The emergence of a clonal group of gonococci showing decreased susceptibility to cefixime in England and Wales highlights the need for continued surveillance.

No abstract

cefixime, ceftriaxone, azithromycin, ciprofloxacin and penicillin were defined according to EUCAST 4.0 standards. Results Of 2115 isolates, 91.6% of isolates were from men. The most frequently tested materials among men were urethral (92.4%) and rectal swabs (3.8%), and among women mainly endocervical swabs (80.9%). Resistance to ceftriaxone (MIC !0.125 mg/L) occurred only sporadically (0-0.3%) during the entire observation period (2015 and 2018), while 1.0-2.1% of isolates were resistant to cefixime (MIC !0.125 mg/ L). Proportion of isolates resistant to azithromycin (MIC ! 0.5 mg/L) was 11.4% (2014), 11.3% (2015), 4.3% (2016), 3.7% (2017), 9.4% (2018). 53.4-71.7% were resistant to ciprofloxacin, and 14.2-24.3.1% were resistant to penicillin. Conclusion Resistance to ceftriaxone and to cefixime was low, whereas azithromycin resistance showed a discontinuous presentation with partly high levels during the observation period. Rates of ciprofloxacin and penicillin resistance were very high. According to the current national guidelines, ceftriaxone 1-2g IV and azithromycin 1,5g orally are usually used in dual therapy. Shortly revised national guidelines will state that use of azithromycin should be avoided if possible if a test of cure can be guaranteed and a susceptibility test is available. Continued surveillance of NG AMR remains relevant to ensure efficient disease management. Disclosure No significant relationships.

ObjectivesOnline testing for STIs may help overcome barriers of traditional face-to-face testing, such as stigma and inconvenience. However, regulation of these online tests is lacking, and the quality of services is variable, with potential short-term and long-term personal, clinical and public health implications. This study aimed to evaluate online self-testing and self-sampling service providers in the UK against national standards.MethodsProviders of online STI tests (self-sampling and self-testing) in the UK were identified by an internet search of Google and Amazon (June 2020). Website information on tests and associated services was collected and further information was requested from providers via an online survey, sent twice (July 2020, April 2021). The information obtained was compared with British Association for Sexual Health and HIV and Faculty of Sexual and Reproductive Healthcare guidelines and standards for diagnostics and STI management.Results31 providers were identified: 13 self-test, 18 self-sample and 2 laboratories that serviced multiple providers. Seven responded to the online survey. Many conflicts with national guidelines were identified, including: lack of health promotion information, lack of sexual history taking, use of tests licensed for professional-use only marketed for self-testing, inappropriate infections tested for, incorrect specimen type used and lack of advice for postdiagnosis management.ConclusionsVery few online providers met the national STI management standards assessed, and there is concern that this will also be the case for service provision aspects that were not covered by this study. For-profit providers were the least compliant, with concerning implications for patient care and public health. Regulatory change is urgently needed to ensure that all online providers are compliant with national guidelines to ensure high-quality patient care, and providers are held to account if non-compliant.