Experimental Human Infection With Neisseria Gonorrhoeae
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ClinicalTrials.gov Identifier: NCT03840811 |
Recruitment Status :
Completed
First Posted : February 15, 2019
Results First Posted : March 23, 2021
Last Update Posted : March 23, 2021
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Condition or disease | Intervention/treatment | Phase |
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Gonococcal Infection | Drug: Cefixime Drug: Ceftriaxone Drug: Ciprofloxacin Biological: Neisseria gonorrhoeae strain FA1090 A26 Biological: Neisseria gonorrhoeae strain FA7537 | Phase 1 |
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 27 participants |
Allocation: | Non-Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Basic Science |
Official Title: | Experimental Human Infection With Isogenic Mutants of Neisseria Gonorrhoeae |
Actual Study Start Date : | April 23, 2017 |
Actual Primary Completion Date : | November 25, 2019 |
Actual Study Completion Date : | November 25, 2019 |
Arm | Intervention/treatment |
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Experimental: Group 1
Subjects (n = up to 8) will receive a bacterial inoculum containing only the isogenic mutant N. gonorrhoeae strain
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Drug: Cefixime
Mandatory rescue therapy consisting of cefixime 400 mg orally in a single dose: on patient request, at the onset of symptoms or on the 5th study day after inoculation. Drug: Ceftriaxone Mandatory rescue therapy consisting of ceftriaxone 250 mg intramuscularly in a single dose: on patient request, at the onset of symptoms or on the 5th study day after inoculation. Drug: Ciprofloxacin Mandatory antibiotic treatment failure therapy: Ciprofloxacin 500 mg orally in a single dose: if the subject has a positie test of cure 1 week post initial antibiotic treatment Biological: Neisseria gonorrhoeae strain FA7537 0.4 mL of a suspension containing 10^5 - 10^6 CFU of Neisseria gonorrhoeae, in phosphate-buffered saline, delivered to the anterior urethra through a No.8 pediatric French catheter |
Experimental: Group 2
Subjects (n = up to 8) will receive a bacterial inoculum containing only the wild-type (WT) N. gonorrhoeae strain.
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Drug: Cefixime
Mandatory rescue therapy consisting of cefixime 400 mg orally in a single dose: on patient request, at the onset of symptoms or on the 5th study day after inoculation. Drug: Ceftriaxone Mandatory rescue therapy consisting of ceftriaxone 250 mg intramuscularly in a single dose: on patient request, at the onset of symptoms or on the 5th study day after inoculation. Drug: Ciprofloxacin Mandatory antibiotic treatment failure therapy: Ciprofloxacin 500 mg orally in a single dose: if the subject has a positie test of cure 1 week post initial antibiotic treatment Biological: Neisseria gonorrhoeae strain FA1090 A26 0.4 mL of a suspension containing 10^5 - 10^6 CFU of Neisseria gonorrhoeae, in phosphate-buffered saline, delivered to the anterior urethra through a No.8 pediatric French catheter. |
Experimental: Group 3
Subjects (n= up to 16) will receive a bacterial inoculum containing a mixture of equivalent numbers the isogenic mutant and WT strain
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Drug: Cefixime
Mandatory rescue therapy consisting of cefixime 400 mg orally in a single dose: on patient request, at the onset of symptoms or on the 5th study day after inoculation. Drug: Ceftriaxone Mandatory rescue therapy consisting of ceftriaxone 250 mg intramuscularly in a single dose: on patient request, at the onset of symptoms or on the 5th study day after inoculation. Drug: Ciprofloxacin Mandatory antibiotic treatment failure therapy: Ciprofloxacin 500 mg orally in a single dose: if the subject has a positie test of cure 1 week post initial antibiotic treatment Biological: Neisseria gonorrhoeae strain FA1090 A26 0.4 mL of a suspension containing 10^5 - 10^6 CFU of Neisseria gonorrhoeae, in phosphate-buffered saline, delivered to the anterior urethra through a No.8 pediatric French catheter. Biological: Neisseria gonorrhoeae strain FA7537 0.4 mL of a suspension containing 10^5 - 10^6 CFU of Neisseria gonorrhoeae, in phosphate-buffered saline, delivered to the anterior urethra through a No.8 pediatric French catheter |
- The Competitive Index of the Mutant Compared to Wild Type Proportion of Organisms With the Predicted Competitive Advantage Recovered From Urine and/or Urethral Swab Specimens From Infected Participants [ Time Frame: Baseline and the day of treatment, any day between Day 2 and Day 6 ]
The competitive index (CI) is defined by the ratio of colony forming units (cfu) of the two strains recovered from urine cultures on the day of treatment (output) compared to the ratio of strains in the inoculum (input):
CI = mutant cfu(output)/wild-type cfu(output) ÷ mutant cfu(input)/wild-type cfu(input).
The CI is used to assess whether the fitness of a given mutant is different than that of wild-type, and CI as a ratio is compared to 1. If it's not significantly different than 1, then no significant difference in the fitness was observed. Mutant or wild-type cfu values of 0 were replaced by 1 in the calculation of competitive index.
The assessment was performed in the MtrD trial mixed group.
- Proportion of Participants That Become Infected as Defined by a Positive Urine or Urethral Swab Culture Among Infections Initiated With Individual N. Gonorrhoeae Strains in Non-competitive Infections [ Time Frame: day of infection, any day between Day 2 and Day 6 ]Infection is defined by a positive urine or urethral swab culture. The proportion of infected participants by Day 6 with N. gonorrhoeae was assessed in each trial by group among participants with non-competitive infections. Participants could become infected and received treatment any day before or on day 6.
- Proportion of Participants That Become Infected as Defined by a Positive Urine or Urethral Swab Culture for Infections Initiated With Mixed Inocula [ Time Frame: day of infection, any day between Day 2 and Day 6 ]Infection is defined by a positive urine or urethral swab culture. The proportion of infected participants by Day 6 with N. gonorrhoeae was assessed in each trial among participants with infections initiated with mixed inocula. Participants could become infected and received treatment any day before or on day 6.
- Median Time From Inoculation to Treatment Among Infected Participants by Day 6, by Strain, in Non-competitive Infections [ Time Frame: Day 2 through the day of treatment, up to Day 6 ]The median time from inoculation to antibiotic treatment were calculated for each group.
- Proportion of Participants With Occurrence of Bacteriuria in Non-competitive Infections, by Strain [ Time Frame: Day of occurrence, any day between Day 2 and Day 6 ]Bacteriuria is defined as Log10 cfu N. gonorrhoeae/mL urine sediment.
- Proportion of Participants With Occurrence of Signs and Symptoms of Urethritis Attributable to Gonococcal Infection in Non-competitive Infections, by Strain [ Time Frame: Day of occurrence, any day between Day 2 and Day 6 ]Participants with any subjective symptoms or objective signs (observed urethral discharge) during period 01 (post-inoculation and before treatment which can occur on or before day 6) from the Solicited Events Form were captured.
- Proportion of Participants With Occurrence of Urethritis in Non-competitive Infections [ Time Frame: Day of occurrence, any day between Day 2 and Day 6 ]Urethritis is defined as >= 5.8 Log10 WBC/mL urine sediment.
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Ages Eligible for Study: | 18 Years to 36 Years (Adult) |
Sexes Eligible for Study: | Male |
Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
- Healthy man > / = 18 and < 36 years old
- Able and willing to be located easily by providing street address and telephone number (land line and/or cell phone number)
- Willingness to provide written informed consent
- Able and willing to attend all study visits including 6-day stay in the Clinical Translational Research Center (CTRC) during the trial (with ability to leave the unit during the day) and follow-up visit during the week after treatment
- Able and willing to abstain from all sexual activity until completion of the study and the follow-up test for gonorrhea is negative
- Acceptable medical history by screening evaluation
- No clinically significant abnormalities on physical exam
- Urinalysis: leukocyte esterase, and White Blood Cell (WBC) values within normal limits (WNL)
- CH50 WNL
- Urine negative for chlamydia, gonorrhea, and trichomonas
- Negative Human Immunodeficiency Virus (HIV), syphilis, and Hepatitis C (HCV) test results
- Negative Hepatitis B (HBV) core and surface antibodies or results consistent with immunization (negative HBV core antibody/positive HBV surface antibody)
- Denies history of Sexually Transmitted Infections (STIs) including gonorrhea, chlamydia, syphilis, HIV, HBV, and HCV
- Denies history of bleeding diathesis
- Denies history of seizures (due to reports of seizures with ciprofloxacin)
- Denies history of cancer, except basal cell carcinoma of the skin > 5 years ago
- Denies history of drug abuse
- Denies history of genitourinary surgery
Exclusion Criteria:
- Student or employee under the direct supervision of any of the study investigators
- Any known immunodeficiencies including complement deficiency, antibody deficiency, chronic granulomatous disease or Human Immunodeficiency Virus (HIV) infection
- Psychiatric disorders that, in the opinion of the physician, would interfere with the integrity of the data or volunteer safety
- Unstable depression (defined as receiving either < 3 months of the same medication (and dose) or a decompensating event during the previous 3 months) or depression that, in the opinion of the investigator, will compromise the subject's ability to comply with protocol requirements
- Heart murmur or heart disease
- Anatomic abnormality of the urinary tract
- Any antibiotic treatment in the past 30 days, or azithromycin in the past 60 days
- Self-reported chemotherapy within the past year
- Current steroid use, except for topical application
- Allergy to penicillin, cephalosporins or ciprofloxacin or to lidocaine
- Treatment with medications in the previous month that are contraindicated with cefixime, ceftriaxone or ciprofloxacin and that cannot be withheld for the single doses given in this study
- Serum creatinine level < 0.7 or > 1.75 mg/dL and deemed clinically significant by the study physician
- Serum ALT level < LLN or > 105 U/L and deemed clinically significant by the study physician
- WBC count < 2.5 or > 15.0 x 10^9/L and deemed clinically significant by the study physician
- Absolute neutrophil count (ANC) < 1.5 or > 7.5 x 10^9/L and deemed clinically significant by the study physician Exception: For African Americans, ANC values as low as 1.3 x 10^9/L will be allowed (25)
- Hemoglobin level < 12.0 g/dL or above ULN and deemed clinically significant by the study physician
- Urinalysis: Qualitative protein level > 1+ or RBC count > 10/hpf
Medications not permitted with cefixime or ceftriaxone:
- Warfarin
- Probenecid
- Aspirin
- Diuretics such as furosemide
- Aminoglycoside antibiotics
- Chloramphenicol
Medications not permitted with ciprofloxacin:
- Tizanidine
- Theophylline
- Warfarin
- Glyburide
- Cyclosporine
- Probenecid
- Phenytoin
- Methotrexate
- Antacids, multivitamins, and other dietary supplements containing magnesium, calcium, aluminum, iron or zinc
- Caffeine-containing medications
- Sucralfate or didanosine chewable or buffered tablets
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03840811
United States, North Carolina | |
University of North Carolina Health Care - Infectious Diseases | |
Chapel Hill, North Carolina, United States, 27514-4220 |
Documents provided by National Institute of Allergy and Infectious Diseases (NIAID):
Responsible Party: | National Institute of Allergy and Infectious Diseases (NIAID) |
ClinicalTrials.gov Identifier: | NCT03840811 |
Other Study ID Numbers: |
09-0106 |
First Posted: | February 15, 2019 Key Record Dates |
Results First Posted: | March 23, 2021 |
Last Update Posted: | March 23, 2021 |
Last Verified: | September 16, 2020 |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
Product Manufactured in and Exported from the U.S.: | No |
ceftriaxone challenge ciprofloxacin males Neisseria gonorrhoeae |
Infections Communicable Diseases Gonorrhea Disease Attributes Pathologic Processes Neisseriaceae Infections Gram-Negative Bacterial Infections Bacterial Infections Bacterial Infections and Mycoses Sexually Transmitted Diseases, Bacterial Sexually Transmitted Diseases Genital Diseases Urogenital Diseases Ciprofloxacin |
Ceftriaxone Cefixime Anti-Bacterial Agents Anti-Infective Agents Topoisomerase II Inhibitors Topoisomerase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Antineoplastic Agents Cytochrome P-450 CYP1A2 Inhibitors Cytochrome P-450 Enzyme Inhibitors Third Generation Cephalosporins Beta Lactam Antibiotics |