Over the last 8 months WA Health has consulted with public health, Aboriginal health and infectious disease experts to revise recommendations for the antibiotic treatment of gonorrhoea in WA Health’s Guidelines for Managing STIs (Silver Book) as a result of concerns relating to increasing antibiotic resistance of gonorrhoea to ceftriaxone in many parts of the world.

Although ceftriaxone-resistant gonorrhoea has not been reported in WA, it is important to prevent its development because ceftriaxone-resistant gonorrhoea is almost impossible to treat. As of June 2013, the Silver Book’s gonorrhoea treatment recommendations will be consistent with internationally accepted guidelines (United State of America and the United Kingdom).

The agreed changes are:

Condition Current treatment New treatment
Uncomplicated gonorrhoea contracted in the Perth metropolitan area; Great Southern, South West and Wheatbelt regions of WA; interstate; overseas; or where place of acquisition is not known

 OR

Anorectal or pharyngeal gonorrhoea

Ceftriaxone 500 mg in 2 mL 1% lignocaine intramuscularly Ceftriaxone 500 mg in 2 mL 1% lignocaine intramuscularly

 AND

azithromycin 1 g (oral)

given together as a single dose

 

Uncomplicated gonorrhoea contracted in the Goldfields, Kimberley, Pilbara or Midwest regions of WA* amoxycillin 3g orally

AND

probenecid 1g orally

given together as a single dose

amoxycillin 3g orally

AND

probenecid 1g orally

given together as a single dose

 

Please note that a *ZAP pack (azithromycin 1g, amoxycillin 3g and probenecid 1g single dose, directly observed therapy) should continue to be used for empirical treatment of uncomplicated gonorrhoea and/or chlamydia infections contracted in the Goldfields, Kimberley, Pilbara or Midwest regions of WA. These regions are probably the only places in the world where locally-acquired gonorrhoea strains are still sensitive to penicillin. ‘Exposing’ these strains to ceftriaxone unnecessarily could facilitate the development of resistance.

A revised version of the Silver Book, including the gonorrhoea treatment recommendations, and changes to the “Endemic Supplement” has been developed and uploaded in line with these changes at http://silverbook.health.wa.gov.au/.

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