Guidelines for the Management of Sexually Transmitted Infections. February 2004
(2004; 88 pages)
Table of Contents
View the documentPREFACE
Open this folder and view contents1. INTRODUCTION
Open this folder and view contents2. TREATMENT OF STI-ASSOCIATED SYNDROMES
Open this folder and view contents3. TREATMENT OF SPECIFIC INFECTIONS
Close this folder4. KEY CONSIDERATIONS UNDERLYING TREATMENTS
View the document4.1. The choice of antimicrobial regimens
View the document4.2. Comments on individual drugs
View the document4.3. Antimicrobial resistance in N. gonorrhoeae
View the document4.4. Antimicrobial resistance in H. ducreyi
Open this folder and view contents5. PRACTICAL CONSIDERATIONS IN STI CASE MANAGEMENT
Open this folder and view contents6. CHILDREN6, ADOLESCENTS AND SEXUALLY TRANSMITTED INFECTIONS
View the documentANNEX. LIST OF PARTICIPANTS
 

4.3. Antimicrobial resistance in N. gonorrhoeae

There are two main types of antibiotic resistance in N. gonorrhoeae: chromosomal resistance involves penicillins and a wide range of other therapeutic agents such as tetracyclines, spectinomycin, erythromycin, quinolones, thiamphenicol, and cephalosporins; plasmid-mediated resistance affects penicillins and tetracyclines. Chromosomally resistant N. gonorrhoeae, penicillinase-producing gonococci, and plasmid-mediated, tetracycline- resistant strains are all increasing and have had a major impact on the efficacy of traditional regimens for treating gonorrhoea.

Chromosomal resistance in N. gonorrhoeae has been observed since the introduction of sulphonamides in the 1930s. Its significance today is that chromosomal resistant strains are often resistant to a number of antimicrobial agents that have been used to treat gonorrhoea. There is also cross-resistance between penicillin and the second- and third-generation cephalosporins. Although not yet of any clinical relevance in relation to the use of ceftriaxone, this trend is disturbing. The high level spectinomycin resistance reported sporadically in gonococci is also chromosomally mediated.

The effectiveness and usefulness of current surveillance of gonococcal resistance are limited, and a simple instrument for assessing and monitoring gonococcal antimicrobial resistance needs to be developed. Lack of standardization of sensitivity testing methodology continues to be a problem. Standard methods should be used and should include a set of reference strains. Disc-diffusion sensitivity testing remains poorly standardized, one problem being the limited availability of antibiotic discs of the correct content.

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