title: Can previous first-line therapies for Neisseria gonorrhoeae be targeted to specific patient subgroups to treat gonorrhea?
abstract: BACKGROUND
  Gonorrhea treatment is challenging because of the emergence of resistance, treatment failure with existing drugs, and the lack of alternative agents. This study investigates the feasibility of targeting previously recommended antimicrobials to specific population subgroups where the prevalence of infection susceptible to these antimicrobials is above the World Health Organization cautionary treatment threshold of 95%.
  
  
  METHODS
  Descriptive data from the Gonococcal Resistance to Antimicrobials Surveillance Programme for England and Wales were analyzed to investigate patient characteristics associated with infection with susceptible isolates using univariate and multivariable analyses.
  
  
  RESULTS
  Of 6173 isolates from 2007 to 2011, 4684 (82%) were susceptible to penicillin, 3899 (68%) to ciprofloxacin, and 5240 (91%) to cefixime. All subgroups of the MSM population had fewer than 95% of isolates susceptible to penicillin, ciprofloxacin, or cefixime. Higher proportions of isolates from heterosexual patient subgroups were susceptible to these antimicrobials. Multivariable models identified the following associations between patient characteristics and infection with susceptible isolates: patients aged 13 to 24 years (penicillin: 92.3% susceptible adjusted odds ratio and associated 95% confidence interval [aOR CI] 1.84-2.97; ciprofloxacin: 88.3%, aOR CI 2.22-3.39; cefixime: 98.7%, aOR CI 1.29-3.52) patients of black ethnicity (penicillin: 93.9%, aOR CI 2.72-4.91; ciprofloxacin: 92.0%, aOR CI 3.94-6.7; cefixime: 99.1%, aOR CI 1.78-6.4), and patients with concurrent chlamydia (penicillin: 93.9%, aOR CI 1.8-3.22; ciprofloxacin: 91.7%, aOR CI 2.71-4.58; cefixime: 99.0%, aOR CI 1.27-4.54).
  
  
  CONCLUSIONS
  This study demonstrated that of the previous first-line therapies, cefixime would be the only antimicrobial suitable for use for infection in heterosexual patients alone.
authors.affiliation: From the *HIV/STI Department, Health Protection Services, Public Health England, London, UK; and †Sexually Transmitted Bacteria Reference Unit, Microbiological Services, Public Health England, London, UK.
authors.forename: Katy
authors.initials: K
authors.lastname: Town
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Lowndes
authors.forename: Gwenda
authors.initials: G
authors.lastname: Hughes
authors.forename: Chinelo
authors.initials: C
authors.lastname: Obi
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chisholm
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Ison
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D020682:Cefixime / Q000494:pharmacology; D002939:Ciprofloxacin / Q000494:pharmacology; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D004739:England / Q000453:epidemiology; D062665:Epidemiological Monitoring; D005240:Feasibility Studies; D005260:Female; D006069:Gonorrhea / Q000188:drug therapy* / Q000453:epidemiology; D020010:Heterosexuality; D006801:Humans; D008297:Male; D009344:Neisseria gonorrhoeae / Q000187:drug effects*; D010406:Penicillins / Q000494:pharmacology; D015995:Prevalence; D012725:Sexual Behavior; D014852:Wales / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D002939:Ciprofloxacin; D020682:Cefixime