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Session title: Innovations in clinical practiceSession date: Wednesday 27 June 2012; 11.45 am – 12.45 pm
O4 Pharyngeal gonorrhoea: assessing treatment responses in an era of uncertainty
  1. R Artykov,
  2. R K Rabiu,
  3. J A White
  1. Guy's and St Thomas' NHS Trust, London, UK

Abstract

Background The last decade has seen a paradigm shift in diagnosis and treatment of gonorrhoea (GC). Recent guidelines are hampered by lack of evidence for optimal timing for test of cure (TOC) and method of testing. The majority of pharyngeal GC (pGC) is seen in MSM and is culture-negative. Traditionally infection is harder to eradicate at this site and TOC is now routinely recommended.

Aim To assess treatment responses and TOC strategy for pGC over a 2-year period that included multiple changes in practice.

Methods Retrospective case note review of all pGC diagnosed by Aptima Combo 2 (AC2) and confirmed with Aptima GC from January 2010 to January 2012 at two urban UK GUM clinics. Treatment regimens changed from oral to parenteral and TOCs performed at 2 or 3 weeks across the study period.

Results A total of 523 cases of pGC were diagnosed; 514 (98.3%) were in men. Of the 343 where culture was taken concurrently, 63 (18.4%) were culture positive. Ciprofloxacin resistance was present in 33% of pGC isolates but none showed cefixime resistance. Of the 476 where pGC treatment was given and documented by us, most were treated with either cefixime 400 mg PO (51.3%) or ceftriaxone 500 mg IMI (40.1%), usually with azithromycin 1 g PO or doxycycline 100 mg bd ¡Ý7 days PO. Of the 386 that underwent TOC within 90 days of treatment, most had both culture and AC2 taken. Positive TOC was seen in 14 (3.6%) patients (only five were culture-positive); all had received cefixime-based regimens as their first line GC treatment. High rates of ongoing sexual risk clouded the determination of treatment failure. The majority of TOCs done at 2 weeks (31/32; 97%) or 3 weeks (43/44; 98%) were AC2-negative. Two AC2-positive TOCs at 7 and 8 days post-treatment, respectively, were difficult to interpret (see abstract O4 table 1).

Abstract O4 Table 1

Conclusions Our data support the new guidelines for pGC treatment with ceftriaxone 500 mg regimens followed by TOC at 2 weeks with a molecular test. Prospective studies and ongoing surveillance are needed to monitor the efficacy of this strategy.

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