Efficacy and Safety of Treatment Options for Uncomplicated Gonococcal Infections

Key Message

Gonorrhea is the second most common sexually transmitted infection in Canada. It is caused by the bacteria Neisseria gonorrhoeae and can be treated with antibiotics, but rising antimicrobial resistance makes implementing the current treatment guidance challenging.

We aimed to identify and summarize the literature since 2016 comparing the clinical effectiveness and safety of treatments for uncomplicated N. gonorrhoeae infections of the urethra, cervix, rectum, pharynx, and eye in adolescents and adults, including pregnant people. We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence.

This Rapid Review includes 4 randomized controlled trials and 1 companion report, all published since 2019. The studies evaluated the following treatments: gentamicin plus azithromycin compared to ceftriaxone plus azithromycin, gentamicin monotherapy compared to ceftriaxone monotherapy, and ceftriaxone monotherapy compared to ceftriaxone plus azithromycin.

There is a lack of comparative evidence evaluating the clinical effectiveness and safety of antibiotics for N. gonorrhoeae infections.

The included studies had mostly cisgender men as participants, so women and people with diverse gender identities were not well represented. Additionally, adolescents younger than 16 years of age and pregnant people were not included in any study.

All the studies were conducted in Europe, so their applicability to the Canadian clinical context is unclear.

Further randomized controlled trials with diverse participant populations are needed to evaluate the safety and efficacy of gentamicin, cefixime, and ciprofloxacin (monotherapy or in combination with azithromycin). Further research is required to evaluate the clinical effectiveness and safety of single-dose versus multidose cefixime.