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“Here we go again”

Implications for SHA’s when implementing BASHH GC guidelines

Martin MurchieSenior Sexual Health Adviser

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Aim of today

• Discuss how Sandyford implemented BASHH GC guidelines

• What it meant for the Sexual Health Adviser team

• Audit outcome

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What's Abba got to do with it?• Gonorrhea here

we go again, • My my how can I

resist you• Gonorrhoea

does it show again!

• My my just how much I’ve missed you?

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A wee bit of history….

• A much misunderstood infection!

• Early writings in Egypt, China & Japan

• Even in the Bible “unclean discharge”

• First isolated in 1879 by Albert Neisser

• Originally called Micrococcus but later named Gonoccocus.

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Early Treatments• Variety of treatments in the beginning

– Urethral lavage / Mercury

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Early Treatments

• The magic bullet 1900s

• Known as Salvarsan– Unstable in air– Also used for syphilis

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Treatments1940’s • Good old

penicillin

• Poor old penicillin– Resistance in

1960’s/1970’s

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Today

• Range of antibiotics have been used.

• Real issue with increasing resistance

• Some cases of “Superbug” multi-resistant GC strains found

• BASHH Guideline – UK National Guidelines for the Management of Gonorrhoea in adults – June 2011

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Recommendations• Nucleic Acid Amplification tests (NAATs) can be

used for both anogential and pharyngeal specimens. Supplementary testing is required for reactive tests from low prevalence populations and for specimens from the rectum or pharynx.

• First-line treatment is now Cefitriaxone 500 mg IM stat plus Azithromycin 1g stat.

• Test of cure is recommended for all cases.

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Sandyford response

• NAATs already in place.

• Culture if NAAT positive also in place

• Treatment change from Cefixime to Cefitriaxone along with Azithromax (unless sensitivities available)

• SHA team diaried all clients with GC for a 3 week test of cure, with 2 recall attempts.

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GC – May 2011

• 82 cases of GC found (this includes cultures)– 23 cases of Throat GC– 8 cases of Rectal GC– 15 cases of Urethral GC– 10 cases if Cervical GC

• 46 clients in total (20% had GC in more than one site).

• Sensitivities for 16 (35%) of the clients (19% resistant to Cipro – 3 clients).

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Treatment

Treatment Given

72%

4%2%

15%

7%

Cefitriaxone with Azith

Cefitriaxone

Ciproxin

Azithromycine

Untreated

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Who attended for a test of cure?• 18 clients attended as

arranged 42%• 1st recall - 25 recalled

– 36% attended.• 2nd recall –14 recalled

– 29% attended• 72% attended over

all.– 42% due to SHA recall

0

1825

914

4

46

31

05

101520253035404550

Recall

Attended

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What about PN?• All 43 clients had

partner notification carried out. 100%

• 88 contacts in total – only 48% traceable

• 56% of contacts attended – though only 26% verified outcomes.

PN outcomes

22, 44%

13, 26%

15, 30%No Outcome

Contacts attended Hard

Contacts attended soft

Total Number of Contacts

52%

48%Untraceable

Traceable.

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Summary• Change of guidelines manageable with

SHA input.

• 72% of clients returned who had SHA contact– Time consuming– PN outcomes disappointing

• Big question IS IT WORTH IT?

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The future…..

• Researchers have found that the bacteria Neisseiria gonnorhoea, which causes the unfortunate malady, gonorrhoea, has, at some point in the history of its existence, picked up part of the human genome. As yet, the extraneous DNA appears to serve no useful function and stands merely as an interesting monument to the lengthy relationship between

our two species.

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Questions?