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STUDIES
Year : 1994  |  Volume : 60  |  Issue : 2  |  Page : 76-78

Follow up of acute gonococcal urethritis in males treated with norfloxacin




Correspondence Address:
KVR Chari


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  Abstract 

This subject was undertaken to confirm the efficacy of norfloxacin in acute gonorrhoea and to note the relapse if any during the follow up period of 3 months. 27 male patients suffering from acute gonorrhoea were treated with 800 mgs of norfloxacin as single oral dose. In all cases, gonococci disappeared from urethral smears by 8 hours, urethral discharge subsided by 72 hrs, urine on naked eye examination cleared in 4 days except in 1 case and burning micturition subsided by 7 days. Cure rate was 100% in the study. No relapse was found at the end of follow up of 3 months. No adverse reactions were observed to norfloxacin except headache in 2 cases. Norfloxacin was safe and effective in the treatment of acute gonorrhoea.


Keywords: Acute gonorrhoea, Norfloxacin


How to cite this article:
Chari K, Tutakne M A, Dhir R. Follow up of acute gonococcal urethritis in males treated with norfloxacin. Indian J Dermatol Venereol Leprol 1994;60:76-8

How to cite this URL:
Chari K, Tutakne M A, Dhir R. Follow up of acute gonococcal urethritis in males treated with norfloxacin. Indian J Dermatol Venereol Leprol [serial online] 1994 [cited 2019 Sep 19];60:76-8. Available from: http://www.ijdvl.com/text.asp?1994/60/2/76/3997



  Introduction Top


Gonorrhoea is reported to be the second commonest sexually transmitted disease next to syphilis in India with its incidence varying from 12.1% to 29.4% of all STD cases. [1] The advent of penicillin resistant strains both in western countries and in India led to the induction of various antibiotics alternatively to penicillin in the treatment of acute gonorrhoea. Spectinomycin was considered alternate choice [2] but spectinomycin resistant strains among isolates of Penicillinase Producing  Neisseria More Details Gonorrhoeae (PPNG) have been reported. [3],[4] Norfloxacin a fluoroquinolone antibacterial agent has been found to be effective in the treatment of acute gonorrhoea . [5],[6]

This study is undertaken to confirm the efficacy of norfloxacin in acute gonorrhoea and to follow up the treated patients for a period of 3 months to assess the final cure and relapse, if any.


  Materials and Methods Top


Twenty seven male patients of acute gonorrhoea admitted to STD ward of Command Hospital (Western Command), Chandimandir were taken for study. Detailed history and findings on clinical examination were noted. Diagnosis of acute gonorrhoea was confirmed by urethral smear examination stained for gonococci by Gram's stain. Culture for gonococci was done in patients who denied history of exposure. Blood for TLC, DLC, Hb, VDRL, liver function tests and ELISA test for HIV were done on admission in addition to urine for two glass test, routine (RE) and microscopic examination (ME).

Norfloxacin 800 mgs was given as single oral dose after the confirmation of diagnosis of acute gonorrhoea. Urethral discharge was collected and stained for gonococci by Gram's stain every 2 hrs for first 12 hrs or till urethral discharge was present. Patients were examined on the 7th and 14th day before being discharged from the hospital. Urine for naked eye examination, RE and ME were done daily for 3 days and later on 7th and 14th day. The day on which burning micturition subsided was noted. Treatment failure was considered if urethral discharge recurred and gonococci were seen in the urethral smears any time upo 14 days.

Patients were called on surveillance after 3 months when urine for 2 glass test, RE and ME were done. Prostatic smears were taken and stained for gonococci and pus cells by Gram's stain. Blood for VDRL and ELISA test for HIV were done. If all surveillance tests were normal, patient was declared cured.


  Results Top


Out of 27 patients, 9 were unmarried and 18 were married. The age ranged from 20 to 39 years. 10 (37.1%) had sexual contact with prostitutes, 6 (22.2%) with amatures, 6 (22.2%) had marital exposure and 5 (18.5%) denied any sexual exposure. Range of incubation period in 16 cases, where date of infection could be ascertained by history was between 2 to 30 days. 9 (56.25%) had incubation period upto 10 days and 7 (43.75%) developed the symptoms after 10 days. Urethral discharge was mainly purulent. It followed burning micturition by 1 to 5 days. 7 (26%) did not have any burning micturition. Urine for 2 glass test showed haziness in all samples in first glass and in both the glasses in 1 case.

After treatment with norfloxacin (800 mgs stat orally), gonococci disappeared from urethral smears by 2 hrs in 1 case, by 4 hrs in 9 cases, by 6 hrs in 14 cases (51.9%) and by 8 hrs in 3 cases (11%). Thus gonococci disappeared in all smears by 8 hrs.

Urethral discharge stopped in 5 cases (18.5%) in less than 24 hrs, between 24 hrs to 48 hrs in 12 cases (44.4%), between 48 to 60 hrs in 9 cases (33.3%) and more than 60 hrs in 1 case (3.8%).

Burning micturition subsided in all cases by 72 hours. Urine by naked eye examination cleared in less than 3 days in 8 cases (29.6%), in 3-4 days in 18 cases (66.6%) and in only 1 case persisted for more than 7 days.

All the cases which were followed upto 3 months after treatment did not show any recurrence of gonorrhoea,

No adverse reactions to norfloxacin were observed except for headache in 2 cases.


  Comments Top


Norfloxacin, a flourinated 4 aminoquinolone antibacterial agent is related chemically to nalidixic acid with more wide spectrum antibacterial action and greater potency. It is very effective orally. It is bactericidal and acts by inhibiting bacterial DNA gyrase thereby inhibiting DNA synthesis. [7] The minimum inhibitory concentration (MIC) of the drug is 0.06 mcg/ ml for betalactamase negative Neisseria gonorrhoea and 0.1 to 0.5 mcg/ml for PPNG organisms. When administered orally, norfloxacin gives peak serum concentration of 2.41 mcg/ml in 1 to 2 hrs with 800 mgs dosage. About 30% of administered norfloxacin is excreted in the urine as parent drug. In urine, it's concentration exceeds 200 mcg/ml in 2-3 hrs and remains more than 300 mcg/ml for 12 hrs in patients having normal renal function. Hence norfloxacin has additional advantage of flushing the urethra with the drug.

100% cure rate was reported in norfloxacin in uncomplicated gonococcal infection both against PPNG and non-PPNG strains [5] and in uncomplicated anorectal gonorrhoea . [6]

In our study with 800 mgs oral dose of norfloxacin, gonococci disappeared by 8 hrs in all cases. Thin urethral discharge and pus cell continued to appear later but these cleared by 60 hrs in 96.2% cases. Only in 1 case, urethral discharge persisted beyond 60 hrs which was later diagnosed as post gonococcal urethritis and was treated accordingly. All above investigations were normal by 7th and 14th day after treatment.

 
  References Top

1.TR Kapur. Pattern of sexually transmitted diseases in India. Ind J Dermatol Venereol Leprol 1982; 48 : 23-34.  Back to cited text no. 1    
2.Pandhi RK, Bhujwala RA, Kotkar CL. Treatment of gonorrhoea in males and females with spectinomycin hydrochloride. Ind J Dermatol Venereol Leprol 1983; 49 (4) 158-9.  Back to cited text no. 2    
3.Ashford WA, Potts DW, Adams HJU, etal. Spectinomycin resistant penicillinase producing Neisseria gonorrhoeae. Lancet 1981; 1 1 : 1035-7.  Back to cited text no. 3    
4.Easmon CSF, Ison CA, Bellinger CM, etal. Emergence of resistance after spectinomycin treatment for gonorrhoea due to betalactamase producing strains of Neisseria gonorrhoea. Brit Med J 1982; 284 :1064-5.  Back to cited text no. 4    
5.Crider SR, Collery SP, Miller LK, et al. Treatment of penicillin resistant Neisseria gonorrhoeae with oral norfloxacin. New Eng J Med 1984; 311 : 137-40.  Back to cited text no. 5    
6.Ramanowski B, Wood H, Draker J, etal. Norfloxacin in the therapy of uncomplicated gonorrhoea. Antimicrob Agents Chemotherap 1985; 30 : 514-5.  Back to cited text no. 6    
7.Burnie J. Norfloxacin. Drugs of today 1984; 20 : 391-5.  Back to cited text no. 7    




 

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