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“Here we go again” Implications for SHA’s when implementing BASHH GC guidelines

“Here we go again” Implications for SHA’s when implementing BASHH GC guidelines. Martin Murchie Senior Sexual Health Adviser. Discuss how Sandyford implemented BASHH GC guidelines What it meant for the Sexual Health Adviser team Audit outcome. Aim of today. Gonorrhea here we go again,

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“Here we go again” Implications for SHA’s when implementing BASHH GC guidelines

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  1. “Here we go again” Implications for SHA’s when implementing BASHH GC guidelines Martin Murchie Senior Sexual Health Adviser

  2. Discuss how Sandyford implemented BASHH GC guidelines What it meant for the Sexual Health Adviser team Audit outcome Aim of today

  3. 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? What's Abba got to do with it?

  4. 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. A wee bit of history….

  5. Variety of treatments in the beginning Urethral lavage / Mercury Early Treatments

  6. The magic bullet 1900s Known as Salvarsan Unstable in air Also used for syphilis Early Treatments

  7. Good old penicillin Poor old penicillin Resistance in 1960’s/1970’s Treatments1940’s

  8. 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 Today

  9. 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. Recommendations

  10. 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. Sandyford response

  11. 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). GC – May 2011

  12. Treatment

  13. 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

  14. 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.

  15. 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? Summary

  16. 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.

  17. Questions?

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