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BASHH guideline for gonorrhoea
  1. C J Bignell
  1. Correspondence to:
 C J Bignell
 Nottingham City Hospital, Nottingham NG5 1PB, UK;

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Time for change

Standards for the management of gonorrhoea need to encompass relief of symptoms, rapid eradication of Neisseria gonorrhoeae from all sites, action to ensure that sexual partners are treated, and sexual health education to promote risk reduction in future sexual interaction. Many antimicrobial regimens have in the past demonstrated the capacity to eradicate N gonorrhoeae from genital sites.1 Efficacy in clinical trials has been shown to correlate with the length of time a particular antimicrobial regimen provides a blood level of four times the MIC90.1,2 Sensitivity and pharmacokinetics are therefore key factors, together with data from clinical trials and toxicity, in determining treatment recommendations. Weighing these factors is particularly relevant to the choice of recommended cephalosporins.3 The prevalence of gonococcal resistance to antimicrobials is variable and can change dramatically. Pharmacokinetics can differ significantly within and between classes of antimicrobials. It is therefore not surprising that antimicrobial regimens differ in clinical efficacy, particularly when eradication from non-genital sites is considered. What worked in treating gonorrhoea yesterday …

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