UK national guideline for the management of gonorrhoea in adults, 2011

Abstract

The British Association for Sexual Health and HIV (BASHH) UK gonorrhoea guideline has been updated in 2011. It offers advice on diagnosis, treatment and health promotion for anogenital and pharyngeal gonorrhoea. Nucleic acid amplification tests (NAATs) are now being used more for diagnosis and are increasing detection rates in the pharynx and rectum. First line treatment using ceftriaxone with azithromycin is now advised, along with routine test of cure (TOC). The aim is to slow the spread of resistant gonorrhoea now that fewer antibiotics remain effective. A patient information leaflet has been developed.

Surveillance of antibiotic resistance

“…In some instances, detection of rapid changes in resistance of pathogens to critical antibiotics has resulted in rapid changes to national treatment guidelines, a key example being the change in the national guidance for the treatment of gonorrhoea from ciprofloxacin to either oral cefixime or intra-muscular ceftriaxone following a marked increase in ciprofloxacin resistance in gonococci [77,78]. Following reports of isolation of gonococci with reduced susceptibility to cefixime and ceftriaxone, the guidelines were subsequently further amended, with a recommendation to use a higher dose of ceftriaxone combined with azithromycin [79].…”

En mann i 30-årene med utflod og dysuri

“…[56][57][58][59][60]71,72 This correlates with the pharmacokinetic properties of the individual antimicrobials. Treatment with spectinomycin has poor efficacy at eradicating pharyngeal gonorrhoea.…”

“…40,[56][57][58][59][60] The safety of azithromycin in pregnancy has not been confirmed but clinical experience indicates that it may be safely used. It should only be used under medical supervision if the expected benefit to the mother is thought to be greater than the possible risk to the foetus.…”

Strengthening Global Surveillance for Antimicrobial-ResistantNeisseria gonorrhoeaethrough the Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP)

“…High levels of resistance to quinolones (e.g., ciprofloxacin) developed by the mid2000s; the US Centers for Disease Control and Prevention (CDC) removed these drugs from recommended treatment regimens for gonorrhea in 2007 (4). Public health agencies in most countries and the World Health Organization (WHO) recommend treating gonorrhea with ceftriaxone in combination with azithromycin in an attempt to slow simultaneous emergence of AMR to 2 unrelated compounds (5)(6)(7)(8)(9). However, recent reports suggest that this combination is becoming less effective in treating gonorrhea (10,11).…”

“…Though the methodologies of each surveillance system differ, all 3 surveillance programs analyze and disseminate susceptibility trend data similar to GISP (16)(17)(18). Data from each of these countries have also been used to inform local treatment guidelines (7)(8)(9).…”