{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T02:34:24Z","timestamp":1773282864663,"version":"3.50.1"},"reference-count":92,"publisher":"National Institute for Health and Care Research","issue":"20","license":[{"start":{"date-parts":[[2019,5,1]],"date-time":"2019-05-01T00:00:00Z","timestamp":1556668800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["12\/127\/10"],"award-info":[{"award-number":["12\/127\/10"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"<jats:sec id=\"abs1-1\"><jats:title>Background<\/jats:title><jats:p>Gonorrhoea is a common sexually transmitted infection that can cause pain and discomfort, affect fertility in women and lead to epididymo-orchitis in men. Current treatment is with ceftriaxone, but there is increasing evidence of antimicrobial resistance reducing its effectiveness. Gentamicin is a potential alternative treatment requiring further evaluation.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-2\"><jats:title>Objectives<\/jats:title><jats:p>To assess the clinical effectiveness and cost-effectiveness of gentamicin as an alternative treatment to ceftriaxone in the treatment of gonorrhoea.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-3\"><jats:title>Design<\/jats:title><jats:p>A multicentre, parallel-group, blinded, non-inferiority randomised controlled trial.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-4\"><jats:title>Setting<\/jats:title><jats:p>Fourteen sexual health clinics in England.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-5\"><jats:title>Participants<\/jats:title><jats:p>Adults aged 16\u201370 years with a diagnosis of uncomplicated, untreated genital, pharyngeal or rectal gonorrhoea based on a positive Gram-stained smear on microscopy or a positive nucleic acid amplification test (NAAT).<\/jats:p><\/jats:sec><jats:sec id=\"abs1-6\"><jats:title>Randomisation and blinding<\/jats:title><jats:p>Participants were randomised using a secure web-based system, stratified by clinic. Participants, investigators and research staff assessing participants were blinded to treatment allocation.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-7\"><jats:title>Interventions<\/jats:title><jats:p>Allocation was to either 240\u2009mg of gentamicin (intervention) or 500\u2009mg of ceftriaxone (standard treatment), both administered as a single intramuscular injection. All participants also received 1\u2009g of oral azithromycin.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-8\"><jats:title>Main outcome measure<\/jats:title><jats:p>The primary outcome measure was clearance of<jats:italic>Neisseria gonorrhoeae<\/jats:italic>at all infected sites, confirmed by a negative Aptima Combo 2\u00ae (Hologic Inc., Marlborough, MA, USA) NAAT, at 2 weeks post treatment.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-9\"><jats:title>Results<\/jats:title><jats:p>We randomised 720 participants, of whom 81% were men. There were 358 participants in the gentamicin group and 362 in the ceftriaxone group; 292 (82%) and 306 (85%) participants, respectively, were included in the primary analysis. Non-inferiority of gentamicin to ceftriaxone could not be demonstrated [adjusted risk difference for microbiological clearance \u20136.4%, 95% confidence interval (CI) \u201310.4% to \u20132.4%]. Clearance of genital infection was similar in the two groups, at 94% in the gentamicin group and 98% in the ceftriaxone group, but clearance of pharyngeal infection and rectal infection was lower in the gentamicin group (80% vs. 96% and 90% vs. 98%, respectively). Reported pain at the injection site was higher for gentamicin than for ceftriaxone. The side-effect profiles were comparable between the groups. Only one serious adverse event was reported and this was deemed not to be related to the trial medication. The economic analysis found that treatment with gentamicin is not cost neutral compared with standard care, with average patient treatment costs higher for those allocated to gentamicin (\u00a313.90, 95% CI \u00a32.47 to \u00a337.34) than to ceftriaxone (\u00a36.72, 95% CI \u00a31.36 to \u00a317.84).<\/jats:p><\/jats:sec><jats:sec id=\"abs1-10\"><jats:title>Limitations<\/jats:title><jats:p>Loss to follow-up was 17% but was similar in both treatment arms. Twelve per cent of participants had a negative NAAT for gonorrhoea at their baseline visit but this was balanced between treatment groups and unlikely to have biased the trial results.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-11\"><jats:title>Conclusions<\/jats:title><jats:p>The trial was unable to demonstrate non-inferiority of gentamicin compared with ceftriaxone in the clearance of gonorrhoea at all infected sites. Clearance at pharyngeal and rectal sites was lower for participants allocated to gentamicin than for those allocated to ceftriaxone, but was similar for genital sites in both groups. Gentamicin was associated with more severe injection site pain. However, both gentamicin and ceftriaxone appeared to be well tolerated.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-12\"><jats:title>Future work<\/jats:title><jats:p>Exploration of the genetic determinants of antibiotic resistance in<jats:italic>N. gonorrhoeae<\/jats:italic>will help to identify accurate markers of decreased susceptibility. Greater understanding of the immune response to infection can assist gonococcal vaccine development.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-13\"><jats:title>Trial registration<\/jats:title><jats:p>Current Controlled Trials ISRCTN51783227.<\/jats:p><\/jats:sec><jats:sec id=\"abs1-14\"><jats:title>Funding<\/jats:title><jats:p>This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in<jats:italic>Health Technology Assessment<\/jats:italic>; Vol. 23, No. 20. See the NIHR Journals Library website for further project information.<\/jats:p><\/jats:sec>","DOI":"10.3310\/hta23200","type":"journal-article","created":{"date-parts":[[2019,5,17]],"date-time":"2019-05-17T08:23:36Z","timestamp":1558081416000},"page":"1-104","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Gentamicin as an alternative to ceftriaxone in the treatment of gonorrhoea: the G-TOG non-inferiority RCT"],"prefix":"10.3310","volume":"23","clinical-trial-number":[{"clinical-trial-number":"isrctn51783227","registry":"10.18810\/isrctn","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4193-6919","authenticated-orcid":true,"given":"Jonathan DC","family":"Ross","sequence":"first","affiliation":[{"name":"Whittall Street Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, 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