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Addressing Antimicrobial Resistant Gonorrhea

Increased action is needed to prevent and control gonorrhea, as worldwide antimicrobial resistance poses a significant public health threat. This article highlights the key issues surrounding gonococcal infections, including resistance to existing drug therapies. It provides information on diagnosis, treatment, follow-up, and reporting strategies to effectively manage the spread of antimicrobial resistant gonorrhea.

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Addressing Antimicrobial Resistant Gonorrhea

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  1. INTRODUCTION • Increased action is needed to help prevent and control gonorrhea. Worldwide antimicrobial resistance is an emerging public health threat.

  2. KEY ISSUES Gonococcal infections have been resistant to existing drug therapies Reported cases of gonococcal infection in Canada have increased since 1997 Progressive resistance to penicillin, tetracycline &quinolones. Decreased susceptibility to third generation oral & injectable cephalosporins * Men Who Have Sex With Men Resistance to cephalosporins particularly observed among MSM*

  3. DIAGNOSIS Depending on clinical situation, consider collecting both cultures and NAAT especially in symptomatic patients

  4. TREATMENT • Patients should be treated with combination therapy (two antibiotics) • For MSM, the preferred therapy for uncomplicated anogenital and pharyngeal infection is: • ceftriaxone 250 mg IM PLUS azithromycin 1 g oral Monotherapy should be avoided in order to help prevent resistance • For other adults and youth (≥ 9 years), the preferred therapy for uncomplicated anogenital and pharyngeal infection is: • ceftriaxone 250 mg IM PLUS azithromycin 1 g oral • For uncomplicated anogenital infection only: • cefixime 800 mg oral PLUS azithromycin 1 g oral • (not appropriate for pharyngeal infections) The above based on Public Health Agency of Canada’s Canadian STI Guidelines: http://www.phac-aspc.gc.ca/std-mts/sti-its/cgsti-ldcits/section-5-6-eng.php

  5. FOLLOW-UP Test of Cure Post-Treatment 3-7 days later  Culture 2-3 Weeks later  NAAT All sexual partners within 60 days prior to symptom onset should be notified, tested and empirically treated Repeat screening for individuals with a gonococcal infection is recommended 6 months post-treatment

  6. REPORTING • TREATMENT FAILURE is defined as one of the following in the absence of reported sexual contact during post-treatment period: • Cases of gonorrhea must be reported to public health officials • Treatment failures should also be reported • Positive N. gonorrhoeae on culture taken at least 72 hrs. after treatment Positive NAAT taken at least 2-3 weeks after treatment Presence of intracellular Gram-negative diplococci on microscopy taken at least 72 hrs. after treatment

  7. CONCLUSION To successfully address the public health risk of antimicrobial resistant gonorrhea, all primary care and public health professionals must work together.

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