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Rectal Gonorrhea in Men: Diagnosis and Treatment

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▸Requests for reprints should be addressed to Denis A. Lebedeff, M.D.; 4911 Van Nuys Boulevard, Suite 308; Sherman Oaks, CA 91403.

Los Angeles, California

© 1980 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1980;92(4):463-466. doi:10.7326/0003-4819-92-4-463
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In a prospective investigation of rectal gonorrhea in men, 1262 patients were studied on the basis of rectal symptoms, gonorrhea contact, or a previously positive rectal culture for Neisseria gonorrhoeae. Five hundred fifty-four patients (44%) had rectal gonorrhea, based on a positive culture; in these patients the symptom of mucus on the stool and the anoscopic finding of generalized exudate proved significant but of low specificity when compared with symptoms and findings in culture-negative patients. Patients were treated with either 4.8 million units of procaine penicillin with Ig probenecid, 3.5 or 4.5 g of ampicillin with 1 g probenecid, or 9.5 g of tetracycline given over 4 days. Four hundred seven patients with rectal gonorrhea returned for test of cure. Failure rates were 5% with each of the first three regimens and 15% with tetracycline (P < 0.01). Procaine penicillin with probenecid is recommended as the treatment of choice, with tetracycline being reserved for penicillin-allergic patients.





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