A Neisseria gonorrhoeae update from our registrar Ian Marr. We still culture it regularly from our samples – susceptibility testing is done at a reference laboratory. PCR diagnosis from early pass urine is the mainstay for most patients (main test method for C. trachomatis as well). The occurrence of multi-drug resistant gonnorhoea is an emerging concern.
Useful gono testing summary from WHO STI Lab manual: Pages from WHO STD LAB Manual
- WHO STD Laboratory Reference Manual – this is a good reference to go to for advice on key techniques – see chapter 4
- CDC USA Report on drug-resistant Ng. April 2018
P N G Med J. 2010 Mar-Jun;53(1-2):15-20. Neisseria gonorrhoeae isolates from four centres in Papua New Guinea remain susceptible to amoxycillin-clavulanate therapy. Toliman PJ1, Lupiwa T, Law GJ, Reeder JC, Siba PM.
Antibiotic-resistant strains of Neisseria gonorrhoeae have the potential to undermine treatment and control of gonorrhoea, which remains a highly prevalent sexually transmitted infection (STI) in Papua New Guinea (PNG). The standard treatment regimen for gonorrhoea in PNG based on amoxycillin and clavulanic acid (amoxycillin-clavulanate) was introduced about 15 years ago and there is some concern that over time circulating strains may have developed resistance to this therapy. To investigate this, N. gonorrhoeae isolates (n = 52) were collected from STI clinics in geographically representative centres in PNG and tested for their in vitro susceptibility to a range of antibiotics. All 52 isolates tested were found susceptible to amoxycillin-clavulanate, despite 40% (n = 21) being penicillinase producers and thus resistant to penicillin. These findings indicate that amoxycillin-clavulanate therapy remains an effective treatment for gonococcal infections in PNG, and support the maintenance of the present standard treatment for gonorrhoea in PNG.
Thanks for that article,
We have had preliminary discussions about reestablishing our our STI testing capabilities at Pom Gen.
Gonorrhoea and chlamydia diagnosis and sensitivity testing would be very useful for the ongoing surveillance of incidence rates and drug resistance in these two pathogens.
We will need to put a good proposal together that argues the importance of this and for seeking funding.
Virtually all treatment in PNG for STI is syndromic based empirical treatment which mean lack of response to treatment may be considered as resistance strains however treatment non adherence may also be a common cause of this lack of response as well as a driver of the emergence of resistance strains.
In practice I used ceftriaxone 250mg im and azithromycin 1g both stat. This mitigates the problem of noncompliance and is supported by The CDC Sexually transmitted diseases treatment guidelines, 2015.
Workowski KA, Bolan GA (2015), ‘Sexually transmitted diseases treatment guidelines’, . Center for Disease Control and Prevention. mdjkf posted: “A brief Neisseria gonorrhoeae update from our registrar Ian Marr at our regular bug of the week teaching round. We still culture it regularly from our samples – susceptibility testing is done at a reference laboratory. PCR diagnosis from early pass urine “