Schumacher Christina M, Ghanem Khalil G
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Sex Transm Dis. 2013 Jul;40(7):539-45. doi: 10.1097/OLQ.0b013e3182941325.
The current recommended first-line regimen to treat gonorrhea is ceftriaxone in combination with either azithromycin or doxycycline. Azithromycin is the preferred second agent. We retrospectively measured and compared gonorrhea retreatment rates between patients receiving ceftriaxone plus azithromycin and those receiving ceftriaxone plus doxycycline.
Using data from public sexually transmitted disease clinics for patients treated for gonorrhea in Baltimore, Maryland, between January 2004 and December 2011, we measured time to retreatment from the date the ceftriaxone regimen was received. Censoring occurred on the earlier of 2 years posttreatment or March 31, 2012. Survival analysis methods were used to compare retreatment rates.
One tenth (9.9%; n = 4457) of patients were retreated within 2 years. Treatment regimen was not related to time to retreatment (adjusted hazard ratio [aHR], 0.88; 95% confidence interval, 0.69-1.12). Patients receiving expedited partner therapy (EPT) were 45% less likely to be retreated (aHR, 0.55 [0.31-0.96]) compared with patients treated before EPT became available. A subanalysis among patients retested for gonorrhea within 90 and 30 days found retreatment rates of 18.8% (n = 91/485) and 13.5% (n = 19/140), respectively. The 90-day cohort showed no association with treatment regimen (aHR, 0.95 [0.55-1.65]); however, all of the retreated patients in the 30-day cohort had received the doxycycline regimen.
Gonorrhea retreatment was common, highlighting the need for rescreening and better partner therapies. The protective effect of EPT further underscores the need for effective oral therapies. Azithromycin may be preferable as the second agent to treat gonorrhea, although doxycycline seems to be a reasonable alternative.
目前推荐的治疗淋病的一线方案是头孢曲松联合阿奇霉素或多西环素。阿奇霉素是首选的第二种药物。我们回顾性地测量并比较了接受头孢曲松加阿奇霉素治疗的患者与接受头孢曲松加多西环素治疗的患者的淋病再治疗率。
利用马里兰州巴尔的摩市2004年1月至2011年12月期间在公共性传播疾病诊所接受淋病治疗的患者数据，我们测量了从接受头孢曲松治疗方案之日起至再治疗的时间。截尾发生在治疗后2年或2012年3月31日两者中较早的时间。采用生存分析方法比较再治疗率。
十分之一（9.9%；n = 4457）的患者在2年内接受了再治疗。治疗方案与再治疗时间无关（调整后的风险比[aHR]，0.88；95%置信区间，0.69 - 1.12）。与在快速性伴治疗（EPT）可用之前接受治疗的患者相比，接受EPT的患者再治疗的可能性降低了45%（aHR，0.55 [0.31 - 0.96]）。在90天内和30天内重新检测淋病的患者亚组分析中，再治疗率分别为18.8%（n = 91/485）和13.5%（n = 19/140）。90天队列显示与治疗方案无关（aHR，0.95 [0.55 - 1.65]）；然而，30天队列中所有接受再治疗的患者都接受了多西环素治疗方案。
淋病再治疗很常见，这凸显了重新筛查和更好的性伴治疗的必要性。EPT的保护作用进一步强调了有效口服治疗的必要性。阿奇霉素可能更适合作为治疗淋病的第二种药物，尽管多西环素似乎也是一个合理的选择。
