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Background: Gonorrhoea is increasing in France since its resurgence in the late 1990's. Understanding trends of condomless sex is a requirement to tailor prevention toward most exposed individuals. This study aims to analyse trends and determinants of condomless penetrative sex (PS) in MSM and heterosexuals diagnosed with gonorrhoea in France., Methods: A standardized self-administered questionnaire filled by 3453 patients was used to monitor condomless sex through the sentinel surveillance network ResIST between 2005 and 2014. Trends were used to describe consistent condom use for penetrative sex (PS). A logistic regression model analysed patients' characteristics associated with condomless PS., Results: Between 2005 and 2014, condomless PS increased regardless of sexual orientation. Condomless PS was particularly common among HIV positive men who have sex with men (MSM (65%)). People living in metropolitan regions outside Paris area (adjusted odds-ratio (AOR) [95% CI] =1.33[1.12-1.58]) were more likely to engage in condomless PS. Conversely, MSM (AOR [95% CI] =0.21 [0.16-0.29]), HIV seronegative patients (AOR [95% CI] =0.68 [0.51-0.89]), patients diagnosed in hospital (AOR [95% CI] = 0.66 [0.45-0.97]) and multi-partners (≥ 10 partners, AOR [95% CI] = 0.54 [0.40-0.74]) were more likely to use condoms., Conclusions: These findings highlight a decreasing use of condom in MSM and heterosexuals diagnosed with gonorrhoea. Prevention strategies should take in account drivers of condomless sex in a context of uncontrolled STI epidemics.

Bacterial culture remains the gold standard for symptomatic infection. Nucleic Acid Amplification Tests (NAATs) have better sensitivity and specificity for rectal and pharyngeal specimens. A bacterial culture with antibiogram must be done for all NAAT positive specimens in order to modify antibiotics prescription if needed. We must fear a diffusion of extensively drug-resistant Neisseria gonorrhoeae in the future. Nevertheless, ceftriaxone 500 mg intramuscular with 1 g of azithromycin against Chlamydia trachomatis remains the treatment of N. gonorrhoeae infections. Screening of partners of identified cases and other STDs is the main measure to add to the treatment of gonorrhea., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Gonococcal infections as well as other sexually transmited diseases have been increasing for several years. Short incubation period and rich symptomatology of gonococcal urethritis in man, make it an epidemiological indicator of high-risk sexual behavior. In women, cervicitis is often asymptomatic. Anorectitis is a classical form of gonococcal infection especially in men who have sex with men. Sepsis and conjunctivitis, while rare, are to be diagnosed as quickly as possible because of their severity. To limit the spread of gonococcal infections, prevention of sexually transmitted diseases must be strengthened, the screening of asymptomatic subjects can be improved by using the polymerase chain reaction technique and finally the latest therapeutic guidelines taking into account gonococcal antibiotic resistances must be applied.

Ofloxacin is a new fluoroquinolone with excellent in vitro activity against N. gonorrhoeae. 32 adult males with acute uncomplicated gonococcal urethritis were treated with a single-dose of orally administered ofloxacin (400 mg). 1 out of 32 isolates was penicillinase-producing N. gonorrhoeae. Urethral cultures were obtained before treatment and on day 3-5. Microbiological cure was achieved in all patients (100%). No side effects were observed. According to these results, single-dose ofloxacin therapy (400 mg) is effective and safe against uncomplicated gonococcal urethritis in adult males.

Gonococcal urethritis being highly contagious, the ideal treatment should be effective, well tolerated and relatively cheap. Among antibiotics fulfilling these conditions, thiamphenicol and spectinomycin are widely used throughout the world and particularly in France. However, the ever increasing incidence of infections caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) strains, the growing number of strains with low sensitivity to penicillin and/or other antibiotics and the recent emergence of strains that are highly resistant to penicillin make it necessary from time to time to re-evaluate the main therapeutic approaches to gonococcal urethritis. In this study thiamphenicol and spectinomycin were compared for effectiveness as single-dose treatments of uncomplicated gonococcal urethritis in 207 male patients who consulted at the Clinical and Biological Centre for Sexually Transmitted Diseases, Saint-Louis Hospital, Paris, during April and May, 1985. Prior to the trial the patients had not received antibiotics for at least 2 weeks. They were allocated at random to two therapeutic groups: 89 patients received a single 2.5 g dose of thiamphenicol orally, and 84 patients received a single 2 g dose of spectinomycin by intramuscular injection. In every case the gonococcal origin of the urethritis had been confirmed by culture. The patients were examined 3 to 7 days after treatment for clinical and bacteriological evaluation. Specimens were cultivated on agar-blood medium, and N. gonorrhoeae was also identified by biochemical and antigenic reactions. The minimum inhibitory concentrations (MIC) of the two antibiotics were determined by the agar plate dilution method, using an agar nutrient medium. The possible production of beta-lactamase and the auxotypic and plasmidic profiles of the PPNG strains were investigated.(ABSTRACT TRUNCATED AT 250 WORDS)