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“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, - PowerPoint PPT Presentation
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www.sandyford.org
“Here we go again”
Implications for SHA’s when implementing BASHH GC guidelines
Martin MurchieSenior Sexual Health Adviser
www.sandyford.org
www.sandyford.org
Aim of today
• Discuss how Sandyford implemented BASHH GC guidelines
• What it meant for the Sexual Health Adviser team
• Audit outcome
www.sandyford.org
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?
www.sandyford.org
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.
www.sandyford.org
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
www.sandyford.org
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.
www.sandyford.org
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.
www.sandyford.org
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).
www.sandyford.org
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.
www.sandyford.org
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.
www.sandyford.org
Questions?