Gonorrhoea is the second most common bacterial sexually transmitted infection (STI) in England and Wales caused by the bacterium Neisseria gonorrhoeae. The persistence of gonorrhoea, its association with poor reproductive and sexual health outcomes, and the prevalence of antimicrobial resistance have made it a major public health concern.
N. gonorrhoeae infection can be easily treated with appropriate antimicrobials. Antimicrobial treatment should be expected to eradicate 95% of uncomplicated gonococcal infections within the community. However, the effective treatment of gonorrhoea has been complicated by the ability of N. gonorrhoeae to develop resistance to antimicrobial agents. In the presence of resistance to first line antimicrobials and possible treatment failure, the likelihood of onward transmission of the organism within the community and development of adverse clinical sequelae in the infected individual are substantially increased.
The annual GRASP collection combines laboratory and clinical data on gonococcal isolates diagnosed in sentinel laboratories. From 2001 the annual GRASP collection has consisted of 26 collaborating GUM clinics covered by 24 laboratories.
See further details on the structure and process of GRASP.
Therapy for gonorrhoea is often given before the susceptibility of the infecting organism is known, and GRASP has both informed and recommended changes to national guidelines to ensure that more the 95% of infections respond to first-line therapy. Current treatment-guidelines recommend a cephalosporin: Ceftriaxone 500mg IM as a single dose with Azithromycin 1g oral as a single dose and Cefixime 400mg oral as a single dose as an alternative if an intramuscular injection is contra-indicated or refused by the patient . Fluoroquinolones such as ciprofloxacin or ofloxacin are no longer recommended as first-line therapies for gonococcal infections.
National Guideline on the Management of Gonorrhoea in Adults 2011 [external link] Commissioned by: Clinical Effectiveness Group, BASHH (British Association for Sexual Health and HIV).
This Action Plan for England and Wales has been developed by the GRASP team at the HPA. The purpose of the GRASP Action Plan is to raise awareness of the national and global problem of AMR gonorrhoea and to provide advice to appropriate healthcare professionals to limit its spread and extend the useful life of current treatments. This document is intended to inform microbiologists, GUM physicians, GPs and any healthcare professionals working in sexual health.