Revision of treatment guidelines for uncomplicated Gonorrhoea

The treatment of Gonorrhoea has long been complicated by the ability of N. gonorrhoeae to develop resistance to antimicrobials. A number of factors indicate that it is time to revise the South Australian treatment guidelines.

• The proportion of isolates demonstrating decreased susceptibility to ceftriaxone has remained low from 2000-2008. However in 2010 SA Pathology reported 13% of isolates had decreased susceptibility to Ceftriaxone compared to 5.3% in 2009.
• At Clinic 275, 12% of heterosexual men and 13.4% of men who have sex with men who are infected with N. gonorrhoeae are also co-infected with C. trachomatis.
• There have been a few instances of treatment failure in pharyngeal infection at Clinic 275 and limited data suggest that dual treatment with azithromycin might enhance treatment efficacy for pharyngeal gonococcal infection.
• The 250 mg vial of ceftriaxone is no longer available.

Management of uncomplicated urethral, endocervical, anal and pharyngeal gonorrhoea

Antimicrobial therapy

Ceftriaxone 500mg intramuscular injection in a single dose
plus Azithromycin 1g oral stat dose.

Antimicrobial therapy in patients with B-lactam allergy

Data are limited regarding alternative regimens for treating gonorrhoea among persons who have severe cephalosporin allergy. The treating Doctor should consult an infectious disease or sexual health specialist.

Followup

Sex partners should be offered testing and treatment and after the infection is notified to Communicable Disease Control Branch (CDCB), Clinic 275 staff will contact the patient to assist with partner notification.

A test of cure using culture techniques is not performed routinely but is recommended in the following situations.

• if symptoms persist or recur after initial improvement
• re exposure to an infected partner
• pharyngeal infection

Clinicians who suspect ceftriaxone treatment failure in N. gonorrhoeae infection should repeat culture and susceptibility testing of relevant clinical specimens and consult a specialist for guidance in clinical management.

Advice to patients

Patients should be:

• advised that the infection is notifiable and a Clinic 275 staff member will contact them regarding evaluation of partners
• instructed to refer their sex partners for evaluation and treatment
• instructed to return one week after treatment for clinical assessment
• instructed to abstain from sexual intercourse for one week after treatment.