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Delaware Health Alert Network #273

August 17, 2012 8:13 am


Health Alert
ANNOUNCEMENT OF CHANGES TO GONORRHEA TREATMENT GUIDELINES

The Delaware Division of Public Health (DPH) wishes to alert the medical community of changes in recommendations for the treatment of gonorrhea.

The CDC continues to see concerning patterns of decreased susceptibility to cephalosporins in the treatment of gonorrhea. On August 10, 2012 the Centers for Disease Control and Prevention (CDC) published its weekly MMWR August 10, 2012 / Vol. 61, “Update to CDC’s Sexually Transmitted Diseases Treatment Guidelines, 2010” which stated oral cephalosporins are no longer a recommended treatment for gonococcal infections.

Data from CDC’s Gonococcal Isolate Surveillance Project (GISP), described laboratory evidence of declining cefixime susceptibility among urethral N. gonorrhea isolates collected in the United States during 2006–2011.


Updated Recommended Treatment Regimens for Gonococcal Infections

Uncomplicated gonococcal infections of the cervix, urethra, and rectum

Recommended regimen

Ceftriaxone 250 mg in a single intramuscular dose

PLUS

Azithromycin 1 g orally in a single dose

 or doxycycline 100 mg orally twice daily for 7 days*

Alternative regimens

If ceftriaxone is not available:

Cefixime 400 mg in a single oral dose

PLUS

Azithromycin 1 g orally in a single dose

 or doxycycline 100 mg orally twice daily for 7 days*

PLUS

Test-of-cure in 1 week (can only be tested by gonorrhea culture, not nucleic acid amplification test {NAAT})

If the patient has severe cephalosporin allergy:

Azithromycin 2 g in a single oral dose

PLUS

Test-of-cure in 1 week (can only be tested by gonorrhea culture, not nucleic acid amplification test {NAAT})

Uncomplicated gonococcal infections of the pharynx

Recommended regimen

Ceftriaxone 250 mg in a single intramuscular dose

PLUS

Azithromycin 1 g orally in a single dose

 or doxycycline 100 mg orally twice daily for 7 days*

Health care providers need to be aware of the potential for future resistance and take these important steps to ensure successful treatment outcomes for their patients:

  1. Treat promptly: health-care providers should use dual-therapy, ceftriaxone and azithromycin for the treatment of uncomplicated gonorrhea.
  2. Culture: if a patient has suspected or documented treatment failure obtain an isolate to test for susceptibility. 
  3. Report suspected treatment failure: to the DPH Sexually Transmitted Disease Program by FAX at 302-857-5086.

* Because of the high prevalence of tetracycline resistance among Gonococcal Isolate Surveillance Project isolates, particularly those with elevated minimum inhibitory concentrations to cefixime, the use of azithromycin as the second antimicrobial is preferred.

For additional information about this or any other STDs or to report a case, call the DPH Sexually Transmitted Disease Program at 302-744-1050 or visit our web page @ http://dhss.delaware.gov/dph/dpc/stds.html

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