Eurosurveillance

ECDC

WHO New Treatment Guidelines for Gonorrhoea and Syphilis

 Rediger
  Published: 07.05.04 Updated: 20.08.2004 10:44:34
The World Health Organization has recently issued "Guidelines for the Management of Sexually Transmitted Infections". The whole document can be viewed, downloaded or ordered at www.who.int/HIV_AIDS/. Below are the WHO treatment recommendations for two common sexually transmitted infections, gonorrhoea and early syphilis:

Gonorrhoea: uncomplicated anogenital gonococcal infection

A large proportion of gonococcal isolates worldwide are now resistant to penicillins, tetracyclines, and other older antimicrobial agents, which can therefore no longer be recommended for the treatment of gonorrhoea. It is important to monitor local in vitro susceptibility, as well as the clinical efficacy of recommended regimens.

Recommended regimens

ciprofloxacin, 500 mg orally, as a single dose

OR

azithromycin, 2 g orally, as a single dose

OR

ceftriaxone, 125 mg by intramuscular injection, as a single dose

OR

cefixime, 400 mg orally, as a single dose

OR

spectinomycin, 2 g by intramuscular injection, as a single dose.

Note: Ciprofloxacin is contraindicated in pregnancy and is not recommended for use in children and adolescents. There is accumulating evidence that the cure rate of Azithromycin for gonococcal infections is best achieved by a 2-gram single dose regime. The 1-gram dose provides protracted sub-therapeutic levels which may precipitate the emergence of resistance. There are variations in the anti-gonococcal activity of individual quinolones, and it is important to use only the most active.

Alternative regimens which may be useful in some countries, depending on the prevalence of resistant gonococci

kanamycin, 2 g by intramuscular injection as a single dose

OR

trimethoprim (80 mg)/sulfamethoxazole (400 mg), 10 tablets orally, as a single dose daily for 3 days.

Note: Kanamycin and trimethoprim/sulfamethoxazole should only be used in areas where in vitro resistance rates are low and are monitored at regular intervals. In addition, second-line treatment with recommended drugs should be available.

Early syphilis: primary, secondary, or latent syphilis of not more than two years' duration

Recommended regimen

benzathine benzylpenicillin, 2.4 million IU, by intramuscular injection, at a single session. (Because of the volume involved, this dose is usually given as two injections at separate sites.)

Alternative regimen

procaine benzylpenicillin, 1.2 million IU daily, by intramuscular injection, for 10 consecutive days.

Alternative regimen for penicillin-allergic non-pregnant patients

doxycycline, 100 mg orally, twice daily for 15 days.

OR

tetracycline, 500 mg orally, 4 times daily for 15 days

Note: Benzathine benzylpenicillin is also called benzathine penicillin G, benzylpenicillin benzathine and benzathine penicillin. Procaine benzylpenicillin is also called procaine penicillin G.


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