{"id":1210,"date":"2016-10-13T15:41:38","date_gmt":"2016-10-13T14:41:38","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1210"},"modified":"2016-10-13T15:41:38","modified_gmt":"2016-10-13T14:41:38","slug":"fresh-who-guidelines-on-gonorrhoea-management-latest-us-surveillance-data-on-gonorrhoea-resistance","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2016\/10\/13\/fresh-who-guidelines-on-gonorrhoea-management-latest-us-surveillance-data-on-gonorrhoea-resistance\/","title":{"rendered":"Fresh WHO guidelines on gonorrhoea management + latest US surveillance data on gonorrhoea resistance"},"content":{"rendered":"<p>The emergence in various locations of resistant strains of Neisseria gonorrhoeae (Ng) is narrowing the therapeutic options. The recent (July 2016) <a href=\"http:\/\/www.who.int\/reproductivehealth\/publications\/rtis\/gonorrhoea-treatment-guidelines\/en\/\">WHO Guidelines<\/a>, revised from 2003, reflect the concern both to treat effectively and steward our remaining defences against the infection in a globally coordinated manner.\u00a0 They recommend either <strong>dual <\/strong>therapy with either <strong>single dose 250g intra-muscular ceftriaxone<\/strong> or <strong>400g oral cefixime<\/strong> combined <strong>with 1g oral azithromycin<\/strong> (preferred options), or else <strong>single<\/strong> therapy with either <strong>ceftriaxone<\/strong>, <strong>cefixime <\/strong>or <strong>2g spectinomycin<\/strong>).\u00a0 The choice between these options will depend on local considerations, including Ng susceptibility data. \u00a0\u00a0In the event of treatment failure following WHO-recommended dual therapy, they recommend any of: <strong>500mg ceftraxone<\/strong>, <strong>800mg cefixime<\/strong>, <strong>240mg gentamicin<\/strong>, or <strong>2g spectinomycin, <\/strong>each of them in combination with <strong>2g azithromycin<\/strong>.<\/p>\n<p>Reported surveillance data for a given location will be crucially important, then, for determining at local level the best options for treatment.\u00a0 Given the global dimension of the threat, however, this data may also be potential evidence for global trends.\u00a0 Hence the wider interest of the latest (2014) <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/65\/ss\/ss6507a1.htm?s_cid=ss6507_w\">US surveillance data<\/a> from the Gonococcal Isolate Surveillance Project (GISP)). \u00a0Hitherto, the US picture (as in the UK) has been one of steady progression (2006-2011) in prevalence of Ng isolates exhibiting reduced susceptibility (cefixime: MIC \u22650.25 \u03bcg\/mL; ceftriaxone: MIC \u22650.125 \u03bcg\/mL), interrupted by a decline in 2013; this is the pattern both for cefixime (<strong>0.1<\/strong>%-<strong>1.4<\/strong>%-<strong>0.4<\/strong>%) and ceftriaxone (<strong>0.1<\/strong>%-<strong>0.4<\/strong>%-<strong>0.1<\/strong>%) (see also <a href=\"http:\/\/sti.bmj.com\/content\/89\/Suppl_4\/iv5.abstract\">Kirkcaldy &amp; Bolan (STIs)<\/a>).<\/p>\n<p>So where do the latest (2014) data point? As regards cefixime, to a return to the pre-2013 upward trend, it seems, with prevalence rising once again from <strong>0.4<\/strong>% to <strong>0.8<\/strong>%; with ceftriaxone, to the maintenance of the 2013 prevalence level (<strong>0.1<\/strong>%).\u00a0 Presumably, it is the prevalence levels of ceftriaxone that, in the US, constitute the primary focus of concern \u2013 since, as in the UK, that is the drug currently recommended, along with azithromycin, for dual therapy.\u00a0 (See \u00a0<a href=\"http:\/\/sti.bmj.com\/content\/early\/2016\/07\/05\/sextrans-2016-052583.abstract?sid=74214ce6-489c-46c2-8412-30bb4fd10214\">Town &amp; Hughes (STI)<\/a> for\u00a0 an equivalent report of ceftriaxone resistance in the UK).\u00a0 But the greatest surprise of the 2016 GISP report is the sudden rise of decreased susceptibility to azithromycin: from <strong>0.6<\/strong>% prevalence of reduced resistance strains (MIC \u22652.0 \u03bcg\/mL) in 2013 to <strong>2.5<\/strong>% in 2014.\u00a0 The report comments that the recommended dual therapy with azithromycin is unlikely to be a contributor to this trend \u2013 though it is possible, they argue, that the small increase in the azithromycin monotherapy by US STD clinics over the last decade could have had some influence on the prevalence of azithromycin resistant strains.\u00a0 There is evidence of high or rising levels of azithromycin resistance in other locations (<a href=\"http:\/\/sti.bmj.com\/content\/89\/Suppl_4\/iv36.abstract\">Dillon &amp; Thakur (STIs)<\/a>; <a href=\"http:\/\/sti.bmj.com\/content\/89\/Suppl_4\/iv28.abstract\">Bala &amp; Ramesh (STIs)<\/a>), including, recently, the UK (<a href=\"http:\/\/sti.bmj.com\/content\/92\/5\/365.abstract?sid=02c15b96-7151-4ef7-8f9f-de58f27e5a68\">Chisholm &amp; Fifer\/STIs<\/a>).<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The emergence in various locations of resistant strains of Neisseria gonorrhoeae (Ng) is narrowing the therapeutic options. The recent (July 2016) WHO Guidelines, revised from 2003, reflect the concern both to treat effectively and steward our remaining defences against the infection in a globally coordinated manner.\u00a0 They recommend either dual therapy with either single dose [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2016\/10\/13\/fresh-who-guidelines-on-gonorrhoea-management-latest-us-surveillance-data-on-gonorrhoea-resistance\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4353,2103,264,4389,1694],"tags":[],"class_list":["post-1210","post","type-post","status-publish","format-standard","hentry","category-antimicrobial-resistance","category-gonorrhoea","category-health-policy","category-resistance","category-sti-prevention-and-surveillance"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Fresh WHO guidelines on gonorrhoea management + latest US surveillance data on gonorrhoea resistance - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2016\/10\/13\/fresh-who-guidelines-on-gonorrhoea-management-latest-us-surveillance-data-on-gonorrhoea-resistance\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Fresh WHO guidelines on gonorrhoea management + latest US surveillance data on gonorrhoea resistance - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"The emergence in various locations of resistant strains of Neisseria gonorrhoeae (Ng) is narrowing the therapeutic options. 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