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The British Association of Sexual Health and HIV (BASHH) and Public Health England work in partnership to support clinicians with up-to-date guidance on managing sexually transmitted infections.
In 2011, the BASHH gonorrhoea treatment guidelines were changed to ceftriaxone 500 mg intramuscular in combination with azithromycin 1 g per oral, as first-line therapy. This dual therapy aims to delay the accumulation of resistance and extend the useful life of ceftriaxone.1 The advice has been widely adopted. Data from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) show that the regimen was used in 86% of patients in 2013. Most of the remainder received ceftriaxone plus doxycycline. Of this latter group, 65% were men who have sex with men and 29% were women; 36% had concurrent chlamydia, and 51% had rectal gonorrhoea. We have identified two main clinical scenarios where doxycycline …