HEALTH ADVISORY # 337

 COUNTY OF ERIE

MARK POLONCARZ

COUNTY EXECUTIVE

GALE R. BURSTEIN, MD, MPH, FAAP                                                          DEPARTMENT OF HEALTH

COMMISSIONER OF HEALTH

                          

HEALTH ADVISORY # 337                                                                        February 11, 2016

Updated Neisseria gonorrhoeae Treatment Guidelines

Please distribute to Healthcare Providers, Infection Control Department, Emergency Department, Infectious Disease Department, OB/GYN, Family Medicine, Pediatrics, Director of Nursing, Medical Director, Laboratory Service, Pharmacy, and all patient care areas.

SUMMARY 

  • The Centers for Disease Control and Prevention (CDC) has released their 2015 Sexually Transmitted Disease (STD) Treatment Guidelines.  The complete Guideline is located at: http://www.cdc.gov/std/tg2015/default.htm
  • The CDC no longer recommends doxycycline as treatment for gonococcal infections.
  • CDC now recommends combination therapy with ceftriaxone 250 mg in a single dose intramuscularly PLUS azithromycin 1g orally in a single dose for uncomplicated gonococcal infections of the cervix, urethra, rectum, and pharynx.
  • Dual treatment with ceftriaxone and azithromycin should be given together on the same day, preferably simultaneously and under direct observation.
  • If ceftriaxone is not available, treat with cefixime 400 mg orally in a single dose PLUS azithromycin 1 g orally in a single dose for gonococcal infections.
  • Patients with a severe cephalosporin allergy can be treated with either: 1) gentamicin 240 mg intramuscularly in a single dose PLUS azithromycin 2 g orally in a single dose or 2) gemifloxacin 320 mg orally in a single dose PLUS azithromycin 2 g orally in a single dose.
  • A test-of cure for pharyngeal gonorrhea treated with an alternative regimen should be performed14 days after treatment.
  • Erie County Department of Health has developed a new STD reporting form that reflects changes in the CDC treatment recommendations which can be found at: Erie County STD Reporting Form: http://www2.erie.gov/health/sites/www2.erie.gov.health/files/uploads/pdfs/stdreportingform.pdf

 

TREATMENT GUIDELINES

A. Uncomplicated gonococcal infections of the cervix, urethra, and rectum

Recommended regimen

Ceftriaxone 250 mg intramuscularly in a single dose  PLUS

Azithromycin 1 g orally in a single dose

*Dual treatment with ceftriaxone and azithromycin should be given together on the same day, preferably simultaneously and under direct observation. If an azithromycin prescription is sent to the pharmacy rather than given directly observed on site, the patient should be strongly encouraged to fill the azithromycin prescription that same day for a dual therapy effect.

 

Alternative regimens

If ceftriaxone is not available:

Cefixime 400 mg orally in a single dose PLUS

Azithromycin 1 g orally in a single dose

 

If cephalosporin allergy:

Gemifloxacin 320 mg orally in a single dose PLUS

Azithromycin 2 g orally in a single dose

OR

Gentamicin 240 mg intramuscularly in a single dose  PLUS

Azithromycin 2 g orally in a single dose

 

B. Uncomplicated gonococcal infections of the pharynx

 

Recommended regimen

Ceftriaxone 250 mg intramuscularly in a single dose  PLUS

Azithromycin 1 g orally in a single dose

*Dual treatment with ceftriaxone and azithromycin should be given together on the same day, preferably simultaneously and under direct observation. If an azithromycin prescription is sent to the pharmacy rather than given directly observed on site, the patient should be strongly encouraged to fill the azithromycin prescription that same day for a dual therapy effect.

 

If medications are not available when treatment is indicated, linkage to an STD treatment facility should be provided for same-day treatment.

 

FOLLOW-UP

 

Any person with pharyngeal gonorrhea who is treated with an alternative regimen should return 14 days after treatment for a test-of cure using either culture or nucleic acid amplification test (NAAT).

 

If symptoms persist after treatment, the patients should be evaluated by culture for N. gonorrhoeae (with or without simultaneous NAAT), and any gonococci isolated should be tested for antimicrobial susceptibility. For assistance with gonorrhea culture, please call ECDOH at 716-858-7697.

 

All persons treated for gonorrhea should be retested 3 months after treatment or at their next medical care evaluation within 12 months following initial treatment, regardless of whether they believe their sex partners were treated.

 

REPORTING

 

Providers are required to report positive cases of STD’s including gonorrhea, chlamydia and syphilis cases and their treatment, to the local health department where the patient resides.  Cases can be reported to the Erie County Department of Health at 716-858-7697 or faxed to 716-858-7964.

 

ADDITIONAL INFORMATION

 

2015 Sexually Transmitted Disease Guidelines: http://www.cdc.gov/std/tg2015/default.htm  

MMWR 2015 Sexually Transmitted Disease Guidelines: http://www.cdc.gov/std/tg2015/tg-2015-print.pdf

Erie County STD Reporting Form: http://www2.erie.gov/health/sites/www2.erie.gov.health/files/uploads/pdfs/stdreportingform.pdf

 

You can sign up to receive Health Alerts & Advisories at www.erie.gov/health/index.php?q=node/59.  The ECDOH Health Alert & Advisory System is an e-mail notification system designed to alert community partners about important health related information. 

 

The Erie County Department of Health does not provide medical advice. The information provided on the Erie County Department of Health website is not an attempt to practice medicine and is not intended as a substitute for professional medical advice, diagnosis, or treatment. It is for informational purposes only. Always seek the advice of your personal physician or other qualified health provider with any questions you may have regarding a medical condition or issue. Never disregard professional medical advice ordelay in seeking it because of the content found on the Erie County Department of Health website or this correspondence.