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Source: Thailand Medical News  Feb 17, 2019  5 years, 2 months, 10 hours, 1 minute ago

Novel Diagnostic Kit Enables Resistance-Guided Therapy for Gonorrhea

Novel Diagnostic Kit Enables Resistance-Guided Therapy for Gonorrhea
Source: Thailand Medical News  Feb 17, 2019  5 years, 2 months, 10 hours, 1 minute ago

Updated treatment guidelines and the availability of the ResistancePlus GC test for Neisseria gonorrhoeae, from SpeeDx Inc, Sydney, Australia, are making it possible for some UK patients with gonorrhea to be treated with the cheap and easily-administered oral antibiotic ciprofloxacin. 

Ciprofloxacin was the first-line antibiotic of choice for uncomplicated gonorrhea in the past, but it was relegated to use as an alternative treatment due to increasing resistance. The ResistancePlus GC test is a novel molecular diagnostic and antimicrobial susceptibility test that can simultaneously diagnose gonorrhea and provide information about whether a patient will respond to ciprofloxacin.1 
The incidence of sexually transmitted infections (STIs), including gonorrhea, is increasing around the world, with correspondingly increasing rates of resistance to commonly used antibiotics. The first two cases of multidrug-resistant N. gonorrhoeae were reported in the UK at the start of 2019. These followed the first globally reported case of gonorrhea with high-level resistance to azithromycin and resistance to ceftriaxone in England in 2018.2 
Global management strategies for antimicrobial resistance, such as those developed by the World Health Organization, identify management of gonorrhea infection as a high priority, with more-effective use of diagnostic tools listed as a key focus for future development.3 
“As a clinician, I would like to treat as many gonococcal infections with ciprofloxacin as possible,” says John White, MD, consultant in sexual health and HIV at the Altnagelvin Hospital and editor-in-chief of the International Journal of STDs & AIDS. “More than ever, we rely on accurate and patient-focused diagnostic strategies to detect and treat STIs.” 
Availability of the ResistancePlus GC test is timely, as the British Association of Sexual Health and HIV (BASHH) has launched its 2019 gonorrhea management guidelines, which include the use of ciprofloxacin, provided antimicrobial susceptibility results are available prior to treatment.4 
The new test could be critical in the battle against antibiotic resistance, helping physicians to prescribe an effective antibiotic using a resistance-guided approach. Prior to the 2019 BASHH guidelines, the recommended front-line treatment for gonorrhea was ceftriaxone together with azithromycin. Ce ftriaxone is a painful intramuscular injection. It has long been considered the last readily available effective antibiotic for gonorrhea. But researchers have now isolated several strains of N. gonorrhoeae that exhibit extensive drug resistance to ceftriaxone and many other available treatments.5,6 

“The new guideline now recommends giving double the previously recommended dose of ceftriaxone (now 1g stat),” says White. “However, they also indicate ciprofloxacin as a first-line option when antimicrobial susceptibility is known prior to treatment.”4 
Such treatment is less painful for patients and is also preferred by doctors, as it is a cheaper treatment that does not require specialized staff to administer the injection.7 
“If we can use less ceftriaxone this may