AMR Gonorrhoea Guidance

Update to National Guidelines for the Prevention and Control of gonorrhoea and for minimising the impact of Antimicrobial Resistance in Neisseria gonorrhoeae

On the advice of the clinical subgroup of the National Forum on antimicrobial resistance in Neisseria gonorrhoeae the national recommendations for treatment of uncomplicated anogenital and pharyngeal gonorrhoea in adults without cephalosporin allergy has changed to 1g ceftriaxone monotherapy. Dual therapy with ceftriaxone and azithromycin is no longer recommended (Table 1). The National Guidelines for the Prevention and Treatment of Gonorrhoea and for minimising the impact of Antimicrobial Resistance in Neisseria gonorrhoeae will be updated to reflect these changes.

Updated: 17 December 2018

Protocols for Ceftriaxone (and not Azithromycin) resistant and high level Azithromycin (and not Ceftriaxone) resistant cases of gonorrhoea are available on the HPSC website. Enhanced surveillance forms are available on request from hpsc@hse.ie or your local Department of Public Health.

For cases resistant to both ceftriaxone and azithromycin, please see treatment failure enhanced surveillance form.

Updated: 06 December 2018

The clinical guidelines for the management of gonorrhoea in adult males and females, and the recommendations for partner notification are as follows*:

Site of infection	Symptoms	Investigation	Treatment	Partner notification
Males
Urethral	Urethral discharge and/or dysuria, starting within 2-5 days of exposure	First pass urine for NAAT Urethral swab for microscopy and culture where feasible	Uncomplicated anogenital/pharyngeal gonorrhoea infection in adults: Ceftriaxone 1g IM, single dose   Uncomplicated anogenital gonorrhoea infection in adults with cephalosporin allergy or previous immediate and/or severe hypersensitivity to penicillin or other β-lactam antibiotics: Ciprofloxacin 500mg PO stat (when known to be susceptible to quinolones) OR Spectinomycin 2g deep IM stat OR Azithromycin 2g PO stat (when known to be susceptible to azithromycin) Pharyngeal gonorrhoea infection in adults with cephalosporin allergy or previous immediate and/or severe hypersensitivity to penicillin or other β-lactam antibiotics: Ciprofloxacin 500mg PO stat (when known to be susceptible to quinolones) OR Azithromycin 2g PO stat (when known to be susceptible to azithromycin)	Symptomatic urethral infection: All partners in past two weeks or last partner, if longer Infections at other sites: All partners in past 3 months Asymptomatic infection: All partners in past 3 months
Rectal and pharyngeal	Often asymptomatic	Rectal and pharyngeal swabs for NAAT as determined by sexual history/symptoms
Conjuctival	Red eye, swelling and exudate	Swab from lower eyelid after removal of excess exudates for NAAT and culture (where feasible)
Females
Endocervical	Often asymptomatic (up to 50%), may present as abnormal vaginal discharge. Rarely, intermenstrual bleeding or post-coital bleeding	Vulvovaginal swab for NAAT; endocervical swab for NAAT; Endocervical swab for culture Urine NOT optimal specimen type for women		All partners in past 3 months
Rectal and pharyngeal	Often asymptomatic	Rectal and pharyngeal swabs for NAAT as determined by sexual history/ symptoms Where asymptomatic or a contact, swab for culture at same time
Conjuctival	Red eye, swelling and exudate	Swab from lower eyelid after removal of excess exudates for NAAT and culture (where feasible)

 ^{*Extracted from Table 6 and Table 7 of the National Guidelines for the Prevention and Control of Gonorrhoea and for minimising the impact of Antimicrobial Resistance in Neisseria gonorrhoeae, by the Antimicrobial Resistance in Neisseria gonorrhoeae Sub-Committee of the HPSC Scientific Advisory Committee}  

Last updated: 17 December 2018

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