.12 Evans, Churcher and Human obtained a cure rate of 82%. Ninety-four percent of their failures were infected with strains of gonococci relatively resistant to penicillin in vitro.13 In patients infected with fully sensitive strains the failure rate was only 1.7%, compared with 39% in the penicillin-resistant group. They suggested that this treatment method may not be advisable in patients who have already failed to respond to penicillin-one of the main indications for the use of the drug. Unfortunately, owing to shipping delay, we were unable to do sensitivity studies in this series. The penicillin sensitivity pattern for our clinic has already been reported2 and of interest is the fact that in a previous study (to be published) using multidose regimens of co-trimoxazole in penicillin-failure cases, an average cure-rate of 80% was achieved. Acknowledgements are expressed to Dr. J. R. MacDougal of Burroughs Wellcome who supplied the co-trimoxazole (Septrin) used in the study and assisted with reference material.
References Table Ill-Effect of previous episode of gonorrhea on cure rate No. with episode
Attack rate
Sample category
No. of patients
Total sample
184
19
10.3
Satisfactory
165
14
8.5
Unsatisfactory
19
5
26.3
co-trimoxazole (8 tablets)
49 (88%)
5
10.2
co-trimoxazole (16 tablets)
46 (100%)
2
4.3
TMP/SDZ (8 tablets)
48 (85%)
5
10.4
TMP/SDZ (16 tablets)
41 (86%)
7
17.1
42S
CMA JOURNAL/JUNE 14, 1975/VOL. 112
I. Single-dose treatment of gonorrhoea (E). Lancet I: 885, 1972 2. FLEMING WL. BRATHWAITE AR, MARTIN JE. Ct al: Penicillin and tetracycline sensitivity in Jamaican strains of gonococci. West Indies Med J23: 222, 1974 3. THAYER JD, MARTIN JE: A selective medium for the cultivation of N. gonorrhoeae and N. meningitidis. Public Health Monogr 79: 49. 1964 4. ULLMAN S. NIORDSON AM. ZACHARIAE H: Trimethoprim-sulfamethoxazole in gonorrhoea. Ada Derm Venereol (Stockh) 51: 394, 197 5. CSONKA GW, KNIGHT GJ: Therapeutic trial of trimethoprim as a potentiator of sulphonamides in gonorrhoea. Br J Vener Dis 43: 161, 1967 6. CSONKA GW: Therapeutic trial of some genital infections with trimethoprim-sulphamethoxazole. Postgrad Med J 45 (suppl): 77. 1969 7. SCHOFIELD CBS. MASTERTON G. MOFFETT M. et al: The treatment of gonorrhoea in women with sulphamethoxazole-trimethoprim. Ibid. p 45 8. ARYA OP. PEARSON DH. RAE SK. et al: Treatment of gonorrhoea with trimethoprim-sulphamethoxazole in Uganda. Br J Vener Dis 46: 214. 1970 9. CARROLL BRT. NICOL CS: Trimethoprim-sulphamethoxazole in the treatment of non-gonococcal urethritis and gonorrhoea. Ibid. p 31 10. SHAH SAA: Trimethoprim-sulphamethoxazole (Septrin): general practitioners' experience in 2085 patients. Pakistan Med Rev 5: 61. 1970 I. HATOS G. TUZA FLC: Treatment of gonorrhoea with trimethoprimsulphamethoxazole and with rifampicin. Med J Aust 1:1197. 1972 12. WRIGHT DJM. GRIMBLE AS: Sulphamethoxazole combined with 2-4 diamino-pyrimidines in the treatment of gonorrhoea. Br J Vener Dis 48: 34. 1970 13. EVANS AJ. CHURCHER GM. HUMAN RP: Sulphamethoxazoletrimethoprim in the treatment of gonorrhoea. Ibid. p 179
using a trimethoprim-sulfamethoxazole one- or two-dose
regimen
A.R.
Brathwaite,* mb, ch b, dph
Summary: One hundred and eighty-four male patients with uncomplicated gonorrhea were treated in a randomized double-blind trial using two drug regimens. The combinations used were co-trimoxazole (trimethoprim, 80 mg and sulfamethoxazole, 400 mg) and TMP-SDZ (sulfadiazine, 400 mg and trimethoprim, 80 mg). In 43 patients who received eight tablets of co-trimoxazole in a single dose the cure rate was 88 % In the 46 patients who received a second dose of eight tablets 24 hours later the cure rate was 100 % When TMP-SDZ was used according to the same schedule the respective cure rates were 85 % (41 patients) and 86 % (35 patients). It is suggested that the two-dose regimen with .
.
co-trimoxazole is very effective in the treatment of uncomplicated urethral gonorrhea in the male and that the single-dose regimen, although less effective, may well prove adequate in patients defaulting after the initial treatment. At the present time, and with our local conditions, this form of treatment should be reserved for patients sensitive to penicillin or whose infections are resistant to this agent. The attack rate for patients having an episode of gonorrhea in the 12-month period immediately preceding the trial bore a direct relation to the outcome of therapy. It was highest (26 % ) in the group with an unsatisfactory outcome and lowest (4.3 % ) in the group with the highest cure rate. No adverse toxic reactions to the drug were recorded. Resume: Le traitement de la blennorragie chez I'homme avec le trimethoprime-sulfamethoxazole, aux posologies d'une dose et de deux doses Nous avons traite 184 malades de sexe masculin souffrant de blennorragie noncompliquee, par deux associations medicamenteuses differentes. II s'agissait d'essais a double anonymat, les malades etant repartis au hasard entre les deux groupes. Les associations utilisees etaient: 1) le trimethoprime-sulfamethoxazole (TMP-SMX) (80 mg de trimethoprime et 400 mg de sulfamethoxazole) et le trimethoprime-sulfadiazine (TMP-SDZ) (80 mg de trimethoprime et 400 mg de sulfadiazine). Chez les 43 malades qui ont recu huit comprimes de TMP-SMX en une seule dose, le taux de guerison a ete de 88 % Chez les 46 malades qui ont recu une seconde dose de huit comprimes 24 heures plus tard, la proportion de guerison a ete de 100 % .
.
*Senior medical officer of health,
Jamaica, West Indies
Ministry of Health and Environmental Control,
requests to: Dr. A.R. Brathwaite, Comprchensive Health Centre, 55 Slipc Reprint Pcn Rd., Kingston 5, Jamaica, West Indies 40S CMA JOURNAL/JUNE 14, 1975/VOL. 112
Chez les malades qui ont recu le TMP-SDZ suivant la meme posologie, les taux de guerison ont ete de 85 % (41 malades) et 86 % (35 malades). II est permis de conclure que la posologie double avec le TMP-SMX est tres efficace pour traiter I'uretrite blennorragique noncompliquee chez I'homme et que la posologie simple, bien que moins efficace, peut s'averer adequate chez des malades qui ne se sont pas representes apres le premier traitement. Actuellement, et compte tenu de nos conditions locales, il faudrait reserver cette form© de traitement aux malades allergiques a la penicilline ou a ceux dont I'infection ne reagit pas a cet antibiotique. La frequence des episodes de blennorragie qui sont survenus durant la periode de 12 mois precedant I'essai de traitement etait en relation directe avec Tissue de ce traitement. Elle etait maximale (26 % ) parmi le groupe dont les resultats therapeutiques avaient ete defavorables et etait minimale (4.3 % ) parmi le groupe de malades dont le taux de guerison etait le plus eleve. Nous n'avons registre aucune reaction toxique au medicament.
In the past few years the results of several trials of single-dose "one-shot" treatment of gonorrhea have been reported in the literature.1 The advantages of this type of treatment include: 1. Convenience for both patient and physician. 2. Administration under supervision, thereby avoiding the problems arising from giving the patient oral medication to take home, viz. failure to take the drug as prescribed, drug-sharing with sexual partners, selling or giving the medication to friends, and hoarding of drugs for the next attack (which may occur after the expiry date for the particular supply). 3. In the case of oral medication, simplicity of treatment for those patients who are afraid of injections. The disadvantage of this form of treatment compared with one of several days is a somewhat increased failure rate, Moreover, the amount depending on the type of antibiotic used. of penicillin required to produce cure has increased and in some areas, notably South-East Asia and the west coast of the United States, the volume of solution required per injection has reached critical amounts, being as large as 16 to 22 ml. The dangers of fatal reactions to penicillin in particular, and to injectable antibiotics in general, are other factors to be considered. At the Comprehensive Clinic, Kingston, Jamaica we have noted a decreasing response in gonococcal infections to our standard "one-shot" penicillin treatment using a mixture of penicillin, 1.2 crystalline penicillin, 1.2 million units, procaine million units and benzathine penicillin, 2.4 million units.a total of 4.8 million units contained in 8 ml.
or
study carried out at this clinic2 showed a relatively high degree of resistance* to penicillin among local gonococcal strains. Twenty-six percent of isolates were sensitive to a minimum inhibitory concentration (MIC) of 0.1 unit/ml or less;
51%toan MIC of 0.1 to 0.5 unit/ml and 23% to an MIC of 0.5 unit/ml and over. A similar degree of resistance was noted to tetracycline, 64% of strains being sensitive to MIC 1.0 Mg/ml and over and 21% sensitive to one of 4.0 iig/m\ and over. In view of these findings a double-blind trial was undertaken using trimethoprim-sulfamethoxazole (co-trimoxazole) and a second drug combination consisting of trimethoprim, 80 mg and sulfadiazine, 400 mg per tablet. The study was carried out from September to November 1972.
patients' numbers, e.g. patient 1 received box 77001, patient 2 received box 77002, and so on to 77240. As an added precaution the patient's name was placed on the box in the case of those receiving 16 tablets. The boxes of all patients were retained and affixed to their record sheets. The drug contained in a particular box was unknown to the supervisor or the physician until after the completion of the trial. All patients were told to return at 3 and 7 days following treatment when urethral smears and cultures were repeated. Follow-up was not extended beyond 7 days owing to the high rate of default (initially 33%) and reinfection (30%) among our clinic patients. The criteria for cure were absence of clinical signs and symptoms as well as a negative smear and culture for gonococci.
Objectives
Results
Our purpose was to determine the efficacy of co-trimoxazole in the treatment of uncomplicated gonorrhea in the male, using one of two dosage regimens, namely eight tablets given as a single dose or eight tablets given at the same time on 2 consecutive days. A second purpose was to determine the efficacy of trimethoprim-sulfadiazine (TMP/SDZ) in the treat¬ ment of uncomplicated gonorrhea in the male using the same
Patients who defaulted from follow-up or were reinfected excluded from the trial. Of the 120 patients treated with co-trimoxazole, 60 were given eight tablets each; 9 of these defaulted, 2 were reinfected after re-exposure and 43 (87.8%) were cured. Of the 60 given 16 tablets each, 12 defaulted, 2 were reinfected after reexposure and 46 (76.7%) were cured. Of the 120 patients treated with TMP-SDZ, 60 were given 8 of these defaulted, 2 were reinfected after tablets each; re-exposure anq 41 (85.4%) were cured. Of the 60 receiving 16 tablets, 19 defaulted and 35 (85.5%) were cured. These results are summarized in Table I. Of the total of 50 defaulters, 26 were later seen by an investigator outside the clinic and after 1 week had elapsed. All claimed that they were clinically cured within 2 to 3 days after treatment. The last two columns of Table I provide a break¬ down of these cases by treatment regimen and show an "apparent" cure rate based on the assumption that all default¬ ers were cured. The age distribution of the 184 patients completing the trial is given in Table II. The mode age was 21 (range, 15 to 59) with 20.1% under 20 years. The distribution in this sample is similar to that for male patients with gonorrhea attending our clinic. Nineteen of the 184 patients had one episode each of gonorrhea in the preceding 12-month period, an attack rate of 10.3%. The distribution of this rate throughout the sample is shown in Table III and its relation to the cure rate is of interest. The increasing difficulty of curing gonorrhea experienced with each successive eoisode is well known, and this is no doubt due to the resultant residual pathology in the male urethral tract.
A
dosage regimens. Subjects
1J0
A total of 240 male patients with urethral discharge attend¬ ing voluntarily for treatment at the Comprehensive Clinic were included in the trial. Patients whose attendance for regular follow-up was thought likely to be unreliable were excluded.
Methods
Diagnosis was established on the basis of a positive Gram's stain and culture on Thayer-Martin (VCN) medium.3 Material was inoculated directly and incubated immediately in 5% CO2 at 37°C for 2 days. Gonococci were identified by Gram's stain and the oxidase reaction. A blood test for syphilis was taken on each patient. Once the diagnosis was established, patients were treated drug. The randomly with either an 8- or 16-tablet box of the Those on a tablets were taken in the presence of the supervisor. 16-tablet regimen were given half the contents of the box, and the box with the remaining tablets was then attached to the patient's record sheet. The patients returned 24 hours later and took the second dose in the supervisor's presence. Each patient was assigned a number for treatment purposes, from 1 to 240. The boxes of tablets in foil wrapping were distributed in the order of the *MIC of 0.1 unit/ml of resistance.
were
penicillin or
1.0 ng/m\
tetracycline is taken as the beginning
Discussion The cure rate obtained in this series by treating gonorrhea in the male with co-trimoxazole was 88% on a single-dose and
Table I.Results of treatment with co-trimoxazole and TMP-SDZ
CMA JOURNAL/JUNE
14, 1975/VOL. 112 41S
100% on a two-dose regimen. Uliman, Niordson and Zachariae achieved a 98% cure rate in 104 patients (67 men and 37 women) using a two-dose regimen of five tablets repeated 8
Table Il-Age distribution of 184 patients completing trial Age group
No.
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Total
37 66 38 19 10 9 2 2 1 184
20.1 35.9 20.7 10.3 5.4 4.9 1.1 1.1 0.5
hours later.4 Previous reports on the efficacy of this drug were of multidose regimens extending over 2 to 6 days with cure rates of 90% and over.5-1 Wright and Grimble obtained cure rates of only 52% and 67% on a 5-day regimen.12 Evans, Churcher and Human obtained a cure rate of 82%. Ninety-four percent of their failures were infected with strains of gonococci relatively resistant to penicillin in vitro.13 In patients infected with fully sensitive strains the failure rate was only 1.7%, compared with 39% in the penicillin-resistant group. They suggested that this treatment method may not be advisable in patients who have already failed to respond to penicillin-one of the main indications for the use of the drug. Unfortunately, owing to shipping delay, we were unable to do sensitivity studies in this series. The penicillin sensitivity pattern for our clinic has already been reported2 and of interest is the fact that in a previous study (to be published) using multidose regimens of co-trimoxazole in penicillin-failure cases, an average cure-rate of 80% was achieved. Acknowledgements are expressed to Dr. J. R. MacDougal of Burroughs Wellcome who supplied the co-trimoxazole (Septrin) used in the study and assisted with reference material.
References Table Ill-Effect of previous episode of gonorrhea on cure rate No. with episode
Attack rate
Sample category
No. of patients
Total sample
184
19
10.3
Satisfactory
165
14
8.5
Unsatisfactory
19
5
26.3
co-trimoxazole (8 tablets)
49 (88%)
5
10.2
co-trimoxazole (16 tablets)
46 (100%)
2
4.3
TMP/SDZ (8 tablets)
48 (85%)
5
10.4
TMP/SDZ (16 tablets)
41 (86%)
7
17.1
42S
CMA JOURNAL/JUNE 14, 1975/VOL. 112
I. Single-dose treatment of gonorrhoea (E). Lancet I: 885, 1972 2. FLEMING WL. BRATHWAITE AR, MARTIN JE. Ct al: Penicillin and tetracycline sensitivity in Jamaican strains of gonococci. West Indies Med J23: 222, 1974 3. THAYER JD, MARTIN JE: A selective medium for the cultivation of N. gonorrhoeae and N. meningitidis. Public Health Monogr 79: 49. 1964 4. ULLMAN S. NIORDSON AM. ZACHARIAE H: Trimethoprim-sulfamethoxazole in gonorrhoea. Ada Derm Venereol (Stockh) 51: 394, 197 5. CSONKA GW, KNIGHT GJ: Therapeutic trial of trimethoprim as a potentiator of sulphonamides in gonorrhoea. Br J Vener Dis 43: 161, 1967 6. CSONKA GW: Therapeutic trial of some genital infections with trimethoprim-sulphamethoxazole. Postgrad Med J 45 (suppl): 77. 1969 7. SCHOFIELD CBS. MASTERTON G. MOFFETT M. et al: The treatment of gonorrhoea in women with sulphamethoxazole-trimethoprim. Ibid. p 45 8. ARYA OP. PEARSON DH. RAE SK. et al: Treatment of gonorrhoea with trimethoprim-sulphamethoxazole in Uganda. Br J Vener Dis 46: 214. 1970 9. CARROLL BRT. NICOL CS: Trimethoprim-sulphamethoxazole in the treatment of non-gonococcal urethritis and gonorrhoea. Ibid. p 31 10. SHAH SAA: Trimethoprim-sulphamethoxazole (Septrin): general practitioners' experience in 2085 patients. Pakistan Med Rev 5: 61. 1970 I. HATOS G. TUZA FLC: Treatment of gonorrhoea with trimethoprimsulphamethoxazole and with rifampicin. Med J Aust 1:1197. 1972 12. WRIGHT DJM. GRIMBLE AS: Sulphamethoxazole combined with 2-4 diamino-pyrimidines in the treatment of gonorrhoea. Br J Vener Dis 48: 34. 1970 13. EVANS AJ. CHURCHER GM. HUMAN RP: Sulphamethoxazoletrimethoprim in the treatment of gonorrhoea. Ibid. p 179
