Reliance on single dose therapy for gonococcal urethritis

BD Sathyanarayana

 Department of Skin and STD, Bangalore Medical College, Bangalore, India

Correspondence Address:
B D Sathyanarayana
1753, 45th Cross (North), Anikethan Road, Kuvempunagar, Mysore-570023
India

Introduction

With any new specific drug released to the market first time to treat the acute uncomplicated gonococcal urethritis, it is usual practice to advise a single dose therapy. We used to advise 4 caps doxycycline and now norflaxacin, ciproflaxacin or pefloxacin single dose therapy is routinely advised by the doctors. Hence I am reporting a case which highlights the shortfall of single dose therapy.

Case Report

Highly educated, bold, frank and reliable male patient aged about 46 years, married, with two children reported to me 3 years ago with complaints of postcoital pain of one week duration.

History of present illness revealed that postcoital pain develops few minutes after coitus and pain radiating to pubic and perineal region subsides a little after urination. Earlier since few years patient often use to get postcoital mild burning pain in the penile urethra which used to subside after micturition without causing much difficulties.

Past history revealed that patient had severe dysurea due to lower urinary tract infection twice since 4 years with pus cells in urine without albumin and with no culture growth for which patient was treated with norflaxacin and peflaxacin one course of 7 to 10 days each.

History of STD revealed that about 19 years ago, two years before marriage, patient had purulent urethral discharge due to gonorrhoea for which with in two days doctor advised 4 caps of l00mg of doxycycline statum. After that he was completely alright. Since 19 years patient has not exposed to out side sexual contact.

On examination no active genital lesions were seen. On perrectal examination prostate was middly enlarged. Urologist′s opinion was saught and he was diagnosed to have; chronic prostatitis.

Semen analysis revealed oligospermia and grams stain of seminal fluid showed intracellular diplococci. V D R L and other investigations were normal. Patient was treated with 20 lakhs units of procain penicillin daily for 5 days intramuscularly and symptoms promptly subsided. One year later, patient reported with same symptoms and this time he was treated with ciproflaxacin 500mg twice a day for 7 days with symptomatic relief.

Spouse history did not reveal any similar complaints and extra marital sexual exposure. Patient is not avaliable for follow-up and later wrote a letter to me stating that he was having symptoms occasionally.

Discussion

If we were to believe the patient′s history which appears to be fairly true, we can conclude that patient had clinical cure after taking doxycycline l00mg 4 caps stat which was in vogue in those days. However, the patient did have several relapses thereafter, which goes to prove the point that gonococci could remain in the genitourinary tract especially in the accessory sex glands as persisters[1] and could relapse and produce clinical symptoms as and when local environment favoured.

My point to highlight this case history which I believe would be a common experience with every specialist treating STDs over a number of years, is that single dose therapy is not effective in eradicating acute gonococcal urethrits and at this juncture I advocate comparative studies of single dose therapy with a course of same antibiotic over a period of time.

1.	Meares Jr EM. Prostatic and related disorders. In:Walsh PC, et al, editors. Campbell's urology. 6th edn, 1992:819. [Google Scholar]