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Guideline Summary
Guideline Title
UK national guideline for the management of gonorrhoea in adults, 2011.
Bibliographic Source(s)
Bignell C, Fitzgerald M, Guideline Development Group, British Association for Sexual Health and HIV UK. UK national guideline for the management of gonorrhoea in adults, 2011. Int J STD AIDS. 2011 Oct;22(10):541-7. [70 references] PubMed External Web Site Policy
Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: National guideline on the diagnosis and treatment of gonorrhoea in adults 2005. London (England): British Association for Sexual Health and HIV (BASHH); 2005. 9 p. [36 references]

Scope

Disease/Condition(s)

Gonorrhoea

Guideline Category
Diagnosis
Management
Treatment
Clinical Specialty
Infectious Diseases
Obstetrics and Gynecology
Urology
Intended Users
Advanced Practice Nurses
Physician Assistants
Physicians
Guideline Objective(s)

To offer recommendations on the diagnosis, treatment and health promotion principles for the effective management of anogenital and pharyngeal gonorrhoea

Target Population

Primarily people aged 16 years and older presenting to services offering level 3* care in sexually transmitted infection (STI) management within the United Kingdom (UK).

*The principles of the recommendations could be adopted at all levels.

Interventions and Practices Considered

Diagnosis

  1. Detection of N. gonorrhoeae at an infected site:
    • Microscopy (x1000) of Gram stained genital specimens
    • Nucleic acid amplification tests (NAATs)
    • Culture
  2. Testing for co-infection with C. trachomatis
  3. Supplementary testing to confirm diagnosis
  4. Specimen collection
    • Men - first pass urine or urethral/meatal swab specimen
    • Women - vaginal or endocervical swab specimen

Treatment/Management

  1. Written patient information
  2. Abstinence from sexual intercourse until treatment is completed
  3. Recommended regimen (i.e., ceftriaxone with azithromycin)
  4. Alternative regimens according to current trends in gonococcal antimicrobial resistance
  5. Treatment of complicated infections
    • Gonococcal pelvic inflammatory disease (PID)
    • Gonococcal epididymo-orchitis
    • Gonococcal conjunctivitis
    • Disseminated gonococcal infection
  6. Treatment of allergy
  7. Treatment during pregnancy/breastfeeding
  8. Treatment of pharyngeal infection
  9. Partner notification
  10. Follow-up and test of cure
  11. Reporting cases of cephalosporin clinical failure
Major Outcomes Considered
  • Sensitivity and specificity of diagnostic assays
  • Clinical efficacy of antimicrobial therapy
  • Antimicrobial sensitivity and resistance to Neisseria gonorrhoeae
  • Complications of Neisseria gonorrhoeae

Methodology

Methods Used to Collect/Select the Evidence
Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

This guideline has been updated by reviewing the previous gonorrhoea guideline (2005) and medical literature since its publication. A MEDLINE search of published articles in any language for the years 2005–09 was done using the subject headings 'gonorrhoea' and 'Neisseria gonorrhoeae'. All entries in the English language or with abstracts in English were viewed because of the paucity of 'clinical trials' or 'reviews'. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness and Cochrane Controlled Trials Register were reviewed using the textword 'gonorrhoea' and all entries were considered. Abstracts from meetings in the relevant period were hand-searched and considered.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence

Levels of Evidence

Level Type of Evidence
Ia Evidence obtained from meta-analysis of randomised controlled trials
Ib Evidence obtained from at least one randomised controlled trial
IIa Evidence obtained from at least one well-designed controlled study without randomisation
IIb Evidence obtained from at least one type of well-designed quasi-experimental study
III Evidence obtained from well-designed, non-experimental descriptive studies, such as comparative studies, correlation studies and case control studies
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities
Methods Used to Analyze the Evidence
Review of Published Meta-Analyses
Systematic Review
Description of the Methods Used to Analyze the Evidence

This guideline was appraised with the Appraisal of Guidelines for Research & Evaluation (AGREE) instrument.

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

This guideline was produced according to specifications set out in the Clinical Effectiveness Group's (CEG's) 2010 document 'Framework for guideline development and assessment' outlined at http://www.bashh.org/guidelines External Web Site Policy (see the "Availability of Companion Documents" field).

Rating Scheme for the Strength of the Recommendations

Grades of Recommendation

Grade Recommendation
A (Evidence levels Ia, Ib) Requires at least one randomised controlled trial as part of the body of literature of overall good quality and consistency addressing the specific recommendation
B (Evidence levels IIa, IIb, III) Requires availability of well-conducted clinical studies but no randomised clinical trials on the topic of recommendation
C (Evidence level IV) Requires evidence from expert committee reports or opinions and/or clinical experience of respected authorities. Indicates absence of directly applicable studies of good quality
Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation
Clinical Validation-Pilot Testing
External Peer Review
Internal Peer Review
Description of Method of Guideline Validation

The draft guideline was posted on the British Association for Sexual Health and HIV (BASHH) website for a consultation period of three months and piloted in a sample of clinics. In response to the consultation a number of changes were made, which are supported by more recent references.

Recommendations

Major Recommendations

Levels of evidence (I-IV) and grades of recommendation (A-C) are defined at the end of the "Major Recommendations" field.

Changes Since 2005 Guideline

  • Nucleic acid amplification tests (NAATs) can be used for both anogenital and pharyngeal specimens. Supplementary testing is required for reactive tests from low prevalence populations and for specimens from the rectum or pharynx.
  • First-line treatment is now ceftriaxone 500 mg intramuscularly immediately plus azithromycin 1 g orally immediately.
  • Test of cure is recommended for all cases.
  • A patient information leaflet is available (see website).
  • There is a link for reporting cephalosporin treatment failures to the Health Protection Agency (HPA).

Diagnosis

  • This guideline should be read in conjunction with the Health Protection Agency Guidance for gonorrhoea testing in England and Wales External Web Site Policy (2010) and the British Association for Sexual Health and HIV (BASHH) guidelines on testing for sexually transmitted infections (STIs)/gonorrhoea External Web Site Policy.
  • The diagnosis of gonorrhoea is established by the detection of N. gonorrhoeae at an infected site.
  • The approach and method used to test for gonorrhoea will be influenced by the clinical setting, storage and transport system to the laboratory, local prevalence of infection and the range of tests available in the laboratory.
  • No test for gonorrhoea offers 100% sensitivity and specificity.
  • Microscopy (x1000) of Gram-stained genital specimens allows direct visualization of N. gonorrhoeae as monomorphic Gram-negative diplococci within polymorphonuclear leukocytes. It offers good sensitivity (90%–95%) in men with urethral discharge and is recommended to facilitate immediate diagnosis in symptomatic men (level of evidence III; grade C recommendation). Microscopy of urethral smears in asymptomatic men is less sensitive (50%–75%). Microscopy should be done on men with rectal symptoms. In women, microscopy has poor sensitivity for the identification of gonococcal infection: 37%–50% for endocervical smears and 20% for urethral smears. Microscopy is not recommended for urethral smears in women or for detecting asymptomatic rectal infection because of low sensitivity (level of evidence III; grade C recommendation). Microscopy is not appropriate for diagnosing gonorrhoea in pharyngeal specimens.
  • Detection of N. gonorrhoeae can be achieved by NAATs or culture. NAATs are generally more sensitive than culture and offer testing on a wider range of specimen types. NAATs show high sensitivity (>96%) in both symptomatic and asymptomatic infection. They show equivalent sensitivity in urine and urethral swab specimens from men and in vaginal and endocervical swabs from women. The test sensitivity in female urine is significantly lower and urine is not the optimal specimen in women (level of evidence II; grade B recommendation).
  • Persons undergoing testing for genital tract gonorrhoea are usually also tested for infection with C. trachomatis. NAATs are the standard test methodology for C. trachomatis testing and commercial tests offer dual capability to also test for N. gonorrhoeae on the same sample. When testing for genital tract infection, a dual NAAT for both pathogens maximizes sensitivity and operational ease of specimen collection, transport and processing.
  • NAATs are significantly more sensitive than culture for detecting N. gonorrhoeae in the rectum and pharynx although are not yet licensed for use at these sites. Commercially available NAATs differ in their cross-reactivity to commensal Neisseria species which may be present at significant levels at these sites, particularly in the pharynx. At present it is recommended that reactive specimens from the rectum and pharynx are confirmed by supplementary testing, i.e., using a different molecular target (level of evidence III; grade C recommendation).
  • Culture continues to offer a specific, sensitive and cheap diagnostic test at genital sites. It allows confirmatory identification and antimicrobial susceptibility testing, which is of increasing importance as antimicrobial resistance to N. gonorrhoeae continues to evolve. Selective culture media containing antimicrobials are recommended to reduce contamination (level of evidence II; grade B recommendation).
  • Whatever the testing approach adopted, positive test results should give a positive predictive value of >90%. In areas of low gonorrhoea prevalence the use of NAATs may require supplementary testing to confirm the diagnosis. Clinicians need to be familiar with the test performance of NAATs and be able to interpret results in their clinical setting.

Specimen Collection

Men

A first pass urine is the preferred sample for NAAT testing. Microscopy and culture require a urethral/meatal swab specimen. The collection and testing of rectal and pharyngeal swab specimens should be directed by sexual history, symptoms at these sites and also considered in men who receive oral–anal or digital–anal contact.

Women

Vaginal or endocervical swab specimens are equally sensitive for detecting N. gonorrhoeae by NAAT testing. Culture requires an endocervical and urethral swab specimen for maximum sensitivity. Urine is a suboptimal sample for the detection of N. gonorrhoeae in women. The collection and testing of rectal and pharyngeal swab specimens should be directed by sexual history, symptoms at these sites and also considered in women who are sexual contacts of gonorrhoea.

  • For culture, direct plating of genital samples and use of transport media with prompt laboratory plating both give acceptable results (level of evidence IV).
  • Data are lacking on the sensitivity of a single set of tests to identify infection with N. gonorrhoeae. The use of a single endocervical or vulvovaginal NAAT sample will identify 90%–95% of women with gonococcal infection. Women infected with N. gonorrhoeae often have infection at multiple sites. A minority of men who have sex with men with gonorrhoea have infection at multiple sites, thus all exposed sites need sampling.
  • To confidently exclude infection in patients who attend within three days of sexual contact, a second set of tests should be considered if epidemiological treatment with effective antimicrobial therapy is not given (level of evidence IV; grade C recommendation). Conventionally this would be 14 days after contact.

Management

General Advice

  • Patients should be given a detailed explanation of their condition with particular emphasis on the long-term implications for the health of themselves and their partner(s). This should be reinforced with clear and accurate written information (level of evidence IV; grade C recommendation).
  • Patients should be advised to abstain from sexual intercourse until they and their partner(s) have completed treatment (level of evidence IV; grade C recommendation); if azithromycin is used, this will be 7 days after treatment was given.

Further Investigation

  • A culture should be taken in all cases of gonorrhoea diagnosed by NAATs prior to antibiotics being given, if possible, so that susceptibility testing can be performed and resistant strains identified.
  • Screening for coincident STIs should routinely be performed in patients with or at risk of gonorrhoea (level of evidence III; grade C recommendation).

Treatment

Indications for Therapy (level of evidence IV; grade C recommendation)

  • Identification of intracellular Gram-negative diplococci on microscopy of a smear from the genital tract
  • A positive culture for N. gonorrhoeae from any site
  • A positive NAAT for N. gonorrhoeae from any site. Supplementary testing is recommended if the positive predictive value of the test is <90%.
  • Recent sexual partner(s) of confirmed cases of gonococcal infection
  • Consider offering on epidemiological grounds following sexual assault

Recommended Treatment

Uncomplicated anogenital infection in adults:

  • Ceftriaxone 500 mg intramuscularly as a single dose with azithromycin 1 g oral as a single dose (level of evidence IV; grade C recommendation) (see the table below)

Table: Administration of Ceftriaxone 500 mg

Ceftriaxone is supplied as a powder which needs to be reconstituted with lidocaine solution. In the UK, it is currently available as vials of 250 mg or 1 g, the 1 g size generally being considerably more economical.

To reconstitute, mix the contents of the 1 g vial with 3.5 mL of 1% lidocaine injection BP (British Pharmacopoeia): half (2.1 mL) of the resulting solution provides 500 mg ceftriaxone.

It should be given by deep intramuscular injection.

The remaining solution can be used for up to 24 hours later, where permitted by local regulations, if it is kept in the dark at 2–80ºC (i.e. in refrigerator).

  • N. gonorrhoeae has progressively exhibited reduced sensitivity and resistance to many classes of antimicrobials. Published trials of gonorrhoea treatment reflect clinical efficacy in past eras of antimicrobial sensitivity. Surveillance data in England and Wales show significant levels of N. gonorrhoeae resistance to penicillin (22% in 2009), tetracyclines (68% in 2009) and ciprofloxacin (35.3% in 2009). High-level azithromycin resistance (minimum inhibitory concentration [MIC] 256 mg/L) was observed in 2007 in the UK. In 2009, decreased susceptibility to cefixime (MIC ≥0.25 mg/L) was observed at 1.2% and four isolates (0.3%) with decreased susceptibility to ceftriaxone (MIC ≥0.125 mg/L) were also identified. Three UK cases of clinical cefixime failure were reported in 2011. Most resistant infections are acquired in the UK.
  • The increasing recognition of multidrug resistant N. gonorrhoeae has been the driving force for the recommendation of extended spectrum cephalosporins as the preferred treatment of gonorrhoea. Concerns about the upward drift of resistance to cephalosporins justify the increased dose of ceftriaxone now recommended.
  • Azithromycin is recommended as co-treatment irrespective of the results of chlamydia testing (level of evidence IV; grade C recommendation), to delay the onset of widespread cephalosporin resistance. There is some in vitro evidence of synergy between azithromycin and cephalosporins, and improved eradication of pharyngeal gonorrhoea has been reported when azithromycin was combined with cephalosporin therapy.

Alternative Regimens

Clinicians using alternative regimens for the treatment of gonorrhoea are recommended to regularly review local and national trends in gonococcal antimicrobial resistance. All the agents below should be accompanied by azithromycin 1 g oral as a single dose.

  • Cefixime 400 mg oral as a single dose (level of evidence 1b; grade A recommendation). Only advisable if an intramuscular injection is contraindicated or refused by the patient. Observations in Asia have raised serious concerns over the adequacy of the 400 mg cefixime dose for the treatment of genital tract gonorrhoea. Repeated treatment failures have been reported with cefixime and other oral extended spectrum cephalosporins.
  • Spectinomycin 2 g intramuscularly as a single dose (level of evidence 1b; grade A recommendation). Spectinomycin was not being manufactured in 2010 so may be difficult to obtain. See BASHH website (www.bashh.org External Web Site Policy) for further details.
  • Other single dose cephalosporin regimens, notably cefotaxime 500 mg intramuscularly as a single dose (level of evidence Ib; grade A recommendation) or cefoxitin 2 g intramuscularly as a single dose plus probenecid 1 g oral. Alternative injectable or oral cephalosporins offer no advantage in terms of efficacy and pharmacokinetics over ceftriaxone or cefixime.
  • Cefpodoxime is an alternative oral third generation cephalosporin that as a single dose of 200 mg orally is licensed for the treatment of uncomplicated gonorrhoea. Published trial data are limited, but in view of its less favourable pharmacokinetics than cefixime and suboptimal efficacy against pharyngeal infection, it should be used with caution at a dose of 400 mg (level of evidence II; grade C recommendation).
  • Quinolones cannot generally be recommended for the treatment of gonorrhoea because of the high prevalence of quinolone resistance worldwide. When an infection is known before treatment to be quinolone sensitive, ciprofloxacin 500 mg orally as a single dose or ofloxacin 400 mg orally as a single dose have proven efficacy (level of evidence Ib; grade A recommendation).
  • High-dose azithromycin (2.0 g as a single dose) has shown acceptable efficacy in clinical trials, but was associated with high gastrointestinal intolerance. The clinical efficacy of azithromycin does not always correlate with in vitro sensitivity testing and high-level azithromycin resistance has been observed in the UK. A single dose of azithromycin 1.0 g alone is not recommended as treatment for gonorrhoea (level of evidence II; grade C recommendation).
  • The alternative treatment regimens listed do not comprise all effective treatment regimens, but reflect clinical practice in the UK.

Treatment of Complicated Infections

Gonococcal Pelvic Inflammatory Disease (PID)

Ceftriaxone 500 mg intramuscularly immediately followed by oral doxycycline 100 mg twice daily plus metronidazole 400 mg twice daily for 14 days (see National Guideline Clearinghouse [NGC] summary of the BASHH guideline Management of acute pelvic inflammatory disease).

Gonococcal Epididymo-orchitis

Ceftriaxone 500 mg intramuscularly plus doxycycline 100 mg twice daily for 10–14 days (see the NGC summary of the BASHH guideline 2010 United Kingdom national guideline for the management of epididymo-orchitis).

Gonococcal Conjunctivitis

A three-day systemic regimen is recommended as the cornea may be involved and is relatively avascular (level of evidence IV; grade C recommendation). The eye should be irrigated with saline/water:

  • Ceftriaxone 500 mg intramuscularly daily for three days
  • For non-anaphylaxis allergy: ceftriaxone as above
  • If history of penicillin anaphylaxis or established cephalosporin allergy: spectinomycin 2 g intramuscularly immediately daily for three days or azithromycin 2 g oral immediately plus doxycycline 100 mg twice daily for one week plus ciprofloxacin 250 mg daily for three days (level of evidence IV; grade C recommendation).

Disseminated Gonococcal Infection (grade C recommendation)

  • Ceftriaxone 1 g intramuscularly or intravenous every 24 hours or cefotaxime 1 g intravenous every eight hours or ciprofloxacin 500 mg intravenous every 12 hours (if the infection is known to be sensitive) or spectinomycin 2 g intramuscularly every 12 hours
  • Therapy should continue for seven days but may be switched 24–48 hours after symptoms improve to one of the following oral regimens: cefixime 400 mg twice daily, ciprofloxacin 500 mg twice daily or ofloxacin 400 mg twice daily.

Allergy

Third-generation cephalosporins such as cefixime and ceftriaxone show negligible cross-allergy with penicillins. Contraindications to the administration of ceftriaxone are hypersensitivity to any cephalosporin or previous immediate and/or severe hypersensitivity reaction to a penicillin or other beta-lactam drug. Recommended treatments for patients giving a history of such hypersensitivity:

  • Spectinomycin 2 g intramuscularly as a single dose (level of evidence Ib; grade A recommendation) with azithromycin 1 g oral as a single dose or
  • Azithromycin 2.0 g oral as a single dose (level of evidence Ib; grade B recommendation) or
  • Ciprofloxacin 500 mg orally as a single dose when the infection is known or anticipated to be quinolone sensitive

Pregnancy and Breastfeeding

Pregnant and breastfeeding women should not be treated with quinolone or tetracycline antimicrobials. Azithromycin: manufacturer advises use only if adequate alternatives are not available. Pregnancy does not diminish treatment efficacy.

Recommended Regimens

  • Ceftriaxone 500 mg intramuscularly as a single dose with azithromycin 1 g oral as a single dose (level of evidence IV; grade C recommendation) or
  • Spectinomycin 2 g intramuscularly as a single dose (level of evidence Ib; grade A recommendation) with azithromycin 1 g oral as a single dose

Pharyngeal Infection

Single-dose antimicrobial treatments have in general demonstrated lower efficacy (≤90%) in eradicating N. gonorrhoeae from the pharynx than in eradicating genital infection. Failure has even been reported with ceftriaxone.

Recommended Treatments

  • Ceftriaxone 500 mg intramuscularly as a single dose with azithromycin 1 g as a single dose (level of evidence IV; grade C recommendation) or
  • Ciprofloxacin 500 mg orally as a single dose if N. gonorrhoeae known to be quinolone sensitive (level of evidence Ib; grade B recommendation) or
  • Ofloxacin 400 mg orally as a single dose if N. gonorrhoeae known to be quinolone sensitive (level of evidence Ib; grade B recommendation). Single dose treatment with spectinomycin has poor efficacy in eradicating gonococcal infection of the pharynx.

Human Immunodeficiency Virus (HIV) Infection

Treatment for gonorrhoea in HIV-infected individuals is the same as in those who are HIV-negative.

Co-Infection with C. Trachomatis

Genital infection with C. trachomatis commonly accompanies genital gonococcal infection (35% of heterosexual men and 41% of women with gonorrhoea). Testing for C. trachomatis should routinely be performed on all adults with gonorrhoea or treatment given to eradicate possible co-infection (level of evidence IV; grade C recommendation).

Sexual Partners

Partner notification should be pursued in all patients identified with gonococcal infection, preferably by a trained health adviser in genitourinary (GU) medicine. Action and outcomes should be documented. Partner notification should follow national recommendations:

  • Male patients with symptomatic urethral infection should notify all partners with whom they had sexual contact within the preceding two weeks or their last partner if longer ago.
  • Patients with infection at other sites or asymptomatic infection should notify all partners within the preceding three months. Sexual partners should be offered testing and treated epidemiologically for gonorrhoea (level of evidence IV; grade C recommendation).

Follow-up and Test of Cure (TOC)

Assessment after treatment may be helpful (level of evidence IV; grade C recommendation):

  • To confirm compliance with treatment
  • To ensure resolution of symptoms
  • To enquire about adverse reactions
  • To take a sexual history to explore the possibility of reinfection
  • To pursue partner notification and health promotion

A TOC is now recommended in all cases (level of evidence IV; grade C recommendation). This is (a) to identify emerging resistance, which on past experience is likely to occur in due course and (b) because the susceptibility results that indicate potential failure to ceftriaxone and cefixime are not yet defined.

Where resource or practical considerations require TOC to be selective rather than universal, then the following patients should be prioritized:

  • Persisting symptoms or signs
  • Pharyngeal infection (all treatments are less effective at eradicating pharyngeal infection)
  • Treatment with anything other than the first-line recommendations

Method and Timing of TOC

The current evidence is very scanty and the following is based on expert opinion and pragmatic considerations:

  • Persisting symptoms or signs – test with culture, performed at least 72 hours after completion of therapy
  • If asymptomatic – test with NAATs where available, followed by culture if NAAT-positive. Test two weeks after completion of antibiotic therapy.

Note that infection identified after treatment may well be due to reinfection.

Cephalosporin Clinical Failure Following Treatment for Gonorrhoea

Cases of failure of cephalosporin therapy should be reported to the Health Protection Agency using on-line forms, at the HIV and STI web portal: https://www.hpawebservices.org.uk/HIV_STI_WebPortal/Login.aspx External Web Site Policy. Only authorized users are permitted to access this secure website – all GU clinics have been issued with usernames and passwords. Otherwise, they can be obtained from gumcad@hpa.org.uk.

Definitions:

Levels of Evidence

Level Type of Evidence
Ia Evidence obtained from meta-analysis of randomised controlled trials
Ib Evidence obtained from at least one randomised controlled trial
IIa Evidence obtained from at least one well-designed controlled study without randomisation
IIb Evidence obtained from at least one type of well-designed quasi-experimental study
III Evidence obtained from well-designed, non-experimental descriptive studies, such as comparative studies, correlation studies and case control studies
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities

Grades of Recommendation

Grade Recommendation
A (Evidence levels Ia, Ib) Requires at least one randomised controlled trial as part of the body of literature of overall good quality and consistency addressing the specific recommendation
B (Evidence levels IIa, IIb, III) Requires availability of well-conducted clinical studies but no randomised clinical trials on the topic of recommendation
C (Evidence level IV) Requires evidence from expert committee reports or opinions and/or clinical experience of respected authorities. Indicates absence of directly applicable studies of good quality
Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

The type of supporting evidence is graded and identified for select recommendations (see the "Major Recommendations" field).

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

Appropriate diagnosis, treatment, and management of gonorrhoea infection in adults

Potential Harms
  • No test for gonorrhoea offers 100% sensitivity and specificity.
  • N. gonorrhoeae has progressively exhibited reduced sensitivity and resistance to many classes of antimicrobials. Cases of failure of cephalosporin therapy should be reported to the Health Protection Agency.

Contraindications

Contraindications

Contraindications to the administration of ceftriaxone are hypersensitivity to any cephalosporin or previous immediate and/or severe hypersensitivity reaction to a penicillin or other beta-lactam drug.

Qualifying Statements

Qualifying Statements
  • Decisions to follow these recommendations must be based on professional clinical judgement, consideration of individual patient circumstances and available resources.
  • All possible care has been undertaken to ensure specification of the correct dosage of medication and route of administration. However, it remains the responsibility of the prescribing clinician to ensure the accuracy and appropriateness of the medication they prescribe.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools
Audit Criteria/Indicators
Patient Resources
For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Getting Better
IOM Domain
Effectiveness
Patient-centeredness

Identifying Information and Availability

Bibliographic Source(s)
Bignell C, Fitzgerald M, Guideline Development Group, British Association for Sexual Health and HIV UK. UK national guideline for the management of gonorrhoea in adults, 2011. Int J STD AIDS. 2011 Oct;22(10):541-7. [70 references] PubMed External Web Site Policy
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
1999 Aug (revised 2011 Oct)
Guideline Developer(s)
British Association for Sexual Health and HIV - Medical Specialty Society
Source(s) of Funding

This guideline was commissioned and edited by the Clinical Effectiveness Group (CEG) of the British Association for Sexual Health and HIV (BASHH). No external funding was sought or obtained.

Guideline Committee

Clinical Effectiveness Group (CEG)

Composition of Group That Authored the Guideline

Authors: Chris Bignell, Nottingham City Hospital NHS Trust; Mark FitzGerald, Taunton and Somerset NHS Foundation Trust

Clinical Effectiveness Group (CEG) members: Keith Radcliffe (Chairman); Imtyaz Ahmed-Jushuf; David Daniels (Chairman, BASHH National Audit Group); Mark FitzGerald; Guy Rooney (Royal College of Physicians representative); Jan Welch

Financial Disclosures/Conflicts of Interest

Not stated

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: National guideline on the diagnosis and treatment of gonorrhoea in adults 2005. London (England): British Association for Sexual Health and HIV (BASHH); 2005. 9 p. [36 references]

Guideline Availability

Electronic copies: Available from the British Association for Sexual Health and HIV Web site External Web Site Policy.

Availability of Companion Documents

The following is available:

  • British Association for Sexual Health and HIV: framework for guideline development and assessment. British Association for Sexual Health and HIV; 2010. 18 p. Electronic copies: Available in PDF from the BASHH Web site External Web Site Policy.

In addition, auditable outcomes are provided in the original guideline document External Web Site Policy.

Patient Resources

The following is available:

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC Status

This summary was completed by ECRI on June 15, 2000. The information was verified by the guideline developer on October 13, 2000. This summary was updated by ECRI on June 24, 2002, and October 31, 2005. The updated information was verified by the guideline developer on January 19, 2006. This summary was updated by ECRI Institute on October 3, 2007 following the U.S. Food and Drug Administration (FDA) advisory on Rocephin (ceftriaxone sodium). This summary was updated by ECRI Institute on July 28, 2008 following the U.S. Food and Drug Administration advisory on fluoroquinolone antimicrobial drugs. This summary was updated by ECRI Institute on May 5, 2009, following the U.S. Food and Drug Administration (FDA) advisory on Rocephin (ceftriaxone sodium). This NGC summary was updated by ECRI Institute on June 6, 2012. This summary was updated by ECRI Institute on October 25, 2013 following the U.S. Food and Drug Administration advisory on Fluoroquinolone Antibacterial Drugs.

Copyright Statement

This NGC summary is based on the original guideline, which is subject to the guideline developers and/or BMJ Publishing Group's copyright restrictions. Reproduction and use of this guideline is permitted provided that (a) the original content is not changed or edited; and, (b) any content derived from the original guideline is acknowledged as that of the author(s) and responsible organizations.

Readers wishing to download and reproduce material for purposes other than personal study or education should contact BMJPG to seek permission first. Contact: BMJ Publishing Group, BMA House, Tavistock Square, WC1H 9JR, UK.

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