Public Health Ontario releases Guidelines for Testing and Treatment of Gonorrhea in Ontario
New testing and treatment approach required for antibiotic-resistant organism
Toronto, April 30, 2013 – Public Health Ontario has published new guidelines for testing and treating gonorrhea, which has become increasingly resistant to antibiotics and challenging to treat.
Gonorrhea is the second most commonly reported sexually transmitted infection in Ontario and North America. Left untreated, gonorrhea can lead to a host of complications including pelvic inflammatory disease, infertility, and blood stream infections. Cephalosporin, the last available class of antibiotics recommended for the treatment of gonorrhea, has been failing worldwide.
“Our research shows a relatively high rate of failure using current therapeutic options,” said Dr. Vanessa Allen, medical microbiologist at Public Health Ontario. “If we don’t act now, those with gonorrhea may not be treated effectively. It will also promote the spread of drug-resistant and potentially untreatable gonorrhea, which would be a very serious public health issue.”
In January 2013, Allen and colleagues published a study in the Journal of the American Medical Association showing a seven per cent clinical failure following treatment with an oral dose of cefixime, from the cephalosporin class of antibiotics at a Toronto-area clinic.
In response to Ontario and global clinical failures, the new guidelines recommend an injectable drug (ceftriaxone), in combination with a pill (azithromycin). Similar approaches are being adopted in other jurisdictions, including in the United States as per recent Centers for Disease Control guidelines.
Other notable features of the Guidelines for Testing and Treatment of Gonorrhea in Ontario:
- All sexually active persons who have signs and symptoms of gonorrhea should be tested. Consideration should also be given to laboratory screening of asymptomatic persons who have risk factors for gonorrhea.
- The new recommended first-line therapy of individuals with confirmed or suspected uncomplicated urogenital, rectal or pharyngeal gonorrhea and their sex partners is ceftriaxone 250 mg x 1 intramuscular injection plus azithromycin 1 g x 1 orally.
- Second-line therapeutic options are less effective than combination ceftriaxone and azithromycin in the treatment of gonorrhea. Second line therapies are only to be considered if first-line therapy is not possible, and must be followed by a test of cure.
PHO’s guidelines are part of a provincial effort to address multidrug-resistant gonorrhea, under the leadership of Dr. Arlene King, Ontario’s Chief Medical Officer of Health. Many health partners collaborated to develop the guidelines, including: the Ontario Ministry of Health and Long-Term Care, Medical Officers of Health from across the province, PHO’s Provincial Infectious Disease Advisory Committee on Communicable Diseases and its Sexually Transmitted Infections (STI) Working Group, and many STI clinics, primary care and specialist health care providers.
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