Gonorrhoea (The Clap )Treatment resistance risk falls but new diagnoses rise

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Gonorrhoea is a sexually transmitted infection (STI) caused by bacteria called Neisseria gonorrhoeae or gonococcus. It used to be known as “the clap”.

Latest Health Protection Agency (HPA) surveillance figures – released today at the Health Protection 2012 conference – indicate that, for the first time in five years, the risk of resistance developing in currently recommended gonorrhoea treatments fell slightly in 2011.

However, experts urge continued vigilance as new diagnoses of gonorrhoea rose 25 per cent in the same year, to nearly 21,000 cases, as reported by the HPA in May 2012. Today’s findings remain a cause of concern as, of the gonorrhoea diagnoses looked at, nearly one third were repeat cases and one third were diagnosed alongside another sexually transmitted infection (STI).

Encouragingly, following the publication of new prescribing guidelines in 2011, the surveillance found broad adherence by GUM clinics. As recommended by the British Association of Sexual Health and HIV (BASHH), nearly all patients (93 per cent) received ceftriaxone first-line treatment, up 53 per cent from 2010.

Professor Cathy Ison, leading the HPA gonorrhoea resistance surveillance programme, said: “We were pleased to see such a rapid change in prescribing practice and are cautiously optimistic about what the 2011 surveillance data show. Ensuring resistant strains do not persist and spread remains a major public health concern. It is more important than ever we diagnose gonorrhoea promptly, adhere to treatment guidelines and identify and manage any cases of potential treatment failure effectively. If not, the threat of untreatable gonorrhoea in the future is very real.”

Laboratory testing of the two first-line antimicrobial treatments showed the drift towards potential ceftriaxone treatment resistance seen over previous years had reversed, and azithromycin resistance had stayed steady (0.5 per cent).

Testing cefixime, the second in the line of defence, also showed a decline in resistance risk for the first time since 2007.  For all three antibiotics the risk of a potentially resistant infection with was higher (or most apparent) among MSM.

Dr Gwenda Hughes, head of STI surveillance at the HPA, said: “The 25 per cent increase in new gonorrhoea diagnoses in 2011, plus high rates of repeat infection and co-infection with other STIs, shows more must be done to encourage safer sexual behaviour through health promotion and ensuring easy access to sexual health services and screening.”

To combat the continuing high rates of STI transmission in England, and the growing risk of gonorrhoea treatment resistance it is essential to always use a condom when having sex with casual and new partners, and to get tested regularly if you are in one of the highest risk groups (e.g. young adults or men who have sex with men). Getting screened for HIV / STIs can lead to early identification and treatment, as often these infections have no symptoms. In addition, reducing the number of sexual partners and avoiding overlapping sexual relationships can reduce the risk of being infected with an STI.


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