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Delaware Health Alert Network #277

September 6, 2012 9:50 am


Health Alert
ANNOUNCEMENT OF CHANGES TO GONORRHEA TREATMENT GUIDELINES

The Delaware Division of Public Health wishes to alert the medical community of clarifications to CDC recommendations for the treatment of Gonorrhea.

On August 10, 2012 the Centers for Disease Control and Prevention (CDC) published weekly MMWR # 61.  "Update to CDC’s Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections"

This notice clarifies when and how a test of cure is performed.

According to the updated guidelines, when an ALTERNATIVE REGIME of treatment is prescribed (see below), a test-of-cure should be obtained in 1 week. According to published information from the CDC, the test of cure can be performed with a culture OR with a NAAT for N. gonorrhoeae.  If the repeat NAAT is positive,  indicating a treatment failure, every effort should be made to perform a confirmatory culture.

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 (This can be done by culture OR NAAT {Nucleic Acid Amplification test})

If the patient has severe cephalosporin allergy:

Azithromycin 2 g in a single oral dose

PLUS

Test-of-cure in 1 week (This can be done by culture OR NAAT {Nucleic Acid Amplification test})

It is important to note that there has been no evidence of Cefixime resistance in the United States thus far, but from 2006 to 2010, the minimum concentrations of Cefixime needed to inhibit the growth in vitro of N. gonorrhoeae strains in the United States and many other countries increased, suggesting Cefixime may be becoming less effective. In addition, CDC reports that recent reports from Europe have described patients with uncomplicated gonorrhea infection not cured by treatment with Cefixime 400 mg orally.

In preparation for the possibility of Cefixime resistance in the United States the CDC has made bold moves over the past 2 years to combat gonorrhea. The first was to recommend dual therapy for the treatment of both gonorrhea and chlamydia in 2010 and now to recommend that Cefixime no longer be considered first line treatment for the disease unless there is no other choice.

Report suspected treatment failure. Treatment failure should be reported to the Division of Public Health, STD 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 STD 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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