COMMUNICABLE DISEASE 
CONTROL BRANCH
- Attention all doctors - 
Date: 17/05/2016     Contact telephone number: 1300 232 272  (24 hours/7 days)

 

Antimicrobial resistance and clinical management of genital gonococcal infection

Thirty percent of Neisseria gonorrhoeae strains from South Australia in the first quarter of 2016 had reduced susceptibility to azithromycin, compared to 0.9% to 3.9% for other states.  All strains remained fully susceptible to ceftriaxone.

Azithromycin is not a first line drug for treatment of gonorrhoea; it should only be used for patients allergic to cephalosporins or with severe penicillin allergy i.e. anaphylaxis/angioedema/urticaria.

Diagnosis
Diagnosis of gonorrhoea is best achieved by collection of a genital swab for culture, and this specimen should always be collected in symptomatic patients. Only 32.4% (94/290) of cases of gonorrhoea reported to SA Health in the first quarter of 2016 were diagnosed by culture.

Nucleic Acid Amplification Tests (NAAT) do not provide any information on antibiotic susceptibility, and are most valuable in localities with long transport delays to laboratory facilities.

Management
Doctors are reminded that the first line therapy for gonorrhoea in South Australia is
· Ceftriaxone 500 mg dissolved in 2 mL of 1% lignocaine solution, and administered by deep intra-gluteal injection as a single dose.
· The use of ceftriaxone is especially important for any patient treated presumptively for gonorrhoea while awaiting culture results, or
   those who are only tested by NAAT.
· Azithromycin and other alternative treatments including oral cephalosporins are not recommended.
· Treatment for chlamydia may be given at the same time as treatment for gonorrhoea if chlamydial infection is present or has not been
   ruled out. In the last 5 years, coinfection with chlamydia occurred in 20% of gonococcal infections in South
Australia.

All patients should have a Test of Cure by collection of a swab for culture from all infected sites one week after completing treatment. NAAT testing is not appropriate for Test of Cure, as it may remain positive for some time after successful treatment.

Remember that only a small proportion of penicillin allergic patients will be allergic to a cephalosporin. Patients should be referred to Clinic275 for treatment if the patient is allergic to cephalosporins or has severe penicillin allergy.

There is a link to South Australian STI treatment guidelines at the Clinic275 website http://www.sahealth.sa.gov.au/clinic275/.
 

Dr Ann Koehler - Director, Communicable Disease Control Branch
For all enquiries please contact the CDCB on 1300 232 272 (24 hours / 7 days)
Public – I4-A1

Download the official health alert here (PDF)
 

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