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GonorrheaPhase 3NCT03959527

Zoliflodacin in Uncomplicated Gonorrhoea

A Phase 3 study testing zoliflodacin, ceftriaxone and azithromycin in people with Gonorrhea, run by Global Antibiotics Research and Development Partnership at 17 sites in 5 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This trial is a multi-center, open label, randomized controlled, non-inferiority phase III trial evaluating the safety and efficacy of a 3 g oral dose of zoliflodacin compared to a combination of a single intra-muscular 500 mg dose of ceftriaxone and a single 1 g oral dose of azithromycin for the treatment of… Read more about this study

Who is it for?
Ages 12 years and older
Conditions the study is for
Gonorrhea
What is being tested?
zoliflodacin, ceftriaxone and azithromycin
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,011 participants
Where
17 sitesin 5 countries
Study dates
6 Nov 2019to 18 Sep 2023
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 12 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Age ≥ 12 years old (if enrolment of minors is in agreement with local regulations and Ethics guidance)
  • Weight ≥ 35 kg
  • Signs and symptoms consistent with urethral or cervical gonorrhoea OR Urethral or cervical uncomplicated gonorrhoea as determined by either a positive culture or NAAT or Gram stain or methylene blue test/gentian violet stain in the past 14 days prior to screening OR Unprotected sexual contact with an individual reported to be infected with NG in the past 14 days prior to screening (confirmation by a positive NAAT, Gram stain or methylene blue test/ gentian violet stain or culture)
  • For females of child-bearing potential, a negative urine pregnancy test at screening
  • For females of child bearing potential, use of highly effective contraception for at least 28 days prior to screening and during at least 28 days after treatment. Females on oral contraceptives must also use a barrier contraception method during participation in the study.
  • For males with a female partner of child-bearing age, willingness to delay conception for 28 days after treatment
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  • Willingness to comply with trial protocol
  • Willingness to undergo HIV testing
  • Willingness to abstain from sexual intercourse or use condoms for vaginal, anal and oral sex until end of trial visit
  • Willingness and ability to give written informed consent or be consented by a legal representative or provide assent and parental consent (for minors, as appropriate).

Who cannot join

  • Confirmed or suspected complicated or disseminated gonorrhoea
  • Pregnant or breastfeeding women
  • Known concomitant infection which would require immediate additional systemic antibiotics with activity against NG (e.g. CT infection)
  • Use of any systemic or intravaginal antibiotics with activity against NG within 30 days prior to screening
  • Use of systemic corticoid drugs or other immunosuppressive therapy within 30 days prior to screening
  • Use of moderate or strong CYP3A4 inducers (e.g. efavirenz, rifampicin, carbamazepine, phenobarbital) within 30 days or five half-lives of the drug, whichever is greater, prior to screening
Show all 19Show fewer
  • Cytotoxic or radiation therapy within 30 days prior to screening
  • Known chronic renal, hepatic, hematologic impairment or other condition interfering with the absorption, distribution or elimination of the drug based on medical history and physical examination
  • History of urogenital sex-reassignment surgery
  • Immunosuppression as evidenced by medical history, clinical examination or a recent (≤ 1 month) CD4 count <200 cells/μL
  • Know clinically relevant cardiac pro-arrhythmic conditions such as cardiac arrhythmia, congenital or documented QT prolongation
  • Known history of severe allergy to cephalosporin, penicillin, monobactams, carbapenems or macrolide antibiotics
  • Known or suspected allergies or hypersensitivities to lidocaine, methylparaben, lactose or any of the components of the study drugs (refer to the zoliflodacin IB and SmPC for the comparators treatments)
  • Receipt or planned receipt of an investigational product in a clinical trial within 30 days or five half-lives of the drug, whichever is greater, prior to screening until end of participation to this clinical trial
  • History of alcohol or drug abuse within 12 months prior to screening which would compromise trial participation in the judgment of the investigator
  • Severe medical or psychiatric condition which, in the opinion of the investigator, may increase the risk associated with trial participation or may interfere with the interpretation of trial results or affect the individual's ability to provide informed consent
  • Individuals whom, in the judgement of the investigator, are unlikely or unable to comply with this trial protocol
  • Previous randomisation in this clinical trial.
  • Use of moderate or strong CYP3A4 inhibitors within 30 days or five half-lives of the drug, whichever is greater, prior to screening

Trial locations and contacts

17 sites in 5 countries.

17 sites in 5 countries

United States6 sites
  • Jefferson County Department of Health

    Birmingham, Alabama, 35233

  • University of Alabama at Birmingham

    Birmingham, Alabama, 35294-0006

  • Bell Flower Clinic

    Indianapolis, Indiana, 46202

  • Louisiana State University Health Sciences Center

    New Orleans, Louisiana, 70112

  • San Francisco Department Of Public Health City Clinic

    San Francisco, California, 94103

  • Public Health - Seattle & King County STD Clinic

    Seattle, Washington, 98104

Other trials in United States

South Africa6 sites
  • SAMRC Botha's Hill Clinical Research Site

    Bothas Hill, 3660

  • Masiphumelele Research Site

    Cape Town, 7975

  • Ndlovu Research Centre

    Elandsdoorn, 0470

  • Wits RHI

    Johannesburg, 2001

  • Setshaba Research Centre

    Soshanguve, 0152

  • SAMRC Tongaat Clinical Research Site

    Tongaat, 4400

Other trials in South Africa

Thailand3 sites
  • Bangrak STI Center

    Bangkok, 10120

  • Institute of HIV Research and Innovation

    Bangkok, 10330

  • Silom Community Clinic

    Bangkok, 10400

Other trials in Thailand

Belgium1 site
  • Institute of Tropical Medicine

    Antwerp, 2000

Other trials in Belgium

Netherlands1 site
  • Public Health Service (GGD) Amsterdam / STI Outpatient Clinic

    Amsterdam, 1018 WT

Other trials in Netherlands

About this study

Official title: A Multi-center, Randomized, Open-label, Non Inferiority Trial to Evaluate the Efficacy and Safety of a Single, Oral Dose of Zoliflodacin Compared to a Combination of a Single Intramuscular Dose of Ceftriaxone and a Single Oral Dose of Azithromycin in the Treatment of Patients With Uncomplicated Gonorrhoea

This trial is a multi-center, open label, randomized controlled, non-inferiority phase III trial evaluating the safety and efficacy of a 3 g oral dose of zoliflodacin compared to a combination of a single intra-muscular 500 mg dose of ceftriaxone and a single 1 g oral dose of azithromycin for the treatment of uncomplicated gonorrhoea.

Conditions
Gonorrhea
Being tested
zoliflodacin, ceftriaxone, azithromycin
Medical subject headings
Gonorrhea

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • zoliflodacinDrug

    Dose: 3g, oral administration

  • ceftriaxoneDrug

    Dose: 500mg, Intra-Muscular (IM) administration

  • azithromycinDrug

    Dose: 1g, oral administration

Study groups in NCT03959527
Study groupRoleWhat they receive
zoliflodacinExperimentalParticipant in this arm will receive a single dose of zoliflodacin.
Receives: Drug: zoliflodacin
ceftriaxone and azithromycin combinationActive comparatorParticipant in this arm will receive a single dose of comparators combination (ceftriaxone and azithromycin).
Receives: Drug: ceftriaxone; Drug: azithromycin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Microbiological Cure Rate for Zoliflodacin Compared to a Combination of a Single Dose of Ceftriaxone and Azithromycin.

    Proportion of participants with microbiological cure as determined by culture at urethral or cervical sites at test of cure visit in micro-ITT (urogenital) analysis set

    Measured: Day 6 (+/- 2)

Secondary outcomes (34)
  1. Safety of a Single Dose of Zoliflodacin Will be Assessed Compared to a Combination a Single Dose of Ceftriaxone and Azithromycin.

    Incidence, severity, causality and seriousness of treatment-emergent adverse events (including clinically significant abnormal laboratory values/procedures i.e., physical examination per protocol)

    Measured: Day 30

  2. Microbiological Cure Rate of Pharyngeal Gonorrhoea of a Single Dose of Zoliflodacin Compared to a Single Dose of Ceftriaxone and Azithromycin.

    Proportion of participants with microbiological cure as determined by NG culture at pharyngeal sites at test of cure visit in micro-ITT (Pharyngeal).

    Measured: Day 6

  3. Microbiological Cure Rate of Rectal Gonorrhoea of a Single Dose of Zoliflodacin Compared to a Single Dose of Ceftriaxone and Azithromycin.

    Proportion of participants with microbiological cure as determined by NG culture at rectal sites at test of cure visit in micro-ITT (Rectal).

    Measured: Day 6

  4. The Clinical Cure Rate in Male Participants After Administration of a Single Dose of Zoliflodacin Compared to a Single Dose of Ceftriaxone and Azithromycin.

    Proportion of male at birth participants experiencing resolution of signs and symptoms of urogenital gonococcal infection that were present at enrolment, at test of cure visit in Clinical Cure Population.

    Measured: Day 6

  5. Microbiological Cure Rate Among Females, After Administration of a Single Dose of Zoliflodacin Compared to a Single Dose of Ceftriaxone and Azithromycin

    Proportion of female participants with microbiological cure, as determined by NG culture at cervical site of infection, at TOC in micro-ITT (Urogenital) population

    Measured: Day 6

  6. Microbiological Cure Rate Among Males, After Administration of a Single Dose of Zoliflodacin Compared to a Single Dose of Ceftriaxone and Azithromycin

    Proportion of male participants with microbiological cure as determined by NG culture at urethral site of infection at TOC visit, in micro-ITT population

    Measured: Day 6

  7. Eradication of Urogenital NG NAAT at TOC After Administration of a Single Dose of Zoliflodacin Compared to a Single Dose of Ceftriaxone and Azithromycin.

    Proportion of participants with a positive NG NAAT result from urethral or cervical sites at baseline and a negative NG NAAT result at test of cure visit in micro-ITT analysis set.

    Measured: Day 6

  8. Eradication of Pharyngeal NG NAAT at TOC After Administration of a Single Dose of Zoliflodacin Compared to a Single Dose of Ceftriaxone and Azithromycin.

    Proportion of participants with a positive NG NAAT at baseline from pharyngeal sites and a negative NG NAAT at test of cure visit in micro-ITT analysis set.

    Measured: Day 6

  9. Eradication of Rectal NG NAAT at TOC After Administration of a Single Dose of Zoliflodacin Compared to a Single Dose of Ceftriaxone and Azithromycin.

    Proportion of participants with a positive NG NAAT from rectal sites at baseline and a negative NG NAAT at test of cure visit in micro-ITT analysis set.

    Measured: Day 6

  10. Arithmetic Mean Plasma Concentration of Zoliflodacin

    Arithmetic mean plasma concentration (ng/mL) of zoliflodacin following oral administration of single oral dose of zoliflodacin 3 g

    Measured: 15 min - 1 hour

  11. Arithmetic Mean Plasma Concentration of Zoliflodacin

    Arithmetic mean plasma concentration (ng/mL) of zoliflodacin following a single oral dose administration of zoliflodacin 3 g

    Measured: 2-2.5 h

  12. Arithmetic Mean Plasma Concentration of Zoliflodacin

    Arithmetic mean plasma concentration (ng/mL) of zoliflodacin following administration of a single oral dose of zoliflodacin 3 g

    Measured: 4.5 - 5h

  13. Arithmetic Mean Plasma Concentration of Zoliflodacin

    Arithmetic mean plasma concentration (ng/mL) of zoliflodacin following administration of a single oral dose zoliflodacin 3 g

    Measured: 10 -12 h

  14. Arithmetic Mean Plasma Concentration of Zoliflodacin

    Arithmetic mean plasma concentration (ng/mL) of zoliflodacin following administration of a single oral dose of zoliflodacin 3 g

    Measured: 24 - 36 h

  15. Evaluation of the Plasma PK Profile (Tlast) After a Single, Oral, 3 g Dose of Zoliflodacin

    Geometric mean time to last (Tlast) plasma concentration above the lower limit of quantitation

    Measured: Day 2

  16. Evaluation of the Plasma PK Profile(Tmax) After a Single, Oral, 3 g Dose of Zoliflodacin

    Geometric mean time to maximum plasma concentration (Tmax) after a single, oral, 3 g dose of zoliflodacin

    Measured: Day 2

  17. Evaluation of the Plasma PK Profile (Cmax) After a Single, Oral, 3 g Dose of Zoliflodacin

    Geometric mean maximum plasma concentration (Cmax) after a single, oral 3 g dose of zoliflodacin

    Measured: Day 2

  18. Evaluation of the Plasma PK Profile After a Single, Oral, 3 g Dose of Zoliflodacin

    Geometric mean plasma area under the concentration-time curve (AUC0-last) from time zero to the last concentration above lower level of quantification

    Measured: Day 2

  19. Antimicrobial Susceptibility (Azithromycin) Profile of NG Isolates Obtained at Baseline (Day 1)

    Antimicrobial susceptibility to azithromycin (MIC90) - profile of gonococcal strains isolated from urogenital site at baseline (Day 1)

    Measured: Day 1

  20. Antimicrobial Susceptibility (Azithromycin) Profile of NG Isolates Obtained at Test of Cure Visit.

    Antimicrobial susceptibility to azithromycin (MIC90) - profile of gonococcal strains isolated from urogenital site at TOC

    Measured: Day 6

  21. Antimicrobial Susceptibility (Cefixime) Profile of NG Isolates Obtained at Baseline

    Antimicrobial susceptibility to cefixime (MIC90) - profile of gonococcal strains isolated from urogenital site at baseline

    Measured: Day 1

  22. Antimicrobial Susceptibility (Cefixime) Profile of NG Isolates Obtained at Test of Cure Visit.

    Antimicrobial susceptibility to cefixime (MIC90) - profile of gonococcal strains isolated from urogenital site at TOC

    Measured: Day 6

  23. Antimicrobial Susceptibility (Ceftriaxone) Profile of NG Isolates Obtained at Baseline

    Antimicrobial susceptibility to ceftriaxone (MIC90) - profile of gonococcal strains isolated from urogenital site at baseline

    Measured: Day 1

  24. Antimicrobial Susceptibility (Ceftriaxone) Profile of NG Isolates Obtained at Test of Cure Visit.

    Antimicrobial susceptibility to ceftriaxone (MIC90) - profile of gonococcal strains isolated from urogenital site at TOC

    Measured: Day 6

  25. Antimicrobial Susceptibility (Ciprofloxacin) Profile of NG Isolates Obtained at Baseline

    Antimicrobial susceptibility to ciprofloxacin (MIC90) - profile of gonococcal strains isolated from urogenital site at baseline (zoliflodacin arm only since no microbiological failures in comparator arm)

    Measured: Day 1

  26. Antimicrobial Susceptibility (Ciprofloxacin) Profile of NG Isolates Obtained at Test of Cure Visit

    Antimicrobial susceptibility to azithromycin (MIC90) - profile of gonococcal strains isolated from urogenital site at TOC

    Measured: Day 6

  27. Antimicrobial Susceptibility (Gentamicin) Profile of NG Isolates Obtained at Baseline

    Antimicrobial susceptibility to gentamicin (MIC90) - profile of gonococcal strains isolated from urogenital site at baseline

    Measured: Day 1

  28. Antimicrobial Susceptibility (Gentamicin) Profile of NG Isolates Obtained at Test of Cure Visit.

    Antimicrobial susceptibility to gentamicin (MIC90) - profile of gonococcal strains isolated from urogenital site at TOC

    Measured: Day 6

  29. Antimicrobial Susceptibility (Spectinomycin) Profile of NG Isolates Obtained at Baseline

    Antimicrobial susceptibility to spectinomycin (MIC90) - profile of gonococcal strains isolated from urogenital site at baseline

    Measured: Day 1

  30. Antimicrobial Susceptibility (Spectinomycin) Profile of NG Isolates Obtained at Test of Cure Visit

    Antimicrobial susceptibility to spectinomycin (MIC90) - profile of gonococcal strains isolated from urogenital site at TOC

    Measured: Day 6

  31. Antimicrobial Susceptibility (Tetracycline) Profile of NG Isolates Obtained at Baseline

    Antimicrobial susceptibility to tetracycline (MIC90) - profile of gonococcal strains isolated from urogenital site at baseline

    Measured: Day 1

  32. Antimicrobial Susceptibility (Tetracycline) Profile of NG Isolates Obtained at Test of Cure Visit

    Antimicrobial susceptibility to tetracycline (MIC90) - profile of gonococcal strains isolated from urogenital site at TOC

    Measured: Day 6

  33. Antimicrobial Susceptibility (Zoliflodacin) Profile of NG Isolates Obtained at Baseline

    Antimicrobial susceptibility to zolflodacin (MIC90) - profile of gonococcal strains isolated from urogenital site at baseline

    Measured: Day 1

  34. Antimicrobial Susceptibility (Zoliflodacin) Profile of NG Isolates Obtained at Test of Cure Visit

    Antimicrobial susceptibility to zoliflodacin (MIC90) - profile of gonococcal strains isolated from urogenital site at TOC

    Measured: Day 6

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 May 2019
  2. Study start6 Nov 2019
  3. Primary completion30 Aug 2023
  4. Study completion18 Sep 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Single dose of Zoliflodacin or comparators combination in single dose: ceftriaxone and azithromycin
Masking
None (open label)
Enrolment
1,011 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03959527
Sponsor's protocol ID
STI_Zoli001
Other IDs
2019-000990-22, 2019
Status last verified
Sep 2025
First submitted
2 May 2019
Last updated
8 Oct 2025
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Luckey A, Balasegaram M, Barbee LA, Batteiger TA, Broadhurst H, Cohen SE, Delany-Moretlwe S, de Vries HJC, Dionne JA, Gill K, Kenyon C, Kittiyaowamarn R, Lewis D, Mueller JP, Naicker V, O'Brien S, O'Donnell JP, Phanuphak N, Spooner E, Srinivasan S, Taylor SN, Unemo M, Zwane Z, Hook EW 3rd; Zoliflodacin Phase 3 Study Group. Zoliflodacin versus ceftriaxone plus azithromycin for treatment of uncomplicated urogenital gonorrhoea: an international, randomised, controlled, open-label, phase 3, non-inferiority clinical trial. Lancet. 2026 Jan 10;407(10524):147-160. doi: 10.1016/S0140-6736(25)01953-1. Epub 2025 Dec 11.

    PubMed 41391465
  • Jacobsson S, Golparian D, Oxelbark J, Kong FYS, Da Costa RMA, Franceschi F, Brown D, Louie A, Drusano G, Unemo M. Pharmacodynamics of zoliflodacin plus doxycycline combination therapy against Neisseria gonorrhoeae in a gonococcal hollow-fiber infection model. Front Pharmacol. 2023 Dec 7;14:1291885. doi: 10.3389/fphar.2023.1291885. eCollection 2023.

    PubMed 38130409

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing zoliflodacin, ceftriaxone and azithromycin in people with Gonorrhea, run by Global Antibiotics Research and Development Partnership at 17 sites in 5 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 19 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 8 Oct 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 17 sites in United States, South Africa, Thailand, Belgium, Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 26 Jul 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Microbiological Cure Rate for Zoliflodacin Compared to a Combination of a Single Dose of Ceftriaxone and Azithromycin. (time frame: Day 6 (+/- 2)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03959527, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Oct 2025.

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