Anorectal gonorrhea in women. Is it more difficult to cure?

It is unclear whether anorectal gonorrhea in women is more difficult to cure than endocervical gonorrhea or whether anorectal test-of-cure cultures are always indicated. Using endocervical and anorectal test-of-cure cultures, the authors evaluated 1,124 women treated for culture-positive endocervical gonorrhea with a recommended regimen of ampicillin (n = 868), procaine penicillin G (n = 78), spectinomycin (n = 45), or tetracycline (n = 133). There were 35 failures (3.1%) among women with anogenital gonorrhea, including 11 (1.0%) among those with anorectal infection. Only eight failures (0.7%) were detected by anorectal culture alone. Although anorectal isolates of Neisseria gonorrhoeae obtained before treatment from women were significantly (P less than .05) less susceptible to tetracycline than were endocervical isolates (geometric mean MIC, 0.35 micrograms/ml vs. 0.21 micrograms/ml), there were no failures of treatment of anorectal infection when tetracycline was used. The authors conclude that anorectal infection in women is not more difficult to treat than endocervical infection. Because of the very high cost-per-case ratio, anorectal test-of-cure cultures in women should be accorded a low priority in a gonorrhea control program.