Safe sex reminder as antibiotic resistant gonorrhoea investigations continue

Public Health England (PHE) is issuing a reminder to the public to practise safe sex by using a condom with new or casual partners.

The call comes as an increase in antibiotic resistant cases of gonorrhoea continues, a further sign of the very real threat of antibiotic resistance to our ability to treat infections.

Finding this sort of extensively drug resistant gonorrhoea in the UK serves as an important reminder of the need to practice safer sex. This includes using condoms consistently and correctly with all new and casual sexual partners. Anyone with symptoms of a sexually transmitted infection (STI) or who is concerned they may have an STI should seek advice from their sexual health clinic.

For more information visit https://www.gov.uk/government/news/two-cases-of-resistant-gonorrhoea-diagnosed-in-the-uk

At the present time, the advice to frontline clinicians remains unchanged - as before we would still be advising all cases of suspected/confirmed gonorrhoea to be referred to local sexual health services for appropriate management, encouraging regular STI testing and protected sex with condoms.

Chlamydia treatment guidelines changed in September 2018

BASHH:

Chlamydia treatment guidelines changed in September 2018:

First line treatment is Doxycycline 100mg bd for seven days (contraindicated in pregnancy) and second line treatment is  Azithromycin 1g orally as a single dose, followed by 500mg once daily for two days

Publication of updated guideline for the management of infection with Neisseria gonorrhoeae (2019) The updated guideline for the management of infection with Neisseria gonorrhoeae is available at https://www.bashh.org/guidelines Changes since the 2011 guideline include: •    First line empirical treatment is now monotherapy with ceftriaxone 1g  •    If antimicrobial susceptibility test results from all sites of infection are available prior to treatment and the isolate is sensitive to ciprofloxacin, then this should be used for treatment in preference to ceftriaxone •    Recommendations for extra-genital testing in those with suspected or confirmed antimicrobial resistance  •    Epidemiological treatment is recommended only for those presenting within 14 days of exposure. For those presenting after 14 days of exposure we recommend treatment based on the results of testing.

The recent changes from the Neisseria gonorrhoeae, chlamydia treatment guidelines and the publication of BASHH Mycoplasma genitalium guidelines have impacted upon the first line treatment for Pelvic inflammatory disease, non-gonococcal urethritis. Please see BASHH website for the guidelines: https://www.bashh.org/guidelines

FRSH:

Combined Hormonal Contraception

The FSRH CHC Clinical Guideline is now available on the FSRH website  https://www.fsrh.org/news/fsrh-publishes-clinical-guideline-on-combined-hormonal/

What is new in this guideline?

• The updated FSRH guideline highlights that there is no health benefit from the seven-day hormone-free interval
• Women can safely take fewer (or no) hormone-free intervals to avoid monthly bleeds, cramps and other symptoms
• If a hormone-free interval is taken, shortening it to four days could potentially reduce the risk of pregnancy if pills, patches or rings are missed
• Consultations about CHC do not necessarily have to be face-to-face; online CHC provision is possible 
• At the first consultation, many women can safely be prescribed a one year supply of CHC instead of the current three month supply
• What is not new, but is still very important?
• It’s important to use combined hormonal contraception correctly: if used perfectly, it is over 99% effective; however, with typical use, about 9% of users become pregnant in the first year of use
• There are some health risks with combined hormonal contraception: use increases a woman’s risk of having a blood clot or breast cancer (although the risk remains small)
• Combined hormonal contraception should not generally be used by women over 50
• Combined hormonal contraception has some important benefits in addition to contraception: it can help with heavy or painful periods, acne and PMS, and it reduces