Gonorrhoea antimicrobial resistance

Fifer et al from Public Health England highlight in a letter in the New England Journal of Medicine1 a multiresistant strain of Neisseria gonorrhoeae (NG) in urethral and pharyngeal samples in a heterosexual man, who failed first-line dual therapy with a single intramuscular dose of ceftriaxone 500 mg and a single oral dose of azithromycin 1 g. The strain was resistant to ceftriaxone, azithromycin, cefixime, cefotaxime, penicillin, tetracycline, and ciprofloxacin, but was susceptible to spectinomycin. The urethral sample tested negative on test of cure but the pharyngeal sample remained positive. O'Farrell2 also highlights increasing gonorrhoea resistance to azithromycin. He postulates a possible mechanism through the use of single dose azithromycin for Chlamydia treatment through the National Screening Programme (NCSP), and inadvertent treatment of undiagnosed NG, as well as use of 1 g azithromycin in combination with ceftriaxone for NG treatment. Both letters remind us how important site-specific diagnoses are in the choice of gonorrhoea treatment. Fifer et al also point out …