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Abstract
Objectives Neisseria gonorrhoeae (NG) infection can resolve without antibiotic treatment, however the literature describing the frequency of clearance at individual sites, how rapidly it occurs and potential predictive factors is limited. In this analysis of a subpopulation identified from a large multicentre UK cohort, we describe the overall rate of spontaneous clearance of infection and explore factors associated with this.
Methods Data from the Gentamicin compared with Ceftriaxone for the Treatment of Gonorrhoea randomised controlled trial consisting of 720 patients with NG were analysed. A subgroup of individuals had both a pretrial test sample and a trial enrolment sample taken. Those who had cleared NG between initial presentation and subsequent entry into the trial without antibiotic treatment were deemed to have spontaneously cleared. Sociodemographic characteristics, sexual history and sites of infection for those who spontaneously cleared infection were compared with that of those who did not. We also estimated the time interval to clearance.
Results Overall, the proportion who had spontaneous clearance was 20.5% (83/405). Clearance of infection occurred over a median of 10 days (IQR 7–15 days). The cohort who spontaneously cleared were similar to those who did not in terms of age, gender, sexual orientation, HIV status and previous NG infection. Chlamydia coinfection was more frequent in the ‘no spontaneous clearance group’ (11.1% (9/83) cf 22.0% (69/322)) (p=0.029). Dysuria was reported more often in the ‘no spontaneous clearance group’ (4.8% (4/83) cf 13.0% (42/322)) (p=0.035).
Conclusion We present data from a large cohort of NG-infected individuals, of whom a significant proportion had spontaneous clearance of infection. This is consistent with previous smaller studies. If this is indicative of cure, point-of-care testing prior to treatment has the potential to reduce unnecessary exposure to antimicrobials. Further work to assess the importance of bacterial load, genotype and host immune response on spontaneous clearance of infection is required.
Trial registration number ISRCTN51783227
- gonorrhoea
- Neisseria gonorrhoeae
- treatment
- antibiotics
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Footnotes
Handling editor Henry John Christiaan de Vries
Contributors JR and SM conceived and designed the study. OCA and SM carried out the statistical analyses. SM and JR drafted the manuscript. All authors approved the final manuscript.
Funding The GToG study was funded by the National Institute for Health Research (NIHR) Health Technology Assessment and registered prior to start of recruitment (ISRCTN51783227).
Disclaimer The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Competing interests JR reports personal fees from GSK Pharma, Mycovia and Nabriva Therapeutics as well as ownership of shares in GSK Pharma and AstraZeneca Pharma; is the author of the UK and European Guidelines on Pelvic Inflammatory Disease; is a member of the European Sexually Transmitted Infections Guidelines Editorial Board; and is a member of the National Institute for Health Research Funding Committee (Health Technology Assessment programme). He is an NIHR Journals editor and associate editor of Sexually Transmitted Infections journal. He is an officer of the International Union against Sexually Transmitted Infections (treasurer), and a charity trustee of the Sexually Transmitted Infections Research Foundation.
Patient consent for publication Not required.
Ethics approval Research ethics approval was granted for the 'Gentamicin for the Treatment of Gonorrhoea' trial from the Health Research Authority South Central–Oxford C Research Ethics Committee (14/SC/1030).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.